Monday, 28 October 2013

The Midwife's Bookshelf: Blessings

Current read on my bedside table: Blessing the Way

Ok, hands up - I hate baby showers.  Yes it's all very nice receiving gifts for the baby, but it feels like the nurture for the mother gets lost somehow.  My friend Keeley is a celebrant and we work together to bring my clients who choose one a 'blessing way'.  This beautiful ceremony puts the mother in the centre of the circle of women who come to share their love and support for the 'right of passage' that is to unfold.  This beautiful little book by Janie Rose (a gift from Keeley) celebrates the journey from pregnancy to mother-hood with wonderful verse and illustration.  I love it.

Related reading: if you wish to learn more about creating blessingways, this wonderful book from The Mother Magazine will help you. 

Article of the Week: Meg Taylor, Midwifery Matters (ARM) Autumn 2013
There are occasionally midwives who inspire you to think about midwifery on a very deep level; Meg Taylor was one of those.  This dedication to Meg (who died earlier this year) from her friend and Independent Midwife Elke is moving and beautiful; and alongside it are some of the wise words the Meg shared on the UK midwifery list.  You can also read her writings here.

If you do not subscribe to ARM and the journal Midwifery Matters then perhaps it's now time you did; always interesting, always sharing and always inspiring.

From my personal library : The midwife's labour and birth handbook, Chapman
Being a midwife is a blessing; but there is a lot to learn (and keep learning) in our journey to support women.  This book is a welcome text alongside the likes of the larger 'recommended texts' in midwifery training.  It has a softer, warmer approach to clinical care and provides ideas and thoughts on midwifery knowledge.  As a practising midwife, whenever I am reflecting on an episode of care, or reading around a topic I am thinking about, I use this title to extend my thinking.

What will you add to your midwifery collection?

Wednesday, 23 October 2013

Sharing the knowledge: let us begin.

Midwifery is one of those professions where you develop your skills over time; always learning, always discovering something new, remembering something forgotten, and gleaning knowledge from many sources.

To qualify as a midwife in the UK, you undertake a 3 year full-time course, with a roughly 50% split of theory and practice (practice taking place within the NHS).  You learn drills, you read books, write essays, 'deliver' babies, watch caesarean sections, 'help' women to breastfeed and 'learn' the day-to-day skills of midwifery in the NHS.  This is normally under the watchful eye of a mentor, an experienced midwife who guides you along the way (assuming of course there is not a huge theory-practice gap with what that mentor is teaching you).

Throughout my 3 years as a student I learnt huge amounts, but (as with most professions) many of the skills I have learnt have come with the experience of serving women in childbirth, watching women labour in their own environment without the time constraints of unit policies, and learning to trust even more that the less I 'do', the better the outcome*.  Much of this knowledge was not 'taught' in my training and I believe there is such a strong culture of fear around childbirth, that we tie ourselves up in knots to address unit policies, many of which are not based on the evidence.

So how do we share and spread that innate midwifery knowledge that respects women and the natural process of childbirth, when the practice we are exposed to within the training may (or may not) often sit within the medical mode of childbirth.  How do we give student midwives and newly qualified midwives a glimpse into a different way of approaching birth?  I believe we need to be writing about it, shouting about it, talking about it, and sharing, sharing, sharing.  Of course, this then exposes us to the risk or being 'ridiculed', or worse, intensively scrutinised in our practice; this then moves this innate knowledge back into the 'secret' side of midwifery, and does not enable policies (such as arbitrary time limits in the 2nd stage of labour) to be challenged.

I am planning to 'put myself out there' a bit and start to write about skills and ideas, such as:

  • confirming the onset of labour without vaginal examinations
  • assessing labour progress without vaginal examinations
  • auscultation using a Pinnards or fetoscope
  • facilitating spontaneous 2nd stage without directing women on 'how' to push
  • water birth
  • physiological 3rd stage
  • the effects of energy on the labouring woman
  • assisting a woman with a mal-positioned baby

I invite questions or suggestions for topics, and I am inviting guest blogging midwives to share their knowledge too.  Along with this I also need to add in that 'disclaimer'; that is to say that I am not saying this is the only way to practice, or that it is always appropriate to the woman you are caring for, or that it will sit easily within the trust you may be working within.

I do hope you will enjoy these blogs, and and share and talk about skills with your colleagues, and ultimately develop your own practice in a way that keeps the woman and the process of normal birth central to your care.

angela x

*doing less is of course not to ignore a woman whose labour is changing and will perhaps require help in another way.

“Be the change that you wish to see in the world.”― Mahatma Gandhi

Wednesday, 16 October 2013

The Midwives Bookshelf

Current read on my bedside table: Childbirth and the Future of Homo sapiens. Odent
This is the latest effort from Odent, who was a strong influence in my understanding around hormones, physiology and the effect of those attending the woman before I even started my midwifery.   I am looking forward to exploring the 'future of humanity' and the significance that birth will play in this.

Article of the Week: Holy Meconium: a potted history.  Midirs, October 2103
In this last edition to be edited by the exiting MIDIRS team(!), this excellent article looks at the issue of Meconium Stained Liqour (MSL) and Meconium Aspiration.  The author examines the evidence (or lack of?) that underpins current thinking, provides challenging thoughts around policies for women with MSL in labour, and considers the issues for midwives in practice.  

A reflection on this article will be going into my PREP folder and on my list of topics to research further! 

From my personal library : Ina Mays Guide to Childbirth. Gaskin
If you have not already read any of Ina May's work then you need to make this a priority!  Spiritual Midwifery was my inspiration as a student midwife, and Ina Mays Guide to Childbirth has also become a firm favourite and a recommended read for all my clients (I have several copies I loan to to them) and students attending my workshops.

My favourite chapter is "Sphincter Law" and when I was priveledged enough to visit The Farm, Ina May ran a workshop on this whole topic.  For me, it is the strongest factor in the progress of labour and as Ina herself says "We obey Sphincter Law".

What will you add to your midwifery collection?

Sunday, 13 October 2013

Shiney New Blog

I am so excited to feel my bloging fingers return to the keyboard, and am bursting with new ideas for midwifery and birth related posts!  It's been too long.....

I am planning to start 'what I have been reading' posts, sharing what's on my book shelves with you, as well as 'how to 'posts on midwifery skills (primarily aimed at students) and of course my usual reflections on current topics.

Speaking of which, we are in October.  October.... the impending end of Independent Midwifery as we know it.  Of course, as with all things in life, the goal posts have changed and the NMC confirmed this week that there is a delay in the implementation of the new legislation and we now have until February.  In the meantime, IMUK, who have been working incredibly hard over the summer months and have found a product that is a solution to the insurance fiasco, continues to beaver away at getting insurance in place long before that deadline (we very much hope that the dear DoH do their bit and help us on our way) .  You can keep up to date here.

Pretty knitted things
Exciting, turbulent, history changing times lay ahead; and it is down to the passionate and strong midwives and supporters that there is light at the end of the tunnel.  Women have always had a strong influence in the course of history; this year was the 100th anniversary of the death of Emily Davison, the suffragette who threw herself under a horse; I feel I am part of a modern suffragette movement (although I am not throwing myself under a horse), not one working to get the vote, but one to get a basic human right to know and choose your midwife as a normal part of the childbearing continuum.  I am a feminist - and rightly proud.  Okay, I am a knitting feminist, and rightly proud.  Okay, I am a knitting, mascara wearing, girl-who-likes-pretty things feminist, and rightly proud.

Mascara wearing midwife on a mission
Anyway world, watch out.  Or you may have a bunch of media wielding, modern suffragettes playing havoc with your his(her)story; and it might not be pretty or knitted.

angela x

Thursday, 9 May 2013

Why I Campaign.....

Oh how I have missed blogging: I have so many ideas I want to share, so many thoughts I want to get down, so many words that need to be committed to the page.  I just don't have the time or space to do it at present.......... instead, I recently made a 'vlog' - which I share with you now.  Hopefully this will help you see why blogging has had to slow for a bit; but hang in there with me - I will be back to blogging as soon as I can!

angela x

Sunday, 17 March 2013

Life 'on-call' - making it work.

Recently, this question was posted on the IMUK Facebook page:
"I am really interested in the work/ life balance for family and relationships when on call all the time. How does it work?"
A really good question, and perhaps a concern that prevents people from working as an IM (insurance issues aside).  So this blog is for all you midwives, student midwives and aspiring midwives about the reality of life on-call and how midwives (IMs, NHS case-loading midwives, commissioned groups of midwives) find it not only workable, but balanced, rewarding, and fulfilling.

I have worked on call since October 2007; I have taken periods off, I've had periods where I have been on my knees, I have missed some family birthdays, I have even missed a family break.  There have been times I have totally resented it (and even tried to side-step for a bit), however the freedom to manage my working life, the autonomy I have as a midwife, the joy of seeing a family grow as you support the mother and empower her, outweighs the days when being 'on-call' can feel too much.

Working Hours
Developing my own self-imposed 'working times' was one of the first things I had to learn: initially I didn't do this as I was just so excited to provide the care I was offering.  What I quickly learnt was that not having my own 'boundaries' made me tired and resentful.  So now, I never work Sundays unless I am at a birth or it is early postnatal days; Sundays is family day, TV day, reading day; I won't answer texts (unless urgent) or check facebook / emails or make routine appointments.  I stipulate this to clients at booking and I have found that most women fully respect this.  My working 'hours' are 8am - 8pm, and only women in labour or urgent issues get my attention.  I home educate so most of my appointments are late in the afternoon so I can be there for my family.

This is a real skill that takes time to develop; early in my IM career if a woman was 'imminent', getting to sleep was a problem.  What I have learnt in my time on-call is interesting; if I have not been called by 10pm, then I am very unlikely to be called out in the middle of the night.  I may get an early morning call, or a late evening call, but, in almost 6 years and caring for over 50 women, I have only been called out in the middle of the night a few times.  So if I go to bed without a call, I feel quite confident that I will get a full-nights sleep.

I have also learnt to tell women the days that are really inconvenient to me.... always spoken light-heartedly and with a smile, but since doing this women seem less likely to birth on those days.  I put it down the Oxytocin Factor - if they are worried about me not being there they release adrenaline and don't labour!  I only do this for really important things, like family birthdays and so forth - and of course I will be there if the baby decides otherwise anyway!

Having a Social Life
This was something else I struggled with; frightened to make commitments in case I got 'the call'.  Now, I just live life 'as usual'; I tend to drive myself places so I have the car if needed, women are asked to let me know if they think things are 'happening' so I can get home / sort my family/ make a decision about whether to go or not.  Generally, I will stay close-ish to home.  My family are really supportive and don't tend to mind too much if I can't make something; they do of-course have times when they feel the pressure of my work, but because there is so much time when I am available, around and participating, they get over it quickly.

Friends also know that sometimes I will cancel things last minute - but I guess knowing their friend is attending a birth must seem quite cool.  They certainly like to hear the birth story later!

Drinking is of course a bit of a no-no; turning up pissed to a birth might not be the safest way of practising.  I do have the occasional small glass of wine, and I like to make up for it when I am 'off-call'; personally I think my liver enjoys the time off.  And it saves me money.

The 'best-bits'
Supporting women and knowing what is important to them; not having to 'quickly' read notes and get to know the woman and her 'preferences'; practising 'hands-off' autonomous midwifery; managing my workload (choosing my hours outside of births); drinking tea and laughing with clients; continuity of care; taking my children to meet the new baby; wearing my own clothes (silly, but I hate tunics - so 'official'); being my own boss; lie-ins - no early shifts for me!; feeling proud of what I do; meeting fellow IM's and sharing stories and skills; meeting students - and learning from them as they do from me; having time with my family when I choose to; not waiting for the 'off-duty' to come out; catching babies with inquisitive assistants.......

The list is end-less.  Working this way is not always perfect, and there may be times in my life when working within the NHS will be the right thing at that time and having 'set' hours will be what I need.  Until that time, I will choose to work in this way - and fight to work in this way.

So I hope this answers the question for you - about what it's really like..... and maybe it might help you answer this question on survey monkey:

Would you work as a self-employed midwife?

angela xx

Wednesday, 6 March 2013

Independent Midwifery: Dispelling the Myths

"I bet your clients are really demanding?".  Sigh.  Nope, not usually.  In fact, I find the hardest bit of being an IM is dealing with such misconceptions and answering questions (from an NHS midwife) as that one.  I wrote previously about 'what we do', now however, it is time to dispel some myths about Independent Midwives (IM's):

IM's are Maverick and Risky
On the contrary; IM's have a large number of women who would be considered 'high risk' within the NHS and as such are seeking a midwife who will support them in their informed choices.  This means careful thought and planning, often involving a Supervisor of Midwives to help arrange the appropriate care.  It means being up-to-date with the latest research so that we can provide safe, effective practice.  There are risks to our job; but we work hard to keep these to a minimum whilst supporting women fully in their choices.

Women who use IM's are wealthy
Different women, from different backgrounds and with differing levels of personal income book with IM's.  Yes, I have had clients whose disposable income is enviable, however the vast majority of my clients have to work hard to find the money for my fees.  Or they simply can not find the money and then we try to work something out.  For most clients, their priority is to book with a midwife whom they know and trust  - and this often means making huge personal sacrifices.

IM's earn 'loads of money'
You can see that in the shiny 2005 Citroen Picasso I drive, and all the holidays I take - NOT!  Out of my fees I have to pay for my equipment, administration costs, petrol, training updates, tax, holiday 'pay' (being self-employed means when I am not working I am not earning), journal subscriptions,  etc etc.  IMs really do not earn huge sums - and we really do earn our money!  24-on call is not an 'easy' option and can take it's toll on family, friends and day-to-day life.

IM's Clients are demanding
If wanting to have one-to-one care with a midwife you know and trust, appointments in your own home, and feeling supported in your choices is considered 'demanding' then yep, my clients are very very demanding.  I do find however that this standard of care pays dividends in normal outcomes, high breastfeeding rates and family satisfaction.  And I always get tea and cake (hence my expanding waist line).  Women are really so demanding!

IM's don't want insurance
We do, we do, we do!  We just can't get it!  Honestly, every time you go to a birth, to hear the little voice on your shoulder saying 'this could be the one that costs your home' is not fun!  We do it because we can (not for much longer), we do it because we care, we do it because midwifery services should not be a 'one size fits all' option.  I do it for myself (terribly selfish), but knowing who I am going out to when I get called to a birth makes me feel like a safe practitioner.  Plus, I don't have to get to know the woman and her family, instead I can just offer my full attention and be 'with woman'.  It's fantastic.

Independent Midwifery is not for everyone, just as being a labour ward midwife, or a consultant midwife is not for everyone.  The important thing is that just as women should have choice, so too should midwives.  

There are many myths around Independent Midwifery and IM's, and the one that is most concerning is that is does not matter if we are no longer able to practice.  The demise of IMs will have catastrophic affects, and midwives within the NHS will find that their autonomy will be significantly threatened - the RCM know this and just continue to play footise with a government that is calling the shots.   Just look to countries where midwifery has been persecuted in this way, and then see how many midwives there are.  It is worrying.

Independent Midwifery must survive - and you can help.  You can share this blog with everyone and anyone who has an interest in midwifery or birth.  You can tell people the TRUTH about IM's.  You can watch 'Home Delivery' on March 21st and see how we work.  You can join our facebook page and learn more.  Women matter - IM's do too.

angela xx

Wednesday, 20 February 2013

Call the Midwife – or call a midwife you know and trust?

I enjoyed reading Sarah Johnson’s recent blog post on call the midwife.  I LOVE call the midwife and read the books when I was student; how I dreamed of working in that way – a local midwife, on her local patch, working with the local women, caring for them in their own homes.   

For most midwives, this way of working is a million miles away from the reality of midwifery care within the NHS; birth at home is no longer the ‘norm’, midwives work in large centralised units, women are very unlikely to be cared for by a midwife they have ever met, normal birth rates are incredibly low and the use of analgesia and the associated risks and side effects high.  Sarah suggests that birth stools are ‘standardised equipment’ in units, and women birth in up-right positions: statistics suggest otherwise, with the NCT citing in their research that less than 40% of women are encouraged to be mobile, upright and off the bed and their backs.  I myself have visited units where birth stools may be quietly gathering dust in the corner, where huge, shiney new units are built with just one ‘token gesture’  birth pool (despite NICE guidance stating that birth pools should be available to all women as an effective form of pain relief) and where one-to-one care is not always achieved for women in labour.   The NHS offers the best it can on a shrinking budget, with a hard working yet disillusioned work force, with a growing population, and with women presenting with more and more complicated pregnancies. 

My dream of practising as a 1950’s midwife might not quite have come to fruition, but I am honoured to have carved a way of working which comes as close as possible: I care for the same woman throughout her pregnancy, birth and postnatal period; I care for women and families in their own home; I attend home births (and follow the woman into hospital if plans change).  I may not have a bike (and am about to invest in a 4x4 to make work life easier), but I do carry my own equipment and have a big ‘Midwife on Call’ sign to hang on my dashboard when I am with a woman in labour! 

When a woman in my care goes into labour, they can call a midwife – they can call a midwife they know and they trust, who will be by their side until their baby is tucked up safely in their arms, who knows all about them and what is important to them.  That is Independent Midwifery – the recognised gold standard of care, a choice for women outside of the NHS.  And it is under threat.  Just as that 1950’s midwife is no longer recognisable, so too, might be Independent Midwives; EU directives, insurance issues, and a government failing to deliver on its promise to really offer choice are seeing to that.

So, women, mothers, midwives, fathers, grandparents – if you LOVE Call the Midwife like me, if you LOVE the idea of calling a midwife you know, if you LOVE the idea of care in the home being the norm, then make sure you make a call to your local MP and tell them that!

You can find out more about this issue by visiting

Saturday, 9 February 2013

fear + loneliness = Brave?

I have often been told that I am 'brave' for choosing to be an Independent Midwife; I wrote about this a long time ago and can honestly say I have never felt brave, or really understood why fellow midwifery colleagues consider me such.  I am just a midwife, working to support women, some courageous and strong, some needing support to find their inner strength, but all who wish to have the bulk of their care outside of the NHS system, with a midwife they know and trust.

I attended a beautiful home birth this week; I was not anticipating to be the primary midwife, but the woman's own midwife was caught in Jury service and unable to attend. I gathered myself together and headed off to the birth - I knew the woman and her family having supported them as the second midwife with their first baby.  As always, I mentally prepared myself, and drew inner strength and calmness into my being.  I was not aware that I would be doing that many times in the course of the woman's labour..........

Birth works: if you follow my blog you will know that this belief is deep in my inner core.  BUT, and there is always a BUT in nature, sometimes birth changes and sometimes nature will challenge us, humble us and remind us that she is a force that we cannot always control, always predict, always guarantee.  After the baby made its way earth-side (a beautiful, calm, wonderful HVBAC), the woman's body was not (for whatever reason) willing to release the placenta; I was concerned.  Too much bleeding necessitated a decision to transfer; a serious maternal obstetric haemorrhage occurred,  a wonderful team of NHS staff worked very hard to save a very compromised mother.  And a very shaken midwife was left holding the baby...... until he was safely tucked back with his mother later on that day.

So, back to my 'bravery'; it was with a sudden clarity that I understood why people believe me to be brave - and it has nothing to do with me.  As I watched the team work around the woman (and I was in total awe of the NHS staff and so very, very grateful that when obstetric care was needed, we had access to it), as I supported her, reassured her, even prayed for her, I have never felt so alone in all my life; the safety net of the NHS is a strong one.    Perhaps this is the reason midwives do not challenge guidelines, or policies not based on evidence; perhaps this is why the vice on midwifery is so strong.  Not that I am brave, but because the 'safety' of working within the NHS is so strong - and watching that team, I think I understood why people would not want to 'risk' that.  Being the lone voice, choosing to leave that safety net, to be fully autonomous, to accept full accountability..... can be very lonely indeed.  The fear of loneliness is why people believe I am brave.

I am not 'brave' for choosing to be an Independent Midwife; it is a wonderful way of working.  It is 'the gold standard of care'.  It is rewarding, challenging, exciting, scary, bumpy, amazing, tiring.  It is working to keep birth normal - and safe. I am not brave...... but if more midwives were given the support to work outside of the NHS, if the government fully supported choice and continuity, if the RCM would acknowledge a group of midwives who work outside of the system, it might be a little less lonely.

angela xx

He who is brave is free. 
Lucius Annaeus Seneca 

Read more at 

Friday, 1 February 2013

Birth Works

There have been some awesome blogs this week from Midwives and from Women, as well as some interesting news headlines; I love reading blogs that inspire me, challenge me, and get more women and midwives thinking about birth and midwifery skills.

Last week I facilitated an 'Inspirational Birth' Study day, covering physiological birth: I have wanted to run this study day for a while, but when it came to planning the actual content for the day, I found myself procrastinating.  Fear in part; worry that I didn't know enough to fill a 6 hour day; concern that I wouldn't convey the message I was hoping it turned out it was a great day: I had forgotten actually just how much I have learnt in my journey as an Independent Midwife, and watching the 'light bulb' moments was very rewarding for me as a facilitator.  

In the current midwifery climate, there is little scope for physiological birth - and I don't state that lightly, as I know that is a direct criticism of maternity services.  How do I justify that statement?  Women are designed to give birth; sometimes, in some circumstances, some women may need some help (thank you Mary Cronk for that beautiful phrase), BUT we know that the vast majority of women are NOThaving normal, straightforward births - and even fewer are experiencing physiological birth  (there is a difference).  Birth Works, but it needs certain conditions, support and understanding for that to happen.  Maternity services in the UK are at breaking point: a rising birth rate and too few midwives (or cuts in services) means that women are not guaranteed one-to-one care in labour; women do not have time to build a relationship with a midwife that facilitates trust; hospitals have policies that are not conducive to physiological birth - but are conducive to intervention and time management; and midwives are not challenged on practise that is outdated and not evidence based (valsalva for one).

In my mind, there are a few issues that continue to confound and prevent change;

1. The demise of midwifery care outside of the NHS institution
2. The continued attack on women and midwives who choose to work with physiological birth
3. That we are no longer teaching our daughters to be feminists (a dirty word in modern society)

Take for example the Daily Mail article this week on women's experience of traumatic birth; then read the comments.  Women attacking women, men attacking women, women sharing very distressing experiences - and many comments indicating 'doctor knows best and women should be grateful' .

Birth is hard work; it is not perfect, sometimes it is not 'beautiful', sometimes it is down right mean; that is birth.  This is NOT however the 'care' that may be inflicted, the unkindness of medical staff or the paternalistic attitude of doctors.  What women want is a positive experience of birth - however that birth may unfold, and having a midwife by your side who understands, supports and believes in birth and whom the woman knows and trusts can make a huge difference to that experience.  That is not too much to ask.

Birth Works - but we have forgotten this.  Instead, we focus on the 'what if's', how to 'manage' birth, how to 'save' women from pain; we have lost trust in birth and have made hospitals and the NHS the saving grace of birth - as opposed to utilising it as and when is necessary - ensuring resources and first rate care are available for women who need it (I for one have been grateful for their expertise when women in my care have needed it).  We have also de-skilled midwives and on a global level we continue to allow midwifery to be quashed, undermined, de-valued and not recognised for the amazing profession it is.  Midwifery and women are controlled -  Freedom for Birth highlighted some of these issues.

Independent Midwifery has enabled me to hone and develop my skills in physiological birth; I already had the belief and passion for normal birth, but had to work very hard in my NHS training to fully experience it.  As an IM, I want to share my passion, my knowledge, my skills (and I still have much to learn and hopefully will never stop learning) - but come October my right to work as an IM will be outlawed - another blog to follow on that.  For now, I shall continue to work outside of the NHS, I shall continue to support physiological birth at every opportunity, and I will aim to inspire my own daughters to be proud to be a feminist.

Birth Works; Women Work; Midwifery Works.

angela xx

Thursday, 24 January 2013

One Born Every Minute

Last night, for the first time in very, very long time, I sat and watched 'OBEM'.  It wasn't a concious choice - we had watched the great classic movie 'Stand by Me' (oh River Phoenix, what a loss) as a family, and when the DVD had finished the TV returned to OBEM just as it started.  And I was hooked; mesmerized; drawn-in and unable to move despite my intentions to get to bed as I am feeling quite unwell of late.  But there I was, one hour later, as the credits rolled.

There are lots of reasons I don't watch programmes such as this one; firstly, my family don't allow it.  They feel it's detrimental to my health as I am unable to watch without large amounts of steam coming from my ears.  Secondly, it reminds me of the fact that the way I practise as a midwife is at risk, and frankly the thought of returning to work in a large, consultant unit, fills me with dread and fear.

So what was wrong with last night's programme?  Let's start with the fact that both labours, both healthy, first time mothers, both considered 'low risk' (hate that phrase), ended with unnecessary intervention:

'Mother one' was already in early labour; as she was 12 days over, she requested to have her labour 'induced' and just get on with it.  "Good news", hails the midwife, "we can break your waters and get you going."  A birth that was starting physiologically is now having a helping hand with an intervention that brings it's own risks (which I did not see being discussed), or other options given (such as go home - you shouldn't be anywhere near a labour ward at present) and is presented to an audience of viewers as the norm (which it probably is on a consultant unit).  Mother one did give birth vaginally - on her back, epidural in-situ and an episiotomy.

'Mother two' arrives in spontaneous labour, but she stalls and after a few hours it is decided her labour must be accelerated.  And when I say decided, this was the conversation:
Midwife "You've been stuck at 4-5cms for a while, so I need to talk to the doctors to decide what to do"........  "The plan is the get you going and put a drip up to get some oomph behind those contractions".  Interesting use of language, a really great way of not demonstrating informed CHOICE and decision making - the mother was not even included in that, the midwife and doctor decided - and another birth that needed a 'helping hand'.  It was however really fantastic to see the mother using an 'alternative position' and standing as she birthed her baby.

After watching the programme I am now aware of several things: Midwives are in charge and know best; women are clearly malfunctioning when it comes to labour; physiological birth doesn't work.  I am so grateful to have had those points clarified and to recognise that it must be time to change my practice as I am very outdated in my beliefs that birth is normal; that labour has it's own rhythm; that women should be involved in all aspects of the decision making; that the amniotic sac provides a safe, protective barrier in labour; that vagina's are designed to stretch to birth a baby; that facilitating a safe, warm, quiet, environment aids progress in labour.  Thank you to the powers that be (insurance companies and eu regulations) that foolish midwives like myself, or like Virginia Howes need to be tamed and brought into line and that we are wrong.

I clearly am one of those 'born every minute' that needs to be reminded on prime-time TV that birth does not work and the NHS knows best.

angela x

Saturday, 12 January 2013

Home Birth is for Hippies?

This was an original article I wrote a few years ago and felt it was relevant again.....

“I’m planning a Home Birth”. It amazes me that this simple, short statement can evoke such a torrent of emotion and be an area where people feel they have the right to comment on someone else’s choices; the phrase ‘you’re so brave’ springs to mind here. Yet without doubt, the discussions and thoughts around home birth bring to mind many powerful images, not least of ‘danger and emergency’, but for some, the image that the ‘sort of woman’ who may choose home birth, as being a slightly alternative, incense burning, ‘hippie’.

Home birth is not a new concept; home, since the time of (wo)man, has been the place where women birthed their babies. In the beginning, home was most likely to have been a sheltered cave, nestled on a hill-side somewhere, and over time has developed into the style of housing that we now know in the western world. Hospital as a place of birth however, is a fairly recent development in the time line of history and yet it has been culturally accepted as the safe place to give birth, even though study after study, report after report does not uphold this notion. Now, don’t get me wrong here; the advent of technology, obstetrics and the caesarean birth have played a hugely important role in making birth safe for both mother and baby – and we now experience very low rates of maternal and infant mortality and morbidity. However, it is not exclusively through birth taking place in hospital that has lowered these rates so significantly, but the development of excellent antenatal care, drugs for the prevention of haemorrhage and infection, and the development of health professionals’ skills in recognising and managing emergency situations.

In an article in ‘The Times’ newspaper (May 09), journalist Melanie Reid launched a scathing attack on women who had or were planning home births: she labelled them as spoilt and complacent, insinuating that intelligent women choose hospital birth, and only ‘sandal-wearing' women (the hippie word again?) would choose home birth.

True? – far from it;
Factual? – indeed not;
Emotive? – yes and yes again.

Ms Reid is not alone however in voicing her opinion, and this is part of the problem for women who are considering home birth – the emotion that decision causes, the myths around home birth and the presumption of ‘safety’ deter many women from pursuing, what is in fact, a very normal, very safe choice.

I had my third baby at home; it was a well-researched, informed, intelligent decision. I met some opposition along the way, but on the whole felt well supported and confident in this decision. No, it was not my ‘first baby’, but how I wish it had been! I had never truly considered home birth an option, after all I did not know anyone who had given birth at home. I had been born in hospital and I was not a sandal-wearing hippie. Why on earth would I want a home birth? Well after experiencing two less than positive hospital births, I felt instinctively that there had to be another way. And there was, and it was fantastic – hard work – but empowering, positive, and ‘uniquely normal’.

The home birth rate in the UK is around 2%, but in parts of the UK the home birth rate is a staggering 50%! In areas where the home birth rate exceeds the average, there are some telling trends in the way maternity care is delivered: midwives actively offer home birth throughout pregnancy and discuss it in an open, friendly manner; women share positive stories of their home birth experiences - giving other women confidence in their own ability to give birth; and women are attended at home, in labour, by a midwife (they often know) and make the final decision on the big day itself! This gives them the freedom to see how they are feeling and coping, knowing that they will be well supported by the midwife, by family and birth supporters, whatever their decision. I would challenge anyone to categorise all those women as hippies.

The DoH has aims to increase the home birth rates for women to experience real choice within maternity services; of course this is still to be delivered and is an ongoing issue for most women.   Following the inception of the NHS it took national campaigns to persuade women to give birth in hospital, needing continual reassurances of cleanliness (hospitals were previously associated with mortality due to infection – very different from now?), and the influential offer of 10 days rest and food. The stark reality in the UK at present is that hospital birth no longer comes with the benefit of complete rest – women are encouraged to leave as quickly as possible due to the high demand for beds (at home you get your own bed); NHS trusts are stretched to capacity with midwife shortages on the labour ward (at home you get your own midwife); and the caesarean section rate is spiralling out of control (planning a home birth halves the chance of you needing a caesarean section).

Hospital is the perfect place for giving birth for the woman who may need additional obstetric care, who may need paediatric care for her new baby or who may not have the support in place to have her baby at home – and no one ever seems to feel the need to comment on those decisions. Next time someone says to you “I’m planning a home birth”, take a closer look; I expect you will find a normal woman, making a normal choice, planning to have a normal birth in the perfect place for her. And not a ‘hippie’ in sight!

Tuesday, 1 January 2013

Looking to the future

2013 and the start of another year: I love the New Year; of feeling positive for the future, of letting go of the past, of seeking new goals and possibilities.

This time 14 years ago I was expecting my first baby..... and I was waiting for my first baby who was still to put in an appearance after my due date had been and gone!  I would still be waiting for another 6 days and my experience of midwifery care and birth was 'normal', but not great.  It took another two babies to understand that birth can be the single most transformational moment in a person's life, and during that powerful home birth, a midwife was also born, one who wanted to share the 'secret' with other women.  Roll on 9 years from that birth and here I am.........

In 2012 I cared for 10 birthing women and their families;  3 first time mothers (all normal births, 1 breech, 2 in hospital), 2 VBACS (1 a HWB, 1 ended in caesarean), 4 multips all having home water births and a water birth in the local birth centre on an NHS bank shift.  It was a privilege to care for these families and to support them through their inspiring births; the lack of alcohol is a pain and I wrote before about how up and down midwifery can feel, but it still never ceases to amaze me.  I'm not sure it ever will.

This year will be a testing year for Independent Midwives as we try to find a way forward with the looming PII issue and the EU laws preventing our practise from October 2013.  I have a busy case-load for the first half of this year, but feel confident and full of optimism that a solution will be found somehow, and I will be able to continue with my midwifery journey as I would like to in the second half of the year.   I also have plans to finish my book, to continue to work with aspiring midwives, to work to ensure IM's exist next year, and somewhere in between fit in my home-schooling family.  It won't be easy, but then 2012 challenged me in more ways than I ever felt possible, and I got through that! Just as in birth, sometimes it is harder than expected; transition can be frightening and overwhelming, but the hard work is worth it as you push your baby into the world.  This year I am looking forward to the birth of a new era in Midwifery and facing those challenges with the same excitement, hopes and fears as any new mother; I have a feeling it will be a year to remember.

angela xx