supervision, part 2

Beautiful Brisbane, the city of my birth

continuing from yesterday's post, ...

[I have posted these comments on a social media site that might not be accessed by many of my readers, so have copied and expanded it here.]

A blog post by UK midwife-author-teacher Sarah Wickham, questioning the Australian regulation of midwives, provides comment on the UK model of supervision of midwives.

 
I share Sarah Wickham's concern, when midwives are subjected to "vexatious reporting and persecution in a number of ways, simply for supporting women’s choices."
 
Without pointing the finger at any person, and I wasn't at the recent homebirth conference in Brisbane, I think it's likely that Sarah has heard only a fraction of the story.  In my opinion there have been too many cases recently, some on public record, in which midwives have hidden behind a notion of the woman's choice, when in fact there was no discussion of escalation of care and appropriate intervention.  Midwifery partnership can only be achieved when the conversation between the midwife and the woman is ongoing, and informed *decisions* are made rather than choices.

An effective program of professional supervision of midwives could, theoretically at least, support the midwife in real time whose client is making an informed decision that does not follow usual professional advice.  This would apply whether the midwife was in private practice or employed in a hospital or other birthing facility.   The UK model of supervision of midwives is for all midwives.
 
A midwife can't afford to be a true believer, or to 'trust birth' in any idealistic way, even though we act to promote, protect and support normal birth and the physiological adaptation of the newborn to life out of the womb.
 
The setting/place of birth (home/hospital) has become an obstacle in this country to good midwifery practice, because privately practising midwives are restricted to homebirth.  The exclusion of PP midwives from mainstream hospital is not in the interests of wellbeing and safety of mother and baby, and probably contributes in complex (and unaccountable) ways to some adverse outcomes. The midwife's duty of care includes what we do in emergencies, and accessing medical (ie hospital) help in a timely manner. 
 
The introduction of the wonderful www, and social media, and digital communication ... has had a profound impact on some women's access to information about birth, and their choices. Anyone who remembers 20 years ago, when homes didn't have internet access, and mobile phones were great big clunky devices, will know what I mean. Now women tell me they have 'researched' their choices, as though it's done and dusted. The rise and rise of freebirthing is very much an internet phenomenon.
 
Please keep the conversation happening.

A midwifery half-truth: doing nothing

A couple of weeks ago I wrote about the myth of choice.

The midwife 'doing nothing' is a similarly misleading notion: not quite a myth, but definitely a half-truth. It's only one side of the coin.  It sets a potentially dangerous precedent, devaluing the expert professional activity of the midwife, being actively 'with woman' in the interest of safety and wellbeing of mother and child, to the point we have today: an epidemic of unattended births ("free births") in the community.  The rationale is like this: "If the midwife does nothing, then we don't need a midwife."



Today I want to critically explore what midwives are doing when we may appear to be 'doing nothing': what happens when I spend time on the couch in an almost dark room in the wee hours, with my eyes closed; what I am doing when I take up some simple knitting or crochet project as I wait for a baby to be born.

Let's consider the pregnant_woman/mother+baby to be central in this discussion.  What does that woman hear from her own intuition, from midwives, from other professional maternity care providers, from family, and from other sources?

There are many voices, and the value that the woman places on each of those messages varies from one to another.  Social media has, for at least the past decade, played an increasingly powerful role, as indeed this blog site offers information and discussion.  The current generation of mothers is the generation who uses online searches to 'research' a question, who follows multiple social media sites, who is prepared to ask questions.  Whereas previous generations had the 'disease of the month' prompted by an article in a publication (such as Reader's Digest), today's generation can search and often self-diagnose - with dubious effectiveness.  Gadgets can be bought: a pregnant woman can set herself up with a fetal heart rate monitoring device, a blood pressure machine, digital scales for the baby, and any number of other potentially useful, potentially useless pieces of equipment.

But I digress.

Back to the assertion I have made, that 'doing nothing' is a half-truth.  Further, I suggest the notion that the midwife does nothing, without taking into consideration the enormous and life promoting role of the midwife in any professional setting, could have negative consequences for idealistic, impressionable, inexperienced midwives, and for women in their care.

A woman who is labouring strongly, who has invited me into her home to attend her for birth, will have spent time with me during the pregnancy, discussing and planning and preparing for this climactic time.

I am in her home; I have moved quietly into her intimate space, and

• I assure myself that mother and baby are well, through observation, active listening, and auscultation of baby's heart sounds after a uterine contraction
• I communicate my assessment and any concerns to the mother, and support her, reassure her if appropriate 
• I prepare the space so that I can maintain my written record 
• I prepare equipment that may be needed, such as the newborn 'bag and mask', and oxytocic for mother
• I recognise any idiosyncratic matters or instructions that are given, such as "don't open the door because the cat might escape"
• I make a mental note of this woman's progress up to this point in time, how she is responding, what professional observations are reasonable, and what I expect to see happening
• I assume a protective role of the space, knowing that interruptions and intrusions and interventions can be disruptive: for example, telephones are not welcome in the birthing room.
• I may sit on a chair or rest on the couch in an almost dark room in the wee hours, with my eyes closed
• I may take up some simple knitting or crochet project as I wait for a baby to be born.

Doing nothing?  No way!

Even if the labour and birth are 'uneventful', even if the baby is born quickly and easily (from an observer's point of view), without any instructions from me, my presence is the essence of my professional action.  I bring the capacity to intervene, when there is a valid reason.  I bring the ability to minimise interruption that may increase anxiety in the labouring woman, so that the woman is free to progress, unaware of what's going on in my mind or in the outside world.

Dear reader, if you know the ICM Definition of the Midwife, and other foundational statements and codes in our profession, you will understand what I am saying. 

"... This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures." (ICM 2011 - emphasis added)

Those who understand the promotion and support of normal, physiological processes in birth will know the masterly inaction of authentic midwifery.  This is not 'doing nothing'!

Midwives need to protect women from an idealistic message that tells only part of the midwifery story, and may confuse those who genuinely need the midwife to act in the interest of wellbeing and safety of mother and/or baby.  If that were not the case there would be no need for a midwife.


Your comments are welcome.

Social Media and midwives

Two of my precious grand-daughters, Poppy and Amelie

I want to declare my interest in the use of social media by midwives.

This blog site provides ample evidence of my commitment to and fascination with openly available websites. This blog is a notice board; a library; a magazine; an ongoing journal of my opinions and comments about midwifery and about life.   It is also an ongoing record of special people in my life, such as the two precious little girls pictured today.

I began this blog in 2006, and it sat, unused and dormant, until mid-2007. At that time I felt a strong need to communicate with young women, particularly those who searched the internet for information in preparation for the births of their babies, and I realised I could do this as a blogger. From time to time over the years I had received emails, usually from women in other countries, thanking me for The Midwife's Journal, which they had found on my old website. A woman from Holland referred to The Midwife's Journal, which had been written at least 10 years prior (ie before the word blog existed in my vocabulary, at least), as a 'blog'.

It occurred to me then that I could continue The Midwife's Journal as villagemidwife, the blogger.

These are the headings from that new beginning [link]:

• Natural birthing in Australia today 
• The culture of birthing 
• Vaginal breech birth 
• Who let the dads in? 
• Nurture and nourishment of the newborn baby 
• Paternal behaviours 
• Mother-infant bonding, and maternal instincts 
• Giving birth 
• The life of the unborn child in the womb, and imprinting at birth 
• Commenting on some of life's big moments 
• Midwife for Christ’s birth 
• You are free, my dove 
• The homeborn newborn: how do mothers manage breastfeeding when there's noone to show them what to do? 
• Protecting normal birth 
• Why protect normal birth? 
• Birth Trauma 

The regulator for health professionals in this country has announced a review of its social media policy:

The National Boards will consult publicly on social media policy in coming months The National Boards in the National Registration and Accreditation Scheme (National Scheme) will release a consultation paper on a social media policy in October/November 2012.

A draft of the social media policy has been released as a preliminary consultation paper to targeted stakeholders for initial feedback, ahead of a wider public release. The preliminary consultation process aims to ‘road test’ the initial draft to weigh operational impact, issues or initial concerns. We are pleased that this early draft is generating a lot of interest, especially on social media. National Boards are monitoring feedback closely and will take the issues raised into account when refining the draft social media policy before it is released for public consultation on the National Boards’ websites.

If you would like to contribute feedback on the preliminary draft social media policy, please email your considerations to socialmediaconsult@ahpra.gov.au by close of business 14 September 2012. When the formal public consultation process opens, the National Boards encourage feedback from registered health practitioners and members of the community on the draft social media policy. The National Boards will publish the public consultation document on their websites, and will encourage wider distribution to seek extensive feedback.

Until then, visit the News section of the National Board websites (via www.ahpra.gov.au) for updates on past and current consultations, general communiqués from National Boards, media releases and more.

I have read the draft policy, which reminds health practitioners that in using social media, we must comply with the National Law, Advertising Guidelines and the code of conduct.


Midwives who in recent years had published testimonials at their websites have found themselves being directed to the law that prohibits the use of testimonials.  Birth Stories, on the other hand, seem to be permitted.

There will be times when I have used experience from real life in my writings, and it is possible that some of those who read my accounts may at times recognise the woman, even if I have been careful not to identify her. Whether this could, in a narrowly defined mindset, be seen as a breach of privacy, is yet to be seen.

There is nothing sinister about blogging, or any other aspect of social media, per se.  The medium is neither good nor bad: it's simply a medium.  The content is what can be anything from wholesome and useful, to trivial navel gazing self absorption, to defamatory and destructive.   The author has the ability to communicate in a way that is useful, or not.  I hope to continue writing in this medium, and I hope there are readers who value the material posted and thoughts expressed.


Your comments are, as always, welcome.