Re: [ozmidwifery] Re: uterine rupture 1998

[Trish David]

Abby, could I ask where you are studying midwifery??? I've read a fair bit about 'wise' women, don't romanticise some half-forgotten past. Don't idealise a model of training and education that isn't open to the scrutiny and evaluation of all its stakeholders. To talk about traditionally trained midwives is like talking about clouds. There are some fantastic programs for the creation of 'lay' midwives across the world, and there are some really dodgy ones as well, not even worthy of the name 'program'. Similarly, to say most student midwives in Australia are taught obstetric nursing is an affront to those of us who struggle very hard to create curricula and learning opportunities to subvert systems that oppress women and midwives while allowing them to work safely in the system that is out there. Would you have them learn for some ideal world in the future while the women of today suffer a lack of midwives who can work with them now? I'm with Belinda. While I believe not all midwives have the same qualities or levels of skill, it serves no purpose to create a schism, to pit us one against the other, but rather we should walk a mile in each others shoes and learn to critically evaluate why we are as we are, and determine how to make it better.... without blame and finger-pointing. Nicky Leap is fond of saying a midwife is a midwife is a midwife, but I believe that rose would smell sweeter if she was as compassionate to her sisters as she is to birthing women. The 'lay' midwives I know, the homebirth midwives I have been priveleged to work alongside, and the 'direct entry' midwives I have met and am now helping to educate, are expected to be able to provide the spectrum of care.... not just for well women, but also for those who have emergencies and illness. These women need competent, fast thinking, appropriately acting midwives with a heart, and who can use EVERY tool at their disposal. As to interventions, we in the one-third of the world with good nutrition, hygiene and public sanitation, freedom from poverty and with good shelter and education might be complacent about midwives only needing to guard normal. But ask the women in the developing world, and the 'third world' whose greatest threat to life is PPH, who have almost 100% morbidity, whose infant mortality rate is off the scale, and who would sell their body for a chance to birth in a well-equipped and clean facility what they want. Bet you can't guess? It's not always a midwife. Wisdom doesn't always fall out of women's mouths or reside fully in the practices of the past. Books have lots of it, and there are many complementary paths to wisdom, not one single way. To choose merely one is to turn one's back on all other possibilities. Anyway, enough sermonising for one night. Trish (PS can whoever started with the coloured wallpaper, and other animated little thingies please think about turning them off? It's really pretty, and artistic. But they take much longer to download and sometimes create problems on the printer if there is something really worth printing out to keep, thanks) Abby and Toby wrote: Hi Belinda, >>I will throw a flame - what is a traditional midwife and why is this person always without faults and seemingly all knowledgeable and sanctified. I don't think anyone thinks that traditional midwives are without faults or sanctified, however, I do believe that in their education they learn more about the natural processes than in our current midwifery courses. I don't think this makes them anymore or less, though, they often have less rates of intervention. >>Why should I as a midwife capable of managing women with induction's, ctgs, multiple iv lines and drugs, catheters, monitors, ventilated babies, suction, uvcs uacs etc etc be classed as something other (therefore subtextually less than)  this traditional midwife - where is she for sick women and babies who deserve a midwife. I believe traditional midwives are different. They often learn from another woman, on the job training so to speak, the wise ways rather than from books, in a classroom, in a hospital, from men etc. I guess the main difference I see, is that they don't see it as "managing" women or labour. In todays studies, from what I understand, student midwives are taught more about interventions and how to "manage" labour, rather than trusting a woman to birth her baby her way. Unfortunately much of the interventions you mention above are because of the system, not because women need them. Obviously there is a need in a very minimal percentage of cases, but most these interventions come from the way we are taught to believe birth has to be and from a lack of traditional knowledge within the hospital system and within women. I don't think this is the midwifes own problem but it stems from the training and conditioning. It is kinda like the difference between a naturopath and a doctor, one is naturally, wholistically trained ( though these days mostly through a college) and the other is medically trained, and not often wholistically. >>Please do not separate midwives, it maintains the divide and conquer problem which means we can do less than if we accept diversity and stand together. I think diversity is wonderful, though I would not put doctors and naturopaths in the same category. Would you not agree that current midwifery studies are not based on traditional, wise ways or even evidence based care in some schools? I find it hard not to seperate the two. That does not mean that midwives who are training now aren't good midwives, but they certainly are trained more as obstetric nurses and have to work hard to learn for themselves the wise and traditional ways of women. >>This traditional midwife vs obstetric nurse stuff is a huge bug bear of mine. I attend homebirth as well and am quite confident and comfortable independently, but my ability to work in labour wards and NICU settings does not mean I work as an obstetric nurse - ever.I also work very hard with students and know full well the dilemmas they endure in their training and can understand their frustration. Unfortunately, I've got to leave it there, just found my daughters first chickenpox and she is radiating heat. Great discussion though and I would love to finish this email another day. Love Abby