Call the Midwife PART 2: The Midwife Approach
This is the follow-up to my first post. That one walks through what midwifery care may look like and what it provides. This post talks about how a midwife's attitude towards birth might differ from the common fears and tensions that surround the topic.
Feel free to skip through the sections:
WHAT IS A MIDWIFE?
Read Call the Midwife Part 1, here.
THE MIDWIFE APPROACH
Birth is normal
Beginning to end
A DIFFERENT APPROACH TO HEALTHCARE
Midwifery care may seem different from the traditional medical system. That’s because it is! There are some basic tenets and beliefs that guide the way midwives practice. They differ from region to region, but can roughly be categorized into: birth is normal, and you should probably be making the decisions.
A common response I sense from people after I give my answer to what midwives do, is:
“oh, that’s seems simple”.
“You make birth sound like not a bloody-disaster-in-the-making”.
What, we don’t make a big deal out of pregnancy? But…isn’t it dangerous?
Don’t we need to be careful of a million things?
BIRTH, A PHYSIOLOGIC PROCESS
"Birth is natural" can be a loaded concept. While clinical and cultural opinions may differ, midwives hold the belief that “for the majority of women, pregnancy and childbirth are physiological events”.
This means: your body was built to do this, and you’re not ill, even though you’re vomiting all day. This doesn’t mean: everyone can for sure do this and we don’t need modern medicine intervening. It does mean: let’s start this off trusting and respecting our bodies, and give it the best chance to do what it can. Then, we take it from there one step at a time.
The ICM’s scope of practice also outlines that:
“midwives should be competent in all means of supporting the physiology of childbirth. Women should have access to midwifery-led care, one-to-one support, including the choice of a home birth and immersion in water”.
This leads us to where normal and choice intersect.
CHOICE OF BIRTHPLACE
Following the thread of birth is normal and let’s give it a chance to be normal until proven not, a part of facilitating physiologic birth is the choice of birthplace. People with healthy pregnancies can choose to have their baby at home, the hospital, or, the birth centre. Being in a place of comfort, safety, and low distraction, wherever that may be for you, is the best place for labour to start and progress. For some, calm is where all the emergency equipment is right down the hall. For others, it is being as far away from those bright fluorescent lights as possible, in their own dimly lit home.
Scrap the choice of birthplace, you get a choice in everything!
We may recommend something, or strongly recommend something, or strongly recommend something. We’ll make our case for it, but respect that we don’t have an authority to “tell you what to do”. As with everything in the world of childbirth, this is also a loaded topic with some contrasting views. I have never had someone choose against a strongly made recommendation, at least not without such good reasons that would be enough to make any specialist shrug their shoulders and say “well, we don’t really know about that”. and acknowledge you as the primary decision-maker.
We may recommend something, or strongly recommend something, or strongly strongly strongly recommend something. We’ll make our case for it, but respect that we don’t have an authority to “tell you what to do”. As with everything in the world of childbirth, this is also a loaded topic with some contrasting views. I have never had someone choose against a strongly made recommendation, at least not without such good reasons that would be enough to make any specialist shrug their shoulders and say “well, we don’t really know about that”.
As always, if you don’t know what decision to make, that’s fine too! You could always decide to follow the community standards, but now you know why, and what you have chosen.
CONTINUITY OF CARE
Continuity of care is the one-stop-shop concept. Midwives are there all the way: for the pregnancy, labour, birth, and postpartum - together, a full course of care. It’s a part of a client-centred approach. Why separate the pregnancy, birth, and early postpartum periods when it is a complete event in itself, flowing from one phase to the next? It also means the care you need follows you. You don’t need to find a paediatrician for your baby two days after they are born and your emotions are running high on milk-producing hormones.
In some cases, this also means having the same midwife or the same group of midwives for the entire course of care. This is called caseload midwifery. It can be helpful when you make that labour call in the middle of the night to hear a familiar voice.
And there you go! At the end of this, your family grows and your midwives get some sleep. Until next time.
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