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Saturday, October 17, 2009

International Midwifery

October 17, 2009

Should start keeping track of the date.

So new horizons forced by unfortunate occurrences have brought me back to the UK and to Manchester. I quite sad to have left Shell and her (our) mommas, but I hope that when I return I'll be able to support them throughout their labour and birth. I always cry.

I've been seeking connections with midwives here, joined the forums and been in contact with some local women involved in maternity care. It has been a slow start, but I'm still adjusting to my new time zone which has been harder than usual to do. Last night was a wonderful break through. I was connected with a women from AIMS (Association for the Improvement of Maternity Services) by a local NHS midwife (independent at heart). Both are great contacts to make.

I suppose my position and interest here has changed or expanded a bit to research international maternity services. I'm being given this wonderful opportunity to experience first hand how midwifery is practiced in very different settings.

My first experience of course was in The Gambia. Quite a shocking one at that. Whether that was typical or not, I'm not sure, But I have a feeling that an on-call midwife is the way it goes. The hospital itself did not have a midwife on staff, but it seemed as though there was a repository from which they could draw. I believe most women gave birth in the local clinics at home, and if they were anything like the birth I witnessed, they included the use of induction (and in my opinion completely needlessly and purely to speed up labour rather than to get it going - but what do I know? It was by first birth and I was sent out of the room to get towels when the drugs were administered).

Then there were the hospital births at home which occurred without access to midwives. One a planned c-section the other a super-fast hypnobirthing mom, who laboured all by herself beautifully, showing up at the hospital fully dialated. Need to take a step back from those. The fact that there was no access to midwifery care in these instances is what is important.

My first real experience with midwives and to me initiation into the birthing "profession" was in Phoenix. While both in Regina and Phoenix there is a strong birthing and natural parenting community, there are significantly more midwives in Phoenix. Of course, we have the population difference. There are Certified Nurse Midwives (CNM) and Certified Professional Midwives (CPM) work somewhat laterally with each other. I can not say together, although a new partnership is in the works which will do wonders for bridging that gap and hopefully dissolving that hierarchy.

The CNM is the direction Canada is going and represent the majority of the NHS system here in the UK. This is where we must look to if we want to understand the pros and cons of community practices run by a group (ranging in size from 5-6 to more commonly 10-11 CNM's). Based on the forums I've been reading and the discussion I had last night, the concept of normal birth is being dissolved. Many midwives no longer facilitate unmedicated noninterventive births, due to volume and policy. This begs the question of malpractice insurance for midwives and how that changes their practice (a topic for another post).

Returning the community practices and the number of midwives that consequently are involved with a single woman's pregnancy continuity of care is sacrificed. This single factor alone is what sets a women up for a successful birth and what should define midwifery itself. If we've lost one-on-one care then are midwives any different than OB's? If you can not promise a women that you will be at her birth, how can she trust that she will be supported? A women should be able to chose her caregiver. This sentiment is lost. After the conversation last night, I discovered that although women do have the right to chose a midwife to care for her from within a community practice that right is not exercised, usually do to not being informed of that right.

What I have gotten out of my short time here so far is that the NHS model of midwifery is not one for the rest of the world to base themselves upon. They are fast moving away from evidence based care and traditional midwifery is being threatened.

My questions have expanded to include woman's thoughts on birth, their preferences and their experiences. Also included in this is the care providers perspectives, their beliefs, their practice and their restrictions.

I'm blessed with support on this path from new friends. Lets see where I am taken.



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