Archive for November, 2013

Split Personality Midwifery: who has the power?

November 30, 2013

Image“I’m in two different worlds.  Two completely different worlds.  It’s strange.  It’s hard”.  These words were uttered by a client of mine, over the phone.  She wants to work towards a home birth after caesarean section, an HBAC.  Did you know, that in the UK, there is the support to do this, unlike other countries, where you might have to go “underground” to get an HBAC, and then risk being imprisoned for doing so.  That, of course, means having to birth without the midwifery support that can be lifesaving.  But in Britain, women have a right to birth where they choose and how they choose.  Not only that, but there is a fantastic service in place for them.  They have top notch midwifery back up to birth at home, if that is what they want.  Not all people know this.  But my client did know this, because her midwife had told her.  Her midwife had supported her.  Also, she had booked a doula.  Her doula had told her too.  Her midwife and her doula didn’t bat an eyelid.  They supported her in her wishes and needs to birth at home.

Then, she had her doctor’s appointment at the hospital.  And she thought that she might share her thoughts with them.  She had asked me if that was a good idea.  We had talked about the pros and cons. Her midwife had said “don’t tell any-one, they will just put you off”.  As it turned out, at the appointment, she wasn’t  asked what she would like to do, she was told “you’re going to need a cannula, you’re going to need continual electronic foetal monitoring, you can’t have a home birth” and my client says she began to feel out of control again, anxious, as she did with the first birth. The very feelings she is trying to avoid by planning a home birth. She did not mention that she was wanting an HBAC, and she went home again.

Two completely different worlds.  The “normal birth” world of midwifery, that is moving forward fast, and is supported by evidence and  government  policies.  And the medical world of obstetrics that is cautious to save lives and eliminate all risk, at a cost of eliminating normal birth. * She is getting a right royal dose of both of these.  In our Mindful Mamma class, we do show people a diagram of these two  models of childbirth.  Midwifery is pro natural birth, trusts women’s bodies, understands the psychology, non-interventionist, views birth as amazing, hands control to the woman.  The medical model uses drugs, interventions, believes birth to be dangerous and unpleasant, takes control from the woman, and does not believe women can do it without help.  Sometimes I wonder if we are too black and white in class.  Nothing is ever that straightforward.  There are midwives who say “you can’t have a home birth” and there are doctors who say “of course you would be better off at home, reducing your risk of obstetric intervention when you don’t need it”. There are doctors who are promoting water birth after a caesarean, because they understand the psychological benefits of relaxation and a sense of control.  There’s doctor who have said;

The first intervention in birth, that a healthy woman takes, is when she walks out the front door of her home, in labour.”
Dr. Michael Rosenthal – Obstetrician 

And his is a very good point.  It is the woman beginning the intervention, because she is choosing to walk out of the door and go into a hospital.  My client has a choice.  She always has a choice.  In our classes, we often hear that women feel empowered.  That they didn’t realise they had so much choice. That they could say no.  That they could choose alternatives.  That they and their baby would still be looked after even if they declined some things.  This is something most people don’t know.  Not even doctors and midwives.  The woman has the choice.  The woman has the power.  My client is learning this, in her split personality experience of midwifery.  She is choosing to stay on the normality side of things, sticking to her home birth choices.  This is no easy choice. She tells me it is confusing, and difficult.  And I fear it will get more difficult for her.  Although she has a choice, she has to be very determined to keep the faith, because, once the “dead baby card” gets played only the strongest of us can stay rational about our choices.  But she has her midwife on her side.  And her doula.  And her hypnobirthing practitioner.  And the British midwifery system, supported by the NHS.  Good luck to her and her baby.

*this is not to deny that obstetrics can and does save lives.  The issue is about knowing when doctors are needed, and when they are not, to avoid doing more harm than good.