Sunday, July 24, 2011

idealism in midwifery

with Karen, and her babies Simon and Hannah, about 12 years ago

This past week I have been engaging in a review of my professional practice. One of the tasks set down is to write a personal midwifery philosophy. I am a lover of writing - bringing together thoughts and knowledge into words that can be passed on to others. Writing a personal midwifery philosophy is, so to speak, 'right up my alley'.

Where do I start?

The word 'philosophy' is made of two words, 'love' and 'wisdom'. A personal philosophy of midwifery could be a statement of what I love in midwifery, and what wisdom I find in midwifery.

In considering this challenge I hit an unexpected obstacle. The material that was sent to me to use in preparation for this review contained an example:

"Personal midwifery philosophy
"I believe:
• Pregnancy, birth and mothering are a normal, privileged, life-affirming and glorious part of life.
• Women can do it even when it is difficult.
• Women have the right to self determination and to be supported and encouraged to get on with this (most) important aspect of their lives.
• Women have responsibilities to themselves and their babies to actively participate in their health care.
• Midwives work with women and women work with midwives in a flexible, (hopefully) nurturing and synergistic relationship."

Dear reader, did you see anything in that quote that set the red lights flashing, and bells ringing?

I can’t fully agree with any part of this philosophy. IMHO it’s idealistic, naive, and indicates a potentially unprofessional mind set. Here, briefly, are my reasons for rejecting such a statement:

  1. Pregnancy, birth and mothering CAN BE normal/abnormal; privileged/nothing like privileged; life-affirming/soul destroying; glorious/terrifying, depressing. What does this statement have to do with midwifery?
  2. Some women can; some can’t, won’t, or don’t do whatever it is, even when it’s difficult. What does this statement have to do with midwifery?
  3. Women have the right to ... What does this statement have to do with midwifery?
  4. Women have responsibilities ... What does this statement have to do with midwifery?
  5. Midwives work with women and women work with midwives in a flexible, (hopefully) nurturing and synergistic relationship. This statement is starting to address midwifery, but what does it mean? Do midwives need to be nurtured by the women they attend?
I hope you don’t think I’m splitting hairs here. This is a serious critique. As I read the quoted sample 'philosophy', it’s as though midwifery has become lost in idealistic notions of women’s choices, rights, and responsibilities. Of course I would like women to have all these things, but they are not part of a philosophy of midwifery. They don't say anything about what's to love in the wisdom of midwifery. 

A woman who gave birth in my care to two of her children more than a decade ago wrote to me about her experience in supporting her son and daughter in law at the birth of her first grand child:
I am again full of extreme gratitude to you for what you gave me all those years ago.
I am realising afresh what a pivotal time in my life my homebirths were.

The philosophy of midwifery care that energised me fifteen or twenty years ago is the same one that I have today. While no words can adequately describe the breadth and depth of the wisdom of working in harmony with our amazing, wonderfully made bodies, I have written:

"As a midwife working in a special partnership with each woman as her professional care giver, I seek to practise in a way that harmonises with the woman’s natural physiological processes, and promotes health. There is no better or safer way for most women and babies than to proceed through their childbearing and nurture of the newborn in harmony with natural process, with a plan to give birth without relying on analgesics, stimulants, or other pharmacological or surgical intervention.

"As a midwife my duty and responsibility to each woman and baby is also to identify any complications that may arise or be likely to arise, and to take steps to obtain appropriate and timely interventions when indicated."

Your comments are welcome.

Saturday, July 16, 2011

midwives in the making

(c) Picture used with permission

Yesterday I had the privilege of presenting a 1.5 hour talk on private midwifery practice to the midwifery students at Deakin University in Burwood. I love having the opportunity to inspire the next generation of midwives.

I know some visitors to this blog are studying midwifery, in many countries. In today's post I want to give you an outline of my presentation, and links to some of the key documents.

The parts of the presentation were:
  • Overview and introduction: developing a strong 'midwife identity'
  • Private midwifery practice, changes in legislation with Medicare rebates and other changes for eligible midwives. Go to Midwives Australia for more information and links
  • Planning for birth: philosophy of birth based on the statement that "In normal birth there should be a valid reason to interfere with the natural process" (WHO 1996); decision-making concepts of 'Plan A' and 'Plan B', birth preparation meeting handout
  • DVD of a beautiful home/water birth [One picture used here with permission - the visual image is sooo powerful!]
  • Highlighting aspects of midwifery practice that can apply only when the whole labour progresses under natural hormonal, unmedicated processes: physiological third stage, and baby's transition from the womb
  • Questions

Please follow these links if you are interested in the topics mentioned. I intend to prepare a post on 'Planning for birth' at my private midwifery blog - will do that as soon as I can.

For the record, my relationship with the Deakin University School of Nursing and Midwifery is that I am employed as a casual lecturer, and as a tutor and marker for some of the midwifery Professional Development Unit Learning Packages. Several years ago I prepared one of the Learning Packages on the midwife in the community (PDU 323) and more recently I have written a Learning Package on Caseload and Homebirth midwifery, which is being processed in preparation for release.

Friday, July 08, 2011

Vitamin D

Melbourne is a bleak and chilly place at this time of year. My little deciduous Bonsai trees have dropped their leaves. Most days there's not much sunshine - not a lot of synthesising of precious Vitamin D going on in our bodies.

This past week I have been seeking an update of my knowledge of Vitamin D. My questions were prompted when a woman in my care, who gave birth in hospital, was instructed to give her baby Pentavite (R) daily in the first year, to ensure adequate Vitamin D intake. The Penta-vite Liquid Multi-vitamins for Infants (0-3 yrs) contains 10.1 mcg of Vit.D3, as well as Vitamins B1, B2, B3, B6 and C.

The hospital midwife indicated that this protocol was now being followed for breast feeding mothers whose Vitamin D levels tested low.

I inquired about current midwifery practice amongst colleagues, and some were quick to send links to sites and articles on the importance of adequate amounts of the 'sunlight vitamin' in pregnancy, lactation, and infancy.

I recommend a current update article in Medscape ObGyn and Womens Health. Vitamin D, Deciphered, Declassified, and Defined for Your Patients written by Sandra A. Fryhofer, MD.
"In the past, vitamin D worries were mainly about bone health. That's all changed. New studies now support an ever-increasing role of vitamin D in preventing all kinds of diseases: heart disease, diabetes mellitus, cancer, infection, autoimmune diseases (multiple sclerosis, rheumatoid arthritis), and the list goes on!"

Other Medscape articles that provide useful perspectives on this topic are
ACOG Says More Data Needed on Vitamin D During Pregnancy
"June 22, 2011 — More data are needed before physicians start routinely screening pregnant women for vitamin D deficiency, according to a statement from the American College of Obstetricians and Gynecologists (ACOG), published in the July issue of Obstetrics & Gynecology."

Also ...
Protean Manifestations of Vitamin D Deficiency, Part 1 The Epidemic of Deficiency

Protean Manifestations of Vitamin D Deficiency, Part 2
Deficiency and Its Association With Autoimmune Disease, Cancer, Infection, Asthma, Dermopathies, Insulin Resistance, and Type 2 Diabetes

Protean Manifestations of Vitamin D Deficiency, Part 3
Association With Cardiovascular Disease and Disorders of the Central and Peripheral Nervous Systems

One of my midwife colleagues wrote:
"It is so important to get enough in your diet and sunlight. Our society has become sun protective obsessed that we are not getting enough. I would suggest to your client buying the best quality organic butter and slapping it on everything. If she can get hold of raw milk from grass fed cows even better. Fish oil or grass fed free range chook eggs. 10-15 min in the sun (till the skin gets a light pink colour) is enough vitamin D Daily and make sure she doesn't wash her skin after a sun bake. How long to be in the sun depends on how far North or South you live and the time of year. Best time to get your vitamin D is between 10-3pm (the time everyone is shunning the sun). The problem with getting your vitamin D from the sun is knowing when to have enough, people work or lay in the sun for long periods of time are more at risk of skin cancer... but a daily dose of light pink skin is healthy."

Having looked at the evidence and debate I will now be more committed to not only checking Vitamin D levels, and promoting healthy diet and sensible daily sun exposure where possible. I recall advice that was given to mothers in the 1950s and 1960s, that they should give baby time each day in the sun with little or no clothes on, weather permitting. Perhaps we will reinstate this old advice.

July 6, 2011 — Vitamin D supplementation of 4000 IU/day is safe and effective for healthy pregnant women and their infants, according to the results of a large, double-blinded, randomized clinical trial published online June 27 in the Journal of Bone & Mineral Research.

[I checked the amount of Vitamin D in my daily multi-vitamin supplement, and it's 200 IU.  According to the lead author Bruce W. Hollis, PhD: "Surprisingly the scientific debate has made little progress since Dr. Gilbert Forbes made a recommendation of 200 IU (international units) per day in 1963, which was based on a hunch."]

Your comments are welcome.