Re: [ozmidwifery] Pressure re ctg's etc
Well said Mary. it can be a very delicate balance at times but definetly worth it. marilyn - Original Message - From: Mary Murphy To: list Sent: Saturday, August 10, 2002 5:40 PM Subject: [ozmidwifery] Pressure re ctg's etc After replying to Joy's message I was thinking about where that "pressure in my head" came from. It wasn't because I was afraid about the baby. The movements were more than adequate, on palpation there was plenty of fluid. All other obs were perfect. Both of us felt that the baby was o.k. I think that the pressure comes from a collective sense of responsibility when part of a larger birthing community. The Community Midwifery Program is always under political pressure from the doctors to not put a foot wrong.Always defending us for our "un-orthodox"(ie non-interventionist) practice. My daughter is a client of that program and I am a midwife contracted to that program. Because of that it is always important for us to be seen to be doing the "right" thing. I felt that we were more or less obliged to do what is assumed to be "right" by the mainstream community. (except for being induced at 7-10 days which is fast becoming the rule at our large teaching hospital). It is something for you all to think about when contemplating NMAP. The gains outweigh the losses, but for midwives there is ALWAYS that loss of true autonomy, for the client a trade of a free homebirth, for some subtle pressures, increased protocols and that sense of responsibility to make sure the Program itself is not damaged, for the greater good. On the whole the existance of the Community Program has been just wonderful and I urge you all to work towards it, but these are some of the drawbacks. Cheers, mary M
RE: [ozmidwifery] Pressure re ctg's etc
Mary hashighlighted some deep, complex and importantissues here regarding the pressure faced by midwives when working in a systems model, however that model is configured. The collective sense of responsibility, the political pressure, the need to defend the 'unorthodox', our protocol bound profession and the need to be 'doing the right thing' by the mainstream are all powerful considerations at any time. Mary's comments have had me thinking all afternoon as I juggled the various aspects in my head and heart. My guess is that it comes back to woman centered care, how the woman is feeling and what she in her head and heart wants to do. If the woman feels safe and certainin herself, then she will knowwhat is right for her. If she is uncertain/fearful, then that is what is needed to be taken into account, no matter what the model of care is or who or what is directing the management of the model. Women know themselves better than any so called expert. If a woman is worried, I'm worried. If they are not worried and they are clear and definite, It is easy tosupport their decisions. I use questions to discover what is happening for a woman, as it is often the strategically positionedquestion that can lead to insights and understanding for both/all of us. There is a story which comes to mind and it mayillustrate my thinking here. I had the immense pleasure and privilege of being midwife for a midwife colleague. She was having her second child. The pregnany was traumatic, her relationship with her husbandruptured during the pregnany and she became quite anaemic. She did everything to get her Hb up. At 40 weeks, she had a breech baby with cord around it's feet in the pelvis (cord presentation diagnosed on scan done when baby became breech). She was offered a caesarian and refused. She agreed to be admitted to hospital and whilst lying there on her back, stroking the baby, pondering life, the universe etc as one does at these times, she felt the head and gave it a gentle push towards the correct position. The baby turned easily, flipping to head first. She rang me immediately, concernedand anxious,worryingthatshe may have caused a cord compression. She had an immediate scan and CTG which showed a head first baby, cord well and truly out of the way. The CTG was great. She chose to go home, despite being cautioned about unstable lie etc. She finally went into labour at 43 +2 days, there was absolutely no interest in an induction. She "wasn't ready" she told me. Liquor volume/movements etc were fine. She screamed all through her labour, which she assured me was nothing to do with any physical sensation, she was releasing heremotional pain. Gave birth intact to a beautiful 8 something pound babywith clear liquor. Her birth notice in the paper included the words, "a screaming success". What's the point of the story in this context? The point of the story for me is that in a midwifery model of care, which is inherently women centered,the women lead the care.The joy of programs such as CMP Freo style and the NMAP is that more women can access midwifery care and, with the development of the relationship, gain the huge benefits that care for the human spirit and the emotions, as well as the physical body, brings. thanks Mary for the opportunity to discuss these issues. warmly, Carolyn Hastie -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Mary MurphySent: Sunday, 11 August 2002 10:40 AMTo: listSubject: [ozmidwifery] Pressure re ctg's etc After replying to Joy's message I was thinking about where that "pressure in my head" came from. It wasn't because I was afraid about the baby. The movements were more than adequate, on palpation there was plenty of fluid. All other obs were perfect. Both of us felt that the baby was o.k. I think that the pressure comes from a collective sense of responsibility when part of a larger birthing community. The Community Midwifery Program is always under political pressure from the doctors to not put a foot wrong.Always defending us for our "un-orthodox"(ie non-interventionist) practice. My daughter is a client of that program and I am a midwife contracted to that program. Because of that it is always important for us to be seen to be doing the "right" thing. I felt that we were more or less obliged to do what is assumed to be "right" by the mainstream community. (except for being induced at 7-10 days which is fast becoming the rule at our large teaching hospital). It is something for you all to think about when contemplating NMAP. The gains outweigh the losses, but for midwives there is ALWAYS that loss of true autonomy, for the client a trade of a free homebirth, for some subtle pressures, increased protocols and that sense of responsibility to make sure the Program itself is not damaged, for the greater good. On the
Re: [ozmidwifery] Pressure re ctg's etc
Hello everyone -I agree with Mary and Caroline... we are pressured to conformto theexpectations of other clinicians, and their wishes often conflict with the woman's wishes and inner knowledge of her body, her baby, andtheir wellbeing. My last two cases have required me to negotiate this difficult path. I described the overdue baby case recently. She was born exactly 21 days from her u/s due date, and although"L" had one ctg at my request to conform with the supporting GP/ob.'s expectations,I followed this woman's wishes throughout, with a lovely outcome. This weekendI've cared formy client(Primip, no partner) with prolonged ROM. I monitored her very carefully, and herlabour was long and gentle. All was well, however I was aware of the time ticking away and after 48 hours sought a CTG and AB's to satisfy the Homebirth Policy and Guidelines for risk management. Around that time her labour pain increased and I felt she was now in active labour. After being turned away from the hospital she was booked into as a backup because it was closed to admissions due to staff problems(!!!), we went to thenext hospital where shehad to be admitted to obtain the AB's etc. A GP/ob ordered them by phone (refused to order IVAB, ordered IM), and CTG was fine. VE performed by hospital midwife at doctors request confirmed 6cm dilation, station at spines, ROL. The woman decided she wanted to go home to complete her labour and birth, and signed herself out "against medical advice". Three hours later she stated "this is not working, something's wrong". My VE confirmed baby was now ROP, and still at spines. She was exhausted and wanted to go back to the hospital, so that's what we did.She was examined by a different midwife who confirmed OP position on VE, and -1 station, stating "obstructed". She then advised my client that a CS had been booked for her by the doctor (who still had not seen or met her), for15.45hrs. Although my client agreed with this plan quite readily, I felt it was odd that a CS would occur like that without either the GP/ob or the ob. performing the surgery even assessing the woman, but that is what happened. I didn't challenge the decision because the client was OK with it. During the surgery it was clear thebaby's head had come out of the pelvis and was facing outwards (OP) whenviewed thru the incision.All was fine. Then came all the pressure for the IMAB's for this "terribly compromised baby" due to prolonged ROM. They threatened"N" (once all family and I had left) that she would be transferred to Perth if she did not comply with the paed'sorder for IMAB's. Shecomplied with the first IM dose, and then negotiated oral ab's from this am, while awaiting results of swabs. She's a strong, intelligent young woman, and I'll be there for her whatever occurs over the next few days.I feel these two cases reallyreflect the pressures which we experience as we support women in their birthjourney, as discussed by Mary and Carolyn. The bottom line ishow the woman feels about the process and outcome - as Carolyn so wisely stated:The point of the story for me is that in a midwifery model of care, which is inherently women centered,the women lead the care.The joy of programs such as CMP Freo style and the NMAP is that more women can access midwifery care and, with the development of the relationship, gain the huge benefits that care for the human spirit and the emotions, as well as the physical body, brings. Thanks for allowing me to "debrief". Regards, Lois Original Message - From: Heartlogic To: [EMAIL PROTECTED] Sent: Sunday, August 11, 2002 8:24 PM Subject: RE: [ozmidwifery] Pressure re ctg's etc Mary hashighlighted some deep, complex and importantissues here regarding the pressure faced by midwives when working in a systems model, however that model is configured. The collective sense of responsibility, the political pressure, the need to defend the 'unorthodox', our protocol bound profession and the need to be 'doing the right thing' by the mainstream are all powerful considerations at any time. Mary's comments have had me thinking all afternoon as I juggled the various aspects in my head and heart. My guess is that it comes back to woman centered care, how the woman is feeling and what she in her head and heart wants to do. If the woman feels safe and certainin herself, then she will knowwhat is right for her. If she is uncertain/fearful, then that is what is needed to be taken into account, no matter what the model of care is or who or what is directing the management of the model. Women know themselves better than any so called expert. If a woman is worried, I'm worried. If they are not worried and they are clear and definite, It is easy tosupport their decisions. I use questions to disco
