Regardless of how you feel about childbirth issues: home vs hospital, natural vs medical the majority of expectant families would like to have a choice of continuity and primary care midwifery EVEN if an obstetrician must also be involved with their care.
By far the vast majority of expectant families want continuity of care … to see the same person in pregnancy, during birth and afterwards. Even those people who can’t imagine such a possibility want it when explained. Pregnant women want stability and find it hard to bounce from one birth provider to another. This creates part of the fear that is so rampant in childbirth today. No birth provider can determine safety if they are only seeing a client once or twice!
Professional midwives have been part of most modern health systems except in the US until recently. Obstetrical nurses took on the role. And in many countries midwives do not have autonomy and many must have an obstetrician present at The Birth. Also most countries with midwifery care do not have continuity of care so the expectant women are seeing different midwives throughout their pregnancy, at The Birth and afterwards.
Being from New Zealand I do believe this is the only country that has an autonomous midwifery profession that provides continuity of care/primary care to all expectant families there without shared care … in other words when an obstetrician is involved the midwife continues as continuity of care/primary care. Great system … and free to consumers!
Why then has the Caesarean rate in New Zealand more than doubled since midwives became the lead maternity carers? The Caesarean rate is above 30% … as high as in most other modern countries.
Without a doubt when there is no societal expectation that expectant families become skilled then the whole system feels that lack. Unskilled birthing families have nothing to do for themselves. This means they are more likely to follow their birth providers suggestions, standards of care, trends of the day and orders. Unskilled families totally believe ‘there is nothing you can do to prepare for the birth because there is no way to know what your birth will be like’.
The midwifery profession has seen itself as the protector and promoter of ‘natural’ birth and if you’ve been reading these posts you know this was always a problematic statement. No one defined the word ‘natural’ or ‘normal’ or ‘physiological’. It is natural for a baby to die at birth. It is normal for women to tense up during painful contractions and hinder the birthing process. It is physiologically possible for a placenta to stop functioning well or separate before the birth. Natural, normal and physiological have been shifted to mean ‘easy, safe with good outcome’. And that’s not accurate.
If the midwifery profession continues to promote and protect this narrow and misleading definition of birth, then all the pregnant women with health issues can be denied continuity of care/primary care midwifery because they fall outside this promoted agenda.
If the midwifery profession continues to support women’s ‘choices’ and they are working with unskilled women then more women will choose epidurals and elective Caesareans because they fear the pain of contractions and don’t want to suffer and they can easily be persuaded that a Caesarean is safer for their baby.
If women do not understand that they can become skilled then we basically have absolutely NO control over the future of childbirth. Today it looks as though there will be a 50% Caesarean rate or higher within the next 10-20 years! Are you kidding me!
As women we have a responsibility but who tells us we need to prepare our pregnant body to become a birthing body? No one! Not even those dedicated women who work as midwives and want other women to experience as natural a birth as possible. In fact midwives actively dismiss birth skills and coaching skills because their ideological beliefs tell them birth is ‘natural’ and women don’t need to learn to birth. Nonsense. And we’ve got to wake up to the fact that by preparing our pregnant body we can learn to open it, create space, keep the inside of our container mobile and pliable and aid the descent of our baby.
As women we have a responsibility to learn birth skills and our partner/other has the responsibility to learn birth coaching skills. Birth is an activity and we must learn to work through that activity in a skillful manner. There is no possibility birth will be less medicalized if we are not skilled. Much of the medical assessments, monitoring and procedures are to prevent ‘suffering’ … women feeling out of control by the natural occurring pain of contractions.
Do you know when women experience the natural occurring pain of contractions and are NOT skilled that they think that pain signifies a ‘problem’ because pain is almost always associated with a problem at other times of life. When women and their partners are skilled they know the pain is the opening up of the cervix and is not associated with a problem unless specified by their doctor or midwife … ask either of those if there are any ‘problems’ associated with the natural occurring pain of contractions.
What’s been sad about The Choice-based childbirth trend is that pregnant women who desire continuity of care/primary care even alongside secondary or obstetrical care are less likely to ever have access to that because the profession of midwifery is so hell bent on defining birth unrealistically. The midwifery profession wants to reach out to women but presently they are only reaching out to a very small percentage of women and that’s sad.
If there were a societal expectation that all expectant families become skilled … a Skills-based childbirth trend … then midwives would have the pleasure of working with families who behave skillfully even when there is a need, standard of care, pressure to have medical care. Is the goal of the midwifery profession to not have assessments, monitoring and procedures or is it to be around empowered women no matter what is happening to or around them?
Because there is no societal expectation for a Skills-based approach to all pregnancies and every birth women do not know how they are failing themselves and failing those dedicated midwives who want to provider continuity of care and primary care. These two groups, who should have been working together, have not … because of misguided ideology.
If we go back in Time or go to traditional communities where there is no medical care, whoever attends the birth with the woman will be there no matter what. This has to now occur in modern maternity systems. We need a three tiered approach to maternity care … continuity of care and primary care midwifery care that works alongside secondary/obstetrical care who both work alongside a skilled birthing population! This three tiered approach would dramatically change childbirth. Women can prepare properly to give birth even if they are going to have a non-laboring Caesarean (just because they enjoy doing so and are encouraged to reap as much enjoyment from their pregnancy as possible). Women can learn to manage and cope well with the natural occurring pain and this will reduce their use of epidurals. Fathers/others can become the skilled birth coaches who help their birthing partners work through the 5 phases of each contraction without fear of the natural pain … it’s manageable with skills! Or it’s manageable LONGER with skills!
Midwives (and doulas and childbirth educators) can lead the way to a Skills-based approach to all pregnancies and every birth and reap the benefits of working with skilled and empowered families. They can simply do this by educating families as to the various skills-based resources available (and we hope they will mention The Pink Kit along with Lamaze, Bradley, Active Birth, Hypnobabies, Hypnobirth and any others). If they have personal clients then carry those resources and have every client choose one or more so the family can make a Skills-based Birth Plan alongside the conventional Birth Plan. Encourage families to use skills during their baby’s birth no matter how it unfolds.
In reality, it is the relationship between pregnant families and continuity/primary care midwives who are the most damaged by not having a societal expectation for a Skills-based approach to all pregnancies and every birth. Sometimes when looking back on that unique Time in US childbirth history when there was a Skills-based approach in the mid1960s/70s had this been encouraged to grow and evolve then there is no doubt midwives would probably have had more success in developing a continuity of care/primary care space in the modern maternity system.
NEXT POST: Many choices – few skills fail babies
Here’s a link. This link will be put on all the posts. Kristen has 6 kids, the last 3 are PK babies. She KNOWS about birth and is one of our affiliates. That means if you purchase The Pink Kit through her she gets a commission. Her husband Scott’s first baby was a Pink Kit experience. He’ll explain how The Pink Kit made certain he was able to become a skilled birth coach to a woman who had previously had three great births.!
Kristen’s written a time-line calendar for use of The Pink Kit. You just need to sign up to her mail list (we don’t keep a mail list) and she’ll send you the Time Line. She’s worked through both Edition #2 and #3 of The PInk Kit so she knows all it’s imperfections and la-dee-dahs past them to the skills she wants to improve for each birth. Can women and men have better births each time? Sure can! The more skilled, the more we master the experience.
http://blog.naturalbirthandbabycare.com/pink-kit-timeline-from-natural-birth-and-baby-care-com/
Please join the Movement to grow a Skills-based childbirth trend. Don’t’ let another birth go by without that family being skilled.