RE: [ozmidwifery] Pressure re ctg's etc

[Heartlogic]

Mary has highlighted some deep, complex and important issues here regarding the pressure faced by midwives when working in a systems model, however that model is configured.    The collective sense of responsibility, the political pressure, the need to defend the 'unorthodox', our protocol bound profession and the need to be 'doing the right thing' by the mainstream are all powerful considerations at any time. Mary's comments have had me thinking all afternoon as I juggled the various aspects in my head and heart. My guess is that it comes back to woman centered care, how the woman is feeling and what she in her head and heart wants to do. If the woman feels safe and certain in herself, then she will know what is right for her. If she is uncertain/fearful, then that is what is needed to be taken into account, no matter what the model of care is or who or what is directing the management of the model.   Women know themselves better than any so called expert. If a woman is worried, I'm worried. If they are not worried and they are clear and definite, It is easy to support their decisions. I use questions to discover what is happening for a woman, as it is often the strategically positioned question that can lead to insights and understanding for both/all of us.   There is a story which comes to mind and it may illustrate my thinking here.    I had the immense pleasure and privilege of being midwife for a midwife colleague. She was having her second child. The pregnany was traumatic, her relationship with her husband ruptured during the pregnany and she became quite anaemic. She did everything to get her Hb up. At 40 weeks, she had a breech baby with cord around it's feet in the pelvis (cord presentation diagnosed on scan done when baby became breech). She was offered a caesarian and refused. She agreed to be admitted to hospital and whilst lying there on her back, stroking the baby, pondering life, the universe etc as one does at these times, she felt the head and gave it a gentle push towards the correct position. The baby turned easily, flipping to head first. She rang me immediately, concerned and anxious, worrying that she may have caused a cord compression. She had an immediate scan and CTG which showed a head first baby, cord well and truly out of the way. The CTG was great. She chose to go home, despite being cautioned about unstable lie etc.  She finally went into labour at 43 +2 days, there was absolutely no interest in an induction. She "wasn't ready" she told me. Liquor volume/movements etc were fine. She screamed all through her labour, which she assured me was nothing to do with any physical sensation, she was releasing her emotional pain. Gave birth intact to a beautiful 8 something pound baby with clear liquor.  Her birth notice in the paper included the words, "a screaming success".   What's the point of the story in this context?  The point of the story for me is that in a midwifery model of care, which is inherently women centered, the women lead the care.  The joy of programs such as CMP Freo style and the NMAP is that more women can access midwifery care and, with the development of the relationship, gain the huge benefits that care for the human spirit and the emotions, as well as the physical body, brings.   thanks Mary for the opportunity to discuss these issues. warmly, Carolyn Hastie -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Mary Murphy Sent: Sunday, 11 August 2002 10:40 AM To: list Subject: [ozmidwifery] Pressure re ctg's etc After replying to Joy's message I was thinking about where that "pressure in my head" came from.  It wasn't because I was afraid about the baby.  The movements were more than adequate, on palpation there was plenty of fluid.  All other obs were perfect.  Both of us felt that the baby was o.k. I think that the pressure  comes from a collective sense of responsibility when part of a larger birthing community.  The Community Midwifery Program is always under political pressure from the doctors to not put a foot wrong. Always defending us for our "un-orthodox"(ie non-interventionist)  practice.  My daughter is a client of that program and I am a midwife contracted to that program. Because of that it is always important for us to be seen to be doing the "right" thing.  I felt that we were more or less obliged to do what is assumed to be "right" by the mainstream community. (except for being induced at 7-10 days which is fast becoming the rule at our large teaching hospital). It is something for you all to think about when contemplating NMAP.  The gains outweigh the losses, but for midwives there is ALWAYS that loss of true autonomy, for the client a trade of a free homebirth,  for some subtle pressures, increased protocols and that sense of responsibility to make sure the Program itself is not damaged, for the greater good. On the whole the existance of the Community Program has been just wonderful and I urge you all to work towards it, but these are some of the drawbacks. Cheers, mary M