Why midwives resist a skilled birthing population?

Why midwives resist a skilled birthing population?

When The Pink Kit skills evolved in the 1970s in the US there were actually no legally recognized midwives although there were a number of ‘lay midwives’, registered nurses, GPs and Vietnam Paramedics who were attending births. In other countries, midwives were the majority of birth professionals. The majority of families who were involved in the development of these skills were giving birth in hospital, much fewer Birth Centers and even less at home with a midwife present. Obstetricians were the primary birth provider with obstetrical nurses being the staff in the hospitals.

I keep having to remind people that the majority of these early women also had perceived medical issues that required medical assessments, monitoring and procedures. Many positive changes were occurring in hospital and Birth Plans were becoming recognized as a positive involvement by the parents-to-be. Yet, on an individual basis, every family had to create their own birth experience. We focused on the birth and coaching skills that we could take into any birth …. at least feeling as though we had some control over our experience.

Without a doubt, couples who brought these skills into their birth regardless of the situation had much better personal experiences. They didn’t necessarily the skills stopped the medical assessments, monitoring or even procedures but they did feel they had much more control in how they handled each contraction and each breath. The couples also loved working together.

Certainly all the birth professionals in the 1970s benefited from the skills these several hundreds of families brought to their birth. However, these several hundreds of families did not have the same birth professional nor birthed in the same hospital or even the same town or State which meant individual providers didn’t see a large group of families who shared these skills in common. Most often birth providers, whether obstetricians, staff nurse/midwife or midwife just believed the woman had a ‘good birth, easy birth or lucky one.’ We knew that wasn’t true however no one listened back then. We knew we could actually create these good, easy and lucky births. AND it wasn’t rocket science just common knowledge.

Most birth providers believed and still do that there is no way you can plan for what your birth will be like because it’s so unknown. We knew that wasn’t true really. Sure you never know what your birth will be like however, we can know how we will respond to labour as it unfolds.

We knew that preparing our body truly helped us to open to let our baby out. We absolutely knew that all the skills we learned and used about breathing, relaxation, communication and knowing how to work with our baby’s efforts made a huge difference in how we responded to birth pains. We also knew that we handled the assessments, monitoring and procedures better and when birth plans changed we continued using our skills so we weren’t left with so much blame, shame and guilt.

Back in the 1970s I certainly tried to explain this to anyone who was interested in listening. I’m still doing that. What was curious back then and has remained totally fascinating has been the total lack of interest in growing a skilled birthing population by the general midwifery community and even the natural birth movement.

We knew that Obstetricians and staff obstetrical nurses and even staff midwives didn’t have much interest. Obstetricians rightly didn’t see birth preparation as their field and truly didn’t care whether a woman freaked out from birth pain or coped with it. This didn’t make them bad men or women, it was like asking an auto mechanic if they truly cared whether a person was a good driver.

We understood that rostered staff didn’t have much continuity of care with pregnant women or even with women in labour therefore it was very difficult for them to see birth skills as meaningful.

However, the many families who were working with midwives were always surprised by their lack of interest. From the family’s viewpoint they believed their preparation was going to make the midwife’s job easier Wasn’t having a good, straight forward birth at home less liable to attract negative attention? This meant the midwife was actually protected by the responsibility the couples took.

Also when the couple had to transfer to hospital, they took their skills and rarely were disappointed by their birth just because they moved into hospital from home. They never felt they had a ‘failed home birth’ instead had made a choice to go to hospital and continued to use their skills successfully.

Yesterday I received an email from Andrea who has collected Pink Kit statistics for seven years. She works in an area of New Zealand where there are 1000 births/year. She is local, been a midwife for 25 years and highly regarded. She also sits on the National Midwifery Council. You can see the PowerPoint presentation she and Suzie gave last year at their National Conference. She’s certainly been telling people what it’s been like to grow a skilled birthing population within her personal practice.

Common Knowledge Trust certainly would never have collected statistics since our goal is for all couples to have positive birth experiences in all births rather than try to reduce medical care or promote ‘natural’ birth instead of ‘birth.’ Birth is birth and we are all entitled to a positive birth experience. Besides it’s fun and enjoyable to prepare for birth and have a great set of skills.

So, Andrea has been trying, trying and trying to get her professional organization to grow a skilled birthing population in NZ. Afterall over 85% of all pregnant women are attended by their own midwife whether they birth at home or hospital yet under midwifery care the c/s rate has more than doubled. So, there is lots of discussion within her profession about how to reduce the caesarean rate.

This is what Andrea wrote: She and I discuss this issue. Andrea spoke to the head of the Maternity Unit in the local hospital (still continuity of midwifery care for women).

Hmmm trying to find some words of encouragement for you…probably not the week to ask me. I really don’t know what the sticking point is and have just had this conversation with X at the hospital. Everyone loves the concept, totally agree with women and their partners being more skilled…and there it ends. I said to X – ‘geez I really understand Wintergreen’s frustration’..7 years now they have looked at their stat’s and cringed at the C/S rate ..they fiddle around trying to make the numbers look better without ever attempting to change anything.

Now this is Andrea’s comments about the local situation. She then goes on to say:

The National bodies ..we havent had a meeting since March but have got one this week ..so we will see. There theme at the moment is get more primary units up and running which will reduce the intervention…not if the practitioners take the same fear driven practise and women lacking skills!!

The primary units that Andrea is speaking about would not offer epidurals. Of course, if we remove inductions of labour, augmentations, pain relief, forceps/ventoose, caesareans then we can reduce all the interventions. But that’s never been what Pink Kit families have wanted.

With primary units, (sort of like Birth Centers) women will have the ‘choice’ but all be sent into the secondary units if there are perceived problems (Why not take good skills with you?). In fact, families who want increased availability to medical ‘if necessary’ will not use the primary units. (Doesn’t it make sense to have every pregnant woman know birth skills and her partner have coaching skills so the primary units will be more successful because there is a skilled birthing population using them?)

So, more of us are fascinated why women who work as midwives just can’t actively get behind growing a skilled birthing population. You’d think they’d be right behind consumers having great birth and coaching skills for both midwifery and obstetricial births.

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