September 16, 2003

A vital question

There is an interesting discussion being aired on the ozmidwifery list in response to a question from a midwife: “Is it possible to have an active birth in a public hospital?”

For those readers who are unfamiliar with the concepts of an active birth, I suggest you check the quiz on our website - if you can answer “:yes” to these questions, you are undoubtedly practising in a woman-centred, holistic, physiologic fashion that many would identify as central to an “active birth”.

In answer to the question posed on the list, this is what I replied....

I think it is possible to have an active birth in a hospital, but it is difficult in the larger units for a number of reasons:

A lack of skills (and sometimes motivation) amongst midwives. As epidurals take hold, midwives forget how to get a woman through transition, how to do observations with her off the bed and certainly how to support her in an upright labour and birth, to name a few examples.
The perception that active birth is "old hat" when it is just as fresh and vital as every woman that will give birth today and tomorrow. I feel that midwives should be reminded regularly of the basics and underpinning philosophy because it is so easy for standards to slip and "tricks of the trade" to be forgotten.
A lack of support from experienced midwives, who could show the students and graduates how it is done. Every student I have ever had in a workshop over the years has said that they were not taught the basics in their training, so it is imperative that the necessary knowledge and practical skills be passed on my midwives on the job.
The chronic shortage of staff (often a problem in non woman or midwife - friendly workplaces) puts additional pressure on the midwives left to face the daily struggle. It may seem easier to just fill the labouring woman up with an epidural, plug in the electronic baby-sitter (CTG) and get on with the paperwork. Interventions add to the midwives' workload, not reduce it.
The inability (unwillingness?) of midwifery managers to rid the maternity staff of "dinosaur" midwives who are resistant to change and block innovations, improved services and supportive practices. This would never happen in other areas of medicine, where staff who did not keep up with evidence based care and demonstrate best practice would be asked to leave pronto. These undermining midwives are not necessarily the older staff, but are often nervous, insecure, timid and scared practitioners who need support, re-education, and understanding. If this doesn't help, then it would do everyone, including them, a favour if they left the profession that clearly is not for them.

I could have gone on, but have left it here, to see what others contribute on this topic. It is an issue that I constantly grapple with, having been the primary promoter of active birth in Australia for the last 20 years. At times I feel we are getting somewhere and maternity services and improving, but then, when I reflect on the progress that has been made over this time, it seems we have such a long way to go, especially as so much backsliding is going on, often amongst midwives themselves. Being of a positive nature I will keep plugging on, but I do wish midwives would take time out to regularly update and hone their skills, before our hospitals are staffed solely by obstetric nurses.

Posted by andrea at September 16, 2003 10:35 PM

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