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How many midwives does it take to birth a baby?

This is not a joke - one or two?

One of the issues that is influencing the staffing levels in midwifery units is the requirement in many units that there must be two midwives present for the birth of the baby. In a hospital the second midwife maybe a student, but student numbers are also affected by a lack of trained staff. The same “rules” often apply in home births - a second midwife must be called in when the birth is imminent.

I have never understood why a second midwife must be deployed to assist with the birth. The usual response when I ask this question is that a second midwife is needed to “receive the baby”, and of course assist with any problems that many occur. In a hospital, help is always at hand if an emergency occurs - that’s what the buzzer is used for. At a home birth, there are always other adults around, who can help the midwife with the basics of first aid, calling the ambulance etc. At home, there are likely to be fewer emergencies anyway, as the birth is much more likely to stay normal as drugs and interventions will not have been used (one hopes!). Home birth midwives are skilled in resuscitation, putting in a drip, managing blood loss etc and can call on others present to assist. Why call in another midwife, just in case? It is an expensive exercise, and in some areas, the requirement to have this extra professional means that limits are placed on how many home births can be booked.

Birth may not be quite so simple in a hospital, as interventions are more commonly undertaken. As a result, many births will be complicated and require extra assistance. In an emergency a doctor will be called and the midwife will assist him/her. Other staff would also be available if more personnel were required - even the students could lend a useful hand.

Simple arithmetic demonstrates that if only one midwife is required to oversee a birth, then twice as many births could be attended. This might be important in a hospital where staff are run off their feet, and may make home births more accessible for many families. Reducing midwives’ stress levels is important because right now, many are suffering from the constant pressure to fulfill all the protocols, many of which are unrealistic given current staffing levels.

During the workshop yesterday, I reminded midwives that because of the unpredictable nature of labour and birth and the possibility of complications occurring in any birth, it is important to keep the labour and normal as possible from the outset and this means not offering women drugs in labour. Once a woman has been given medication, she is less likely to be physically capable of assisting when a problem occurs (such as turning over if a shoulder dystocia develops) and more likely to be fuzzy in her mind and unable to think clearly (a frequent outcome of narcotic and Entonox medication). The baby will also be affected and this may contribute to a poorer outcome for the baby.

The more midwives work to keep the birth normal, the less likely there will be problems in second stage and the need to call in extra staff. In a health service that is completely stretched and working under incredible restrictions, reducing inductions, encouraging mobility at all times, not offering drugs for pain, using intermittent auscultation rather than CTGs and using more relaxed time lines will be important, not only for increasing safety at birth, but for reducing the epidemic of midwife stress that seems universal.

Posted by andrea at February 18, 2007 05:26 PM