Don't ever quit, you are too valuable. Not only as a midwife, but as a role model too. There are alot of us passionate students out here ready and willing to fight bloody hard for midwifery and midwives, and we need you. It would be a sad day when midwifery starts loosing woman/midwives like yourself.
Kirsten Darwin.
~~~start life with a midwife~~~
----- Original Message ----- From: "Trish David" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, October 05, 2004 10:57 AM
Subject: Re: [ozmidwifery] Students, training and other things was Re: uterinerupture 1998
Abby, if I didn't think I was trying to impart a degree of wisdom, and assist students to find their own wisdom, together with the women (heard of the follow-through experience???) and the lovely midwives in hospitals who assist them with onsite learning, and the VERY occassional homebirth midwife who can take a student... then I would give it up. With (diminishing) respect, evaluate a curriculum or two, enrol in a midwifery program, and don't generalise what you see in a workshop of 10 midwives to what is taught in every curriculum in Australia.
Every curriculum I have evaluated has a focus on non-intervention for 'normal' childbearing and that includes programs from 4 states in Australia, both postgraduate and undergraduate. I have participated in curriculum development at undergraduate, grad dip and masters level midwifery and used programs from NZ, Holland, Scandinavia and UK and Canada for inspiration and international comparison. And I know many colleagues in other universities who have done the same. In addition, we now have Standards to which we are held that are based in international benchmarks for midwifery education, and there are moves now to develop more national benchmarks in what is offered in midwifery programs. Your criticisms are hollow in the face of this real work. Your rhetoric is empty of real examples.
My students learn active birth, pelvic mapping, physiological processes, support for all of this and many have also been to 'workshops' with ten midwives and say they learned little new that wasn't offered in their program..... hmmm. I encourage them to go, though, because they sometimes bring something new back for me, too.
As to the third world, yes, I have seen the Birthrites video, too, it is wonderful, but only a very small sample of what is out there and certainly can't be generalised to the rest of the world. Through ICM/WHO documents etc as well as direct communication with women and midwives know that the problems in many countries cannot be fixed with a few herbs, no matter how good their public health and nutrition. Have a look at another fabulous video "Celebrations" about the role of midwives across cultures and contexts. Women die because they don't have access to a 'facility' that can offer them antibiotics, anaesthesia and operative birth. They die of tetanus and pnuemonia, of septicaemia and blood loss, of obstructed labour and AIDS. Planting crops and fixing plumbing is one aspect of what is needed here, but good nutrition and education take two-three generations to improve the health of a population. In the meantime these individual women are just trying to stay alive.
Women in these contexts want good drugs, skilled users of instruments and operative procedures, immunisation and contraception, safe abortion, nutritional supplements and freedom from patriarchal, economic, religious and political oppression. They want TBAs with western as well as traditional learning, they want access to western trained doctors and midwives, nurses and dentists, etc. Midwifery cannot stand alone to deliver, we need to put aside a moral highground and work with all sectors of health and education, etc to achieve outcomes in thees contexts.
Dare I say it, the same is true here. In many, many gov't reports women in Australia want an integrated maternity service that uses the best talents of all practitioners working together to offer choice (including all the unpalatable ones like epidural, induction and LUSCS on demand, all of which I would cringe at).
Yes, midwives are 'trained' differently now. Now we have to learn how to be discerning consumers of research, to critique all forms of dogma, to understand the physiology, not just rote-learn something, we must also understand a rationale for actions and learn to be fully accountable for them, we must commit to lifelong learning, to participate in quality improvement of services, and to work in a multi-disciplinary environment with a wide variety of women. We no longer have the excuse of this is the way I was taught.... I believe we are coming to quite a good balance, though we are not there yet. I look forward to the day when there are enough homebirths for students to participate in, enough homebirth midwives for them to learn from, and enough midwife-led programs for them to work in whilst in hospitals. For now, we don't have that, but we sure teach students what that is about. Every program I have read has whole units devoted to political issues and professional issues in midwifery and maternity. The scope is much wider than ever before. And yes, we do give students survival skills and knowledge for working in the system, would you have us sacrifice them? It is our duty to them to support and help them survive the system, while assisting them to decide what is bad about it... and what is good (and there is some good out there). I don't think it's true to say a lot of universities teach students how to intervene, or fail to impart reverence and trust. I wouldn't presume to know what goes on in individual classrooms because I am not there. And many graduates I speak to, many lecturers, and many students have a very midwifery philosophy and strive hard to keep that alive. Perhaps we can't give them every tool, no one knows everything, and our training programs are short but overstuffed with content. Perhaps we could improve, and we continually strive to.
Now, give me some examples. Back yourself up. What traditional ways are you talking about specifically? What specific wisdom is missing and how would you provide it? Not just a blanket statement like working with women, this has no meaning beyond what the individual determines it to mean, give an example. Teach me.
What traditional herbs would prevent PPH (we use one, ergot, that has been in use for 4000 years but is now much more reliable quality because of what modern pharmacology has done to it) and where is the proof?
Where are you going to find independent midwives to apprentice the 1500 midwives + per year we need (Vic)? Where are you going to find the women willing to have students follow them through, because we are certainly having problems doing this now?
Abby, please, get out there and find some good examples for us. We think we have many of them on offer, poorly resourced and always under pressure they may be, but we do have them. We mightn't live up to your ideals, but there are many midwives trying hard to change the system, often in the face of considerable apathy and antipathy from the women of their communities......
I think it's time I quit midwifery, really. Too hard, too painful. Trish
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