Even more positive today. Went to see my GP who was lovely.Over the weekend I started to bleed and have extreme abdominal pain. My blood levels had reduced almost to nothing. It appears it was a miscarriage. A small blessing, not only was it not an ectopic pregnancy and I didn't have to go through the associated pain and heartache, but also I know that the fertilized egg managed to travel down my tube and try and implant in my uterus. Good news. This is my silver lining.
My GP and I had a chat about the births of his children which were both at the hospital where I practice. I asked him which midwife had looked after his wife. He could not remember. She had a ventouse and a third degree tear so the birth was extremely medicalised. "Shame" thought I.
I wondered "Which came first?" Was this iatrogenesis? (a problem caused by a medical intervention, lots of it in the birth game)? Was the midwife intimidated because they were health care professionals and hence became over cautious? "I think I just heard a deceleration I'll just pop you on the CTG monitor for a while." therefore confining her to the bed unable to move with the rhythm and flow of natural labour.
Perhaps the woman herself insisted on an epidural. Perhaps she was admitted too early in labour.
When a woman is admitted in labour we assess dilatation of the cervix. The policy at our hospital is that if the cervix is 3 cm dilated the woman may be admitted to delivery suite in labour. I am vehemently against this policy. The reason for my objection is that once the woman is admitted the obstetric clock starts to tick. From here she must dilate at least half a centimetre an hour if this is her first baby and a centimetre an hour for subsequent babies. If she fails to meet this criteria then the obstetricians intervene. Perhaps by artificially rupturing the membranes, perhaps starting a hormone infusion to increase the strength of the contractions. Either way this begins a cascade of interventions which directly contributes to the increasing number of instrumental and operative deliveries. And, incidentally has not improved infant mortality or morbidity.
As a midwife if I could offer women any valuable piece of advice it would be: have your baby at home. Research has shown that this is as safe, if not safer, as having your baby in a hospital for normal low risk pregnancies. If you do not choose to have your baby at home then remain at home for as long as you can in labour. Do not even think of going into hospital until your contractions are one every two minutes, lasting a good 60 secs and rendering you unable to move speak or do anything other than concentrate on the contractions.
Once this pattern has established for at least one to two hours then call the hospital. If I answer I will advise you to stay at home a while longer, take paracetamol and have a warm bath.
I do not do this because I am a terrible Midwife who cannot be bothered seeing you. I do this because I am concerned that you will arrive too early and become the passive recipient of interventions that you do not require. You are women! You can do this! Have faith in your body and it will not let you down. I have seen many women following the birth of their babies. None are more proud and elated than those who give birth naturally, perhaps in the pool, perhaps on dry land, on all fours hunched over a bean bag. Listening to what their bodies are telling them. And of course, a midwife; quiet, observant. Listening to the baby's heart rate once in a while. Watching the labour progress. Offering words of gentle support and encouragement. You can do this!
I used to love my job. I was passionate and motivated. I was going to single handedly change maternity services in this country. However, working within the NHS one soon becomes despondent. Poor resources, medicalisation, midwives being sued by the women for whom they care. It becomes increasingly difficult to practice good midwifery. The other day on delivery suite I looked at the board. Except for one woman in the pool, every woman had an epidural. You can not fight this. This is what the majority want. They are scared, they have lost faith in their bodies. They have had tiny baby sized shrouds waved at them too many times "If you don't conform your baby will die and it will be all your fault".
My passion is all but gone. Every so often I look after a remarkable couple and have a lovely day doing what I do best. I come home and I think "today I made a difference". That couple will remember their midwife. That is why I am still here. That is why I continue. Perhaps I am making a difference, just a little bit at a time?
