Monday, October 12, 2009

When a decision about who to trust must be made

The young mother who I will call Jenny had booked a private midwife as well as being booked at a public hospital birth centre in Melbourne. As the pregnancy progressed, Jenny's plan for homebirth became clearer in her mind, and she retained her booking at the hospital as a backup arrangement.

A couple of days after reaching 37 weeks' gestation Jenny found that her waters had broken. It was a small trickle of clear fluid initially, and it continued to flow. Jenny called her private midwife. Labour had not commenced; Jenny was well; and her baby gave plenty of reassuring kicks, so there was no cause for concern. She had an appointment scheduled at the birth centre that day, and presented at the desk. The midwife who she spoke to was busy and distracted, and asked Jenny if she would perhaps like to come back later.

"Well actually my waters have broken", Jenny said.
"Oh, well you'll need to go and have monitoring" was the reply. Jenny was given instructions on where she needed to go.

A midwife applied the straps of the CTG monitor around Jenny's belly, and was walking away when Jenny asked, "Could you please tell me what this is about?"

"Oh sure!" (as though it was unusual that a woman would want to understand what was being done to her)


Jenny then went back to the birth centre with a report that her baby was happy, and a strip of monitor paper to prove it.

"This is your first baby, and you're not in labour. You've got 24 hours (to use the birth centre). After that you will be moved around to the delivery room for an induction of labour. If you're not in labour by 7 tomorrow morning you will be induced. And here's an antibiotic tablet to take at midnight. It might stop you from getting infected."

The midwife's tone was dismissive, fatalistic. Jenny felt gutted, and alone. Her partner had not been able to go with her to the birth centre, and she really missed him at that point. The implied message, as far as she was concerned, was that she had already been written off. There was no discussion of options, of evidence supporting this course of action, or even of anything Jenny could do to encourage the onset of labour.


It was after 4pm when Jenny returned to her home and phoned her private midwife.

"You need to decide now who to trust, Jenny. Me, or the hospital. I am going to offer you an alternative plan, which is quite different from the plan that has been offered by the hospital."

Jenny's midwife reassured her that spontaneous onset of labour was very possible; that homebirth was a very real option.

"I want you to go for a walk with your partner when he comes home. I want you to try to let go of all the anxiety and fear. Have a good dinner, and get yourselves off to bed. You will need plenty of energy for the work ahead of you. Call me in the morning and we'll talk about the next step. Call me at any time if you are worried, or if your labour is strong," her midwife explained. "And I don't want you to take that antibiotic. I don't want to mask any signs of infection, if that were happening, which is very unlikely," she added.

Jenny was awake and working hard by three, in good labour, and her midwife was asked to come at about 6am. At 7am her partner called the birth centre to let them know that Jenny would not be wanting an induction of labour. Their beautiful baby was in her arms later that morning.

To download a review of current evidence and guidance on Pre-labour Rupture of Membranes, go to Maternity Coalition's INFOSHEETS.

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