the importance of trust

I (Joy Johnston, aka villagemidwife - see note at the end of this post) often say to women in my care, "I need to trust you, and you need to trust me."

This sounds reasonable to me, particularly within the context of primary maternity care that spans the pre-, intra- and postnatal periods.  While midwifery is not rocket science, the commitment a woman and her family make to a new baby is perhaps the most far-reaching investment they will ever make.  Trust is something to value: it's not lightly given; it's not easily won; and once won it can be lost.  I can not assume that a woman in my care is trusting me, and she may not know if I am trusting her.  This is the case especially when difficult decisions need to be made: when I am asking the woman to trust my professional judgment and advice in order to protect the wellbeing of the mother or child.

According to contemporary thinking, midwives and women engage in a partnership that is based on reciprocity and trust (a phrase coined, as far as I know, by sociologist-academic Karen Lane.)  It's a two-way relationship.  It's a relationship that builds over time, and is tried and potentially strengthened as each woman and her midwife navigate the unique terrain that each pregnancy-birthing episode offers.

Partnership should not be seen as an idealistic notion: the current internationally accepted definition of the midwife includes:

... The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.... (International Confederation of Midwives)

The stark reality of life is that some people find it difficult to trust anyone, while others give away their trust lightly to anyone who sounds as though they know what they are talking about.  Most people fit somewhere between the two extremes.  The definition of the midwife is looking at the big picture, while the experience many women have with a midwife or midwives may be far removed from any sense of working in partnership.  Similarly, midwives who provide continuity for their own caseload of women may find themselves in situations in which the sense of partnership is sub-optimal.

A young midwife told me she felt that a woman in her care does not trust her because she has had only a few years' midwifery experience.  A couple of comments that the woman made left the midwife wondering if she was able to continue as midwife. 

That discussion prompted me to think a lot about what it means to trust, and the importance of trust in midwifery - in the processes of decision-making that a midwife uses.

I do not, ultimately, trust birth.  Birth, like any other part of life, is able to be complicated by disease and corruption.  The midwife's role in maternity care is to firstly work in harmony with awesome natural processes, and secondly to recognise complication and intervene to prevent loss of life or damage. If I trusted birth there would be no need to work as a midwife.  I would simply accept 'Que sera sera' (what will be will be).

I have reflected on the many women for whom I have provided midwifery services over the years, and wondered if my statement, "I need to trust you, and you need to trust me" is true.

Many women have gone through the birthing process with minimal intrusion or action by me: my job is to be 'with woman': to watch and occasionally give support, then fill out the paperwork.  In almost all of these cases there has been, I believe, a working partnership based on reciprocity and trust.  The woman who is trusting her midwife is able to surrender to the work of her body when the time comes.

Some women have needed more than I have been able to give them in community based midwifery care, and we have transferred care to a hospital maternity service.  I expect that in some of these situations the woman's ability to trust me as her midwife, or to trust herself as the birth-giver, has been less than optimal.  In some, my ability to trust myself as midwife, or the woman as the birth-giver has been compromised.  At times I may have been too weary, or emotionally drained, or fearful, or ...




Spring 2013

Tomorrow is the official start of Spring in the southern hemisphere.  It's exciting to see the tender young leaves on deciduous trees, and flowers on the fruit trees.

Spring 2013: Bonsai Japanese Maple and azalea

The signs of new life are within the natural processes that offer endless wonder and thrill to those who are ready to see.

Midwifery has taught me to respect and work in harmony with the natural processes as much as is possible.

These little bonsai trees have been in my care for several years. 






postscript...
Don't believe everything you see on the internet!
I began today with "I (Joy Johnston, aka villagemidwife...)" because, for some reason Blogger (the program I use to write this and other blogs) thinks I have changed my name. Probably my own fault - I told my sister I would help her get started writing a blog, and somehow Blogger now thinks that I am my sister - Barbara Clark. Everything I have written is now attributed to her, so I need to either find out how to get into my blogger profile and change my 'name', or get used to writing under a pseudonym. I have followed the instructions to go to Blogger profile, but keep getting a message "oops that didn't go well"!

I'm just venting, but if you have a suggestion for fixing it, I'm keen to get it sorted out! XXjoy

pps
Thanks Paul for fixing it.

"I'm glad you're here."

The young woman was labouring hard when I arrived.  Hers was a better-than-textbook first labour: she got up at 4:30 am; was having mild contractions every 7 or 8 minutes by breakfast time; accelerated into 3 contractions every 10 minutes by mid-morning; and felt like pushing before midday.  After quickly arranging my few pieces of equipment I knelt beside the birth pool, checked the fetal heart rate after a contraction, and waited with her.  When her eyes met mine, she whispered, "I'm glad you're here."

The home, a lovely old inner-suburban Melbourne cottage, seemed to embrace and welcome this birth.  There was harmony and warmth in the exposed brick walls.  The baltic pine floor boards showed the wear of many occupants over the years. The mild summer day, and a gentle breeze, gave support and energy to the work of childbirth.  I learned later that the young woman's parents had lived in this home when their first child was born, and that several of the babies of this family had either been conceived there, or were brought there after birth. 

"I'm glad you're here."

The mechanisms of birth proceeded without delay.  The strong, expulsive effort of the womb, brought the little head to the vaginal opening.  We had no mirrors or torches - we worked by feel rather than by sight.  The mother's hand gave her all the information she needed.  After the head had fully emerged we waited, then supported the baby as she came to the surface of the water, opened her lungs, and took her first breaths of air.  After a brief rest we assisted the mother and her baby out of the pool, and they rested as we awaited the after-birth.  There was no bleeding.  There was no cause for concern at any time.

I reflected on that simple statement, "I'm glad you're here", as I completed the day's work, writing my notes and preparing the official birth documentation.  I reflected on them again as I visited the home the next day.

"I'm glad you're here" was firstly a statement of the rightness of home as the setting for this birth.  The young mother told me later that she would have found it very difficult to know when to travel, if she had been required to go to hospital.

It was also a statement of the rightness of the 'with woman' relationship.  The partnership I have with that young woman is a unique and special bond.

Clearly, this birth did not rely on any special skill or treatment that I might have offered.  Apart from putting my hand gently on the woman's leg when she felt a muscle cramp, I did very little.  A new graduate midwife could have done everything that I did.  The midwife attending a home birth relies more on the wonderful spontaneous actions of the woman's body, than on any midwifery act.  The essence of midwifery is being, rather than doing.

"I'm glad you're here" says it all.