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Women's requests undermining midwifery practise?

The first day of the workshop in New Zealand was very interesting. These midwives, all very experienced, are mostly working in the “Know Your Own Midwife” scheme at the Hospital, although there are also independently practising midwives in the group as well. Some have come from other centres some distance away - the usual kind of mix that attend these programs.

To hear them talking of the way they practise was very heartening. The big focus in NZ midwifery is the woman, and everything they do revolves around the needs of the woman - her needs are paramount. Having said this however, as usually happens in a hospital based system, the needs of the institution also are considered and some conflicts can inevitably arise.

The big difference between Australia and NZ maternity services is the lack of private obstetrics in NZ. Obstetricians are only involved in complex cases in NZ, and readily back away from anything that is “normal” - quite the opposite of the way obstetricians behave in OZ. Midwives manage 70% of all the births in NZ, making referrals as necessary but otherwise carrying out all aspects of the woman’s care. Midwives here are justifiably proud of their system and it is a model that is envied by many overseas.

To hear about the rising rates of intervention, given these circumstance, was worrying. Epidurals are being requested by women and as they are the centre of attention, these requests are being fulfilled. Inevitably, the rate of caesarean births is rising, as are forceps and vacuum births, and this trend has the potential to undermine the quality of midwifery care. We talked at length about how to curtail these trends, the consensus being that better education is necessary. We also focussed on the role that midwives can play in discouraging women from demanding medication during labour, by building their confidence through well chosen words and positive feedback. There will be more focus on this aspect today, as we explore practical measures for keeping women off the beds.....

Posted by andrea at March 05, 2005 04:17 PM