midwife's muse

Political

Have just read Mink's blog and off went my brain.The stats she quotes are right, but why are they so good? It's all about one-to-one midwifery and the fact they have the staff, motivated staff, to provide the individualised care that women need in labour. They have rooms, or suites, which are specifically designed to allow a woman, undergoing a normal physiological function, to behave in the way nature intented, not as a rigid system which is an obstacle course which needs to be tackled. This is why women who labour and give birth at home will generally have a shorter, less stressful birth. They have a midwife who stays for as long as is needed. She is not running from one room to another, clock-watching, aware that doctors are waiting outside to call 'time' if they consider progress has been too slow. If the woman decides that she wants a cup of coffee, whether she actually drinks it is another story, she can make herself one. When she feels that now is a good time for a bath there is no problem about asking permission, in a birth centre her midwife is only concentrating on her, at home it's her house so whose to stop her? The midwives, why are they more motivated than some in the NHS Obstetric Units? They are doing the job that they trained for. Most people don't realise that a midwife is, or should be, an autonomous practitioner. We are solely responsible for our actions and therefore should practise our 'craft' in the way that we feel best. Unfortunately we are hamstrung as a national shortage, and deliberate understaffing by trusts, means that we have to provide a standard of care that few of us are happy with. We also have to work within the guidelines, policies and protocols of our employer. These will often differ from 'best practice', and why? Because, although they may be midwifery guidelines, with midwives assisting with their development, the final say will rest with not just the clinical director, a doctor, but also with the trust executive who may sometimes have a nursing background, but in my experience never a midwifery one.

Yes, I am very angry and upset. I listen to reports about the shortage of midwives. I hear the politicians pay lip-service to the recruitment/retention issues. I have feedback from my women about how lovely the midwives were but.........., and I can do nothing.

My answer, it's expensive. Divorce Maternity Services from hospitals. Hospitals are for ill people, people who need something healing, replacing etc. 70-80% of pregnant women are young and healthy, why associate them with a structure most of us would rather avoid. Widen the scope of the Maternity Centres, have antenatal and postnatal facilities, drop-in centres. Increase the staffing levels by 25%, it doesn't all need to midwives. Assistants, or doulas, could help with a large number of tasks which require less training. Obviously there will have to be doctors, but if maternity was divorced from gynaecology there would need to be far less of them, and those doctors would then specialise solely in Obstetrics. Design these units so they don't have rooms that resemble low-tec operating theatres, make them user friendly. All the research has shown that this has a profound effect on the outcome of labour, for the better. Normal Birth rates would rise, operative births would fall, then we would need less doctors on site and the costs would fall dramatically. QED.

5.10.05 17:34