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Midwifery in Salford

I’m travelling back to London tonight, on a delayed train (what’s new?). The workshop in Salford was a challenge in some ways - most of these midwives seemed really challenged by the ideas I presented and expressed little faith that women can give birth without their assistance, usually in the form of drugs for the pain. There were several times when they fell into that trap of making excuses for their attitudes: “our women are not like that - they expect something for the pain”, “the women we get are not capable of managing without help”, “the women we have in our unit are not prepared for birth - they expect us to take over” etc. It is hard not to be totally frustrated by this negative, patronising and insensitive attitude, but I hope I have managed to inspire them to give it a try. .

We talked about the idea of “with holding” assistance in transition - where midwives acknowledge and accept the this is the hardest part of labour and gently nurture women through the hard yards whilst not yielding to the temptation of giving drugs. I pointed out that the giving of drugs was the medical model of care, a remedy offered by people who had nothing else to offer. We talked about the normality of women “losing it” in at this time, and the welcome signs of progression in labour, even if they seemed turbulent and out of control. The impression I had was that whilst most of these midwives knew what I was talking about, they lacked the confidence and trust in women to try this tactic, even if they knew the benefit for women in achieving a natural birth would be worth the effort.

Some of these midwives were very familiar with homebirth, although the giving of Entonox at home births was an accepted practice. One midwife told me how she was prepared to place herself on call as back up for other community midwives in her area who attended home birth because some of them tried to practice midwifery in the home as thought they were in hospital. She talked about going through their “delivery” bags and tossing out all the hospital paraphernalia they had included for “just in case” She was concerned, and knew from a lot of personal experience that you can’t manage a birth at home as though it was a hospital - this was a recipe for creating problems.

Another midwife in the group told me about her work with the refugees that are housed in nearby Salford reception Centre. This is one of the main places that newly arrived immigrants are sent when they come into the country. They are held for two weeks while being assessed, and then sent on to other centres for rehousing or reprocessing. Quite a few of these women are pregnant, usually as the result of rape, by one or several men. If they are well advanced in the their pregnancies, her team requests that they stay at Salford where the team can continue to take care of her, thus removing the need for the woman to get to know a new group of health professionals. This midwife was very concerned that the way these women may be treated in labour may be interpreted as another form of rape - incarcerated in a strange environment, surrounded by people (sometimes men) who don’t speak her language and subjected to procedures that could be interpreted as hostile and unfriendly. The cultural needs of refugee women need to be respected and their terrible histories treated with sensitivity, so that the birth of the baby can be a time of healing, not of further humiliation. Homebirth seems the best option for these women - keeping them out of the system, in a place that although is not their real home at least is more familiar and comfortable and where she can be accompanied by friends or others from her community. I was very impressed by this midwife’s grasp of the importance of birth to women and these ones in particular and I hope she is able to implement to services they require.

I feel sure I have left this group with much food for thought. It will be interesting to read their evaluations when I get to London and to see what they have learned from these two days.......

Posted by andrea at June 30, 2005 05:11 PM