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Midwifery
posted by Emma on 10 Jul 2008
The front page of the Guardian today is all about the state of maternity care in the NHS at the moment, which I have something of a vested interest in. Summary: it's not pretty.
The Guardian reports that "the most serious concerns at poorly performing trusts include:
· Insufficient midwives available. Some women report being left alone and frightened during labour.
· Women not getting the continuity of care with the midwives they met before birth. Obstetricians not spending enough time on the labour ward - despite the Royal College's recommendations.
· Guidelines from the National Institute for Health and Clinical Excellence on risky pregnancies not being followed.
· Too few beds and bathrooms being made available.
· Care and support for women after the birth not being good enough."
Yep, sounds like my experience so far and the experience of almost every mother writing on mumsnet.com who's given birth in hospital, the leading forum for all things motherly. This is why Andy has saved my bacon by shelling out £3000 for an independent midwife, and why I'm having a home waterbirth with hypnobirthing (all being well). No, I'm not a hippy. No, I don't trust medics. Ever read The House of God?
Could be worse, though. I could live in America, where childbirth is almost entirely medicalised, midwives are a dying breed and the intervention cascade is even more prevalent than here (the thing that happens if, say, you get induced, which leads to stronger contractions, which leads to more pain relief required, possibly epidurals, which leads to a slow down in labour, which leads to a distressed baby, which leads to a c-section.) If you can find it on the internet, watch The Business of Childbirth (the makers are enforcing their copyright so it's not freely available to view, but worth it if you can find it).
And on the note of independent midwives, here's an astonishing thing. In two years, they could be outlawed in the UK. Yep, it would be illegal to trade as one. Why? Because currently it is impossible to buy insurance as an indie midwife. (Well, you could go to Lloyds, but the annual premiums would be in the hundreds of thousands per policy.) Since there are so few independent midwives in the UK, the market isn't big enough for the insurance companies to make any money from it, so they just don't offer it. That's fine, since those of us who hire indies recognise that there's no insurance. However, the government are currently proposing legislation to make the practice of midwifery illegal without insurance cover. Ergo - illegal to practice. Read more here and sign the petition - please.
(And please DON'T comment on the fact that I'm having a homebirth if you think they're somehow dangerous, unless you have read more about it than me. Go here if you want to find out more.)
Comments: 5
I sometimes worry about these reports and what they do to people and their expectations. They naturally highlight cases where poor practice has occurred and people often lose sight of the fact that in lots of cases (posssibly the large majority) the care is perfectly adequate if not exceptionally good. All I do know is that our NHS midwives before, during and after the birth of our boy in January were fine. Maybe we were jut lucky - though more likely we were just probably not unlucky.
M
Posted by: Matthew | July 10, 2008 11:24 AM
I work at a medical malpractice law firm here in the US. Our focus is on brain-injured baby cases. While I agree with you that induction is not a particularly good idea, I'm not altogether sure that midwives are error-free either. In one of our cases, because a midwife thought she could handle the birth and refused to call the doctor, the infant was delivered too late and suffered catastrophically. In another case, the nurses and midwives couldn't read the fetal monitoring strips and didn't know the baby was in distress until it was far too late. I have little invested because I don't plan to have children, but give me an OB AND a midwife any day.
That said, I'm not against home birthing. 99% of births go off without a hitch and people get hysterical for no reason. But medicalizing childbirth is not something I'm against, either - it's the most dangerous thing most women will voluntarily do in their lives.
Posted by: KatharineC | July 10, 2008 02:08 PM
Em, I'm really shocked to discover this level of hostility to midwives. Both my children were born without medical intervention - with the first, a junior doctor did at one point advance on me with forceps and was swatted away by an experienced midwife (appropriately named Sister Savage) who made it plain we were managing very nicely. With the second, the only doctor I saw was an inept anaesthetist who couldn't find the right place to inject an epidural! I'm afraid I think birth is getting way too medicalised - it's not an illness and shouldn't be made into one. There's a sort of quasi-marxist thing about this too, I think - the separation of the producer and the means of production that happens with medicalisation and the notion that a woman can't give birth without lots of technical interventions. You also have to remember, birth is risky - thankfully, not very in this country, but risky nonetheless. We're too risk averse. The up side is that it's also utterly fantastic. I really enjoyed having my babies - it was so exciting seeing these brand new people arriving in the world.
And before anyone tells me it's alright for me, I was lucky. Yes, I was. and I know it. I worked for seven years in a children's hospice, so I've seen more than my fair share of sick, birth damaged and dying children. It hasn't altered my view.
Posted by: Sarah Bower | July 10, 2008 02:57 PM
PS: I'm not going to sign that petition, though, because I think we should put our money where our mouth is when it comes to the NHS and state education. The answer to shortcomings in provision is not to opt out but to fight from within.
Posted by: Sarah Bower | July 10, 2008 03:01 PM
I started out with a water birth at a midwife-led birth centre (not a doctor in sight) but was moved after complications to hospital - still had a midwife overseen natural birth with no major intervention in the end. Of the many NHS midwives I came into contact with in that 24 hr period all were great and stuck to my birth plan as much as possible, for which I was enormously grateful. All the women in my active birth class who used independent midwives found the experience really reassuring and positive. Very best wishes for your birthing experience.
Posted by: Equiano | July 10, 2008 05:44 PM