As I pack up in readiness to return home from the UK, I’ve been reflecting on the workshops in this round and the experiences that I have had. The programs have offered a wide variety of groups and levels of midwifery care: very medicalised maternity care in Italy and Belfast, enthusiastic woman centred care in Inverness and Leamington Spa and great students in Limerick.

Again it struck me how insular these various hospitals are and how unaware midwives are of developments in their field in nearby towns, let alone other parts of the country (or overseas!). Many are struggling to change policies or want to develop new programs to extend options for women, yet they have not looked around for evidence they could use to bolster their case or strengthen their arguments. As I often point out in workshops, every hospital has a different approach to service provision, so there are many variations on the theme. It is likely that any new development a hospital wishes to pursue will have been tried already in another unit, and drawing on their feedback can save a lot of time and heartache.

Many midwives are frustrated with the tight control the doctors have over their practise and the inevitable increase in interventions that comes from over medicalising maternity care. In Wales, the Clinical Pathway for Normal Birth has had a dramatic effect in lowering caesarean rates, increasing the rate of home births and giving midwives confidence to practise their skills.

This Pathway, which puts the emphasis on keeping birth normal through adopting a midwifery model of care, provides clear guidance for caregivers, setting out parameters for “normal” that enables many women to achieve physiologic births. One example is that the usual standard of “one centimetre and hour” for dilatation has been extended to “two centimetres in 4 hours” which gives leeway to those women who dilate unevenly, with perhaps a lull after they arrive into the hospital.

In time, no doubt the requirements of this Pathway will be reviewed and the criteria re-evaluated, in the way of all such documents. It has certainly given midwifery a new lease of life in Wales and the results have been very pleasing. Yet so few people in the rest of the UK have heard of these developments. I have mentioned the Pathway many times in workshops and suggested that midwives have a close look at producing something similar for their units. I understand that Scotland is pursuing the development of an all-encompassing guideline of a similar nature, and I hope that this is the case. I wonder in Britain will follow suit?

Meanwhile, there is nothing to stop individual midwives or maternity services from developing their own pathway for their own local practices. I suggest you click on the link above and have a look at this Pathway and the associated documentation (evaluations etc) contained on the Welsh site. There is plenty of food for thought there! Posted by andrea at October 24, 2004 07:41 PM