[ozmidwifery] midwifery knowlege (ARM)

[Mary Murphy]

Midwifery formulae:The sod's laws of midwifery?Debbie Patrick - AS A MIDWIFE working on a busy delivery suite, opportunities to stand back and muse on the ebb and flow of midwifery activity are comparatively rare. However, on occasion, some everyday occurrence just jumps out and make you think a bit. I was recently working with a student midwife, we were expecting a woman in labour and saw her walk slowly up the corridor towards us, taking several pauses as contractions delayed her progress. As the student showed her to her room, another midwife and I exchanged glances and grinned at each other, with a, "better be getting your delivery pack ready," look. 1. Number of pauses taken by labouring woman walking down delivery suite corridor = the greater the woman's cervical dilatation. (can also apply to number of pauses/curses heard during a phone conversation). Sure enough, the woman gave birth a short while later. Not rocket science you cry, every experienced midwife knows that! Yes, but how do we know? Along with many midwives, I had been both enthralled and horrified at the observations of midwives everyday practice described by Hunt and Symonds (1995), but was particularly struck by how the midwives could tell the progress of labour by observing a woman's behaviour. Midwives, particularly those with over five years clinical experience, are amazingly good at identifying the less well documented signs of progress in labour without relying on vaginal examination -the burping, hiccoughing, restlessness of transition, the crying out for mum and shunning of physical touch. We also seem able to detect intuitively when progress in labour is not so straightforward, often without being able to articulate a specific cause. We appear to see and get to know these intuitive feelings about progression of labour better if we observe them in a one-to-one situation, such as working in a midwife led unit or at home births. However, most midwives develop them over time wherever their experience is gained (Patrick, 2002). We also try and pass these 'midwifery formulae' on to the next generation, the midwifery students and medical students, so that they may also recognise that the linear progress of 1cm of cervical dilatation an hour proposed by Studd and Duiagnan (1972) is something that simply does not often happen in spontaneous, unmedicated labour. Well, we try to but........ 2. Presence of student midwife/doctor during labour = increased risk of operative birth. There also appears to be a further midwifery formula, whereby merely having a student midwife or medical student working with you, (particularly if they are desperate to attend a birth having been 'unlucky' in the past), virtually guarantees that any woman they follow ends up with an operative birth. It matters not a jot how straightforward the woman's obstetric history may appear to be, the lack of 'risk factors', the previous totally straightforward births she may have had, how much the student is involved in their care, something always seems to happen. An example of this also happened to me recently, where I was foolish enough to comment to the student midwife I was working with how straightforwardly women can often labour in the birthing pool, with unexpected progress, only to assist the women we had been attending out of the pool a few minutes later following a placental abruption! (all ended well by the way, but on 'dry land'). These midwifery 'sod's laws' got me thinking along the lines of other types of occurrences that could be potentially expressed as a sort of 'midwifery formula', and I'm sure there are many others that could be articulated! This observation leads on from the last one: Presence of woman in labour in the birthing pool = increased midwifery feelgood factor on the delivery suite. Is this just relief that at least one woman is labouring 'normally' (whatever that is) in a mixed midwife/consultant led unit?!