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 http://www.brainyquote.com/quotes/quotes/l/luciusanna121145.html#vPE1uJcEvV29CUTm.99 

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

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!