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Challenging the status quo in midwifery

I’ve been using the new Labour Pain charts in my workshops, to help the groups to focus on the information that parents need to have about the importance and significance of the pain of labour. The charts help me to focus on the main points too, and although I don’t usually need to go into the same level of detail with the midwives as I would with parents, I feel it is important to remind midwives of the main interactions between the various hormones that are active during labour and how they can influence their release.

This discussion around the normality of pain in labour usually raises discussion about the various drugs that women have come to reply on. Today in the group, the midwives were surprised to learn that Nitrous Oxide (Entonox) is not used during labour in Europe or in the USA. It is interesting how habits and techniques can become very regionalised, and how little midwives often know about the way that birth is managed in other countries.

There are two Canadian midwives in this group and one of them commented that she worked as an obstetric nurse in Canada for four years before coming to the UK to learn midwifery. She was surprised how medicalised labour is in Britain, and said that she was able to facilitate normal labour and birth more easily in Canada. She explained that there seemed to be more of a collaborative approach there, with less of the hierarchy that seems to operate in the UK. If a nurse wanted to challenge what was being suggested for labour management, she could “ask for clarity” and everyone present would stop and consider what was being done, with explanations all round. I can’t imagine this working in the UK - no-one would dare to request (or expect) this kind of teamwork. It’s probably because of the stratification in UK society generally - doctors have a definite place and are called either “Doctor” or, in more rarified circles “Mr”. The idea of using first names between staff members would be seen here as disrespectful, yet it is a good starting point for forging an equality between colleagues that can lead to much better teamwork.

The students in the group expressed how difficult it is to question what is done, and how unapproachable some senior midwives can be. I’ve had students mention this to me many times, and where it happens it could easily stifle healthy curiosity and valuable personal reflection. Such a shame - a student’s questions are often a useful trigger for consideration of alternatives. This would only happen if the senior staff did not feel threatened or uncomfortable by perceived challenges to their authority. I think all midwives should read the very useful article “Fish can’t see the water” to sensitise them to the institutionalisation that occurs in many hospitals.

Posted by andrea at March 19, 2006 05:13 AM