Book Review

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The Midwife Companion

The art of support during birth

Andrea Robertson

Already a fan of Andrea's after reading her book on teaching active birth (Empowering Women) which has the best section on pain in labour I have ever found, I was eager to read her latest book. Her previous books have been written for consumers and childbirth educators and with this she ventures out to write specifically for midwives from the viewpoint of a mother, a childbirth educator and a quiet observer and supporter of many labours. In her role as an educator, she has listened to many labour stories and heard women talking about what has helped and what has either not helped or hindered the woman labouring. I think it is pretty brave of Andrea, a consumer, to write a book for midwives, so many of whom tend not to take too well to advice and teaching about "our job" from "outsiders". However, the result is a refreshingly non-judgemental, useful and wise book.

Andrea presents anatomy and physiology in a holistic style explaining among other things, the benefits of pain in labour, the interaction between the hormones and their effect on the woman and her labour, labour positions and how they influence the pelvic measurements. She tackles "women in a panic" and the taboo "women you don't like". She packs the book with useful hints on making women comfortable with rolled towels, hot towels and pillows, questions our beliefs about defining interventions and normality. Andrea also writes with great compassion --- for women, their families and for midwives.

While acknowledging that home is the most natural place to labour and birth, most women still give birth in hospital, so Andrea explores ways of helping women within a hospital setting, supporting her supporters and managing complications.

The last chapter on "making it happen" deals with seeking support for your practice, ways of bringing about change in either small ways within the work setting or at government level. Don't be put off if that seems too high powered --- it's a brilliant book, thoroughly referenced throughout, written clearly and illustrated by beautifully simple line drawings. I'd recommend it highly for all those in clinical practice.

Alice Coyle, independent midwife.
MIDIRS Digest, Vol 7:3
September 1997

When I first paged through Andrea Robertson's book, the sentence "Women don't need 'rescuing' from their labours" leapt out at me. This statement neatly sums up the author's intent: to remind the midwife that women have an innate ability to birth, and that the midwife's role is to be her companion, support and facilitator, not her manager. This book provides a refresher course for women seeking to rediscover the art of midwifery.

Andrea Robertson describes good, practical ideas and information on creating positive environments for labour and birth. She gives us many self-help techniques, low-tech solutions for pain relief and tools fro labour. She also gives us chapters on the way we can communicate effective verbally during birth; the physiology of labour and birth in which she describes such important aspects as oxytocin, endorphins, catecholamines and adrenaline; the importance of prenatal education; and how to act as a birthing woman's advocate. And finally, a chapter entitled "Making it Happen" empowers the midwife herself by helping her delineate and carry out goals to improve her practice, find ways to explore alternatives to how she practices, discover ways to nurture herself, and implement ways to coordinate with staff to improve birth in a hospital setting.

This is a good manual for midwives, but I also recommend this book to pregnant couples to help them address their needs and formulate plans to better enjoy their birth experience.

Midwifery Today
Winter 1997

The style in which the author of this book writes made me feel as though she had just left the woman's side to share and reflect upon the experiences and dilemmas inherent in providing woman-centred care.

Successive chapters explore the art of support during birth from psychological and physiological, ethical, legal, professional and holistic perspectives. The text is well supported and informed by evidence from reliable global sources, with references listed at the end of each chapter.

The book will help students of midwifery to gain insights into the art of being with women and the skill of combining this with the science of late 20th century midwifery.

Practitioners of midwifery will find in it a wealth of useful recommendations to support evidence based care. Many of these were gleaned from women themselves, by adapting care to support the normal physiological responses to labour and exercising the knowledge to use interventions judiciously.

Some of the suggestions for using heat should, however, be applied with caution --- especially the use of microwave ovens to heat wheat packs.

This is a skilful exposition which held my attention and will, I'm sure, become a "companion" for my future teaching and practice. I would recommend the book to students and practitioners alike as essential reading."

Dorothy Walters
Senior Lecturer, Midwifery
Midwives, August 1997

If you are a midwife who doesn't believe that she has anything to gain from listening to the advice of those who are not themselves midwives, skip this review. If, on the other hand, you are a midwife who understands that inspiration and enlightenment can come from anywhere and that good, sound common sense is not the perogative of (in fact it's sometimes not even in the same ballpark as) a medical education, then read on.

Andrea Robertson's last book "Empowering Women: teaching active birth" was a skilful and sensitively written work combining medical and psychological concepts with ease. It was aimed mostly at women and childbirth educators. This book is aimed at midwives, but written from the perspective of the mother. As a childbirth educator, Andrea has probably listened to many women telling her about their experiences. She has heard about the helpful midwives and the ones who have turned an otherwise straightforward birth into a really unpleasant experience. Using this as a basis she has come up with a very useful book indeed. Useful, that is, for those who will listen.

Pregnancy and birth are treated in a holistic way and the range of subjects is impressive. These include basic anatomy and physiology, hormones and their effect on labour, labour positions and the way they affect pelvic dimensions, and the benefits of pain in labour (something which echos the excellenet section on pain in her last book). They also include important but rarely discussed subjects like how to deal positively with women you simply don't like and what to do when a woman is in a panic. The emphasis is on normal birth throughout and although she recognises that home is the most "normal" place to have a baby, she provides much useful information on how to facilitate normality in the hospital setting. There are useful hints throughout and while you could dip into it, I would recommend reading it from cover to cover --- more than once.

From where I stand, allowing counselling principles and elements of psychology to influence medical and midwifery practice may be the only way left for us to start deconstructing the model of technological birth and rebuilding a more mother friendly maternity care system. Books like this are substantial steps in the right direction.

Pat Thomas
AIMS Journal
Vol 9 No 3 Autumn 1997