April 29, 2004

Optimal foetal positioning?

Today I set out on the start the Midwifery Intensives Tour. It is always busy getting everything ready for these events (hence the few Diary entries over the past week) and it is good to be on the road at last. We have hundreds of midwives booked in and a full program over the next 12 days.

Travelling with my good friends Lynne Staff, Maggie Banks and Vicki Chan always gives me a great deal of pleasure. There is lots of time to share stories, talk politics, compare notes and discuss ideas, especially as the tour will involve a lot of plane travel between the capital cities.

Tonight over dinner we were talking about the language issues (always a central theme of any workshop on birth) and the difference between “caesarean birth” and “caesarean delivery”. Maggie feels that we should still retain the term “caesarean delivery” because that puts the power where it is - with the doctor. I agree, but also think that we should try and get rid of the term “delivery” altogether. I appreciate that making the distinction between what women do (birth) and doctors do(deliver) is important, but to expect midwives to remember the distinction may be too hard. Perhaps one solution would be to re-label it as “caesarean surgery” and avoid both terms. Of course, women are still having a baby, even when surgery is involved, and a baby is still being birthed, even if it is through an incision rather than a vagina. Tricky!

We also talked about the way posterior positioned babies are becoming a major issue, to the point that women are now scared when their baby is positioned this way. Much fuss is being made about “optimal foetal positioning” as a way of avoiding this “catastrophic” position of the baby, and elective caesareans are also being performed because of the baby’s position, especially when it is thought to be a large baby. All this emphasis on getting the baby “lined up favourably” is setting women up for fear and drama if the baby chooses to lie some other way. Whatever the position of the baby, it can be born vaginally (almost always), and women will find ways of working with their bodies and their babies to get them around and down towards birth. If we start alarming women regarding the position of the baby, their bodies will seize up with fright, the pain will increase and an epidural will most likely be needed. An epidural is the worst possible solution for both the woman and her baby, because she needs mobility and freedom to work with her pelvis and baby that is completely impossible with an epidural and all the additional straps and drips that come with it. Talking to women about these issues during the pregnancy is a major role of the midwife, and getting these messages across to midwives will be a major part of this program.

Meanwhile, I can see will have many fun conversations during these next days.

Posted by andrea at April 29, 2004 09:51 PM