I've just read Jan Robinson's twin story - WOW! Congratulations to all
involved.
Jan Ireland, you have asked a lot of questions - I can't answer them all.
Throughout the pregnancy I try to stress to my clients that homebirth is
not an end in itself. I liked the way Nicky Leap talked about her work in
London, when the women were free to give birth at home or in hospital - it
was no big deal. That's what I would like to see here, but it becomes such
a huge issue when a woman has to step out of the 'system', and be told by
most people that she is mad, and pay a lot of money for an independent
midwife! I do my very best to facilitate homebirth, but once the
recognised boundaries of wellness and time (from an exhaustion point of
view) have been overstepped, I think a midwife needs to be very sure that
it is the woman's wish to continue at home, and that the woman understands
what's going on. That's hard in labour, as it requires front brain
thinking.
Many of the issues you raise would be good to deal with in a confidential
Peer Review setting. I would also like this for the birth I attended. I
hope MIPP will be able to establish a process for Peer Review, and do it in
a way that is accountable and responsible.
I think in this case the reasons for transfer to hospital were a mix of the
ones you mention, and a few more. Once we were in hospital the woman
rested and we waited for the doctor, who was delayed. As baby was a happy
chappy, there was no need to stress about the lack of uterine action, or
the slow progress. It then became a collaborative decision with the doctor
to NOT interfere. Her words "babies are meant to be pushed, not pulled"
were very reassuring. An IV with only 5units of Syntocinon, and heaps of
encouragement from the cheer squad, and we saw continued SLOW progress.
Baby was born by his mother.
Third Stage was also slow, and after about an hour, when manual removal
under GA was mentioned, I advised active management - IV synt and
controlled cord traction. Placenta born beautifully, and minimal blood
loss.
I must get into my car and visit them now.
Joy
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