One-to-one midwifery care means different things to different people.
Some take it to mean one-to-one care throughout the whole pregnancy, labour and postnatal period. This is obviously ideal but not practical in all settings or possible; there is usually a back-up midwife who can take over care where the named midwife is not available for any kind of reasons.
Some parents-to-be come into the hospital in labour under the illusion that they will only have one midwife, not understanding the shift patterns or that midwives need breaks. Some think this is not proper one-to-one labour care as parents have to meet and form new relationships with strangers but I would like to argue that it can actually be of benefit to get a new midwife into the mix; either to reiterate what has been advised already or to come in with new energy or ideas to help the woman in her labour.
Some midwives can just walk into a room and say a few poignant phrases and pieces of advice that where there was whaling and disillusion within a few contractions there is calm and ‘yes! I can do this’ spirit. This is maybe a little of an extreme example but I do find that often there is a benefit to have a fresh midwife take over labour care at the end of a long shift, especially if midwife has not had a proper break.
Where one-on-one care really makes a difference is where the women have supportive partners and birth partners who understands that labour is not an illness but more of a quest that the woman has to go thru. Those partners give encouragement, they make the environment nice with music and lighting, take them for walks, gives them cuddles and kisses, they rub their back /feet /cramps /hands /scalp /shoulders, ensure they hydrate, take snacks and shield them from the world making them feel safe. If this is in place, it doesn’t really matter who the midwife is.
Reading this http://talkbirth.me/2012/03/28/birth-pause/ has put words to my own observations that had not yet become thoughts. “Birth Pause” sounds very poignant and relevant to what happens when a baby’s birth goes smooth and linear.
As a midwife I try always to check with mums-to-be if they want baby delivered onto their lower abdomen, most do and some want them wiped beforehand. Additionally baby stays there for at least a minute if active management has been chosen for birthing the placenta, which allows for the birth pause. But maybe to leave baby there in future, even once cord is cut instead of moving baby towards the breast would allow the mum to further inhale and exhale until she is ready herself to reach for her new baby (we are all different and our birth pauses will differ in timing for each individual and for each birth). This happens quite naturally when physiological management is chosen, as there is no reason for me to be moving baby unless asked or cord is short.
Additionally babies are known to crawl by reflex to the breast, this I have seen and it is quite amazing! So my new mantra will be “leave baby be for birth pause”.
I have found in my practice that things come in three to make me reflect on my practice, this time it is the use of fetal scalp electrodes (FSE) – the lesser of evil perhaps than rushing labour with an instrumental delivery because the fetal heart cannot be heard properly or at all.
I was in three delivery rooms today of three quite varied cases and reasons. First the woman whom I was caring for; initially loss of contact on the continuous electronic fetal monitoring (EFM) due to the position of the woman who was standing in second stage labour. A clear case for FSE so that woman could continue to labour in the position that suited her. In my opinion it was felt that the doctor was being too trigger happy to deliver the baby as baby came out in excellent condition following a ventouse delivery which in turn had required a small episiotomy cut. The fetal cord bloods taken showed that this baby was not a distressed baby at all.
The second delivery I attended was when I answered an emergency bell. Fetal heart rate was not being heard at all on the EFM as very small and the baby was actually coming down the birthcanal. It had apparently been hard to get a good trace throughout, so again a clear case for an FSE due to the difficulty of the EFM. Again a ventouse delivery and episiotomy possibly unnessesary as baby came out in excellent condition.
The third delivery I attended happened very quickly and as there was a lot of very loud screeming I thought I should see if the midwife needed some help in calming this very distressed woman. In this particular case there was no need for a FSE but had it gone slower then maybe it would have been justifiable, as there really wasn’t much of a trace to go on as it were.
The failure to use them is probably due to a history of not enough equipment in general and a continued lack of all equipment actually offering FSE monitoring. Because of this we are in general not very good at siting them, and in my experience it becomes a very stressful intervention due to the need to run around finding and puzzling together the equipment needed, but I think it may be time to address this issue to improve to the practice in the unit, maybe it would reduce what seems to be unnessesary instrumental interventions. The lesser of two evils I think perhaps.
- more accurate fetal monitoring help make better clinical decisions (rather than make them blindly)
- active positions for mother can be encouraged as there will be no loss of contact when secured
- infection risk to both baby and mother
Check out the following trailer and promo documentary on childbirth!
A beautifully written ode, published on my mother’s birthday (very fitting I think); http://motherrevolution.wordpress.com/2012/03/12/before-i-was-a-mother-revolution/
Beautiful Birth Movie. – watch this truly wonderful water birth!
I thought I might have posted more blogs than this in my first weeks but had some gruelling hours and then just needed to switch off for a few days. My batteries are now recharged and thinking back to my long hours what stands out is a waterbirth I attended and a disagreement. I will tell you about the waterbirth as the disagreement is rather a sad and uncomfortable affair.
This first-time mother had been in for an assessment at 13.00 in the evening and she was sent home as in early labour. Arriving back again at 20.00 she was again assessed and she was now in established labour and 4-5 cm dilated. She started using the gas & air and had no plan for her birth, happy to go with the flow. Showing her the room where she would labour and birth in, and further discussing her option she was keen to try hydrotherapy (the waterpool). After entering the pool she first became very relaxed and then started to contract strongly. She requested for stronger pain relief and decided on having an epidural but she didn’t want to get out of the pool. So she stayed in the pool. Half an hour later she was involutary pushing, that is at 23.15. Decision was made to examine her early but for me to just visit the ladies room and grab a snack beforehand. I suspected she was probably close to delivery hence it was important to be ready on all fronts. I only got as far as to sit on the toilet seat when I heard the student shouting in the corridor – Vertex visible! Well I quickly finished and ran back to the room and sure enough vertex was not only visible, baby’s head was nearly crowning. We all got ready and baby delivered within 20 mins. Baby did it’s little swim and was then handed to mum in great condition. The tears and laughter of both mother and father were so heart-warming! There was kisses, hugs and hand squeezes all round.
I love to see all that emotion that the birth of a child brings to the new parents, it often brings me a little tear of joy myself. Speaking to very experienced midwives with more than 20 years experience they say this never changes. As another friend of mine would express it – We are truly blessed!