Speaking to a New Zealand Midwife
Did you and your husband go see the Yo Yo Ma movie? Looking forward to seeing it if it’s still playing.
Been busy. My daughter in US has had serious double pneumonia and my family here has just arrived back from Bali. I’ve also had to take some time to consider what I want to say and how.
I want to approach you with thoughtfulness because midwives are very passionately sensitive about birth, their profession, the ‘system’ and feel constantly attacked.
For 20 years prior to immigrating I spoke to midwives and birth advocates globally but the concept of growing skilled birthing families for all births was dismissed aggressively.
I have also tried again and again to speak with women who work as midwives in New Zealand since I arrived in 1995 without success. I gave a 3 hour presentation at the 1996 NZCOM conference and met the same aggressive rejection as elsewhere. It wasn’t until I read The Trouble With Women that I fully understood why midwives/birth advocates rejected birth skills in such a determined manner. Both the US and New Zealand had a 20 year period of promoting birth skills yet this approach was given up and replaced by the present choice-based trend. The reason skills were rejected was directly due to what I call the Original Sin in childbirth. With the best of intentions and without understanding the unintended negative consequences 3 very dedicated male obstetricians put forward methods of skills directed to only a small portion of pregnant/birthing women … those seeking natural, pain free, non-medical births. We can discuss why this was the original sin and why now we must go back and correct the message. Once we correct the message then we can put in place the processes, actions and implement a skilled approach to all births regardless of the circumstances.
Coming forward to the present …
The maternity system New Zealand midwives and birth advocates worked so hard to create was always going to lead to what is now happening because of many confusions, conundrums, gaps and misinterpretations that have existed in the childbirth conversation since I’ve been involved … for 45 years!
Here’s a list of some of those confusions etc that were always going to lead to the issues facing childbirth today.
1) What does ‘natural’ birth actually mean?
2) Are midwives the best care provider for low risk normal pregnancy and birth or all expectant women?
3) Why do midwives offer 24/7 care when the foundation of their profession is: ‘pregnancy and birth are normal life events that rarely need medical care’?
4) And what exactly does ‘pregnancy and birth are normal life events that rarely need medical care?’ really mean?
4) Do all midwives explain their Partnership and how is the partnership put into practice by both partners?
5) What is the bias when the word ‘choice’ is used in pregnancy and birth?
6) What does it mean to the general population when a whole profession is led by a strong belief system?
7) What is the bias around the word: ‘Interventions’?
8) What does it mean when midwives see themselves as ‘non-medical’ profession?
9) Assumption women want non or less medical births.
10) Why Birth Plans and choice are confusing and were always going to fail too often
11) Why skills are essential for all families and not just for those seeking natural birth, painless labour and less medical care
With a simple tweak and an across-the-board implementation of an easy protocol, the midwifery led maternity system in New Zealand could truly lead a global revolution as shown in Andrea’s statistics. This simple tweak strengthens the partnership between clients and providers by treating birth as an activity for which families should be skilled as well as make choices.
Our Trust’s hope (and mine) in 2000 when Andrea Vincent decided to shift her perception and actions was simple. We knew if she followed the protocol, got her clients to become skilled that she would be able to show over a significant period of time the benefits of strengthening her partnership with her clients and show a positive statistical change.
We hoped that her statistics would motivate more of your working colleagues to come on board, quickly experience a similar positive change and want all student midwives to be taught how to implement this simple tweak in the partnership model so they could start off with a stronger partnership relationship to their clients. Instead, Andrea’s statistics have been ignored except by giving her a pat on the back.
My present questions to women in your profession are:
1) How do Andrea’s statistics get taken seriously? Seventeen years is a respectable period of time to validate ‘practice based evidence’.
2) How do we get more working midwives on board? I tried for 15 years in Nelson unsuccessfully to get a trial of both KYOM and Community midwives.
3) How do we get all midwifery students from year 1 taught how to implement this simple protocol as the specific way to strengthen the partnership ?
The response by midwives to Andrea’s statistics has been that 1) other midwives have equally good statistics which is no doubt accurate when you look at midwives who take on very specific self-selecting clients. However, Andrea’s clients are general population. Her success is an easy to replicate protocol rather than her being a better midwife or her clients special. 2) midwives are too busy and have no time to do anything more. Andrea gets her clients to do more 3) midwives can’t fit the concept of a skilled birthing population into the midwifery ideology. Since the late 1970s the childbirth trend has been based exclusively on Women’s choices 4) midwives honestly believe that there is no way in hell that there are a universal set of skills usable by all expectant families, every type of birth.
To highlight what I’ve just said, some months ago someone suggested I contact Heather Muriwai. We corresponded for a short time. She completed her correspondence with the below comments. They pretty much reiterate what I’ve just said and what I have heard by thousands of midwives around the world since the late 1970s. This time, however, I decided to create a two table document (Attached) highlighting individuality and commonality.
My practice statistics are comparable and in some areas better than Andreas as many of my colleagues are. We consider these normal- not exceptional. The care involved and the results gained are no more than any woman should have. I do not believe that any form of mandatory protocols would be advantageous. We have enough of those already don’t you agree? As each woman has different needs and wants from her midwife, there are the midwives who can provide this. It is not a one size fits all.
I sent the attached document to Heather but she did not respond.
Her choice not to respond is typical of how women who work as midwives have responded for the past 45 years. Andrea is exceptional. She has changed the course of childbirth and this can be simply achieved throughout the country. The first step is to acknowledge that we all have both individuality and commonality. Second step is to realise that our present ‘choice-based’ system cannot alone achieve: 1) more normal births 2) better birth satisfaction in every birth 3) reduction of rising maternity costs 4) more delighted midwives and obstetricians. Third step is to see ‘birth’ as an activity all pregnant women ‘do’ and this transforming activity should be naturally associated with each pregnant woman and expectant father having a high level of skill. These skills should be self-learned and not taught by midwives or done on women by midwives.
Attached also is a letter I’ll be sending to every DHB, MOH, College of Midwives, all midwifery trainers and perhaps some MPs. You’re welcome to comment.
I understand that YOU do know your profession is at risk. You might feel as many midwives still do that their profession is constantly being attacked. Andrea and I understand the risk from another perspective which is simple. The present issues were built into the system because of the gaps, confusions, conundrums and ideology that formed the system as mentioned at the beginning … and that’s not a comprehensive list. Instead of losing the gains made since 1990, why not make a simple tweak? Andrea did and 17 years of statistics need to be regarded by someone!
I understand that you are moving away from your profession. However, you know people and my hope is always optimistic that something I say, something I do, somehow someone will begin to pay attention to this simple protocol and how quickly NZ childbirth statistics can shift. The change must come from your profession… it will not come from Women. Simply put, the partnership is weak and needs to be strengthened by the profession that created it in the first place. Yes, home birth consumers were part of that creation however they have always represented an incredibly small portion of the general population. Presently only 3.5% of births are at home.
I will not push you to speak more. I realise I come across as intense. Since the mid1990s I’ve done due diligence to explain to your profession that what midwives want globally and what NZ midwives put in place was destined to lead to exactly what is happening. We are always where we are because of what we’ve done. As Maya Angalou said: ‘Do the best you can until you know better. Then when you know better, do better.’
If anything makes sense then I hope you’ll take steps to at least encourage others in your profession to meet with me and Andrea and start to organize
In the talk I gave in November 2016 I used specific quotes from The Trouble with Women (The history of Parent’s Centre0 and Women’s Business (The history of NZ midwifery rom 1980s-2010). These quotes specifically highlight the gaps, conundrums, confusions, misinformation and belief systems that have led us to where we are now. The solution is simple as Andrea’s statistics show. Getting women in your profession to be willing to put in place such a simple change has proven absolutely impossible since the 1970s … no kidding! I’m still trying.
And there are more. We are where we are because we’ve done what we’ve done. Andrea is where she is because she changed what she was thinking, saying and doing. Someone has to listen surely.
Anyway, take care and thank you for this opportunity.
NOTE: You … Yes, YOU … do not need to be a New Zealand midwife to help grow a Self-learning Skilled Birthing population. Reach out and let’s talk. Together we can change how all pregnant families approach their coming birth and how birth and coaching skills are used in ALL births without exception …. [email protected]