Saturday, 7 January 2012

Labour Ward Rituals

Why oh why does nothing ever change in the medical dominated world of midwifery? Maybe it is changing but it is kept hidden from me and I see little change in the 13 years I have been away from the labour room rituals. Is there ever going to be a time when I accompany women to hospital when they need to go for assistance but they are then treated with dignity and the experience is one of joy ( and good women centred practice) in all respects?....
Recently I took a client in to hospital with suspected early labour at 34 weeks. I went home as nothing much was going on but 24 hours later was called back by my client as all of a sudden baby was on its way fast.

 When I arrived on the labour ward I walked into the brightest lit room you have ever seen, every main light was on but also a spotlight was beaming down onto a visible head. Two male paediatricians were in the room arms crossed leaning against the window a bored look on their faces.....doing nothing of course just waiting there watching the woman in her most private time. There was also a doctor present and 2  midwives, another person kept popping in and out but I, and I am sure also my clients, have no idea who it was. As the birth was so advanced and in front of so many people there was no way I could make any changes or even comment on anything I saw, it would have been inappropriate and far too confrontational, but it really was awful.

The woman was in typical labour ward position, propped up on her back  (this was a woman who was planning a home birth and wanted everything natural) . She was being encouraged to use the valsalver manoeuvre of sustained breath holding and pulling back on her thighs. This manoeuvre has been demonstrated to be dangerous practice by the World Health Organisation and has been labelled “practice be abandoned” as it can cause fetal distress.  
One midwife was standing next to me and I was able to whisper to her " please consider not cutting the cord if this baby is well as the evidence is clear that it is beneficial especially for premature babies" of course I was ignored and when a healthy pink crying baby was born a few minutes later the blood rich cord was instantly clamped, cut, the baby wrapped in a towel and handed up to his mother. The mother was overjoyed, of course she was, baby was healthy a good size and in perfect health.  The irony of it was that as the midwife was cutting the cord all the blood spurted all over her face and arms! She thought it quite funny, I thought it quite sad! Shame the blood didn’t spurt into the baby!  If they were passing baby to mum anyway why couldn't they have left the cord? It was what mum wanted and should be common practice...its even in NICE now!

I helped mum to unwrap baby and the baby commenced to nuzzle at the breast, I covered them both and that was where I hoped they would at least remain, however after about 5 minutes the baby was taken from his mother for a paediatrician to look at him. You could see he was healthy just by looking at him in mums arms! All the Doc did was listen to his heart (yes it was beating he had been pink and crying and breathing for a good while now)and then the midwife commenced to put a nappy on him (did mum want this?  of course the answer is that she didnt know for she didn’t ask.... did she even stop to think that the parenst may have looked forward to being the first ones to dress their baby?) She then wrapped him AGAIN  in 2 towels and finally gave him back to mum with no mention of skin to skin or feeding. As I see it this is nothing more than labour ward ritual,  this taking of baby for a paediatrician to look at, it happens at Caesarean sections too yet a midwife is completely able to assess at birth instantly if a baby needs a doctor or its mother. Of course as I was there I encouraged the mum to unwrap (again) put him skin to skin (again) and breast feed which he did beautifully and instantly. Why does this happen ?If I had not been there maybe the mum would not have unwrapped the baby and would have continued to hold her heavily wrapped baby without attempting to feed or certainly not as early and quickly as she did. At that point with him being born early, I considered skin to skin and feeding was the most important thing for that mother and child yet the midwives began immediately to pester the mother to stop feeding and hand him over to weigh and get prophylactic antibiotics started. The only thing wrong with this baby was he was 6 weeks early. He was a good weight, over well over 5lb and it was a spontaneous quick labour in a healthy mother. It seems so bizarre that there was such a rush to get drugs into him that he may not need but that they were more than happy to deny him the blood and feeding that he did need.

Why couldn't this baby have been born without an audience? Surely just outside the door is as good as in the room? Why did she have to be born under a spotlight and why wasn't the women in a better position to achieve a more positive birth, help with pain, prevent tearing etc. she could easily have been on all fours, the room dark and everyone waiting outside in case they were needed. Most importantly why was the cord not left to pulsate? They passed him to mum anyway so why not keep the cord on ? Just in case readers are not aware of the overwhelming benefits to leaving cords to pulsate the blood into the baby (rather than over the midwife) you can look at this link: 
Ok on with the struggle to make changes….

Wednesday, 4 January 2012

To push or not to push...that is the question

Attended a lovely birth on New Years Day. In hospital, so I was unable to 'catch' the baby but was able to support my client and her partner throughout. Labour was induced for medical reasons and strong regular contractions quickly ensued. After a short while my client said she wanted to push and it became apparent that she was in second stage of labour. She was told by the hospital midwife not to push but to breathe through the contractions. She started pushing anyway and a lovely healthy baby born shortly afterwards.

This had made me think about lot of issues surrounding the issue of pushing.

Firstly, why women are so often not believed when they say they want to push? I have heard that story too often, even with a woman who have had babies before and the head is visible! Whether the urge signals the second stage of labour or not, being told to suppress those feelings and fight them is counterproductive. Just acknowledging that a woman has those feelings can help her by demonstrating that we believe her and trust in the normal physiology of birth.

Secondly, If a woman's cervix is fully dilated and her baby is moving down the birth canal then she is in second stage of labour and her baby will soon be born. Fantastic! So why tell her not to push for heaven's sake!

And thirdly, if her cervix is not fully dilated there isnt any compelling evidence from research that this will cause a woman or her baby harm.In fact early urges to push are common and in some labours may encourage baby into more a favourable position for birth.

Lastly, women's urges often ebb and flow. So encouraging them to be instinctive and push as they feel inclined will almost always result in strong overwhelming expulsive urges only when baby is well down in the birth canal and about to be born.

So I for one will always believe a woman when she says she wants to push and continue to tell her to do just what she feels she needs to do.

Strong women not good girls

Just wanted to have a moan about a little thing (or maybe it's the tip of a very big one!) ...but its bugged me for years. In fact since I was a student midwife a very long time ago and I noticed one particular midwife saying it. And I would say that midwives say it most, less so doctors, and that it tends to pop up in the second stage of labour.

Telling women that they are '...good girls'. I cringe inwardly and then want to scream and shout at same time. I think it's rude, patronising and infantilizes women.

So why is it said to women when they are doing one of the most strong, grown-up things in their lives?

Power and control may have a lot to do with it. Also the culture of birth, the labour ward etc. Or maybe it's just that as professionals we forget what messages our language conveys and we need to pay attention to it more.