midwife's muse

Freebirthing?

This is a purely personal perspective and I'm argueing the concept as it has been presented to me i.e a birth unattended by a person professionally trained/ qualified to assist at births.

I was not aware, until recently, that there was an 'organised' movement towards this. Obviously I had read the occasional article where a couple within the UK had gone forward with this, and as a result were under scrutiny from the authorities, and within my team of community midwives we have had women who have threatened this as a way of ensuring that they receive the care they want, generally a homebirth where there are risk factors which indicate that a hospital birth would seem to be the safer option.

In a previous entry I asserted that 'it is illegal in the U.K', I failed to elaborate so I shall now. Freebirthing is not illegal but, and to me it's quite a big but, if any person with the woman gives any care that could be regarded as assisting they are acting illegally. There is a very good synopsis of the situation here.

I''m going back to a personal level now. To be honest I couldn't give a **** about the legality, although that is there for reasons, think child protection, weird sects, trafficing and you wouldn't be far wrong, it's the safety angle that troubles me. I am an advocate of homebirth, but even so I never relax, I am constantly on the alert for indications that all may not be as plain-sailing as it appears, I know that what makes homebirth a safe option is this picking up on minor signs, and acting on them. The ability to transfer in, or prepare for a problem is an invaluable safety net, would a freebirthing woman realise the significance of what appear to be trivial occurances? We are lucky in this country in that we have excellent paramedic support, but if an ambulance is not called until the emergency has happened it may be of little use. One scenario that causes me, as a midwife nightmares, and certainlly when considering a woman birthing alone is shoulder dystocia, even within the obstetric unit it is the big dread. How would a woman alone, or even with a supporter, cope with this? Quickly log on and follow manoevers, phone for an ambulance, contact a local maternity unit, the chances are that none of these would produce answers quickly enough for the baby. There are several more emergencies which trouble me, admittedly they are not common, but they do happen and they can easily cause severe compromise, or death.

Back to me as a Mother, with a pregnant daughter, 2 grandchildren and working as practicing, experienced community midwife. Readers of my blog will know that I have, in the past, encountered problems with the powers that be with my providing care for my daughters, friends and colleagues. So, as a qualified midwife, with her own caseload, who cares for women within that caseload with no input from hospital or G.P I have been censured for providing care to women who have requested me, who know me and therefore, I assume, trust me and my judgement. With my first grandchild I was expressly forbidden to act as a midwife, the rationale being that I could not be a midwife and Mother. Over three long years I have chipped away at the hierachy and finally have been given permission to be 2nd midwife for daughter's pregnancy and birth, even this required that daughter be interviewed by a Supervisor of Midwives and the Head of Midwifery, is any one surprised then that freebirthing is viewed with such caution. If people have concerns about my ability, an individual trained to deal with emergencies, to provide care to my daughter due to emotional attachments, how will a woman alone, or a caring partner, relative, friend with no training deal with a situation requiring urgent action?

I know that my view of freebirthing is hugely influenced by me as a midwife, by the experiences that I have had, by the adverse outcomes I have witnessed and by the professional articles I have read. Would I intentionally attend my daughters labour with no support, no instruments, no emergency equipment? No. Would I support her if she wished to freebirth. No. However, if it came to it and I was the only qualified person there, she refused to allow any other midwife/doctor into the house (her right) I would have to stay with her, my midwives Code of Practice sets this out, but it would cause a serious problem between myself and daughter.

As I stated before this is all a personal view. My stance is that I would hope that no one feels that freebirthing is their only option but I can see that there are occasions where so many obstacles are put in women's path, when requesting homebirth, that they feel it is the only answer. It isn't and it shouldn't have to be. For the majority all will be well, but for a minority the outcome will be tragic and for this reason I have to remain against the practice. 

4 Kommentare 20.1.07 17:13, Comment

The end of an era

Four years now a colleague and I have been facilitating Active Birth Classes but all that finished on Monday night. Why? Were we bored with them, sometimes yes, but then we would revamp them, come up with another way of passing on the information. No, the reason they ended were, cutbacks, saving money. On a teeny, tiny scale, this just illustrates how short-sighted those who hold the purse strings are. The classes were provided within our contracted hours, they last 2 hours, so thats 4 midwife hours, roughly £60 a week, on 30 weeks of the year, so it was costing around £2000 a year, about the same as 1 Caesarian Section costs. The aim of 'active birth' is not to get women in labour leaping about, not even being particularly energetic but to help them work with the physical and physiological processes of labour, and perhaps reduce the likehood of intervention. All who attended our classes gave feedback on whether they helped, or not, all believed they had helped and certainly the section and intervention rate amongst women who came to our classes was half that seen generally. So, we had been providing a service which did not cost the Trust extra but had the potential to reduce expenditure by less use of epidurals, lower intervention rates and therefore shorter hospital stays, and they have stopped them, but given us an audit to do instead. B*****s.

No Amy today, her Mummy hasn't gone to work because her car wouldn't start. Talking of cars, mine is causing me anxiety at the moment. Whilst out on my rounds yesterday the engine management light came on. Hmm, 30 miles from home, 2 more visits to do, what should I do? My decision was simple, pretend you havn't seen it, so home I came, no other symptoms just this ominous, glowing picture of an engine.

Still no baby. When I woke in the night and saw the snow I felt sure that daughter would be phoning to say that it was happening. It's snowing again now, with more forecast for tonight so I shouldn't be too complacent, I could still find myself negotiating snow-filled, country lanes.

Company who owe the £35,000 produced 3 cheques yesterday but asked us not to present them until they phoned, yet another delaying tactic. I wish they would hurry up, I need to have some expensive dental work done, another abcess, tooth needs to come out but I am reluctant to go ahead until I know we can afford the replacement. Look on the bright side though, a sore mouth ensures I eat less, so a painful but effective diet. 

2 Kommentare 24.1.07 10:18, Comment

Zilch, nothing.

All quiet on the grandchild front, we are back down to amber alert. It has been good for the housework though. In an effort to not think about it I have washed the kitchen floor, done the ironing, tidied up everywhere, cleaned the bathroom and done some shopping. Hubby has played 'hunter, gatherer' and been busily chopping and splitting wood, now we will just sit and stare at each other.

2 Kommentare 28.1.07 15:33, Comment