March 04, 2004

Petty rules thwart practical midwifery

It is amazing how bureaucracy and petty mindedness can get in the way of common sense and block practical midwifery skills. Yesterday I heard a number of stories from midwives of how their efforts to be “with women” were being thwarted by silly rules.

One midwife told the story of being a second midwife at a home birth, and her job was to lug jugs of water upstairs for hours in an effort maintain the water pool temperature at exactly 37.4 Degrees C! Another said that at her hospital it is forbidden to carry hot water anywhere, and providing a bucket of hot water to heat up wet towels, would certainly not be allowed. Many said that at their hospital it was absolutely forbidden for anyone to heat up a gel pack for a woman in the microwave in the kitchen (which is strictly off limits to patients and support people anyway) because the microwave might be used by staff to heat up their lunch!

Women are routinely restricted to only two support people in labour, and they must not leave the labour room once arrived. If one needs to go home, they are not allowed to be replaced by a substitute! It appears that the main bother is the need to buzz them into the unit - security is like Fort Knox in British labour wards - you practically need a password to gain admittance. All of this because every few years someone snatches a baby from a post natal ward somewhere in Britain and “precautions must be taken”. I pointed out that baby snatching was most unlikely to happen in the labour ward because the baby was still safely inside the woman, but “just in case” these places are run like prisons. The outdated term “confinement” is actually more current now that it ever was in the past, it seems! Anyway, as soon as the baby is born it will be fitted out with a leg band that will set off an alarm if the baby is moved away from the unit (the same system they use for preventing shop stealing!).

It is interesting that when these practices are questioned, it is usually stated that “this is policy”. Midwives can be so easily cowed by this bold statement. I would suggest they ask to see the written policy - if none is forthcoming, then there is no policy, and these directives can be safely ignored. Who do midwives let themselves be bossed and bullied by these ill thought out petty rules and regulations? No wonder labouring women feel intimidated when they come into hospital to give birth - often the midwives are already cowering and simpering to avoid being caught up in political power plays within the unit.

The only real solution is to remove birth from hospitals altogether. No-one is going to challenge the right of a woman to use water and heat for easing pain when she is in her own home. Her partner’s ability to manage a jug of boiling water without burning himself will never be questioned. Midwives will not have to worry about some senior staff member waiting to pounce if some puerile rule is infringed. Home birth is the only sensible alternative to hospital madness.....

Posted by andrea at March 04, 2004 04:21 PM