[ozmidwifery] a labouring woman is a labouring woman???

[Susan Cudlipp]

Dear all I have been enjoying this discussion on the difficulties faced trying to provide women-centred care in hospital settings. While I agree that there are many problems with 'differences of opinion' regarding styles of care, I have found that the one of the biggest causes of intervention is that WOMEN REPEATEDLY ASK FOR IT!  Despite our very 'natural' approach based childbirth classes, despite even our obstetricians (sometimes) trying to persuade them otherwise, a large number of our clients badger, insist, and moan until they get an induction, or an elective caesarean  One of our OB's suggested we have a sign made saying "please do not ask for an induction as  a refusal often offends"!  Same OB also recently talked a woman out of a planned C/S when she presented in early labour the day before C/S day - had a good vaginal birth instead!  But in the present climate of fear (from the well publicised recent unexplained stillbirths in post-term women) it is hard indeed to refuse a woman who is truly worried that her baby is in danger.   There is also the great difference in attitude of the clientele we get, while some of our women are well-informed and keen to birth without intervention, we have many who are the opposite. Recently I cared for a 14 y o girl who was screaming for a caesarean with the first cramps (this was a spontaneous labour).  There was NO WAY she was going to do this without adequate pain relief, and, for her, a good epidural, followed by active management, was the best way to go.  She birthed beautifully and triumphantly - but without the pain - and I felt proud of being able to get her there, even though her 'management' was not my preferred way, it was the right 'management' for her. In absolute contrast was the lovely multip who birthed her stillborn term baby with only a couple of panadol on board to ease her.   My point is that we have to adapt to the needs of the particular labouring woman we are caring for at the time.  In the hospital situation (which is where most women do birth) we do not often have the luxury of getting to know our women very well before their labour, very few of them are willing to take responsibility for their births, most hand it over without ever realising that is what they are doing.  My colleagues are all caring and capable midwives, with different personalities and styles, true, but each of them will give the best care she is able to give to each woman in our care, and I am proud to work with them.  Sometimes we have a better day than other times!  And even the best of us can be 'wrong' for a particular woman, or can be having a bad day ourselves, or the acuity of a particular day can make for less than optimum care.   I was one of those who 'put my hand up' for Birth Centre, and enjoyed it tremendously. BUT I have to say that I would not work in that setting again because of the impact it had on my own well-being and that of my family, the long hours and unpredictability took their toll and I can quite understand why so few wanted to do it at that time.  So I happily work within the system, in a smallish hospital ( +/- 700 per month) and enjoy the care of ALL women, whether or not their labour, birth, attitude, situation or outcome is what I would consider to be optimum. I have seen many changes in our little unit, and this is on-going, and the best way to effect change of attitude seems to be to foster professional respect and team mentality between midwives and doctors, I have noticed a definite 'relaxing' of attitude of late, and lessening of 'ob nurse' mentality.  Andrea is correct in saying that about 65% make up a core staff, so don't lose heart all you students - the system is best changed from slow and steady pressure from within.   Meantime - those women out there need better education! Change will best come from consumer demand - so our consumers need to know what they are missing out on.   Sue