Monday, 23 September 2019

Handmaidens of the hospital birth machine - No More

The emotional work of being with women is immense and what we see and come to embody is that birth is now a battle ground, leaving bruised, battered and traumatised women in its wake, with many midwives the witness or the handmaids of the hospital birth machine
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I walk into the Panopticon, affectionally known as the fishbowl, the central area in the birthing unit where a bank of monitors line the walls, each one displaying a fetal heart rate and her/his mother's contractions as part of the fetal surveillance tactics of modern obstetric care. Despite the evidence that these tracings called CTG's - cardiotocographs - don't change fetal/newborn outcomes; lead to more and more interventions and harpoon women to beds, restricting their movements and compromising their ability to find comfort, every woman in the place is hooked up to one of these 'machines that go ping'.

I could be in any birthing unit in a tertiary referral hospital in the country and what I've described above is what I'd see.

Birthing is not a relaxed, happy event in a medically dominated, fragmented care system.

I was wondering 'was it ever?'

The correct answer is probably not. Certainly not in major teaching hospitals. Perhaps yes in small country hospitals, where everyone knew everyone. Many of these small hospitals have been closed over the last ten to twenty years.

Birthing women have been ignored, dismissed, controlled and managed ever since hospitals became the norm.  There is something very weird about healthy women bringing babies into the world in places where sick people go to be cared for and healed or die. Intervention in the birthing process has been accelerating in the last few decades.  More and more women are emerging from their childbearing experiences shocked and traumatised.

That's one hell of a start to mothering a defenceless, needy brand new human!

The identification of unexpected and preventable events that influence mortality is a key indicator of the safety of health care for those who access the services. When interventions to reduce these events are not utilised, or health providers don't have the skills to use them, it's called 'failure to rescue'.  'Failure to rescue' as an outcome indicator identifies hospital characteristics as a potent contributor to adverse outcomes. What does 'failure to rescue' mean for midwifery care and maternity services?   Marie Hastings-Tolsma and Anna Nolte have written an excellent paper, reconceptualising 'failure to rescue' in midwifery. In considering the importance of protecting labouring women from encountering an adverse event, the authors ask "What processes are in place to prevent unnecessary interventions for low-risk women and thus, promote normal birth processes?"  

The authors continue: 
The ability to provide ‘watchful waiting’ is typically eroded by the culture of the hospital setting. Such restriction contributes to failing to rescue where women seek care which promotes normal childbirth.

None of us are prepared to put up with this situation any longer. Things have to change.

What's different now is that we are more aware, we are more educated and we have more knowledge abour our physiology and what conditions help physiology to work in an optimal way.  We expect to be treated with respect and care to be given with our best interests at heart.

We also have the evidence.

The evidence says that relationship based care is the best; that knowing your midwife reduces complications, increases the normal birth rate and supports successful breastfeeding.

At the ICM ICM Africa Regional Conference ICM President@FrankaCadee left us with a strong parting message in her welcome address that “the hand that rock the cradle should also rock the boat.” The time is now for midwives, we cannot keep silent and ‘behave’! 

No more tinkering with and disrupting women's physiology!

Women don't have their brains bathed with natural oxytocin 'the love hormone' during labour and birth when they're being induced with artificial hormones

Women birthing in hospitals don't get pronurturance - care at birth associated with lowered rates of postpartum haemorrhage and improved rates of succcessful breastfeeding and more settled, happier babies - hospital protocols get in the way!

Midwives are stressed, burnt out and depressed by their sense of powerlessness and what they see happening to women on a daily basis in the health care system.

Dr Liz Newnham says the Time for Midwifery is Now and provides the following suggestions:
  • The truth is out there
  • Call out obstetric discourse
  • Speak truth to power
  • Refuse to participate
  • Support birth physiology
  • Prioritise relationship
  • Association #Strongertogether

    And our ICM President has the last word ....


Catherine Bell said...

hear hear!

Anonymous said...

Women can and should do their due diligence,learn all they can to prepare adequately for birthing. Come from a place of informed collaboration with your midwife.
No one can determine the path of every birth, but knowledge is power. Learn what the rates of interventions are for local hospitals. Where possible plan a home birth, know the risks and understand your own risk tolerance.
23 years ago after 2 c sections (we did what we could to have home births) I was delighted to have a VBAC for baby #3. I had one!! Stitch for my 9 lb 4 oz natural birth. We did attend hospital due to 2 sections, but they were doing admission and discharge paperwork at the same time. Got to hospital and baby arrived 2 contractions later. I had jokingly said to the midwife that we weren't going this time till the head was out.
It was a personal victory that I savour even today.
Women need to do what they can to get the birth they want. My path is not for everyone.
I read 22 books, talked to Mom's at La Leche League, spoke to midwives, read the 5 year report on births for hospitals in my province, found the money for the fees before midwifery was legal here, made sure my husband was on the same page.
We do not have to be at the mercy of a system that was never designed to deal properly with healthy birthing.

Thinkbirth said...

Thanks for sharing your inspiring and exciting experience clever woman! I love that you still savour that personal victory on a daily basis - that delicious sense of accomplishment is an evolutionary reward - like the runner's high - extending and mastering ourselves takes effort, determination and preparation - our reward is feeling good. Sadly, too many women are being robbed of that elation. Great recommendations from you for women who read these words. How do we entice women to read them and ponder the significance of what you have written?

Dr Robyn Thompson said...

Thank Goodness for YOU FRANKA. I walk your path, strong and confident with decades of Midwifery experience.

I am tortured every day by the information that Wonderful Women feed back to me in the traumatic wake of their Systemised, Medicalised, Victimised experience in the Centralised, Institutionalised, ILLNESS MODEL of Obstetric and Midwifery care.

Institutions run by Accountants based on turn over and the dollar, supported by Medicine for the same reason. Women's bodies abused without any understanding of the abuse of Routine Procedures.

Traumatised Women discharged 24 hours after major abdominal surgery that in many cases on review may have been prevented. Women struggling with the aftermath of damage from epidural/spinal - procedures over an hour, leaking CSF associated with severe headaches, rushed to the OR for Section and blood patch. A woman in a wheelchair, spinal cord damaged by Regional Anaesthesia.

Since political male decision to centralise Women into institutions in order to close community services, to save costs, the Essence of Midwifery Services is void. That is the ultimate we can provide for Women who give birth to and care for for future generations. Women who go unrecognised and unpaid with a reasonable income for their 24/7 work for weeks, months and years.

A desperate return to One-Midwife-One-Woman for a Woman's entire journey from Pregnancy right through to at least 6 postnatal weeks, more if necessary is required to stop the chronic and dangerous abuse of Women, their bodies and their babies.

The life-time emotional, mental and physical trauma that Women experience and Midwives know can be avoided, if a Woman is respected for her self knowledge, her confidence is respected and encouraged, she is not coerced by fear, Consent is obtained to the letter of the Law, her Rights are explained, she is informed about the side effects of drugs, she is informed about the research in relation to procedures and pathology requests. Most of all she is supported by her Midwife. To be well informed about the LAW, their Rights a major advantage in reducing the unnecessary interventions that have continued to incline unchecked since Institutional Centralisation.

IMAGINE the reduction in comparable costs for the Taxpayer and the Public and Private system costs.

As I age, this Midwife longs for the opportunity to return to the privileged life a Midwife. To fill that void I am fortunate to be able to continue to provide as much information as I possible can for Women . The aim is for Women to be confident in having the knowledge to be able to ask questions. To be strong, confident primary decision makers in the absence of the smaller percentage of Women who do require assistance in the presence of urgent or emergency situations of course.

Thank you so much for the opportunity to respond and thank you again Franka.

Unknown said...

The medicalisation of birth is about one thing and one thing and the acquisition of more of it. They care not about women, babies or midwives.