Hey Gloria, I'm with you here. Although its always important we 'watch our language', sometimes I think getting into semantics clouds the issues and sets up even more confusion for women and their families.
Some of the suggestions here leave me feeling like you, we're dressing it up as something it isn't, and manipulating the role of the midwife in the process. I feel to call a unit an 'evidence-based care centre' kind of detracts from the fact that midwives (at least the fabulous ones I know!) also practice intuitively in conjunction with best evidence. To say a unit is 'woman/women led', 'mother led' or 'community led', means we must put our money where our mouths are and set up all of these units as true co-operatives, probably incorporated bodies with a business committee made up of midwives, OBs, women, mothers, fathers and other community reps. While this would work beautifully and be a gold standard in some settings, I can't see it working on a national/global level (at least not yet!) I also agree with Gloria in that I don't really see the problem with a unit being 'midwifery led'. In this context, midwives do run the unit, do provide care, do make clinical/administrative decisions and so calling the unit 'midwifery led' is really just being honest. If midwives working co-operatively with one another, women and their families, and collaboratively with other health professionals do their jobs well, then I believe this is a brilliant and appropriate model. I chose to birth my first three children at home, in part because the care at our local hospital was not 'midwifery led' but rather 'dr dictated'. My midwives provided me with an excellent and life-changing service, and as a consumer I have no problem with saying the care I received in the home setting was 'midwifery led', because it was, with absolute collaboration with myself and my partner of course! I birthed my fourth son in hospital as we had moved to a regional centre and there was simply no midwife available to birth with me at home (also, middle of 2001 with the whole insurance crisis!). I was cared for by midwives who were somewhat bemused by my complete lack of respect for hospital policy but nonetheless were respectful of my choices and informed decisions. This care was 'conducted' by midwives, but absolutely under the auspice of hospital policy and determinations from the local GPs who practiced there. Had I not been so assertive and determined I am sure the experience would have been very different. I guess I just worry that getting bogged down in the labels has the potential to distract us from some of the most pressing issues we face, such as how we can get 'midwifery led' models off the ground around the country in the first place! To me this is a much more challenging problem than what we call them if/when we finally get them up and running! Just my thoughts, Miriam Hannay (2nd Year FUSA) --- Gloria Lemay <[EMAIL PROTECTED]> wrote: > I'm not in your country and therefore can not speak > to what would work > there. However, from reading all the posts, I like > the "Midwifery Led > Units" terminology and I'll tell you why. It's > honest. Whenever a woman > leaves her own home, she is no longer in a place > where she's calling the > shots, plain and simple. She has just done the > first intervention in > natural childbirth by stepping over her own > threshold. If you start calling > the units "community led", "women led", etc it's the > same b.s. as when they > call a hospital a "Women's Hospital" ---everyone > knows it's really an > "obstetricians' Hospital" or even more honestly > "Anaesthetists' Hospital". > To call them "Women's Hospital" is just a cruel > trick. The power belongs to > the practitioner. I think Midwifery Led Unit is > telling it like it is. . . > there's nothing wrong with midwives leading the way. > Many women wish to > have the guidance and leadership of a midwife and > that's what they'll get in > those units. I like to have things named > accurately instead of all the > mumbo-jumbo positive thinking nauseating things that > people think up in > order to smear peanut butter over bad behaviour. > Gloria in Canada > ----- Original Message ----- > From: <[EMAIL PROTECTED]> > To: <[email protected]> > Sent: Wednesday, September 21, 2005 3:15 PM > Subject: Re: [ozmidwifery] Midwifery-led units - > warning, a bit of a rave! > > > >I tend to agree with Jenny, Community led birth > centre would address the > > potential for alienating other family members, > particularly fathers who > > at times need just as much support and > understanding as the mothers, the > > other point I like is that it literally throws it > back onto the > > community to take some responsibility for their > own unit. Of course > > people will ask but what does it mean? and of > course we can reply that > > it works on midwifery philosophies rather than > medical ones, anyway just > > some thoughts. > > > > > > On Wed, 21 Sep 2005 12:55:06 +0930, "Jennifairy" > > <[EMAIL PROTECTED]> said: > >> ok, bear with me while I think out loud in your > general > >> direction.... > >> well we have the 'baby friendly hospital > initiative', so how > >> about the 'woman friendly birth centre'? I mean, > better > >> still, 'the community' (representatives of) > should really be > >> heavily involved in this kind of primary care > health > >> structure (physical as well as intellectual), > then it could > >> be 'community-led birth centre'..... I think > (right now this > >> minute, subject to change without notice) that as > long as we > >> are identifying the structure (ie the physical > space, not > >> the governing body) with the politics of care > provision (ie, > >> who is the 'primary carer') then we are going to > have > >> confusion. I had a bit of a look at what > constitutes > >> 'midwifery-led care' & 'continuity of carer' etc, > for an > >> assignment at uni, & these terms encompass a > whole range of > >> different models of care - its not as clear cut > as it seems! > >> The definitions would seem to be consistent, but > how it > >> works out in practice 'on the coalface' (now > theres a term > >> that seriously needs an overhaul!) varies > enormously. > >> As I said, Im guessing that what we'd mostly like > to see is > >> the idea of a 'woman-led' birthing culture > actually > >> happening.... & that requires a shift in > perception not only > >> for Mr & Mrs Joe Average (boy, Im just piling up > the dodgy > >> metaphors arent I?) but for the PTB's within the > 'health > >> culture' ..... because that means moving away > from the whole > >> 'doctor as God' thing that goes with > relinquishing > >> responsibility = litigation etc, to actually > believing that > >> 'ordinary people' can take responsibility for > thier > >> health/care... as long as the 'ordinary people' > wont or cant > >> do that, there will be others who do, & where > there is > >> responsibility there is power, & where there is > power there > >> are invariably individuals who are drawn to > it..... > >> Starhawk in her book Truth or Dare identifies 3 > kinds of > >> power in society - power-over ( backed by force > or some > >> other kind of control, deeply embedded in > heirarchical > >> structures, enables one individual to make > decisions that > >> affect others..); power-within ('empowerment', a > sense of > >> personal control & 'mindfullness'..); & > power-with > >> (influence, the power not to command, but to > suggest & be > >> listened to or not, to work with others for a > common > >> goal..).... > >> & Im bringing this up because what I see is a > clash of > >> cultures, where midwives are 'traditionally' > allied with > >> women & their self-identified needs (power-with) > rather than > >> that of the institution which is all about > heirarchy & > >> control (power-over) because it was spawned from > a > >> militaristic culture.... > >> So really we are talking different languages - > the language > >> of 'power-over' is very different to that of > >> 'power-with'.... & to come back circuitously to > my point > >> (its there somewhere!), the terms that keep being > used > >> ('midwifery-led care', 'medical-based model', > even > >> 'free-standing birthing unit') come from the > language of > >> 'power-over'.... because they all identify who is > 'in > >> control', who is in the 'power-over' position... > >> um, Ive just looked at the time & Ive gotta run, > thanx for > >> bearing with me while I ramble incontinently, & I > will leave > >> you with one of my favorite definitions - madness > is when > >> you froth at the mouth; insanity is when you > froth at the > >> brain (sorry, has absolutely no bearing on this > >> conversation, completely irrelevant, but for some > reason I > >> remembered it now - Im just a sharing kinda gal) > >> jennifairy > >> > >> > >> > As I watched the 7.30 Report last night, that > dreadful > >> > term "midwifery led unit" kept springing up. > I have a > >> > real problem with this term, as you can read > on My Diary: > >> > > >> > > http://www.birthinternational.com/diary/index.html > >> > > >> > Can't we do better than this? > >> > > >> > Thinking caps on please! > >> > > >> > Andrea > >> > > >> > ----- > >> > Andrea Robertson > >> > Birth International * ACE Graphics * > Associates in > >> > Childbirth Education > >> > > === message truncated === Send instant messages to your online friends http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
