Re: [ozmidwifery] midwife is a midwife...?

[Marilyn Kleidon]

Hi Sue:   I really don't know if what i am going to say is true, it is just my perception. Here goes: it seems to me that as some women demanded that intrusions and interventions in childbirth be decreased (shaves, enemas, drugs, episiotomies, IOL, ARM,  etc..) and so demanded choice in childbirth the response was to also offer women the "choice" to have these interventions. The argument that these were most often unnecessary intrusions at the least and unnecessary interventions at the worst with little evidence (if any) to support their use was and remains lost on many childbearing women, their partners, and our colleagues (midwives and doctors) as well. I would be the first to argue that almost all of the above list actually do have appropriate places in maternity care but again, no place in routine, normal care and are not really appropriate "choice" options. But then when I think of the cosmetic surgeries that people (men and women) are "choosing" I have to believe that maybe I am in the wrong galaxy.   I have a friend working "labour and delivery" in a New York hospital at the moment. This was a hospital that had one of the first midwifery clinics in New York and were very proud of their low intervention rates and natural childbirth statistics. In the last 12 months the midwives have had their practice severely restricted (really low risk women) so that now, if a women requests and receives an epidural she becomes an obstetric patient (even if all her antenatal care was with the midwives) and is delivered by the obstetrician and obstetric nurse, she is no longer under midwifery care. My friend has witnessed the doctors coming around offering the women epidurals after the midwives have reveiwed their options for pain relief: but wow what a choice: if you have an epidural then your midwife cannot be your birth attendant. umm! Since she is working as a labour and delivery nurse she attends the birth either way and spends a fair bit of time persuading the women to stay with the midwifery care. However it is so hard to talk so many women out of "their epidural", there has been an amazing PR campaign.   marilyn ----- Original Message ----- From: Susan Cudlipp To: [EMAIL PROTECTED] Sent: Wednesday, April 14, 2004 8:52 PM Subject: Re: [ozmidwifery] midwife is a midwife...? Mary I agree totally with this - and say "Roll on the day"  I guess my only real point is that hospital based midwives seem often to be perceived as 'collaborating with the enemy' whereas the truth is that the vast majority are doing the best they can within the present system.  It would have been wonderful if that scared little 14 y.o. girl had had such support during her pregnancy that she was able to consider birth as an achievable goal.  She really did not believe it was going to happen, which is why she was shouting long and hard for a c/s.  Her first words as the babe arrived were; "Mum - I DID IT!!"  Which is why I described her birth as triumphant - it truly was, and in the circumstances I felt triumphant too. This young girl WAS empowered, even though her birth was 'medicalised' to a degree.  I'm no fan of epidurals and like the fact that we do very few of them where I work.  However, for some women they are a very useful tool, if used judiciously.  Some labours - with the best will in the world - are going to be very difficult, and it is a TOOL which can make a great deal of difference. (please - no hate mail!) I wish there was a stronger consumer demand for better care, our own birth centre closed mainly due to lack of consumer demand, which was very sad. We couldn't argue to keep it going for the small % of women who wanted it.  And from comments from others on this list this seems to be the case generally What do you do to change the attitude of the general public?   Why is it that c/s is so popular?  Why do women insist on being induced for no medical reason?  One girl recently wanted IOL as she was a few days overdue - the OB said to her -" you are not ready, your cervix is long and closed, your baby is OP, if I start the labour off it will probably be long, hard and painful" - Her response? I DON'T CARE! I want my baby out NOW   - (sigh)   Sue ----- Original Message ----- From: Mary Murphy To: [EMAIL PROTECTED] Sent: Thursday, April 15, 2004 8:32 AM Subject: Re: [ozmidwifery] midwife is a midwife...? It seems to me that people think that a caseloading midwife never cares for people who are afraid of childbirth. (both men & women) The truth is, that many of my clients are just as frightened as those in "the system".  The difference is, that at each prenatal visit we talk about the issues and how to overcome them.  Because women have the opportunity to talk to "their" midwife(s), they are able to access strategies to help them.  Sometimes this doesn't happen and they go into labour still afraid.  However, they have by this time built up trust in their midwife that she will CARE for them and if necessary, take them to hospital if they need/want and epidural or anything else.  They are then able to accept the medicalization of their labour/birth as something they have really chosen for themselves. If they have overcome their fearz in labour (common) then they are empowered by their newly discovered strength. They also know that their midwife will not judge them, but accept the woman's choice.  That is the strength of a more personalised service.  The correct implementation of NMAP would give ALL women this kind of care and give ALL midwives the thrill of working in this very satisfying way.  Cheers, MM -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.