These archives contain posts from the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. All are welcome to join the group. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
I qualified as a midwife last August and found myself pregnant in September. I am a healthy 35year old para 8 who has had no previous problems with her pregnancies or postpartum period. I am currently 36+ weeks. I was very keen to have homebirths with the last three but felt pressured into hospital births each time which I found very clinical and medicine led. With my new knowledge and experience, I felt that this time would be very different for me. A long-term friend of myself and my husband is also a colleague at the unit where I work. She was my mentor through my labour ward training and we both agree that labour should be kept as normal as possible with little or no intervention unless absolutely necessary. She agreed to attend me as a home birth and as she works for the same trust that is providing my care, we did not feel this would be a problem.
My community midwife 'agreed' to my home birth plan but then informed me that
I would have to meet with a supervisor to arrange a plan as I was a 'high risk'
grandmultip'. The supervisor came and was very supportive. She wanted me to
agree to a managed 3rd stage which I do not want. I left it as I would rather
wait and see. My midwife said that she would feel better giving syntometrine
as I am more at risk of PPH. I thought that it was my choice. Also they decided
that when in labour I should call my friend and my local unit to arrange for
a second midwife from the unit to come with all the equipment needed as in my
area, midwives carry everything in their car. My idea of my labour was a quiet
relaxed experience with my family and my midwife friend that all my other children
and my husband know and trust.
The supervisor told me that she would contact my friend to arrange where she
could get equipment from and talk about how confident she feels about the experience.
Next thing I know, my friend's supervisor is on the phone to her telling her
that she cannot deliver my baby as she has not attended a homebirth since qualifying
5years ago. Apparently, the supervisors discussed it and decided that my friend
could be there to support me as a friend but that one of my my own team of midwives
would attend to deliver me (if anyone is available) with a supervisor for support!
This was 4 days ago. Nobody has contacted me to say that my friend cannot attend
me and I do not like the idea that I am being classed as abnormal before I even
get a chance to labour! My friend is more than confident and competent to deliver
me and I do not want a string of people involved in my labour. I feel that the
only obstacles are the midwives' confidence which has them practising defensively.
I know and trust my friend absolutely, I know that if she feels I need to transfer
to hospital there are real concerns. I do not feel this way about the other
midwives I have come into contact with so far.
At present, I intend to go ahead with my home birth but unless my friend is
there, I will not be requesting a midwife. My friend is concerned at her role
in this and feels that if I ask her to attend as my friend, she will still have
a duty of care to me and will have to document etc.. She is concerned that she
may get into trouble for attending. What next? Who to talk to? I just feel that
I am wasting my breath trying to get the birth that I so desperately want. What
about equipment? Can anyone please help?
L
Just wanted to send you some cyber hugs. I am due to have number 9 in 7 weeks
or so. I was under the NHS but felt like the minute things didnt look text book
I would be threatened with
everything as I was last time. I now have a great IM who has gone through all
the risks with me and we all know what to do in different scenarios. As a mw
you will already know the drills for these so if anything you would be a better
candidate for homebirth surely. I look on my mw as my friend now and the only
thing that I would really hate is having to transfer as she wouldnt be delivering
my baby so I can see how important having your friend deliver your baby is to
you.
I cant give you any advice on the other side of things but just wanted to wish
you well in your fight for the birth you deserve.
L
As far as I can see this is your body, your baby and your birth. In addition to this it's also your house and anyone who comes in does so by invitation only. It's been a while since I practiced as a midwife so I may be a bit rusty (but hey - you're a midwife - you'll soon tell me if I'm wrong :-))
I cannot see how they can prevent your friend from helping you deliver your
baby if that is what you wish. I also understand your friend's concerns - is
there a woman in her area who is planning a homebirth before your baby is due
and who might allow her to attend? This might satisfy the supervisor who is
obviously anxious about this being your 8th.
Personally I think what they've said is a load of rubbish - your friend is a practicing midwife with midwifery skills - are they saying that she's only qualified to work with women who have the full works of intervention? What about women who turn up on the labour ward just in time to give birth - don't they allow her near them? This is mad -we are talking about a normal labour and birth - she is perfectly well qualified to help you. I think they are just scared because this is your 8th. But if you didn't have any problems with bleeding in your previous labours then there's surely no reason to think you will this time - especially if you are giving birth at home without all the interference which often takes place in hospital. I'd get back onto them (or alternatively onto AIMS www.aims.org) about this. If they want your friend to have more homebirth experience it's up to them to arrange it - not you. Also, surely she can act as an independent midwife to you, not clear on the technicalities of this regarding supervision and the supervisor's comments but am sure one of the independent midwives here will be able to tell you.
M
Isn`t there an email group for women who are 'grand multips'? I seem to remember
there was one set up a year or 2 ago - there may be some support to be found
there and research to be shared?
B
This is rubbish. I thought you'd just qualified as a midwife? What did you
learn in those 3 years, what were you taught about grandmultips? What evidence
was presented to you to during your tutoring to indicate this would be a true
statement? I'd hazard a guess none. Because it's not true. Studies and controlled
trials clearly show grandmultiparity does not pre-dispose one to any greater
'risks'.
You are not more likely to have a PPH.
You are not more likely to have hypotonia.
You are not more likely to have poorer birth outcomes.
In fact a good few studies show grandmultips have BETTER outcomes than those
of lesser parity at birth.
Not that I should have to do this, as being a midwife you SHOULD know how to
look up and research evidence based practice on your own. But here is Angela
Horns page on Grandmultiparity and Homebirth with studies included for your
reference.
http://www.homebirth.org.uk/multipara.htm
A
Two years ago I was the midwife at my sister's homebirth (first baby). I had not "done" a homebirth before as a midwife, and had only just recently started working in the community, so I had to get all my homebirth equipment together for the first time to use for that birth.
I was well supported by my supervisor, and talked it through with her before
hand. We agreed that I would be the "first" midwife, but that I would
call my second midwife sooner than usual, to support me in my new role and to
make sure that I would have someone objective around if I was finding it hard
to make decisions. I was not at all worried about a homebirth because
I had read around the ARM and homebirth UK websites in detail, and had talked
to other midwives about homebirths to get their tips. Also, I had developed
a hands-off style of midwifery practice in the hospital, and did not encourage
women to use the delivery bed, made use of the floor space, and generally opt
for physiological third stage etc. I couldn't see how my
practice would be much different at home.
In the event, I did try to call a second midwife in time, but my sister had
quite a quick labour, the road was closed off and the second midwife got lost!
She made it 10 minutes before the baby. It was a wonderful experience for both
of us.
However, she and I have had lots of negative comments from midwives and non-midwives
about midwifing friends and family, and I intend (in my next life) to do some
writing and research in this area. It is an issue that many midwives feel is
"not professional" and if you are unlucky to have the wrong supervisor
you may not be supported to do this. This seems to be the case with your friend.
If she is not happy with the support from her own supervisor then she should
be able to ask for a different supervisor to support her in this.
I should imagine it is easy enough for your friend to put most of the equipment
together before hand that might be needed, and to keep this in a box at your
house.
Good luck
J
Interesting one, this is! I have midwife-d a very close friend before and apart
from my personal
anxiety that I might fail her (which was really my issue, not hers), and it
has been by far the most life affirming experience of my life (next to having
my own children).
Should we not be friends with the women we care for? I still keep in regular
touch with most of my previous clients and we now have got to the stage where
we share personal info (frankly all my clients get subjected to my 'guess what
stupid thing of the week AS has done today?' routine). So what is the general
consensus, would you rather have a midwife who don't know your children's name?
The final question is, how can you NOT befriend the woman you are caring for?
AS
Mmmmm, Interesting one AS!
Sorry, not been on here too often lately, good to see all you lovely faces again!!
Miss you!
Personally, I can't see how it is possible to be an effective midwife ~ with
women ~ if we don't befriend them to a certain extent, but more often it is
a mutual respect that emerges, life affirming indeed.
However, I think L is making a much deeper plea here. She is asking advice on
the real 'guts' of her issues & she needs advise quickly!!! Personally,
I am at a loss to know how she could tackle this, to get the birth she deeply
desires without getting her chum into trouble. I would be very interested to
hear what others would advise or recommend her to do. How wonderful if L gets
to birth her baby the way she so desires, at home, surrounded by her family
& friends.
Good Luck L!!! Let us know how it pans out?
Elaine
I had DS2 at a private birth centre and remember feeling really hurt that the
midwife I had seen throughout the pregnancy and birth didn't even reply to the
invite I sent for DS2's christening. I didn't think we were ever destined to
be 'best friends' but I did think that we'd got on well enough to be sending
christmas cards, replying to invites etc. It left a bit of a sour taste in my
mouth, especially as, after DS2 was born she had entreated me to get in touch
with her if I had another baby as she'd love to be my midwife again.
I had DS3 at home with an IM. who I would consider to be one of my closest friends,
she is DS3's godmother, we see her on a regular basis, and I find it hard to
imagine having shared one of the best days of my life with her and then not
seeing her again. I can imagine that keeping in touch with all one's ex clients
could be an onerous task, but would assume that, as is the way of the world
some friendships will go from strength to strength and others will fall away.
V
I try to stay in touch with clients and class them all as professional friends.
While I can not chat to all on a regular babis as life does on, I always tell
them I welcome pictures and emails and love hearing from them all. I think of
them all as I pass by thier roads on my travels.
VH
If I were you, (and felt unable to put my foot down for fear of getting my
friend into trouble), I should hire an IM to sit in the kitchen and drink tea
whilst I gave birth with my friend.
AC
With my new knowledge and experience, I felt that this time would be very different
for me.
Even pregnant midwives are not up to fighting the system or uninformed individuals
who place themselves in powerful positions. Practice the statements on assertiveness
that MC regularly posts here to have something up your sleeve if required and
you may want to avoid indivduals who do not support you.
You are not at increased risk of a pph and a parity >5 is not an indication
for a managed third stage. Syntometrine is always available if problems occur
as a treatment for pph. It is your choice. "Thank you for your advice and
i will let you know of my decision" is a useful phrase in this case.
You know, this is very strange, catching a baby is catching a baby wherever
it is. She may need support on equipment required, or decisions on transfer
in the case of any problems, but if she is a midwife who is woman centred, confident
in caring for women in a midwifery model she will transfer those skills beautifully.
Can she not act as 1st midwife with a colleague for support (either there or
on the phone, or quietly in the kitchen etc).?
At present, I intend to go ahead with my home birth but unless my friend is
there, I will not be requesting a midwife.
Is it worth stating to the supervisor in a letter that
1.. you intend to call your friend to the birth of your baby.
2.. as a professional midwife she will have a duty of care
3.. you may or may not agree to further professional entering your house
4.. you feel that their advice is not meeting your needs and that they are erroding
your choices
5.. suggest they read the excellent literature review in Lesley Page's book
'The New Midwifery' on multiparity
6.. you thank them for their advice but do not intend to have a managed third
stage in light of Lesley Page's work
K
Dear A
You may not have meant this to come across aggressively but if I was 36 weeks
pregnant and asking for support I might have found this rather intimidating.
Being a midwife and pregnant you are still victim to powerful people making
you feel as if you are doing acts that are harmful to your baby. L is a midwife
based on her local NHS hospital and a product of her college/university. if
people teach you that PPH is a risk factor and that everyone around you (e.g.
these supervisors) support this notion why should she question any differently?
it is only when you are educated/ enlightened/ whatever you may call it, that
you recognise how misinformed you have been. You cannot be deeply informed on
every issue in maternity care, which is why this list is useful as it pools
everyone's niches together.
K
Personally I think midwifery education currently is very dire and in need of a good shake up. I'm not even sure where to start. A few points cross my mind though. How can we train midwives who belief in woman's ability to birth their babies and that pregnancy is a normal physiological process when they are surrounded by images of childbirth which are medicalised? I have come across a few midwives/student midwives in my time and sometimes are shocked enough by their views on childbirth that I question the motivation behind their decision to become midwives.
Interesting how once, women were controlled and oppressed by restricting their access to knowledge but now, the very knowledge they possess are used to restrict themselves. I suppose it also boils downs to which body of knowledge is seen as having more clout over another and unsurprisingly, it will always be the ones that blinkers you with statistics and jargon words that win hands down. After having looked through the latest edition of "Why Mothers die", my husband made the comment that the publication failed to make one major correlation, which is if you have your baby in the hospital you are of an increased risk of dying. Now whether or not there is any validity to his statement, I am not sure but I do wonder what impact such a statement could have on pregnant women.
I think what I am trying to say is, midwifery education at the moment, and
has been for a far while, been gearing to providing the demands of the NHS.
It isn't in the interest of the institutions to cover topics such as twins vaginal
births, hands off vaginal breech births, PPH at home etc. etc. because a)the
majority of the midwives out there aren't seen as requiring these skills as
there will always be the emergency crew that will come in to save the day at
a touch of a button b) these 'conditions' are seen as 'abnormal' so therefore
not in the realm of their practice. Now I am not agreeing with these notions,
but which would you choose as a punter - a midwife who can not safely facilitate
a normal hands off vaginal breech birth (because she lacks the knowledge and
holds the belief that such a presentation is abnormal) or a surgeon who does
ceasarean sections daily? It is the erosion of the midwife's skills and what
is perceived as normal. When I started training, OP presentations were a pain
but it is still normal but now,
I hear from women who talk about their midwives harping on about the pitfalls
of their OP presenting babies. Talk about self fulfilling prophecy. So many
women scared to death with talks of sections just because their babies are breech
at 30 weeks!
Anyway enough rambling. Please excuse me if I sound a bit edgy. I'm all for women taking responsibility for their pregnancies and childbirthing but I think us midwives (present companies excluded) could just reciprocate a little and take responsibility for our profession. Stop being martyrs, we know the NHS thrive on it and while we all love a bit of drama let's not turn our profession into some sordid daytime soap. And I am so sick and tired of that cack statement that disempowered student midwives are given, "keep your head down and when you qualify, you can practise how you want and change the system". That's rubbish, our heads are still down and those who don't drop out just gets sucked in into the culture. I just wish that we sometimes remember that there were midwives long before the NHS, we're here to serve the women, not the system.
P.S. Sorry for the ramble, found out that I am not pregnant and am quietly
disappointed. My uterus on the other hand is probably having a celebration party!
AS
I'm almost afraid to put across my point of view for fear of being shot down in flames for not having done enough research, but here goes:
It seems to me that in every woman, midwife or not, research-filled or intuition-following (or both), is at a vulnerable stage when planning her own births or going through labour. I was amazed personally at reading the postings of a mother-to-be who is "overdue", nervous about her baby and herself, when I realised that she was the same mother I had envied for trusting herself to go "over" by many weeks with a previous baby. I had imagined that somehow she had a different set of emotions when dealing with these issues, that for HER going overdue was easy, but for me it was difficult.
But in truth, women are taught by society throughout their lives that their
bodies are not really to be trusted, that birth is dangerous, that we should
always plan for "something to go wrong", that we should be pitifully
grateful if we come through childbirth alive (even if damaged), with a live
baby.
"Radical" knowledge about birth, and pregnancy, the reading, the deep
trusting of your own body, can be rocked by uncertainty and lack of support
back to this untrusting state, no matter who you are. This is exactly what has
happened. A woman who is planning a homebirth with a trusted friend because
she knows it is best for her, is having her confidence rocked by a system that
would prefer her not to.
The response to women's lack of confidence in her own choices may be very different.
Medics and some midwives may tell the woman that in order to be less vulnerable,
she needs more medical support, more intervention; "rescuing" her
from the body she has learnt to mistrust. Others may choose to blame women and
tell them that in order to be less vulnerable, they need to do more research,
to fight the system, to stand their ground.
Telling her she has not researched enough, or that she does not represent midwifery
adequately, or whatever, may be felt as further evidence of her inability to
make good decisions. Of course, you may feel you don't have any responsibility
to support her. But itis interesting how quickly women who are feeling vulnerable
are blamed (often by other women), for that vulnerability.
V
I rather think that the point of my message was missed. I am fully confident in having a homebirth with number 9. I am not worried or intimidated by other midwives, I am well up to date with current research which concludes that I am not at any increased risks. My intention was to find support and practical suggestions as to ways that my friend could attend me in labour without causing problems at work. My friend is very confident in her own skills and is not concerned by colleagues comments about increased risks of PPH etc. which there have been! The idea of her attending as an independent midwife with a second on call sounds plausible. Can anybody just call themselves an independent midwife? How does this work legally?
What about equipment delivery pack etc.? Any advice/support would be much appreciated
as so far there has only been shock, and disbelief from work colleagues that
she could possibly want to attend a grandmultip at home. We would just like
to know where to start.
L
I wish I lived near you I would volunteer to be midwife 2. What really concerns
me about your posting is what you indicate about the degree of ignorance and
lack of midwifery knowledge of the midwives at your colleagues workplace. If
they are so lacking in knowledge of the research around women having many babies
one has to be concerned about their level of knowledge in other areas of midwifery.
I wonder if a tactful word with the supervisor about the need for urgent updating
would be useful
MC
Dear Listwives
Where do we go if it is the supervisor who needs updating! I know of supervisors
who still think that parity=PPH, amniotomy as the norm and induction of labour
at 41 weeks is the way to go. A friend who is working at a huge teaching hospital
in the county was assisted by the Director of Services Manager who is also a
supervisor, my friend was told to perform an ARM just to get on with things!
There are still senior grade midwives at the unit where I am who think that
amniotomy is the answer, especially if the labour is not progressing at the
rate defined by the medics, i.e. cervical dilation of <1cm/hr. Midwives of
many years experience who think that any woman having her 4th baby or more is
at risk of a massive bleed and therefore 'must' have a venflon in situ. The
d/s manager still thought that parity=pph. I pointed her in the direction of
Lesley Page's work. A unit staffed by midwives who think all babies >10lb
must be borne of diabetic mothers and need regular BM's. Where women are given
antibiotics in labour if SROM >18hrs and where augmentation is the norm.
This is a culture that has existed for years, probably propagated by obstetricians
with the assistance of their handmaidens but you have to be bloody minded and
determined to keep on chipping away at their way of working.
T
(Who to keep her sanity is off to work in a MLU in May.)
Would be nice to know why then in hospitals where they are 'supposed to know'
VERY WELL about Lesley Page's work they still site venflons for women 'para
3 or above' and all the rest.
Really strange! Perhaps I ought to ask them next time I stumble across them,
I will let you
know their response ;-)
JP
It is easy for me to say because I do not work in the NHS but I have actually
been in the circs you describe, some years ago. Where a Supervisor's level of
knowledge and inability to perceive her own need for updating was causing concern
not only to me, but to her more enlightened staff. Her unenlightened staff just
did as she prescribed. (It was issues surrounding the giving of formula feeds
at night "so that the ladies get their sleep"). I was able to informally
share my concerns with the LSA officer, and I do not know how she managed it,
but I fell about when I was on the unit some months later, and the same SOM,
who had been on a course, was pontificating on co-sleeping and the importance
of helping the breastfeeding mother to feed at night and to have sympathy and
hot milky drinks available!! I kept my face straight and thanked her for such
good ideas. Honest !
MC (who can be a two faced b---ch at times)
Hi T
Please will you join the MSLC for your trust - we NEED you!!! I am joining as
of the May meeting and am told it's rather heavy on lay-people and low on professionals.
Keep up the good work in your unit - you sound fantastic! The woman of our town
will miss you come May.
K (NCT)
Dear T. Just another little suggestion You could stick your tongue well into
your cheek and still say to the SOM that you really are concerned about the
level of knowledge of research around several issues like ARM etc and would
it be a good idea to do some updating for the peer revues or whatever
MC
Dear MC
Acting the ingenue at 44 is bloody difficult but for sure it is something I
will try next time I am with these midwives. Having had a good rant there are
some excellent people there, but the majority do seem to cow tow to policy and
medics. As a recently qualified midwife it can be hard to keep banging on and
waiting for the sceptical looks, but I am sure some of them have really lost
the art of being with woman. I have said to the senior m/w that I'm sure some
of them don't even like women! Had a conversation the other night about how
childbirth can be one of the most important days in a woman's life and it is
our role to facilitate all they require. After a few seconds deliberation.....
all in the office agreed, so maybe there is hope!
T
>But in truth, women are taught by society throughout their lives that their bodies are not really >to be trusted, that birth is dangerous, that we should always plan for "something to go wrong", >that we should be pitifully grateful if we come through childbirth alive (even if damaged), with a >live baby.
This is so sadly true. I was chatting with a close friend the other day who
like me is expecting her fourth baby in the summer. Unfortunately her third
baby had a very rocky start to life and now has cerebral palsy. She blames herself
entirely for not knowing something was wrong at the birth, and is now planning
on asking the consultant at her next appt for an elective CS.
She believes that all that matters now is the safe arrival of a healthy baby,
and that she does not really count. It brings me to tears every time I think
about her. I love her dearly, and of course have no real idea how it feels to
have a disabled child, (though I can imagine after witnessing her go through
hell and back over the last two years)but really wish that she had the confidence
in her body to deliver a healthy baby.
I'm just hoping that if she goes ahead with the CS it will at least be a positive
experience for her and help to heal some wounds......
J
I think it has been made clear that a midwife can attend in an independent
capacity and that access to scans etc are fine. But what is the legality regarding
any equipment. eg birth pack, entonox, resus equipment?
K
Hello L
Your friend can attend you at your birth. She must inform the local SOM of her
intention to practice, but the SOM cannot prevent her from attending, unless
she feels your friend is unsafe to practice, in which case she needs to suspend
her from practice through the LSA, and it can't be an arbitrary reason, must
be something that puts public in danger. The SOM may request
to inspect her equipment and (I think) meet with her if she wishes. You remain
eligible for all standard NHS care, which the SOM, or HOM at local hospital
should be able to arrange for you - e.g. scans, blood tests. If your friend
attends you for free, she is covered by RCM professional indemnity insurance;
if you pay her the insurance becomes invalid.
Hope you have a lovely baby having.
V
LW updated April 28, 2005