Tuesday, November 19, 2013

a time for quiet reflection

As I drive, alone in my car from my home to the home of the woman in labour, I enter a special time of reflection. 

This past week I have attended the births of two babies, and in both instances I had about 45 minutes of driving.  Both mothers called me in the 'wee hours', and each baby was born spontaneously and without incident at home.  My aim in writing about something as ordinary as driving from my home to the woman's home for birth, then returning when it's all over - something that midwives have done since the beginning of time -  is to hold on to a very special memory.

As I head out from my home my thoughts are initially focused on the task at hand.  Gather the various bags containing the equipment and supplies I may need - all packed and ready to go.   Paperwork for registering the birth and statistical reporting is also ready.  Remember to take the oxytocics out of the fridge.   Pick up an apple to eat on the way home.  Water bottle.  Possibly re-check the map if I am not confident of the directions.

Then, as I pull out of the driveway and head down the deserted street, my thoughts move to the mother who is labouring.  In the night I see only the small, moving perimeter that is lit by the car's headlights.   That's the special world I am entering.

Each mother in my care is an ordinary person - there are no idealistic notions of perfect bodies, perfect natural processes.  It's a fallen world.  I know some of her strength, and her vulnerability.  She has told me some of her fears.  I commit her to our loving Father's care, as she prepares to give birth. 

I think about the baby.  I know a little about this baby - the recorded, technical points such as gestation, heart rate, position, ...  I have also put my hands over this baby, palpating and holding the precious little form in my two hands, through the covering of the mother's skin, and said "Hello baby" each time I have checked.

I think about the family.  The father, and the siblings.  What arrangements are being made for the care of the older children.  Are there supportive grandparents on hand, or a strong community network?

Thus my mind is prepared for the birth journey which may be quick, or slow; may be uncomplicated, or difficult; may be as the mother anticipates, or not.  I seek wisdom, strength, and courage as I enter the birthing space.

...

Now I am driving home, in the daylight. 

I gather my thoughts about the mother, the baby, and the family I have just left.  I ask God's protection and wisdom for that mother, father, and family.

Having had little sleep in the past 24 hours, I am conscious of my own weakness; my need to be alert and safe in driving home.   Before switching on the radio, I commit to memory any tasks I might need to do to complete the job. 

In the wonderful early morning light I notice the features of the land and trees - the forest of tall, grand mountain ash trees, with tree ferns graciously spreading their fronds in the Dandenong National Park; or a new townhouse development site in the urban sprawl to the south-east of Melbourne. 

...

I must close this brief post now, as I need to return to a new mother and baby for a postnatal check. 

Tuesday, November 05, 2013

Why do private midwives need hospital visiting access?

Yes, I gave birth to my four children in hospital. This is #1
In a perfect world, would every woman want to give birth in the privacy of her own home?

Perhaps.

In a perfect world, there would be no sickness, no pain, no decay, corruption ... no need for hospitals either.

But we don't live in a perfect world.  No matter what steps we take to optimise health of mother and baby; to optimise the positioning of the baby in the womb for a normal birth; to prevent infection; to prevent social disorders that result from smoking, substance abuse, and obesity ... no matter ... the midwife is always watching and observing in case complication or illness arises.

Home is a wonderful place for birth when the woman and baby are well, and progressing normally.  At any time the decision to stay at home may need to be reviewed.

Some people may tell me I am being driven by fear in saying this.  We in the 'natural birth' realm see slogans such as 'Trust Birth'.  I hear midwives speaking of the physiological processes in birth as though they come with an iron-clad guarantee.

No! and No!

Don't get me wrong.  Birth is an amazing, awesome process - most of the time.  Natural physiological processes in birth and breastfeeding, together with the cocktail of hormones, and the physical and psychological factors that can influence these processes are truly wonderful - most of the time.

There is no better way for most than the natural process.  God the creator made the woman's body as well as the man's, mysteriously in the image of God, and said it is good.  That is a profound truth.  The balancing truth is that today we are able to protect and save life, through medical intervention, to a greater degree than ever before.

That's where hospitals come in to my thinking today.

I'm not talking now about a perfect world.  However, a better world is a reasonable goal.

There will always be women who need or choose to give birth in hospital.   These women ought (in a better world) to be able to use the services of a known and trusted midwife in hospital.  That option is not commonly available in the world we live in today.  Some women are fortunate that they have a wonderful midwife allocated to care for them in their labour, or even in a caseload/know your midwife program.  But the usual feature of birth in Australia today is that a woman is attended in labour by a stranger - someone she has not met prior to coming into labour.  Women with financial resources and private health insurance might have an obstetrician who has provided their antenatal care, with whom they feel a bond of trust, but that doctor is not in continuous attendance - the midwife/stranger is. 

In a better world, women would be able to engage their own midwife, or small group of midwives, who are committed to providing continuity of care that spans the community and the hospital.

In a better world, midwives would be able to choose to work either privately or as employees of a hospital or health service; either as shift workers, or with a personal caseload, or in one of the multitude of hybrid models of care that are designed to meet the individual needs of the women as well as the midwives.  These options should provide reasonable rates of pay and conditions.  Midwives can only do our job well when we are in good shape ourselves.  We teach women to be intuitive about the needs of their children and themselves - we ought, in a better world, to apply the same thinking to ourselves.

The journey to maternity reform has been an uphill one.  I am hoping that it won't be long before we see a pathway to a better world of maternity care.

Thankyou for your comments.