Janet & Jo

I can only speak about the places I have worked where the vast majority of midwives are mothers and choose to work part time. If you are with a woman in labour and or attend her LUSCS you may not even get to see her again during her stay. She will see a different midwife/s each shift and only stay in hospital 2-3 days. In my experience( and it has been a few years) it is unusual for the feelings you are talking about to come anywhere near the point where the woman is willing to discuss them with a total stranger no matter how nice they appear on first meeting. The women are in a state of shock.  The reality is that as a hospital employed midwife you are unlikely to ever to see the woman again after she is discharged from your unit on day 3-4. 

If you have any suggestions for how we should handle this I for one am willing to listen. I personally try to speak to all such women and their partners and suggest that down the track they may experience some PTS and need to talk with their midwife again and suggest that they call but have never had a woman do this. Should we give them a handout? Perhaps someone who has been through the experience could design one because its not that we dont care but we are as much at a loss on how to deal with it as you suggest.

I am in no way excusing  but try and consider the frustration of turning up to work every day and facing a situation that you know sucks and is letting down women daily. It is wearing and what makes midwives give it up. The passionate ones find their way to something better but the majority just give up and become the turn up, do what I have to and get my pay variety not because they didn't once have the passion but that they had to give up or quit for their own survival. 
The system doesn't encourage thought about what happens to the women and their families before they walk in the door let alone after they leave. Did you know that the NBV sees the following as warning signs that the nurse or midwife may be breaching professional boundaries and may need to seek professional guidance
frequent thinking of the patient while away from work 
seeing the patient for an out of hours appointment at a venue when no other staff are present 
self-disclosure of information of a personal nature to a patient  
undue concern about meeting expectations of the patient or family 
feelings of personal responsibility for patient progress 
awareness of greater irritation if system delays patient progress 
how ridiculous is this because I for one cant switch off the minute I leave the place and often worry about the havoc that has been created in women's lives and that I know the system offers no resources to help them recover from it. I think everyone is with you on this but we need concrete suggestions that can be incorporated into the system we have while we keep fighting to change it. 

Any suggestions. Should all women have a follow up appointment with the midwife who was at her birth, is this appropriate as they may have been part of the problem, should all women have a follow up appointment but the woman be allowed to choose who she wants the appointment with, at what stage would this be appropriate, 2 weeks, 8 weeks 3 months? How does this fit with the M&CH nurses who are now involved in the woman's on going care? How does her doctor, be it her own GP, obst or the one who attended (or not) her birth  be involved in this? 

I ( and probably lots of others on this list) am listening

Andrea Qauanchi
On 03/02/2006, at 11:30 PM, Janet Fraser wrote:

Jo, you're speaking from my heart as well. I was at a meeting last year of women working to support others in birth trauma. All of us had been suicidal at one point, myself included, none of us had had any support from careproviders.
I'm always happy to share my journey but it rarely scores a comment on ozmid. What this means I cannot judge but it makes me fear for other women in my position if we can't talk about it with careproviders. It's not about blame, it's about responsibility for our actions as consumers and a hope that our careproviders will also take responsibility for their actions. We really need everyone to be be truly "with woman" on this one, not with protocol and not with status quo.
----- Original Message -----
From: Dean & Jo
Sent: Friday, February 03, 2006 7:43 PM
Subject: RE: [ozmidwifery] Post cs support

I think it is ESSENTIAL for midwives and consumer groups to be working together on this one.  Amazingly enough, many complaints we hear about are from women who feel their midwife let them down.  Interesting issue (as I am a doula also, perception and expectation of support is of great interest). 
Most would agree with the fragmented care currently offered there is a huge reliance on trusting someone who has just walked in the door.  anyone caring for a woman tries to do their best; but their best may not correspond with the woman's needs, even the 'nicest' midwife can upset someone unintentionally.  where does the accountability lie?  bit tricky there...probably too hard to define: but it doesn't remove the fact that some woman is feeling like shit.
I think it is important for midwives and doctors (if they would ever listen) to listen to the trauma experienced by women.  From experience I can say that MY perception of a particular birth was it was positive: but to the woman is was shit.  Care providers need to base their post birth care on not what defines positive to them, but what defines positive to each individual woman....so easy in this system! NOT.
I wish that one particular person who posted on Janet's Accessing Artimise list would give me permission to paste some of her recent post about the grief she felt postnatally.....over a year later.  To exploit her pain would be adding to her grief: but her words are so powerful, it is heart breaking. 
Trauma after birth effects so many and there seems to be little being done to minimize it. Bugger all being done to acknowledge it.  passing the sense of responsibility on to others seems to be the way.
The 'head in the sand', 'too hard basket', 'total denial', 'my hands are tied' mentality has to stop soon before birth trauma claims more than a woman's soul. 
I am deeply concerned about the lack of information provided by participants of this list (a deep source of supportive woman focused care providers) o the topic of post cs support.  From a consumers perspective: if people like yourselves cant offer up strategies to minimize trauma after cs, then what are we to do?  It doesn't bode well.
no disrespect intended.  I value and hold all active members of this list - however as a consumer it is my right and my role to point out weakness.  birth trauma is a huge weakness that needs to be dealt with.  The ideals of one on one midwifery should not be seen as the solution to current trauma.  yes it will hopefully reduce the trauma of future women, but for those who birth today...there is stuff all except isolation....not what they need.
I was hoping to hear multitudes of posts sharing the methods of supporting and educating women about cs birth:  information on post cs care: methods of debriefing that does more than shift blame: words of wisdom about how we as a society are caring for our future.
love Jo
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Janet Fraser
Sent: Friday, February 03, 2006 2:58 PM
To: ozmidwifery@acegraphics.com.au
Subject: Re: [ozmidwifery] Post cs support

Speaking as someone who helps pick up the pieces after these scenarios, this is what I offer as a starting point:
As well as a pamphlet on PTSD symptoms, and one for partners on how to support a traumatised woman.
The various groups I run offer peer support and accurate birthing information. We encourage women to seek their birth records and go through them with a disinterested party, to look at the reasons why they made choices which put them in more vulnerable positions, and provide resouces with how to make more nurturing choices next time - provided it's not an emergency hysterectomy as that's a whole other kettle of fish. We offer contacts for groups and counselling in each state, where they exist.
: )
I'll be interested to see what those closer to the coalface are offering to consumers as well. It would be neat to work in concert!

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