RE: [ozmidwifery] Love of midwifery

[Robyn Thompson]

Title: Love of midwifery

Hi Fiona

I just happened to be on line about Professional Indemnity Issues when your email came through.  I can feel your frustration.  The intervention rate is the same country and city.  I visited 6 women in their homes last Wednesday and 5 out of the 6 had LUSS.  This is common every week I home visit.  These are women who birth in the hospital system and now have breastfeeding problems.

 

One woman tired and exhausted told me that her obstetrician booked a LUSCS because she told him that her baby had just turned to the breech, just on term.  She went along with this (second baby) because she felt fearful with the information he gave her.  Not informed choice just fear and trepidation.  While she was being prepped by the midwife for Operation the baby turned to cephalic.  She knew this because it was the same strange feeling she experienced when the baby turned to breech.  The midwife palpated her and agreed the baby was now cephalic and proceeded to continue with the prep, catherisation and took her to the Operating Room.  No discussion just that everything was ready and off we go.  She felt scared and was not able to stand up and walk out at that point.  Now she wishes she had, she feels very cheated hence her breastfeeding problems.

 

Women need to be informed, educated and supported but the reality is - it is not happening.  So I feel for you and the frustration of the midwife within.  CTG is not a management decision really, women can refuse CTG but they must be educated, most agree to these intervention on the basis of fear.   Fiona you need to be supported, I feel like I would love to come and work in the area just to start a midwife approach, but I am getting to old for all of this now, the battle here is just as bad. 

 

I must say that when I take someone into the hospital system from home we go armed with a written plan and we make sure that the team listens to us.  We request a meeting and that means pull up a chair and sit down and talk to us.  The woman is never lying down on a bed when we talk and in most cases she takes the highest/most elevated place with her partner and myself close by.  We make sure we have an arrangement that nothing is done unless the woman is well informed and gives her consent.  But I must say that this has developed over many years, I have learnt from strong women how to deal with the pressures of the system.  Not always perfect but most of the time good results.  The women use the Hospital Bill of Rights to refer to if there is any argument about their Rights (see RWH booklet on Patient Rights and Responsibilities) and they also have a copy of the Homebirth Bill of Rights and Responsibilities which should apply for all women.  By knowing their rights they maintain equality.  Maybe there are some strong midwives around who would like to set up a midwifery group private practice and start referring and advertising so that women can have the option to at least start with midwives for antenatal education, information preparation and come back to debrief.  I don't envisage it will take off immediately but if you are patient referral will work by word of mouth.

 

A few years ago now, had to transfer a woman to hospital eventually for epidural and much, much later for LUSCS.  It was the first time I heard a woman tell the Obstetrician to "get out of the room, you are in my face and I don't like it.  I will call you when I want to talk to you".   The Obstetrician looked at me indicating her need for support.  I just politely told her she should do what the woman says that is her right, and I am employed by her and fully support her.  Guess what the doctors were all waiting to get away to watch the football Grand Final.  They missed it of course and another shift came on much later.  The woman chose only to communicate with the more woman friendly Registrar and requested that her LUSCS be done by the Registrar.  It all worked out for her in the end.  

 

Not sure if this will be helpful Fiona but women need midwives like you.   

 

 

Midwife regards,  Robyn

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Smith, Anne
Sent: Monday, October 28, 2002 8:35 PM
To: [EMAIL PROTECTED]
Subject: [ozmidwifery] Love of midwifery

Dear list,

I am a midwife who is very passionate and very for woman centred care.  I love being a midwife and can not imagine not being a midwife, but l have become so dissolusioned with the system that it is breaking my heart.  I have been a midwife for 5 years and feel that the system (especially where l work in a large country city) which is medical based has not changed.  It has actually become worse.  Despite being a strong advocate for evidence based practice and presenting this evidence to doctors and management, l have been walked all over, some midwives have been yelled at, 'put in their places' by RESIDENTS and we have basically have our hands tied.  The amount of autonomy we have is decreasing, which makes me feel sometimes that all the hospital wants are obstetric nurses.  They do not want midwives because they cause too much trouble.  Who cares about the women?  Management want to make the doctors happy and stuff the midwives. 

One example, i am really against the use of CTG's in normal pregnancy and labour.  Because of one bad outcome, management wants to introduce admission CTGs for all women who present in labour.  I produced for them so much evidence based material which actually states that this is not a good idea, but they introduced it anyway.  I dont know why l try because nothing worse.  I dont know what to do and all my collegues feel like this as well.  We need different models of care, we need to take over the care of women in normal pregnancy and birth.  I fully endorse NMAP but will it have an effect in my workplace.  Will it really change the obnoxious doctors we work with and management who only care about beds and money?  Midwives have tried to get a midwives clinic in this town for 11 years, but has been blocked by the doctors (one in particular).  We have no free antenatal care except for one midwife who works with aboriginal women (who we also refer white women to).  If women only knew what was going on and they care they get from their doctors is less than substandard.

I hate feeling like this.  Women are being ripped off, assulted, and their rights violated, and there is only so much l can do.  I do the best l can for these women but l feel that it is no where near enough. It makes me feel like l have a hollow pit in my stomach thinking of coming to work.  But l love midwifery, and l know that what ever happens, l need to go on...

sorry, but l really needed to get this off my chest.

MIdwife trying to make a difference

Fiona Dunmore



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