June 24, 2003

Midwives and litigation

Today is the second day of an Active Birth workshop in Bristol, England. Many of the participants in this group have a lot of experience with home birth, which is not surprising, given that we are not far from Bath, an area well known for its midwifery led units and home birth.

We canvassed quite a few issues related to home birth during the day. We also talked about the problem of litigation, which has midwives running scared in this country. Midwives are adamant that they must “document, document, document” to avoid litigation and this is regularly drummed in by management and the obstetricians.

I would have thought that poor practice and lack of communication with women were the underlying factors that trigger litigation and that no amount of documentation will cover this up. As someone pointed out yesterday, there is nothing to stop midwives from “filling in the gaps” after a birth, especially when the labouring woman requires actual hands-on midwifery care rather than a pen-weilding baby sitter.

I threw in the comment that the NICE (National Institute for Clinical Excellence) guidelines that the baby be monitored using pinards or sonicaid every 15 minutes during first stage and after every contraction in second stage, is an intervention in a normal birth. These guidelines were put in place as an alternative to routine CTGs, which NICE have now said need not be used as a routine, especially on admission. The underlying reasoning for this recommendation seems to be that if there is litigation, extensive documentation of the baby’s heartbeat will somehow make a difference to the outcome. The issue of the effect of disturbing the woman labouring normally every 15 minutes was dismissed by my group yesterday as unimportant - they claimed that women “like to know how the baby is doing”. I wonder how they divine women’s feelings on this? Perhaps they have asked her in this way “you want to know how your baby is doing, don’t you?” when in fact the real reason for meddling with her concentration is that the midwife is terrified that she will be carpeted for a gap in the records for the fetal heart rate.

The state of midwifery in this country is dire. Fear of litigation is shaping midwifery practice, the obstetricians (who know virtually nothing about normal birth) are dictating midwifery practice and trust in birth as normal process is slipping away. If women in Britain were more forthright and less pathetic, if midwifery leaders appeared from somewhere to offer solutions and take strong public positions in support of normal birth and everyone learned how to celebrate those successful midwifery practices that do exist, perhaps something could be done. I will not be holding my breath!

This is my last workshop in the UK for this trip. Tomorrow I go to Spain for a program there and then I will be off home, where I hear that the NSW Government is finally rolling out the first programs under the NMAP. Great to hear of progress being made somewhere!

Posted by andrea at June 24, 2003 05:23 PM

Comments

You may find it interesting to visit the sites about poker card, casino no deposit, online casino casions, gambling cash, blackjack sites, roulette casions, gamble tip, internet casino web, slot machine odds, online casino bonus deposit, online gamble game, casino gambling strategies, casino game strategies, las vegas table, video poker casinos, roulette online card, slot rule, blackjack online deposit, blackjack betting 3d, poker 888, gambling 8888, blackjack tip, poker on net, casino casions, casino gaming, gambling no deposit. .

Posted by: blackjack on January 19, 2004 09:44 AM