An interesting discussion.
Brings me to the assignment I've just completed on the variation in
education, regulation and registration of midwives and competency
assessments that occur across our wide brown land.
And these will be the things that bring us to be either supportive or
not of hospital birthing. South Australia maternity system is definitely
much better organised and funded than the New South Wales one. Can't
speak for any other. I've done clinical placements in both states and
working in environments with new equipment, standard spa baths, and
midwives who collectively practice evidence-based midwifery with
supportive services is delightful compared with the other - outdated
equipment, tired midwives and outdated policies and protocols.
I've also attended many years of homebirth and as Tania says, there is
simply no comparison in experience or outcome when working with families
you know and trust. I am still and alwys will be in awe of what midwives
can do when working with women they don't know.
I always believe however that even when entering an institution that may
be outdated and tired with the odds of normal birth against us, that my
presence can always make a difference to a woman who has invited me to
assist her. So I also offer hospital 'supports' because I believe and do
make a difference.
The NSW area where I live and work has limited midwife antenatal clinics
even, and midwifery group practices just don't exist. Birth practices
are disjointed and outdated but they are changing and the last five
births I attended in the capacity of a final year student were simply
great within the limited scope of practice that exists in this neck of
the woods.
I guess we can all try and see the good that each area/service/midwife
can bring to the women we all serve and help to create change where needed.
Perhaps standardisation of education, registration and competency
assessments through nationalising maternity service (like in NZ and
other OECD countries) would be for the best for women and midwives - may
create a more predictable, evidence based active group of committed
midwives.
???
Sue
Absolutely agree Jo that it is the women who are perhaps at higher "risk"
that would most benefit from the continuity of care from a known midwife,
the outcomes at the Women's and Children's in Adelaide have clearly shown
that the women who are in high risk groups going through the MGP are
having
better outcomes, less intervention and more normal births, than the
low risk
women going through the medical model of care. Definitely food for
thought...goes to show that the research is indeed right.
I feel that it's the right place here to put in my 2c worth too, about
IPM's
and homebirth. Please remember that IPM's, while at times appearing to be
superhuman - and I say that from my experience as a consumer of IPM care,
they are also human. Building up a rapport with a woman over the space
of a
shift is indeed an art, and something I am amazed that my colleagues
can do,
day in day out. Really knowing a woman, having a relationship with her
and
her whole family that spans months, and sometimes years, having an
emotional
investment in helping her to achieve the best birth possible, is
something
that simply can't be compared with working on a shift by shift basis.
If you have never stood by, and watched a woman be lied to, or coerced
with
untruths, or half truths, if you have never been treated appallingly by
those who are your equals, but feel you are beneath them, if you have
never
seen the look of defeat in a woman's face as all the positive energy
leaves
the room and someone calls her stupid and naïve for trying to have her
baby
without intervention, then you have no idea about the pain that is
felt, and
the helplessness, and even the feeling of betrayal you feel because
you can
no longer protect or hold the space, for that woman. I have been in these
situations, and I can really understand why some midwives prefer not to
provide care to women choosing to birth in the hospital system. There
is an
element of self preservation about it too, let's not forget that.
Sometimes, it's just too painful to go willingly and knowingly into a
situation that you know is not going to go the way the woman wants.
Transferring in for an obstetric need is of course, something completely
different...
And that's not to say that the care you provide Sharon, in the
hospital in
which you work, is not the best you can do, with the circumstances you
have.
What we all know is that it is not the best thing for all women, and
according to the research, it's actually not the best thing for most
women...just because it's all that's on offer doesn't mean we
shouldn’t be
looking to improve it, and one midwife one woman care is just the
beginning...
Tania
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