In the US birth staff used to be exclusively obstetrical nurses. Now there are Nurse Midwives. In most other modern countries Nurse Midwives have always been the staff attending. As mentioned in earlier posts, home birth has also been an option in many modern countries within their health system. In the US where 50 States make their own laws, midwives (both nurse and lay midwives) have fought hard and long for recognition and a place in the health system both in and out of hospital.
The fight birth staff have endured often comes down to who delivers the baby. Along with that fight has been a desire for pregnant women to see the same birth professional throughout pregnancy, during birth and if possible after the birth for a few weeks. This is ‘continuity of care’ sought for by so many pregnant women. Birth staff have fought for independence so they can offer continuity of care and deliver babies. Staff midwives have often fought for the right to attend home births and then continue care if the woman transfers. They have also wanted to be trained directly as midwives rather than become nurses first. Within the profession, there has been heated debate over this issue … is a midwife different from a nurse? Does a midwife need nurse training in order to be professionally competent?
When we look at birth staff from their professional point of view, many women attending births want more ‘choices’. And many pregnant women want birth staff to also have more choices. While many pregnant women want to be attended by an obstetrician others would like a midwife.
Birth staff also work on shift. For birthing women this can be either good or bad. If they haven’t liked the nurse midwife or obstetrical nurse attending them they are often relieved when the shift changes hoping for a more compatible person. On the other hand if they’ve liked the person on shift having them leave, adjusting to new people can be disruptive.
From a birth staff viewpoint, some nurse midwives and obstetrical nurses like to work shift because this provides order in their own lives. Others would like to have independent clients and offer continuity of care and some would like to offer home birth care where not available.
Whether an obstetrical nurse or nurse midwife both are highly skilled birth professionals quite capable of delivering babies. These dedicated birth professionals can exist within both a primary or secondary care system. These two systems are a bit confusing. Primary care can be defined as working with pregnant or birthing women who are low risk while secondary care kicks in when there are higher risks. Primary care can also be the continuity of care pregnant women would like regardless of risk assessment.
Maternity systems in modern countries vary, choices by birth staff vary as well as does payment for services. Regardless of the system, birth staff are well educated and highly skilled and quite capable of attending births and delivering babies. Their field of expertise ends when complex medical procedures are required such as a Caesarean. The choice for birth staff to perform other medical procedures is left to the State or Country to decide. The skill of birth staff is sometimes not reflected in their legal ability to do certain things. This has been the basis for much of the legal fight.
When we shift our perspective from the choices and skills of birth staff to the choices and skills that birthing women and their partner/family/other make is a whole other issue. It is this interface where the Choice-based and Skills-based childbirth trend can easily lead to very different maternity systems.
Our human mind has the ability to imagine. We can imagine how much more difficult it is for skilled staff to work with unskilled clients compared to working with skilled ones. This is true for any field or occupation. Skilled clients might not prevent some problems yet other problems can be prevented. Being a skilled birthing woman will not prevent genetic defects, may not prevent premature births or the complexity of delivering triplets. Being a skilled birthing woman will not prevent having heart problems or lupus and may not prevent high blood pressure or carrying herpes. This does not mean that these women should be unskilled. In fact the reverse is true. Birth skills give women with health issues (baby or themselves) the ability to rise above these issues as they skillfully work through the birthing process. Skills give power when problems are involved. Being able to do something makes for a better experience even when a high level of health attention is necessary.
For birth staff working with skilled birth women can improve the chances of women birthing better not hindered by the fear and tension experienced by so many unskilled women. Birth staff know very well how unskilled birthing women require more medical care and intervention.
Working with skilled women improves everyone’s attitude, inspires more people and reduces the stress and fatigue that comes from attending unskilled women who appear to ‘suffer’. have high needs and increased medical intervention that could easily have been prevented by better preparation (meaning … skills). Birth staff know that the high rate of epidurals and Caesareans does have something to do with unskilled women who just get tired, can’t get on with their labor, freak out and can’t cope.
Working with unskilled women who have a long list of ‘choices’ they want and sometimes demand gets even more challenging for birth staff. Staff working in maternity are too often faced with Birth Plans that are complex and unrealistic. Birth Plans can seem picky with each choice placed at equal value. Birth Plans can be confusing. When women want or don’t want something unless ‘deemed medical necessary’ birth staff know this is a recipe for argument during the birth and emotional repercussions after the birth (that the staff will not be party to but they know it happens all the time).
In the US during the initial Skills-based childbirth trend of the 1960s/70s birth staff attended millions upon millions upon millions of skilled birthing women with both medical problems and not, who abided by the standards of care deemed necessary for all women and who lacked ‘choice’. This meant birth staff saw skills not wrapped up with Birth Plans. What will Birth Plans look like if we put in place a more mature Skills-based approach to all pregnancies and every birth? The one thing we hope is that families will present their birth staff with a Skills-based Birth Plan along with their conventional one. Skilled families can show birth staff what skills they will be using and birth staff can continue to encourage those skills throughout the birthing process.
Let’s shift our focus to fathers/others who come into contact with birth staff. Our imagination helps here as well. As a birth staff member would you rather work with a father/other who doesn’t have a clue what his role is, stands around, looks dazed, tries to stay out of your way and may seem to disappoint the birthing woman or would you like to work with a skilled coaching dad who really is engaged in helping his birthing partner work through the energetics of giving birth. Which choice would you make? Skilled or unskilled? While this might seem like a no-brainer. The Choice-based childbirth trend has so severely shifted the role of fathers/others that some people now think fathers should NOT be involved with birth. This is crazy. We just need a Skills-based approach to all pregnancies and every birth.
What stops us from implementing a Skills-based childbirth trend? Curiously, birth staff are the front line and would more than likely support this trend. They are sick and tired of seeing birth not be the wonderful experience it can be. They become hardened to Birth Plans that are unrealistic and women who fight from ideology while behaving poorly. Yes, birth staff are the ones who will tell you whether the majority of birthing women are coping well with the experience or getting through it. When asked most birth staff now give this answer to the question; ‘how many skilled birthing women and men do you see?’ The response is pretty consistent every where. ‘1 in 10 to 20 women are skilled, many more do not cope well and most just get through and are glad its over’. There are very few birth staff who consistently get to work with skilled families. Had birth staff been asked in the 1960s/70s their response would have been very different. They would have said: ‘7 or 8 out of 10 women are using skills and about that number of fathers to a greater or lesser degree’.
Birth staff are committed to birth and they want mothers and fathers/others to have the very best experience. However, they do not see women during pregnancy and cannot advocate for a Skills-based approach to pregnancy and childbirth.
Birth staff are profoundly impacted by how society views pregnancy and childbirth. They know the difference between choice and skills. Like most people involved with birth, they would probably like those two concepts to work together. At the same time, they know full well that when confronted with no choice, the unexpected, choices that go against desire that skills can soften the experience and improve it.
As members of society, let’s not forget birth staff. Let’s bring more skills into every birth.