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Birth centres and language

This week I presented a workshop at Queen Charlotte’s in London. This famous hospital relocated a few years ago to a new site, with a new building and all mod cons. The plans had been on the drawing board for some years and by the time the service was established, it was realised that the number of births in the area had grown and they needed extra capacity. It was decided that the extra births (around 1000 per year) could be accommodated if a Birth Centre was established, so part of the adjoining Hammersmith Hospital was converted for this purpose.

The Birth Centre at Queen Charlottes is a very well appointed service. The rooms are spacious and well equipped with large floor mats, huge bean bags, birth balls and birth stools and each has an en-suite bathroom and a large tub. The small regular bed sits in the corner and has a pull-out trundle bed for the father if he wishes to stay after the birth. One room has a hammock-like sling hung from the ceiling that women can use for support during labour or to hold onto for the birth.

The midwives who work there are carefully chosen for their experience and skills with normal birth and the outcomes, as you would expect, indicate that the midwifery model of care is very effective for keeping intervention rates down (the caesarean rate in the main part of the hospital is 36%).

The participants in the workshop were from several hospitals and all were involved with either caseload midwifery (one-to-one) care or were employed in a birth centre. It was stimulating to have such a group of experienced midwives to work with - all were familiar with home births and all were deeply committed to providing woman centred care.

Yet even so there were issues that we needed to explore. Two of the midwives were Italian and both had provided home births in Italy. Given the lack of opportunity for this approach in Italy, they had decided to come to England - “the home of midwifery” - so they could work freely as midwives. They discovered that in England, even amongst midwives, birth is often medicalised. They were shocked at the regulations and rules that are all pervasive in the maternity services, often stifling midwifery practise and forcing women and their midwives to fit into predetermined moulds. Both worked in a birth centre and were able to facilitate normal births, but declined to use Entonox and TENS, for example, which are both “very British” inventions and almost unknown outside the UK.

We also discussed the language issue at length. One of this group talked about “confinements” to the surprise of the others and all were very fond of the “delivery” word. Since they had identified communication with women as a theme they wanted to explore during the program, we talked about the way words impact on women’s impressions and emotions, especially during labour and how a few well chosen words can confirm the faith and trust of the midwife and build a woman’s confidence in her ability to give birth well.

Two of the group are involved in the setting up of a new birth centre service in the Mayday Hospital in Croydon just outside London, and we talked about the impact that the language can have in creating the right impressions in both the staff’s and the women’s minds. I encouraged them to think about designing paperwork that used the “birth” word rather than “delivery” as a starting point and gave them a copy of an article ai have written on the subject of language to stimulate further thinking around this subject.

Queen Charlotte’s Birth Centres uses an adaptation of the All Wales Pathway for Normal Birth to record labour progress, which I was delighted to hear. More about this wonderful tool later - I am off to Wales today to give a short presentation and will be talking to the creators of this outstanding midwifery innovation this evening. I’ll write it up further in a later Diary entry.

Posted by andrea at July 07, 2006 05:33 PM