Midwife Andrea Vincent’s experience:
Andrea initially cherry-picked those families she wanted to influence: first timers, those who had terrible previous births, and those who really wanted a natural birth. She also periodically tried to teach some of the skills herself rather than get families to do the work, because she ran up against all the “reasonable reasons why not” families give. The “I’m too busy” or “too many skills” or “my husband isn’t interested in helping me.” Once a baby is born, your whole life changes. Many skills have to be learned, and quickly. That’s what overwhelms so many families. However, when families become skilled during pregnancy (and CKT has an expectant fathers’ blog that shares the 10 skills men need to grow throughout the 5 phases of pregnancy), and use skills during birth, they adjust and handle the newborn period much better, because they are used to learning and adjusting to change. There is far less post-natal depression or disappointment six months later. Most people who use some skills at one birth will go back, refresh their mind, practice more deeply, and double down on the use of skills at each subsequent birth.
Andrea is saving the government lots of money. Families feel so much better about their births, the post-natal period is more settled, families take more responsibility, and are less dependent (in fact she’s still in practice because she has demanded her clients become skilled, thereby easing the burden on herself and lessening overwhelm).
When midwives start to use the protocols, this is what to expect: At first, about 20-30% of your clients will say “yes” if you merely give them a choice. You have to educate and persuade them that times have changed, and there is now evidence that birth outcomes are better when families learn skills, AND that there is a Partnership expectation that they uphold their end of the deal by taking responsibility to become skilled.
Through determined education, Andrea says 5% just won’t get on board and 10-15% say they are, but obviously haven’t learned skills (Parents Centre found the same thing). That leaves about 80% who will become skilled to some degree or another.
What will it take to change the societal message and implement actions that can directly lead to the goals hoped for when the midwifery model of care was implemented? It requires midwives and CBEs to lead consumers, and there are precedents for that. Consider obesity, diabetes, and heart problems. Fifteen years ago doctors didn’t believe diet, exercise, or stress related to any of those. Doctors now both educate and push clients with these conditions to change their lifestyles. Midwives and CBEs can easily do the same thing, and they will have greater success because learning birthing skills is a one-off effort, and NOT a lifestyle change.
We have the potential right now to grow a skilled birthing population within this amazing midwifery partnership. We have the opportunity here, now, in New Zealand, to accomplish what no other nation ever has: Expand the Magic Circle to include all birthing families, with birthing skills and choice, cared for by midwives in a social partnership of unequaled trust, knowledge, respect, and support.
Here is what Andrea Vincent and Common Knowledge Trust will do:
*We will teach “Strengthening the Partnership” Workshops. This is a paid workshop, but you’ll get a lot out of the support and collaboration.
*We will correspond with people outside the workshops, ongoing.
*CKT will train midwives/CBEs to present samples of the skills effectively and persuasively.
*CKT will make the Birthing Better resource available to midwives and CBEs at a 50% discount. We will set up an affiliate account so you will be able to direct people to the online course. The resource is now organized into an order of learning. Within six months a whole new resource (except the video segments) will be installed on Udemy platform.
Alice Fieldhouse said in 1960 “The decision to change commits people in a line of action with uncertain outcomes and so evokes doubt and anxiety…It requires a mature personality to accept the need for change, as this necessitates an implicit admission that what has been one hitherto is less satisfactory.” TWW, p. 69.
Appendix
Simple Protocol
- At first meeting, every midwife thoroughly explains this precious Midwifery Partnership.
- Every midwife needs to inform every client that she has gone to school for four years to
Become qualified to attend births, and as midwives, they are responsible for the health
And wellbeing of both mother and baby.
- Each midwife needs to explain to every client that midwives respect each woman’s choices and at each appointment together they will build a Birth Plan about what each client wants at her birth.
- Each midwife needs to explain to every client that every birthing woman will have to “do” the activity of birthing their baby no matter where they birth, with whom or what is happening to or around her. This means she and her partner/other need to have good birth and birth-coaching skills.
- The midwife should give a hand-out to every expectant family the list of skills-based methods known in New Zealand – Active Birth, Hypnobirthing, Birthing Better (preciously The Pink Kit), Hypno-babies, Lamaze, The Bradley Method, Birth Without Fear, and others the midwife may be familiar with.
- The client should be informed as to the differences between each skills-based method and where they can access them…or give/lend them.
- Clients should be informed that it’s best to start preparing their pregnant body to become a birthing body about 24 weeks along, and the birth and birth-coaching skills about 28 weeks onward. (The Internal Work from Birthing Better should be started at 32 weeks).
- The midwife then explains that at each appointment the conventional Birth Plan will be created and each skill learned will be put into the notes. For example: breathing, relaxation, teamwork, pelvic work, the internal work, communication and touch. It is NOT necessary that the midwife know each skill.
- If the midwife has an interest in any skill, they should ask their client to teach or show them.
- About 34 weeks, the midwife should help the client (only if necessary) create a skills-based Birth Plan…a simple list of the skills the woman and partner/other will use during their baby’s birth.
- The midwife should explain these specific situations when the skills should be used:
- As soon as labour starts and not to wait until it gets tough. The earlier skills are used the more deeply they will be used when birth becomes challenging.
- If labour moves toward an unplanned Caesarean, the skills should be encouraged to use while being prepped and in surgery, as a way to stay engaged and focused on the working with the baby’s birth journey.
- If an elective Caesarean is planned, the midwife should encourage the family to still prepare their pregnant body to become a birthing body. The Mind knows there will be a non-labouring c-section but the body is preparing for labour. This means women and men can still get the rush of preparing for their baby’s birth and remain more connected. They should also learn the birth and birth-coaching skills, then use them on the way to hospital (their labour), while being prepped (their transition) and the surgery (their birth).
- During the birth the family should constantly be encouraged to use their skills and praised when they do.
- If a different midwife is present she can read in the notes what skills the family has learned.
- If secondary care providers are present they can read in the notes and encourage and praise families to use their skills.
- After the birth there should be a debrief of the conventional Birth Plan as well as how the family felt about how well they used their skills and how they can improve next birth.
This simple protocol means that quickly and across the board New Zealand can shift from an exclusive “delivery of service/choice” system to a “delivery of service/choice+skills” system. Knowing that families are more engaged and involved because they possess simple skills changes childbirth for the positive.
Expected Results of Simple Protocol
- 20-30% of all expectant families will be eager to self-learn skills. “Something we can do at home for ourselves.”
- No midwife will be able to determine which woman will be keen to self-learn skills.
- A skills-based approach must be offered to all pregnant women and encouraged no matter her unique situation. Every birthing woman is birthing her baby and every birthing woman can skillfully do so whether at home, in hospital, having a natural or medical birth, whether her birth plans unfold as she hoped or change dramatically, and whether she labours toward a vaginal birth and achieves that, or ends up with an unplanned Caesarean or a non-labouring Caesarean. Every midwife and secondary care provider can encourage and praise women (and their birth-coach) for the use of skills.
- Statistics will begin to change right away, but with Birthing Better there will be a split between women who learn the body skills but do not do the Internal Work and those who do both. The Internal Work significantly reduces the need for medical intervention at second stage as well as reducing or preventing trauma to the soft tissues of the birth canal.
- Midwives and women will soon be able to tell which of the known skills-based resources being offered are the most effective in lowering the c-section and other intervention rates, as well as improving the subjective experience of birthing women.
- Men/fathers/others absolutely must be encouraged to become skilled as birth-coaches and to use those skills to help the birthing woman to use her skills. This cannot be overstated. A skilled birth-coach is an essential part of any family and how that family adjusts to and works with an expanded family. We must not leave fathers and others out of this. Fathers play an equally important role in the health of any family.
- Midwives will see many more women cope and manage, upwards to 8 out of 10 women will behave in a more skilled manner once they self-learn and are encouraged to use their skills while “doing” the birth.