How Birth Works
Our first online conference was an inspirational day, brimming with ARM warmth and connection. Soo Downe Professor of Midwifery at UCLAN chaired the event, paying tribute to the first ARM Vision for Midwifery Care as her inspiration and the second “New Vision” published in 2012. Soo briefly presented Squaring the Circle, which she edited in partnership with Sheena Byrom: a cutting-edge and comprehensive collection of the latest research and debate on normal childbirth.
Kemi Johnson: Failure to Wait – sabotage of a perfectly good birthing
Kemi (‘birthkeeper’, birth consultant and independent midwife) describes how much intervention is caused by the failure to wait for labour to start and establish. She highlights the WHO guidance for normal labour and the evidence supporting membrane sweeps which should be considered a method of induction (Cochrane 2020). Above all Kemi strongly recommends we respect the process, the mother and the baby.
Molly O’Brien: Understanding biomechanics in the birth process
Molly has made a systematic exploration of the midwifery skills and observations which helped to resolve long and difficult labours caused by malposition and as a result teaches a variety of interventions based on biomechanics. She finds many spontaneous births are prevented by a combination of biomechanical issues, medicalisation and fear and confirms what most midwives suspect, that labour dystocia is a leading cause of emergency caesarean section.
Margaret Jowitt: Reflexes in the Second Stage
Margaret reflects today on the role of the clitoris in the fetal ejection reflex and demonstrates how the penetration of the structures of the clitoris deep within the pelvic floor may provide an oxytocin surge as the head of the baby descends and the more worrying possibility that the recent trend to recommend in the OASI bundle large 60-degree angled episiotomies may impinge on those deep structures.
Gloria Esegbona: The Art of Second Stage
Gloria is an Obstetrician and Gynaecologist, maternal pelvic sonographer, educator and researcher. In a fascinating and detailed presentation, Gloria shows how the majority of pain and injury in mothers and babies occurs as a result of high force on small area, and demonstrates a range of strategies to create optimal pressure on the abdominal and pelvic floor/ perineum.
Jim Thornton: OASI Discussion
Obstetrician Jim Thornton critiques the OASI care bundle – clinical interventions not commensurate with midwifery philosophies of non-invasive, hands off, maternity care in labour. “Routine rectal examination in the presence of an intact perineum fails all the criteria of a useful screening test. Most midwives wisely don’t do it. Those that do, should stop”, says Jim.