From MIDWIFERY MATTERS, Issue No.119
Anon
I have recently had the very great pleasure of being with a woman who birthed 'my' 50th baby as a student midwife. This half century has caused me to reflect on the care I was able to provide this woman and her partner in a stand-alone birth centre. If my care was a car, I am proud to say that it was a Rolls Royce. One-to-one care provided in a home-like environment enabled this wonderful woman to birth her baby in a safe, comfortable environment, with water and massage for analgesia. I was then able to help the proud first-time mother to breastfeed her baby.
After the traditional flurries of phone calls and photographs, the parents were able to welcome their families to greet the new arrival and then to cuddle up together for the night as a new family in a cosy double-bedded, en-suite room.
Like the Rolls Royce, the care provided in such an environment is not efficient, but resource-heavy. The ratio of staff to women is very low. The Rolls Royce costs more to run, and it is easy to argue the case that the Toyota Prius of the midwifery world, the consultant-led unit, reduce costs by centralising care. As the midwifery headcount falls due to retirement, disillusion and low morale, the government has no choice but to plough ever onwards with centralisation. There simply are not enough staff to run the stand-alone units and small district hospitals. As it is not politically acceptable to talk about falling head counts, we are told that it is safer for women to birth in units where there is 24/7 access to obstetricians and neonatologists.
I found the very great satisfaction of this wonderful birth experience tinged with sadness. The 'low risk' women are given choice and control over their birth experience. The women unfortunate to be deemed 'high risk' are not able to choose a waterbirth, or water for analgesia, or for their birth partners to be with them overnight. They are looked after in brightly-lit rooms, with little privacy or dignity by an overstretched staff who do not have the time, and sometimes the inclination, to care for women properly. The postnatal wards are noisy, unfriendly places to be. Visiting is strictly controlled in an effort to maintain security and reduce infection. The women who spend time there are treated as patients who are expected to conform to the routine of the institution. Have we really gone back to the days when the pregnant woman is handed over to the medical staff whilst the cigar-smoking, pacing father is told to wait? Should women really be alone until their cervical os reaches the magical 4 cms and they are deemed to be in active labour?
Breastfeeding mothers are simply not given the time they need to establish their feeding. In addition to this, there is such pressure on beds that many women are discharged inappropriately and either give up breastfeeding or have their babies readmitted subsequently under the accusatory label 'failure to thrive' .
I have been able to attend the ARM retreat twice during my training and have met midwives who describe their careers as 'working by stealth' on high risk delivery suites and wards in order to normalise as much as possible the experiences of the women who are subjected to this 'care system' . This 'job description' has made me question what I wanted from my career.
When I started my training, I was striving towards independent midwifery, then, when I came to understand the insurance issues, I felt that community midwifery was right for me. Now I see my future on a 'high risk' unit in order to work by stealth. Reality has shown me that the most likely location in my local Trust as a newly qualified midwife is on the consultant-led unit. I know there are brave midwives who have chosen to work independently on qualification and I salute them, but it is not for me.
I will choose to work with our medical colleagues. I will take pride in the little things; maintaining privacy and dignity, controlling the light and noise in a room, empowering women to participate in decision making and make fully informed choices. I will choose to do a little good for a lot of women.
My current mentor has warned me of the consequences of such a career plan. I will make myself unpopular, 'they' will talk about me behind my back, 'they' will overturn my decisions and conspire against me.
Well, bring it on.
I aspire to be like the midwives I have been fortunate to work with who are universally respected, by doctors and midwives alike, for their clinical competence and their skill in practising the art of midwifery. They manage to work by stealth without upsetting anyone.
To those wonderful midwives, I thank you for showing me the way, inspiring me and showing me it can be done. I want to be in your gang when I grow up.....
This article was originally published in Midwifery Matters ISSUE 119, Winter 2008, p21
AH updated 21 October 2009