These are the interventions I’m going to discuss today.
IV fluids
Pharmaceuticals
Handling/overtouching
Directing
Cesareans
Episiotomies
Where did this list come from (since there are 5 episodes in this series)? They came from a question I asked to groups of New Zealand midwives in 2013/14 as our Trust ran ‘Strengthening The Partnership Model’ workshops.
New Zealand has the most amazing yet failing midwifery model of care for all expectant women. It’s amazing because every pregnant woman can choose her own ‘lead maternity carer’ (midwife mostly). Midwives are Direct Entry trained and don’t see themselves as ‘medical’.
New Zealand midwives are very loved. They give women 24/7 care throughout pregnancy, birth and 6 weeks post-partum. They come to the birth when a woman ‘wants’ and then stays no matter how long. When a woman needs Obstetrical care, the midwife remains her ‘lead maternity carer’.
Obstetrical care is free to pregnant families, choices are elevated and no matter the circumstances, a woman’s choices are respected. She can say ‘no’ at any time.
Midwives can attend women at home or hospital and move between the two. If they work in hospital, they can also have clients who birth at home.
New Zealand Midwifery Partnership is the dream come true for natural birth advocates and midwives. The profession is autonomous and runs it’s own training, accreditation and peer-review. What could go wrong or be wrong?
1) The c-section rate has risen, under a ‘choice-based’ midwifery led maternity system (97% of all expectant NZ families) from 12.9% (in 1990 when midwives became the primary maternity providers) to close to 28% by 2016.
2) Midwives are absolutely exhausted. Imagine giving 24/7 care to about 60 women/year prenatally, in birth (be there whenever a woman wants you and stay the whole time) and post-partum.
3) New Zealand women love their midwives yet are asked to do so little in this partnership. Midwives go to school for 4 years to learn skills in their role in this Partnership. Women are just asked to make ‘choices’ and to tell the midwife what they expect of them.
4) The New Zealand midwifery model is based on a philosophy about childbirth: “Pregnancy and birth are normal life events that rarely require medical care” and ‘Women know how to birth, should be left alone to discover birth and the job of the midwife is to sit in the corner and knit”.
5) New Zealand midwives like so many natural birth advocates are offended that “It’s normal and natural when pregnant to self-learn birth and coaching skills then use those skills to work through the activity of birthing your baby’”.
Put this all together. New Zealand midwives say ‘We want more natural births’. When asked: ‘What’s stopping that from happening?” the answer is: ‘Interventions”. So, in all the workshops, we made a list!