Sunday, February 15, 2015

i'm a crappy midwife (doula)

so. i'm not a very good midwife.

one of my criticisms as a student midwife was in terms of the quality of labour support i provided.

i can be hands on, provide massage, and comfort. but it's probably not my strong suite.
i'd rather women hire a doula for this.

as a midwife i'm there for clinical support. doulas don't have this responsibility.
they can make judgements without having the responsibility of clinical outcomes.

don't get me wrong, when it comes to the support i provide for women. i can be a fierce defender and protector. i will go out on a limb for the women i serve.
this might be more prenatally, postnatally. and even during labour.
i won't force women into anything.

but i'm probably not the best person if a women needs to be coddled.

i also don't have a lot of women who get epidurals. even though i attend some births in a hospital and have access easily to analgesia i'm not going to run and get women pain relief just because they've asked for it.

i'll be with them. taking every pain as they come, helping them through. encouraging them. because when they've gotten to that point, the baby is usually soon to follow.

i feel when birth is uninterrupted and working, it's best if it's left alone.

michel odent has said that it's best if men are left out of the birth space.

i say it's best if all clinical practitioners are left out of the birth space. whether that be a midwife, GP, or obstetrician. even nurses.

birth works best if it's not monitored.

if labour is not progressing, that is when clinical care comes in.

i've come to tell all my first time moms to expect labour to be 24hrs.
they must sleep when they first start to feel the pains,
they should ignore them, until they can no longer do so.
deny labour until all they can say is, "fuck. this hurts".

this weekend i had the privilege of attending a birth in which for generations were present.

i was paged at 9am that her waters had gone.
she wasn't having any pains.
she was GBS negative.
there was nothing for me to do, but wait.
i would meet her the next day to do an NST if labour hadn't begun.
baby was moving, fluid was clear. she was content.

i checked in with her at 430pm. she was having regular contractions, she had napped.
labour had started.
we made a plan to meet at the birth centre at 8pm.

when we met, her pains were stronger. more regular. she was coping
her kookum and mother came with her.
her kookum thought it was too early for her to be there. she had had 10 babies, had 34 grandchildren. 19 grand babies. the woman knew what she was talking about.

i checked the mother. 3cm, cervix was thin, baby was in the pelvis.
i was happy.

i told her to go home.

we know that it takes the longest to get to 6cm.
i can't see any point for me to be in a woman's space before 6cm.

unless she needs my support.

i told her to go home and to touch base in 4 hrs.
i said she could call me in an hour, we could meet in four. we could meet whenever.
anything she wanted.
i said she could stay if she wanted, but i told her to go home.

4.5hrs later she called.
there was a shift in her voice. she wanted to meet.

a half hour later we met. she was about 5cm.
she was feeling pains in her back and hips and baby felt posterior.
i had her lay on her left hand side.

i had to do some other work. she had so many people for support, she didn't need me.

about 45 min later she wanted to use the gas and air.
and 30 min later she was feeling nauseas and went to the bathroom.
she was sick.
she started feeling a tonne of pressure.

i checked her there and she was 8cm.

she moved from the toilet to the tub.
45 min later she held her sweet baby boy in her arms.

this was her first baby.
she trusted herself.
she trusted her body.
she moved from place to place when she wanted.

she didn't need me.

the next day everyone who came to visit asked if i was the one who delivered the baby.
my answer was the same.
no she did.
i was just there on the other side.

in most cases, this is what i see.
i tell women to go home, or if they are planning to have their babies in the city, to find somewhere there to go until they reach the point that they can't be home any longer.

i find that when women hear this, do this. they are in tune with their bodies and arrive just when they need to be.

most labours don't need clinical monitoring.
if i'm there for clinical support, then i don't need to be there.

if labours are not progressing smoothly, as we'd expect. there is definitely more for me to do throughout. i might have to work harder to help a baby turn. help a mother relax. and sometimes that means a women may need therapeutic relief. it might mean they need augmentation with medication to help their labour progress.

i'm glad that i can be the person to do this. i can monitor the effectiveness and not push medications.
not force pushing.

sometimes a women just needs to be locked in a bathroom and left alone.

this is why i say i'm a crappy midwife.
because  ultimately, i think it's best if i'm not there.

i know that some midwives pride themselves on their labour support. and don't think women need a doula.

i'd rather a women have a doula. and me be asleep on the couch until she needs me.

i'm learning that women aren't disappointed to go home after being checked. but that most often then not, they need that check in. i'm definitely there if a woman needs me. and like i said i will fiercely fight to protect that sacred space of birth and the mother-baby dyad. i won't jump to get an epidural, just because it's asked for. but i'm also not great at being 12- 36hrs of emotional and physical support. not when at the end of it i need to be present and alert.

i don't actually think i'm a crappy midwife.
but i also don't think of myself as someone who is best suited for labour support.
for better or worse.
it seems to be working.