Sunday, May 6, 2012

Reflecting on yesterday's webinar

great artwork from our girl!
Yesterday, 5 May, was International Midwives' Day, and I was very pleased to participate in a global webinar organised by Sarah Stewart, and hosted by the Otago Polytechnic University in New Zealand.  Click here for the program, and to find links to the recordings of all the sessions.

I heard most of the first 10 hours of program, which continued through the night; 24 hours in all.  My mind was overloaded when I stopped.  I look forward to listening to other presentations.

Through the night I found myself churning through what I consider to be idealistic midwifery. This matter concerned me as I listened to some of the presentations, and as I engaged with others in the 'comment' function by which participants were able to type in questions or comments.  I could not help comparing the situation of under-resourced independent midwives in Pakistan, with what I know of Australian independent midwifery.

Idealistic midwifery presents the woman as someone who will achieve whatever she chooses, whatever she really wants, if she goes about it the right way.  The idealistic midwife seems to believe in a perfect world, where women have a goddess status, where there are no regulatory or societal boundaries, and where the woman's choice is the only important issue.

A necessary by-product of idealistic midwifery seems to be the demonising of hospitals, doctors, medical interventions, and anything else that I might have referred to as 'Plan B'. 

I cannot accept the setting of the bar so high.  I accept that there will be some who need more than I as the midwife can offer.

The world in which we live and work has expectations of medical management.  There are many reasons why some women feel the need to give birth in hospital, to accept medical analgesics or antibiotics or IV fluids, or induction of labour or active management of the third stage.  I cannot appoint myself as judge and jury for each case.  I must respect that these are the result of mainstream care practices, leading to care decisions made by these women and their midwife or doctor.  When a woman in my care agrees that transfer to hospital is appropriate, the processes we must go through will be different from those at the woman's home, and so they should be.

The midwife in a primary care setting today, whether it's in Melbourne or in a developing country, has the opportunity to prepare women to accept the birthing work of their bodies, and to use their own natural resources to the best of their ability.  'Plan A' is essentially the same, across time and culture.  Women give birth spontaneously today the same way as our ancestor-mothers did hundreds of years ago.

'Plan B' is totally different for midwives and mothers in different parts of the world and different times.  It's a matter of availability of resources and emergency medical care.  While in my practice I can refer a woman to a well staffed and equipped, modern obstetric hospital where a team of highly trained and supported experts will address whatever the emerging complication or condition is, my sister-midwives in less well resourced parts of the world will face a very different 'Plan B'.  My friend who is working as a midwife with MSF in Africa has told me she had never imagined as many dead babies or dead mothers as she has seen in that place.

Idealistic midwifery ignores the fact that illness and infection and complication can strike down even the fittest and strongest among us.  Idealistic midwifery fails to notice that even people who eat well and exercise can become ill.  Idealistic midwifery forgets that the midwife's primary goal is the wellbeing and safety of mother and child.  Not natural birth, wonderful as that is; or drug-free birthing, or any other standard we might aim for.

Ideals are great.  Where there are no ideals, no vision, the prevailing culture can quickly over-ride, and principles be forgotten.  But ideals must be tempered with realism.  Life is often best when we can accept being 'good enough', doing our best with what we have, rather than being disappointed that we don't achieve perfection.
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