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One-to-one midwifery

This has been a thoughtful group of midwives in Nuneaton, who between them have many years of experience and have seen many births. There was a lively discussion about the goal of “one woman, one midwife” that is a current campaign here in Britain.

One excuse given by Health Authorities in the UK for not actively encouraging home birth in many areas is that there are too few midwives to provide this service. They claim that if midwives are re-directed from the wards to home births, then women giving birth in hospitals will be at risk because of reduced levels of care.

Two midwives are required for a home birth in Britain. One takes care of the woman for the duration of the labour and the other is called when the birth is imminent. The principle is one midwife for the woman and another for the baby, in case there is a problem. This approach must assume that there is no other adult in the house, whereas usually there are several adults present who could call an ambulance, hold equipment, and assist the midwife in the unlikely event of a problem. In other countries, such as Australia, home birth midwives usually work on their own, and will call on others in te house to help should it be necessary. Why does the British system require two, when the rest of the world has shown that one can manage very well?

Another factor to consider is the dependence on the midwife that seems to have developed amongst British women. There is a view that the midwife needs to be present for the whole labour and I believe this is not healthy, for the midwife or the woman. In The Netherlands, Dutch homebirth midwives spend few hours at a home birth, coming and going during labour perhaps several times and then staying for a couple of hours after the baby arrives. Dutch women have learned they can manage labour themselves, without any drugs and relying solely on their own internal resources (endorphins) to get them through.

This issue of dependence needs consideration: women would benefit from learning they are capable, competent and strong, and labour provides the ideal opportunity for them to make this discovery. If the midwife is constantly hovering, listening to the fetal heart every fifteen minutes (slavishly following the non-evidence based NICE guidelines), making themselves indispensable to the woman and her family, is this healthy? Are we breeding a generation of women who are weak, lacking self-confidence, with low self esteem and a “poor me” mentality? Do the midwives (from a similar cultural background) need to be needed to boost their own egos and position?

I believe that women should be encouraged to labour by themselves (I don’t mean alone), using self-help strategies rather than developing a drug dependence and supported by a midwife who shows her trust in the process and the woman by keeping her distance. Women don’t need to be closely “monitored” when they labour physiologically, and the resulting boost to confidence and the realisation of one’s strength and capability is exactly what every new mother needs to kick start the nurturing of her new baby.

Posted by andrea at October 24, 2005 08:28 PM