From MIDWIFERY MATTERS, Issue No.102, Autumn 2004
Debs Neiger
THE LAST TWO YEARS OF MY LIFE have been a complete revelation to me personally and professionally. On a personal level there was my completely healthy and enjoyable pregnancy, the home water birth of my little boy and our ongoing breastfeeding relationship which, after a very rocky start, is amazing now! Being a mother feels very fulfilling and I have surprised many people who thought I wasn´t the ‘maternal type´.
I took a year´s maternity leave from my full-time work in a large maternity unit so as to be there for my baby for as long as possible, intending to return for maybe three days a week after my maternity leave was over. However, this has not quite gone to plan. I had hired independent midwives (the wonderful Chris and Michelle!) for my pregnancy care and it became clear that Chris was very keen to recruit me for their independent practice.
Working independently had always been my ideal (I´m from Germany originally where independent midwives are quite common) but the negative attitudes towards independent work, the lack of indemnity insurance and last but not least the lack of a partner made me think that independent work just wasn´t an option for me. What an opportunity!
I started doing odd visits for Chris and Michelle when Gabriel, my little boy, was about two months old and I have never looked back!
What a way to work…. I didn´t know whether to be scared senseless or jump around for joy about the lack of policies… women were given true choice and most importantly they got what they needed and wanted… someone who they knew and trusted and who knew them.
The first birth I attended with Michelle was a revelation. We did what midwives ought to do… sit back, watch, reassure, only becoming proactive when things appeared to divert from the normal path. A gorgeous baby boy was born at home safely and quickly into my hands after a flurry of activity organising a transfer to hospital. All was well… more than well…this had been the first homebirth that I had attended (apart from my own) and it was just beautiful to see the new family snuggled up together on the sofa instead of watching the tearful goodbyes on the postnatal wards!
Soon I had to go back to work in my NHS job. I decided to go back for only one night a week, whilst also working independently as Gabriel was still exclusively breastfeeding and refusing bottles of EBM.
Working my first night back in the NHS I noticed how much I had changed in the last two years.
I made very conscious choices when it came to my maternity care, many of which are regarded as:
• Picky (wanting to know who attends me in labour)
• Silly (hiring a birthing pool)
• Risky (having a homebirth with first baby, no syntometrine, catching my own baby)
• And even downright dangerous (no Vitamin K, no vaccinations, not seeing health visitors for check ups, exclusively breastfeeding until baby is ready to eat which was in Gabriel´s case just short of one year!) .
Maybe I should have a lotus birth next time round just to be able to announce it proudly to members of the local playgroup (who have difficulty understanding why I still have my placenta in the freezer or why in fact anyone in their right mind would ever put a placenta in the freezer!)
Knowing what to choose
In my quest for my ideal pregnancy, birth and postnatal experience I came across many opinions and ‘well-meaning´ advice that made me realise why so many women are denied fully informed choice when it comes to having babies. It is exceedingly difficult to find good, unbiased, evidence based sources of information when it comes to childbearing and rearing!
Magazines
Parenting magazines are popular; they have nicely photographed articles which appeal to expectant mothers, they have ‘experts´ on the staff who can give valued advice on common questions, they have competitions in which you can win baby goods and ‘real´ women tell their ‘real´ stories… what a great and fun way to inform oneself about pregnancy, birth and babies. So why do I feel like screaming every time I pick up one of these magazines?
Formula adverts reign. All babies wear disposables. Articles proclaim what will be done rather than offered to you and when in terms of antenatal checks, birth and the postnatal period. Freebies tend to be sponsored by baby milk companies (ever you ever seen a breastfeeding related give-away in a baby magazine?) And, one of my bugbears, weaning advice is given by formula companies (Did I hear anyone say ‘vested interests´?)
Books
Another popular source of information is parenting books. The quantity of books about how to live your pregnancy, birth your baby and look after it once born is vast. Many of these books simply reflect the opinions of the authors and are in no way research based.
This is fine and obviously everyone has differing parenting styles to be catered for, but many parents do not realise that the book they have chosen may give them advice that could damage them, their child or family as a whole. One very popular book by a ‘maternity nurse´ has been on the bestseller lists for years and had me reeling in horror at the damaging advice on breastfeeding and baby care. The information comes attractively packaged in a book, friends or family have recommended it, it is featured in the parenting magazines. Natural deduction: it must be good advice!
Mass media
The media further influences women´s choices about their bodies and babies. Pregnancy is usually portrayed as hazardous, birth goes wrong and is a life or death situation and breastfeeding is either impossible or highly comical.
Peer Pressure
Friends, family, neighbours random people on the street are also a big influence. Once noticeably pregnant, people seem to feel the need either make a comment that has the potential to scare mothers to death (‘Are you sure there is only one in there?´) or to debrief their own experiences, usually negative (‘You are so brave to have your baby at home….if I had been at home me and the baby would probably have died!´ or my favourite ‘I never had enough milk, he was a really hungry baby!´) These kinds of comments do not inspire confidence, neither are they conducive to informed decision making!
Professionals
Last but not least health professionals don´t make it easy for pregnant women to make a truly informed choice. Time constraints, being relatively bound to protocols of individual trusts and the notion of, ‘well, it is usually done this way, so this must be the best way…´ sometimes get in the way!
When I work for the NHS I feel that the majority of women I care for have not been able or enabled to work out how they would like their personal journey through pregnancy, birth and beyond to happen. Many feel incredibly scared and that they are unable to birth a baby without a lot of help, be it professional or pharmaceutical assistance. Many appear indifferent, leaving the television on for the birth of their baby.
Many are completely unaware of their options or even the fact that they have a say in what happens at the hospital. Many are happy and relieved to hand over all responsibility for their bodies and babies as soon as they enter the hospital.
This makes me incredibly sad! I´ve found the journey through pregnancy birth and early parenthood unbelievably empowering. It made me more confident and strong as a person, a true rite of passage.
It may be silly, but I am assuming that many women could benefit greatly from being empowered to make informed choices.
For women to be able to make these choices about their care options they need to obtain a few crucial pieces of information.
I consciously do not say, “need to be given’ because it may require a little bit of determination and stubbornness on the woman´s part to actually obtain this information.
Firstly, she needs to become aware what choices she actually has regarding her maternity care (e.g. midwife led, obstetrician led, private, NHS, home birth, elective CS, ultrasound scans, fetal monitoring…..the list could be vast!) Then she needs to consider the risks and benefits that come attached with these options. Alternatives need to be considered and especially with offered procedures she might ask what would happen if nothing was done.
This sort of decision making however requires some amount of reading… and finding reliable evidence based sources to base one´s decisions on.
Furthermore, presenting the choices to a caregiver can be more tricky than anticipated….especially if these choices are seen as ‘alternative´! Many midwives and doctors find it difficult to realise that a woman can be well informed, know her options and make choice that she deems best for her situation.
The choice she makes might not be that of the majority of women or even what the professional finds to be the most appropriate action in the situation. As a lay person it is very difficult to assert yourself and stick to your guns when a professional tries to change your mind.
For example: As a student I helped care for a woman who had planned a homebirth but was transferred into hospital when she went into labour two days short of 37 weeks gestation. Her baby was born 20 minutes after arriving at the hospital and all was well.
This woman was very well informed of the particular issue of vitamin K administration to the baby and had decided against it. As she was kept on the transitional care ward due to the babies ‘prematurity´ she had a daily visit from the paediatrician whose determination to persuade her to give the baby vitamin K I can only describe as bullying. His reasoning was that she must give the drug as the baby may otherwise die and that she was being very irresponsible (!).
The woman although very well informed was left in tears after every visit and we discussed her choice at length. However, after three days she felt that she could no longer go on justifying her choice and consented to vitamin K administration.
I felt very sad that an intelligent, outspoken and informed women could be bullied in that way to make an acceptable choice….
I still find it quite difficult to support women in their choice in the hospital environment.
I would love to be able to say that I have the confidence to stand up to senior midwives and doctors and always be a true woman´s advocate, but life, policies and politics sometimes get in the way ……
Last night I gave a couple food for thought about vitamin K administration. They actually loved being able to think about all the different aspects and found it quite fascinating that there was so much to it.
Previously they had not been aware that they even had a choice!
That´s one down….countless others to go.
IK updated 1 December 2004