Wednesday, October 23, 2013

Caseload midwifery - women do well, midwives love it, so what's the down side?

Five beautiful cousins enjoying a day out at the Weribee Zoo

A recent publication on Caseload midwifery brings together evidence from leading Australian midwifery researchers and academics.  Caseload midwifery is good for the mothers, good for the hospitals, and good for the midwives.

"In Australia, the growing popular choice for expecting mothers is to stick with one midwife from pregnancy to post-natal care. Anne Marie George looks at why caseload midwifery has more to offer than a boutique service." [article]

Good for mothers:
  • less use of medical interventions in labour than women in standard care
  • less use of painkillers (aka 'dangerous drugs')
  • 22% fewer caesarean births than women randomly assigned to 'standard' care.
Good for hospitals:
  • saves the hospital money
  • appropriate use of midwives compared with rostered staff
  • less sick leave for midwives
Good for midwives:
  • autonomy, giving the midwife a strong professional identity
  • flexibility, enabling the midwife to integrate midwifery work with other daily activities
  • arrangements for backup when needed
  • commitment to the women

Everything good comes with a price tag.  If caseload midwifery is so good for women, for employers, and for midwives, what's the down side?

I am writing from my own experience, over the past 20 years, with a caseload.  The caseload research referred to above was done in hospitals, while my experience has been in private practice.  The place of birth for most of the women in caseload research has been a public hospital, while my work has been with women who are usually planning homebirth.  But the commitment of the midwife is the same, regardless of where the birth is intended, or who pays the midwife.

When I began to practise independently, with my own caseload, I experienced the development of a strong midwife identity that has only grown over time.  I began blogging before we knew what a blog was.  In 1996-97 I wrote The Midwife's Journal, bringing together my experience and learning as a midwife against a backdrop of ordinary daily experiences of my life.  I appreciated the flexibility and freedom that caseload midwifery offered me, when compared with rostered shift work.

From my perspective, caseload midwifery is all about families - the family that is being made/extended with the birth of a new little person, and the family of the midwife who commits to being 'with woman' throughout the journey.

Most midwives are women, and most women have children, and the responsibility for caring for children is, for considerable periods of time, a mother's responsibility.  And so it should be.  It would be ridiculous for the amazing processes of bonding and attachment that are mediated by a hormonal cocktail through the pregnancy-birth-nurturing continuum to simply shut down.

If a midwife is also a mother of dependent children, she needs reliable support at any time, day or night, in order to take a caseload.  This fact prevents some midwives from taking up the caseload options - until the children are old enough.

I began caseload midwifery in 1993, when the youngest of our four children, Josh, was 12.  I knew that he, and his three older siblings, were reliable and responsible, and could be trusted to let themselves into the house after school, find something to eat, get on with his homework or music practice, and would be safe if I was out.

The down side of caseload midwifery is the very thing that makes it so valuable.  Commitment costs the midwife.  Getting up at 11:30 pm or 3:00 am is never easy, but that's what a midwife does - for the woman in her care.  Going through a journey that presents difficulties or distress is never easy, but if the midwife is 'with woman', they go through it together.

I began this post with a picture of our five precious grand children - the next generation in our family.  Midwives who have caseloads are guardians of the next generation, protecting wellness and promoting health in families.

1 comment:

Emma H. said...

Joy, thanks you so much for your commitment to women over the years, you really are appreciated. Thank you for the sacrifices you have made.