Friday, December 20, 2013

The art of preserving

Some of the plum and apricot crop are preserved as jam
We had a hot day yesterday, and there was a couple of kilos of ripe plums needing to be made into jam.   While I went out to visit a postnatal mother and her baby, Noel worked on the jam.  Now we have newly filled jars to add to our stock for the year, or to give away.

This happens each year.  Sometimes a big crop, sometimes hardly any.  We use simple methods - blanching and freezing, drying, and making jam - and we know that our fruit is preserved free of chemical additives. 

My thoughts now turn to bigger issues.  As I am thinking about retirement from midwifery practice, I look for fruit, and wonder what from my professional journey is worth preserving.

I think the need to preserve knowledge and to pass on skill has always been a professional duty of midwives.  When I have read historical books written by or about midwives, I have enjoyed linking my knowledge to the knowledge of the woman who lived and worked in a different century, attending the women of her community as they gave birth to their babies.  Many women have written journals, and some who are skilled writers have published stories that have endured.  Twenty years ago, when I launched my career in private midwifery practice, the internet (wonderful worldwide web) was new and exciting.  I sensed new possibilities that the www offered.  A book in a shelf is accessible only by those who are physically able to take the book and read it.  The www is a virtual library, and everyone who can access it can benefit from it. An ordinary midwife, like me, could write her stories and present them in a way that anyone could access them.

Recently I had a conversation with a young woman who is expecting her third child.  As her second pregnancy progressed it became apparent from ultrasounds and electronic monitoring that her baby's heart was not functioning well.  This mother experienced weeks of investigations, and visits to specialists, and medication, before her baby was born.  This mother knows the anxiety and stress of a complicated, high risk pregnancy.  We agreed that, in pregnancy and birth, 'uneventful' is good. 

Midwives working in primary maternity care (private and mainstream) in places like Melbourne today usually see healthy mothers and healthy babies - whether the births occur at home or in the hospital.  But a midwife can not forget the possibility of damage or death in any birth, no matter how 'low risk' or uncomplicated it appears.  We know that healthy mothers are most likely to have healthy babies, yet it would be foolish to make some sort of guarantee, that if a mother follows a particular process of preparation, and diet, and physical activity, or state of mind, she will give birth naturally and without incident. 

Every woman is an individual, and her birthing experience is uniquely related to herself, her baby, her family and community situation at the time.   A woman who asks me to be her midwife has usually made very clear choices about her maternity care: that she intends to give birth naturally, avoiding drugs to stimulate labour or to control pain, because she believes that to be the safest way to proceed.  I agree. 

Some women have no concept of carefully informed decision-making; they seem to believe it's their right to choose a birth journey.  The feminist movement has taught them that by controlling their bodies in all areas, including reproduction, they are taking charge of their lives.  It has become common for women to claim that they have been violated in the obstetric interventions used to get their babies born.  Idealistic notions of birth, that a midwife can somehow coach a woman's breathing, or put pressure on some magical point, or manipulate the woman's pelvis, and make it all work well - these ideas may be attractive, but lack substance.  There would be no need for professional attendance if the outcomes could somehow be pre-determined.  There is a journey for each mother and baby, and the interests and wellbeing of both will either open or close doors to options as time passes.  While mainstream obstetric care might proceed quickly to surgery, the authentic midwife will guide a mother in a way that promotes normal birth if that is a reasonable option.

When looking at the epidemiological data of births in Australia, we notice trends: older mothers, more caesarean births, fewer unassisted, spontaneous births.  This is the terrain in which midwives practise for planned home birth, as well as mainstream maternity care.  Women who are giving birth at home aged at least 35 years (30%) are likely to have physical and emotional factors that relate to their age and impact on their ability to give birth in a natural physiological way. Women who have had previous caesarean birth(s) cannot pretend that the uterine scar means nothing.  Women who have been smokers for a number of years; or who are obese; or whose sugar metabolism is compromised, cannot ignore the impact of these conditions on their birthing potential.

If I could preserve one midwifery lesson today, it would be that the woman and her baby are unique, and the midwife's role includes understanding how the related sciences translate into useful knowledge for that individual mother-baby pair.

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