Midwives.. Can we trust them? How are they regulated?

There could be a bit of an argument here about whether the professionalisation of midwifery was a good thing.. Was it? Is it?

Yes, It's fantastic. It means that we are assured that any registered midwife we may employ as childbearing women (either independently, or through an NHS Trust or other organisation such as Neighbourhood Midwives, One to One or UKBirthcentres) has been through standardised training, - attending a set number of supervised births and other 'procedures' or interventions, and having been 'signed off' as fully able to attend women in pregnancy, birth and beyond and to refer those women on to other practitioners if anything deviates outwith the midwife's remit.
It also means that a midwife has an overarching professional body, now the NMC, (historically the Midwives Board, 1902 and the UKCC) whose remit is to act as a safeguard, a regulator, and a governing body.
Midwives rules, through their professional body (and this is obviously a bigger and wider discussion if we are to consider the profession across the globe) govern and guide the midwife in terms of what her practice may consist of, what her duties are, and how supervision works.
Supervision, as it is laid out in the Midwives' Rules, means that every practising midwife has a named supervisor. This is not the same as a manager, and may not even be someone working for the same organisation (although issues of pay and workload are starting to mean that individual organisations are getting possessive of their SoMs (supervisors of midwives). The SoM is the person who you can ring if you're at a home birth at 2am; ...it's been a long labour and everyone's getting tired and you are worried there might be a problem..have you tried everything? should you be worried? what might you have not thought of? The SoM is one of the people you can ring for support or advice. She will, in a non-judgemental way, help you to explore the options you may not have thought of, offer clinical advice, or help seek further opinion or help if needed.  She meets with you regularly so you can talk about where you feel your weak areas of practise might be, where you'd benefit from some extra training and how to facilitate and support you to do that. She will be aware of how you practise, and where your midwifery path is taking you. It is a layer of professionalism that protects midwives and the public by recognising any gaps in knowledge before they become a problem, by allowing midwives to ask for help and support in a culture which allows her to do that without stigma and blame (important, because a midwife who is scared to ask for help or advice may not acknowledge, or may try and hide dangerous practice).
Supervision, for midwives, means that there is a statutory obligation to engage with it. I believe that when working well, this means that outside the structure of management, busy shifts and shift patterns and little time for reflection, midwives are obligated to pause for thought, and to do so in a useful, productive and supported way.

The downside of professionalisation is perhaps that a role becomes elitist (For that, look at the history of midwifery and how the lay midwives got the reputation as gin-bottle wielding witches whilst the well-to-do ladies could train as registered midwives). It also may become restrictive, and subject to the 'machine' that drives it. Again, historically we could look at the context of childbearing women who could afford choosing a doctor (just in case) rather than a midwife to be the paid professional at a birth; and at the introduction of the idea of teaching hospitals and that greater efficiencies would be gained by having all childbearing women under one roof.
Today, I think we are looking at the professionalisation of midwifery through another lens again. For many years my colleagues and I have discussed the notion of midwifery apprenticeships; of a midwifery school that would allow midwives to learn the trade outside the constraints of the NHS, in a way that would then allow them to choose how they worked - as home birth midwives, as obstetric nurses, as birth centre, or labour ward midwives... Midwives, as they learned, would be drawn to their field of expertise and could be mentored accordingly. For this they would need a strong professional body; one which would ensure the dissemination of good information - practice, research and experience, which would ensure all midwives in whichever realm they practised had good structures of support and mentorship, and which would be able to intervene early in case of any concerns. A regulatory body that consisted of midwives - experts in the area of practise about which they were called to make decisions- not one that comprises mainly of  other professions and medical practitioners.
Instead, what I see is a profession where the vast majority of midwives barely get time to pee, let alone eat, so the idea of time for meaningful discussion or reflection is anathema; they practise defensively - carefully following protocol in order to not be caught out (perhaps in the belief that this is always safe, or is what women want, but that's for another discussion) - and only go to mandatory training when they absolutely have to/can get released.  They are frustrated, compromised - and crucially, from a service provision point of view, they are interchangeable with one another to plug gaps in a stretched service. Their practise begins to resemble more and more closely that of nurses, and of automatons and they gradually are taken under the umbrella of the nursing profession and regulation - with a medical rather than a social model of care at it's root.
The NMC, in response to some terrible care and terrible supervision across the UK has responded by proposing the removal of midwifery supervision. I am not sure I fully understand as yet what is proposed to replace it. It has been suggested that management, performance management will plug the gap. But I am deeply worried about it.
The other layer to my concern is the professionalisation of birth practitioners. Indeed it may be tempting for myself, to become an un-registered birth doula, birth support -or lay midwife by any other name. It would remove many of the stresses and limitations on my practise, and would also give access to many of my potential clients who currently can't afford the fees I need to charge to cover the insurance premiums which restrict me, and which wouldn't pay out sufficiently in a worse case scenario anyway! Doulas are beginning to call themselves 'birth professionals' I have heard, and perhaps the term is used loosely, but all the same the lines are becoming blurred. Midwives' practice, through it's 'nursification', professional indemnity insurance issues (again, another discussion) and limitations therefore, is being eroded whilst the un-registered, often very knowledgeable and valid birth support population is growing- and with it women's knowledge and expectations. There are numerous well-known and well-written such birth professionals who are not midwives (or obstetricians for that matter). Some of them have written midwifery textbooks! I am concerned that, whilst there are many brilliant people providing these services, that without the framework of a meaningful governing body, organisation or legislative structure that dangerous gaps in knowledge or experience will go unchecked and women and babies will suffer.
In terms of social inequalities, the women who can afford the more experienced, well-known practitioner will do so, and therefore potentially be safer, and those who can't will choose the cheaper option. As we hear about more and more women free-birthing, those doing so without help at hand if needed, or with inexperienced help, will be in danger. We are also in professional danger as midwives, who may be called to attend a free birth. Without knowing the woman or her history, our clinical judgement is clouded. We can make the best decisions we can in the situation we are presented with, but whether our union and our regulatory body will support us is in very serious doubt. A good SoM on hand through a decision to attend a call is vital.
Free-birthing in a culture where there is expert help on hand if needed is one thing, but free-birth where many midwives have limited experience of normal birth, and where midwives who work outside the NHS are being limited in their practise carries greater risks. Women are now in a position of weighing up those risks and deciding sometimes that the risk of birthing alone is less than the risk that she perceives is carried by engaging with maternity services.
I am really worried about where maternity provision is going. I would just like to practise as a midwife and be paid a living wage to do so, in a way that is workable, sustainable and safe for both me and the families I care for. Please.

Suggestions and volunteers for a 'Midwifery Think Tank' welcome. Please be in touch.

Choice is for life, not just for pregnancy.

Tous les Trucs (Everything you need to know) 

This was the name of a book I bought myself in France (obviously). I was 18, and apart from thinking I was really clever for buying a book in French, it was also a great buy. (For those of you who are interested, it lists everything you might ever want to cook, how to choose it, and how to cook it to perfection (french-style)- An ideal purchase for an au pair confronted with a fridge containing a rabbit to cook for tea. I put it down to experience...) I was reminded of that book recently (I still use it occasionally - but no rabbits involved).

Being a midwife, I am used to quoting or being asked for information about all things childbirth. I can see and feel, when I talk to women and families who are expecting a baby or babies, that it is a huge relief to them, to have access to the wide range of information that they need to help them feel in control and to help them navigate their way (and to have information that they didn’t even know they needed!).


 ‘Tous les trucs’

To take it away from pregnancy a moment... Being a little older, and hopefully a little bit wiser...having experienced a little more life now, with its ups and downs, I see that there are other occasions where a person may need a ‘midwife’ of sorts... a ‘tous les trucs’ book where they can look up what it is they need to know, including all the things that they didn’t even know how to begin to ask about. There have been times of what you might call 'crisis' where I have had no idea what questions to ask! The trouble with these times is that, unlike a pregnancy, where you’ve got 9 months to ask questions and plan, even if you didn’t plan it, there is not necessarily any time! There are hundreds of books and even more online, as well as health professionals and other experts– all of whom have their own, often invaluable things to say. Where do you start?

When a person emerges from a challenging period in their life, some people said 'hey! you should write a book!'. There are LOADS of them. And everyone’s got their own story, their own agenda, their own history. What has struck me, is that all these things that I was reading have lots and lots in common about ‘choices’ and about how to live a healthier, 'better' life. It has also struck me that even when, for example someone close to us is diagnosed with something scary, life-threatening, we are shocked, we eat more greens for a while, try and de-stress a bit, before we slip back into our old habits. It has struck me mostly just how DIFFICULT it is to live what might be described as a healthy balanced life in the world we live in. (Traffic, tescos, pace of life, the power of advertising and also of drug companies, stresses, responsibilities...) We KNOW (governments know, doctors know, journalists know...) that the more modern and industrialised a country gets, the more its population suffers all sorts of dis-ease and illness. We KNOW this is to do at least in part, with how many toxins, chemicals, poisons, radiation, we eat, breathe, tolerate, rub into our skin. Yet because of the way our modern world works, we KEEP DOING IT!!! I am not going to try and tell anyone what they should be doing/eating/breathing/bathing in (well, I might try and tell a few people), but what I will say, as a midwife, as a mum, as a human on this precious earth, you do have CHOICES.  There is much in our world that we believe we don’t have a choice about, or that we believe is fine, because ‘everyone else does it’. ‘Everyone else eats that kind of food’ ‘Everyone wears that kind of make-up’,‘You HAVE to have your baby in a hospital’, ‘You HAVE to go to school’, ‘The economy MUST keep growing’ (despite the fact the earth is still the same size!). Do most breastfeeding mums sleep with their babies? Do I have to agree to have my labour induced? What are the consequences if I choose not to have antibiotics? What is the alternative to having that electronic fetal heart monitor attached to me? Question. Do the right thing. The right thing for you might not be the same as the right thing for the next person. That’s fine. You have choice.

It's our job as midwives to support you in the choices that you feel are right for you.


For those of you who have managed to read through my small explosion of words, thank you and well done - And I apologise if you were looking for something more pregnancy related today. It will come. Keep watching. It is relevant, of course. We are always banging on about choice in pregnancy and birth, and you will certainly keep hearing about it from me. But for today, I wanted to stretch the boundaries a  bit, and to twitter about how it's applicable in the rest of our existence as well. Is this what is called living mindfully? ...Maybe I'll have to stretch the boundaries of midwifery a bit more...some further reading for you in the meantime...

www.storyofstuff.com/
www.aims.org.uk/
www.theeconomicsofhappiness.org
www.canceractive.com/
www.safecosmetics.org

A new phase...

Ok, so here goes... Please be kind! - Although I started this blog a couple of years ago, obviously then was not the time. Now, I am very excited to be in a new phase of my own internet wizardry and have sent multiple pages out into the World Wide Web!

As you will see, I hope, I am starting a programme of antenatal fun, and a breastfeeding circle which I hope will give some good extra support to Mums of babies small and not-so-small. I'm really pleased to be able to hold the circle within a rural community, and I hope it will help also bring families and community together. It's also an easy space for crawlers and those who are running around, so the Mums can hopefully sit!

I'm excited about the workshops, and I hope you will be able to pass on and share this blog-link so that we can get some lovely groups of parents together to learn, grow, and develop friendships on their amazing journeys. Watch this space for the up-coming sessions in which we are hoping to incorporate a gong bath and some fantastic use of sound to help create those wonderful vibrations that will heal, nurture and invigorate you!

In the meantime, I will endeavour to stimulate you with interesting blog posts, and look forward to your comments and visits!
Thank you for being here!

Who Cares?

When we are pregnant, or soon to become a parent and we hear words such as care, choice, responsibility, what do they mean?

Often, I think, the words bring up images of those who are responsible for our care. Health workers of various types – health care assistants, doctors, midwives – Maybe a uniform, and we are not quite sure who is who. But they direct us in the various choices we are said to have.

The ideas I’d like to throw into the mix here are about caring for ourselves. Taking responsibility. Making those choices real.

Two recent events have come to mind. The first is something I was reading about pre-term birth which explored the issue of maternal stress.  It led me to thinking about midwives and others who maybe have an extra weight on their shoulders- managing stress- as well as workplace issues and how good we might or might not be about looking after ourselves.

The second was a film preview I organised of 'Freedom for Birth' ( www.oneworldbirth.com ) recently where the subsequent discussion highlighted the fact that health practitioners talked about offering choice, a member of parliament felt that the democratic process and Government were playing their part by streaming funding according to need as demonstrated by the service, and women talked about how they felt. (Yes, a very interesting discussion!)... The less politically correct way to say it is that the consultant midwife did an excellent political job of explaining how good the local service is at offering choice, the politician did an utterly lousy job of showing any willingness to understand or to represent Joe Public (in this case mainly Jolene Public) and quite frankly made several enemies, and the women voiced clearly and articulately how they felt denied choice, coerced and bullied.

The effect of these two things on me was to move me from the question of choice to the words ‘care’ and ‘responsibility’ – and to impress upon you, no matter your profession, status, stage of pregnancy or parenthood... or life, that as a human being on this amazing planet, you need to care.

Choice is about responsibility. It means finding out how to eat well, how to balance you work and life, figuring out what affects you emotionally and physically - or how to start to find out what might effect your decision making processes (have a look at things like Michel Odent's primal health http://www.birthworks.org/site/primal-health-research.html, or www.birthintobeing.com) how to be aware of your changing self and family, growing baby, to question and to ask.  (And if you need to, to seek out www.aims.org , the consultant midwife or head of midwifery, an independent midwife and your MP!).

This struck me in the context of thinking about us, as midwives, as women, who in our busy lives are grabbing unhealthy snacks and stressing, and pregnant, accessing the system to offer us ‘choice’ and ‘care’. Surely we all know that there is a more efficacious way to look after ourselves and our babies? A place where we stop to think.. What do I need?...What would benefit me and my family most?...Why do I want to see my midwife today?.. What do I want to know about? ..What have I noticed, or been thinking about?  Start from the point, not of what service is offered, but of yourself, and your body, yours and your baby’s (babies’). Much of healthcare in pregnancy is about supporting you in what is a normal (life-changing) stage, and should be about avoiding interference. Let’s shift the balance of power and care for ourselves. The politics - those who are ultimately in charge of how and where the money is directed, and what pressures are on medics, insurance companies and lawyers- are only going to be affected, in the end, if we take charge of ourselves. I am not saying do not access health care, but I am saying to inform yourself and to access it on your own terms.

Home birth support group

Meeting with some lovely and dynamic people at the Calderdale home birth support group this morning has reminded me of my new promise to myself to blog! Those groups are always interesting, and it is always a pleasure to meet new people and to form a small part of their journey into and through the amazing transition that pregnancy and birth is. It took me a while to realise that not only does each subsequent pregnancy bring us into a new realm of 'being' as a person, and as a family, but also all sorts of other experiences and challenges. I remember feeling o so wise having reached a certain stage in my life, only to get swept onto other things, which made me realise I how much more there was ! - To learning, developing, changing...
(I am reminded of 'Women who run with the wolves' http://www.clarissapinkolaestes.com/women_who_run_with_the_wolves__myths_and_stories_of_the_wild_woman_archetype_101250.htm - a book which I have never read cover to cover, but love to dip into)

Two things stood out for me at the group this morning; - one, was thinking about planning a home birth whilst being accepting of the possibility of a need for transfer to hospital.- The discussion caused me to reflect on the idea that there are so often unprocessed fears or emotions around birth, or the idea of parenthood - or any aspect of the above, and that those emotions, or mental processes which are perhaps very deeply engrained - part of our personality almost- can not only hinder us in labour (possibly a useful thing, as it gives us the time and opportunity to get them 'out there'), but can also make it feel more difficult, and indeed be more difficult as our bodies respond to what is going on in our thoughts. Sometimes what feels like a 'safe space' for one woman to birth in, does not feel the same for another (or maybe for our partners or support, who may be coping or processing their own fears or emotions) - or maybe we think we want one thing, but something deep within feels a need for something else ( an example - the woman who has made a birth plan for her husband to be the first to touch the baby, who actually finds she wants to be under a duvet or shut in the bathroom).
The other issue I have been prompted to reflect on is that of 'free birthing'... birthing without the presence of a health professional. I will write more about this later - And also will let you know when it has started about a new blog designed specifically to give women considering freebirth some of the information they need (relevant to our health service and systems of law/birth notification and registration in the UK).  It seems that with the looming difficulties that independent midwives are going to have with attending births legally that we may well find that free birth becomes more common. Please keep your ears to the ground about what is happening for us. At the moment it is not looking great - although a big positive is that if the neighbourhood Midwives scheme rolls out, many more NHS midwives may find it easier to practice in a much more autonomous way that they do now. that's got to be good for women and families! ( www.independentmidwives.org.uk )
One of the key points from this morning's discussion was that it is quite crucial for women to check in with a health professional at some point in her pregnancy - Aside from the issues around antenatal care, which obviously need a good deal of thought and informed decision-making, this is an issue for registars. When registering a birth, they have no way of confirming that the baby is actually yours, so having some recognition somewhere is definitely helpful! Ideally to have a midwife arrive very soon after the birth to file a birth notification form to the registry office - And I have to say, ideally have a midwife involved in some way all the way through - I'm presuming that if you're reading this and thinking about free-birthing you will be educating and informing yourselves appropriately...

On to more mainstream matters... or maybe not (!) - check out the lovely Julia Dawid's new website for some fun and fresh light on all that is birth and pregnancy. Singing and meditation are two of my favourite therapies these days, and this collection is definitely worth a look..http://thesingingmidwife.net/
Enjoy.