January 06, 2003

"Us and them" attitudes amongst midwives

I’ve been reflecting today on the experiences that I’ve had at births over the past few weeks. In particular I’ve been thinking about the attitudes of the midwives that I have encountered, and specifically the differences between midwives working in labour wards and birth centres.

We are all aware that birth centres operate as a midwifery model of care, where the needs of the labouring woman and her baby are the pivotal point around which everything revolves. Whatever she needs is made available to her and her strength and ability is never doubted until there is a proven complication.

In labour wards, the attitude appears to be that the staff’s and hospital’s needs are paramount and women labour according to the protocols, with their wishes being largely discounted. This was starkly played out last week at the birth I attended in the brand new labour ward of my local hospital. The parents have since called the midwife that met us as “the Russian Hitler” which was pretty perceptive.

The woman was told firmly that she must get onto the bed for the CTG and when I queried this, the response from this midwife was “she had to locate the baby first (palpation and a VE) and this could only be done on the bed”. While I was challenging this, the woman was obediently getting onto the bed and ready for the ordeal of examination so the debate became academic. The examination was painful, and the midwife immediately said “do you want to gas?”. This exposed the midwife’s poor level of skills in easing women’s discomfort without drugs - why on earth is a midwife with this attitude allowed to work with labouring women? I guess this is the result of chronic shortages - hospitals will employ anyone they can get.

As soon as we could, we helped the woman into the shower. I requested a birth ball for her to sit on - the raised eyebrows spoke volumes and after a while, when it hadn’t arrived I went in search of it. Locating it languishing in the hall, I helped myself - being a brand new unit I wasn’t yet familiar with where to find the things we need (but I am now!) and much later when the midwife came back, she was surprised to find it in use.

Meanwhile I was working out how to stop up the plug hole so we could use the bath (see my earlier Diary entry). When this was challenged, I was told very firmly that “we don’t do this kind of thing in the labour ward”. Why ever not? This “us and them” demarcation has got to stop - women should not be subjected to discrimination because they have chosen a labour ward instead of a birth centre.

Twenty years ago, when the Birth Centre opened at the Royal Hospital for Women in Paddington, Sydney, I remember seeing midwives from the Birth Centre scuttling furtively into the labour ward to collect supplies. They were clearly unsettled by being in a hostile environment where they were frequently subjected to ridicule. As the plaudits accumulated for the Birth Centre, the midwives in the labour ward finally woke up and realised that they too could be getting similar positive press. Instead of sneering at “those women” who chose the Birth Centre, they began boasting that “we can do everything here in the Labour Ward that they do in the Birth Centre”. Whilst it wasn’t quite true, because of the lack of physical facilities, it made a big difference to staff morale and enabled women to be more comfortable with transfers and regular Labour Ward admissions.

It is time that the staff in my local unit woke up to the potential of their brand new facilities. They could be leaders in the field instead of terrified that they will be stepping out of line if they put the woman first. This new unit could be a showpiece, with better statistics than similar units, if the baths were used and basic midwifery skills were employed. I shall be writing to the hospital making these suggestions. I will also point out that women’s rights must not be trampled because of staff inadequacies and poor skill levels. They have a responsibility to get it right.

Posted by andrea at January 06, 2003 11:06 AM

Comments

Andrea, This is a big problem not only for you as a doula but for Midwives believing in a natural birth. I am finding at the current hospital I am working Lip service is given to natural Birthing and when the first groan instead of a shower or into the spa/bath offer an anaelgesic injection of the Nitrose Oxide mask. Further the cord is rushed to be cut and Synto given------- I was rudely corrected as I allowed the cord to continue uncut till it stopped Pulsation then asked the person to give the synto only to be told it was given in the leg unseen by me at the birth!! I crossly said I asked you not to to be told it is not acceptable policy--------[No writen policy to be seen. Mum had birthed on all fours and was turning over for the 3rd stage and Bub onto tummy!!!
One day all Midwives will realise that positive behaviour encourages Mums to believe in their own body strengths. May be each one teach one to Birth!
Big Hug-- Robyn

Posted by: Robyn J Aulmann on February 15, 2003 06:31 PM

Comments

Andrea, This is a big problem not only for you as a doula but for Midwives believing in a natural birth. I am finding at the current hospital I am working Lip service is given to natural Birthing and when the first groan instead of a shower or into the spa/bath offer an anaelgesic injection of the Nitrose Oxide mask. Further the cord is rushed to be cut and Synto given------- I was rudely corrected as I allowed the cord to continue uncut till it stopped Pulsation then asked the person to give the synto only to be told it was given in the leg unseen by me at the birth!! I crossly said 'I asked you not to', to be told it is not acceptable policy--------[No writen policy to be seen. Mum had birthed on all fours and was turning over for the 3rd stage and Bub onto tummy!!!
One day all Midwives will realise that positive behaviour encourages Mums to believe in their own body strengths. May be each one teach one to Birth!
Big Hug-- Robyn

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