Friday, October 21, 2016

Idealism and midwifery - continued

In the previous posting on this topic, I attempted to introduce the notion that idealism around the birth of a baby impacts on what we do and how we do it in both negative and positive ways.


***************

I have recently noticed a degree of idealism around the circumstances of a birth that has left me troubled.  That has led me back to writing to you, dear blog reader, as has been my custom for many years.

To set the scene, there is a social media group that focuses on childbirth and the law.  The usual contributors to the discussions in this group are midwives, a few lawyers, and childbirth educators, lay birth attendants, and women who from time to time take an activist position, particularly in relation to natural birth.

From time to time I or someone else will post a link to a Coroners report of interest to the group, such as the death of a baby soon after birth.  Recently a report was released by the Victorian coroner, on the death of baby Martha from complications in a spontaneous breech birth.  A few weeks ago the New South Wales Coroner reported on the death of baby NA, also from complications in a spontaneous breech birth.

Readers who follow the links provided will see that these two cases have little in common, except the tragic loss of a baby's life.

The matter that disturbed me in reviewing both cases, and that I call idealistic, naive, and uninformed, is the notion expressed strongly in the group that a mother might have avoided the birthing complications had she been left undisturbed, "truly unhindered".

The sort of midwifery I have practised for many years, with a high degree of safety, includes respect for the woman's need to feel unwatched.  Ina May (Gaskin)'s rule, that sphincters work best at home and when unobserved is a truism that midwives love to quote.  Michel Odent has spent his life after obstetrics teaching us that the human woman is a mammal, and has similar needs to other mammals.  World Health Organisation published an excellent handbook on normal birth in the 1990s, stating that "In normal birth there should be a valid reason to interfere with the natural process."

Somehow the pendulum has swung, in the natural birth community at least, to promote non-interference in an extreme way.  There seems to be a growing group of mothers who believe they themselves and their babies are better off if there is no professional (midwife or doctor) who will intervene in the progress of their labours and births.

When a baby is presenting feet or bottom first (breech) it's not a normal birth - even though it may be spontaneous and natural, and even though there may be no adverse outcomes.  Under the WHO normal birth rule quoted above, there may be (in spontaneous breech birth) a valid reason for interfering with the natural process.  The skilled midwife recognises points at which an intervention (interference) with the natural process is optimal and may be life saving.  There is no time then to call for assistance.  A baby being born breech whose head has become entrapped needs to be released immediately. This urgency, which does not happen in the same way when a baby comes out head first, is what has driven the medical world to preference of caesarean birth for breech babies.

The person who thinks that a woman who is totally unhindered and relaxed can birth a baby smoother and faster than the alternative situation does not understand that death and life are in the balance at the time of birth.  

Nature is under no obligation to be kind, or to give us the outcomes we want.


Thursday, October 20, 2016

Idealism and midwifery

It's very easy to find evidence of idealism in anything that pertains to the birth of a baby.  After all, a new life is being brought into our world: precious, full of potential, carrying a unique blend of special characteristics of both parents - both families - into the future.

Idealism happens to some of us time and time again.  Each time I gave birth I found myself wanting to make this world better for that wee one.  I wanted to be a better mother.  I wanted us as a family to provide a better home. 

...   and then, after a few sleepless hours, with a baby who was simply doing what all healthy babies must do, which is to find food, my idealism was truly tested.  My beloved, lying wearily beside me in our bed, had no adequate solution either. 

Over time I became reconciled to the huge gulf between the ideal and the actual.  I learnt that it was, in fact, advantageous for a baby to come into this imperfect world, where the mother, despite her best intentions, is unable to solve every problem.  A world where the baby learns that there are times when both parents are unable to perform to their usual capacity; where there's no-one making eye contact or vowing their love; where even a dripping moist nipple at the end of a full breast fails miserably to meet the need.

If the home was always ideal, how would the child ever cope with the real world?

Conversely, if the mother did not have idealism deep in her heart; if she did not want the best she could possibly provide for her family, how would any child thrive?
_________________________________

A similar dilemma exists in midwifery.

The ideal is that each woman receives a primary level of professional care from a known and trusted midwife.  The ideal is that the woman and the midwife work in a special partnership that provides optimal care and achieves optimal outcomes for mother and child.   The ideal is that the mother's body will function without illness or complication.  The ideal is that the midwife's wisdom will enhance the woman's acceptance of new and primal terrain that must be traversed. 

The reality may be very different.

Our lives are often messed up, at all levels of our physical, social, psychological, and spiritual existence.   In fact, I have been amazed at how often the processes of pregnancy and birth and nurture of the newborn come together in beautiful harmony, demonstrating the wonder of creation.  The way our bodies function in health, as finely integrated systems, is good.   Illness and disease have, to a greater or lesser degree, corrupted this state of goodness.

Dear reader, I need to sign off now, but will plan to return to this theme as soon as I can.