Filosofofofy

Midwifery isn't what you think. It isn't shouting "PUSH!" at the top of your voice and watching with satisfaction as the woman turns purple. It's not wandering in, smiling in a vague yet caring way, catching a baby and wandering out again. It's more than this. Sometimes, it's less than this. But through the profession runs the philosophy of woman-centred care, and that informs and influences everything we do.

We advocate for her. The doctors banging on the door because labour has gone on too long and they want to get in with their forceps and drag the baby out? "NO!" we say, as long as mum and baby are doing fine. Drugs to augment her contractions being prescribed when what she really needs is a sandwich and a walk up and down the corridoors to get things going? "NO!", we say, and get her up and moving. We try to ensure that any intervention is justified and needed, not simply being done because that's what's always been done. We keep up to date on research so we can be ready to support the decisions our women make. We don't tell the woman what to do - we give her all the information she needs so she can CHOOSE what to do. We sit with her through labour, not doing much, but being vigilant for signs that things aren't OK. If we're good, we make her feel like she can do anything - if we're bad we can start off a cycle of resentment and fear that leads to a c-section, or postnatal depression, or simply the uncomfortable feeling of a job badly done. Midwife means "with woman" and that's what we should be, all the time.

Obviously, it doesn't always happen. Our efforts may be obstructed by "old-school" midwives, who still think of women as patients, who think of birth as dangerous, who think that they know best and that the womans own intimate knowledge of her body and her life mean nothing. We may be obstructed by doctors, who are only called to complicated births and so begin to think of birth as complicated. We may be obstructed by the fact we that we are short-staffed and overworked and we just don't have the time to spend with each woman, to encourage and coax them, to talk through their fears and their hopes and their choices. Sometimes it's easier just to strap them to a monitor and pop them on a bed.

A couple of weeks on labour ward have shown me how birthng can be. What a beautiful, transforming joy it is. But I've also seen how it shouldn't be - a textbook "cascade of intervention", where the midwife starts doing things and sends the woman irretrievably down a path of more and more interference with her labour. I've seen women pushing on all fours, and being made to lie down because it's what the midwives feel more comfortable with. I've seen an unnecessray section, I've seen a cheerful first time mum who wants to do everything naturally be gradually worn down by people who just want to get her off the labour ward conveyor belt. Next time, I'll tell you all about it. But right now, I need to think. I need to firm up my own philosdophy and my own convictions. I need to remind myself that one day, I'll be making the decisions.

I'll be with woman.