Is midwifery still a labour of love?

Abstract

Sitting next to a woman on the tube recently, I noticed she was engrossed in an article entitled ‘Women hire own midwives after trauma of NHS births’ (Goodchild, 2012)’. At my next stop, I got the paper and perused it over the obligatory latte. It stated that London mothers are resorting to private midwives because they fear giving birth on the NHS, the reasons they gave were the rising birth rate and the shortfalls in midwives. The story also provided private midwives views on why hers and similar services are being increasingly used. She highlighted that reality shows such as ‘One Born Every Minute’ showing women being left by the midwife for long periods of time or not seeing the same midwife twice were partly to blame. I think we all understand that a women’s previous experiences can affect subsequent pregnancies and choice place of birth as well as service provider. So what is being done? Many NHS trusts provide services to support women who have had difficult or traumatic births. These services include debriefing interventions to help reduce psychological problems in the postnatal period or VBAC (vaginal birth after caesarean section) clinics to offer information and support for women who have had previous caesarean sections and who want a vaginal birth. These obviously do not go far enough to meet the needs of all women. What we may now see is a group of women in their first pregnancy who have a dread of childbirth because of other people’s experiences via reality shows. True, women have often relayed scary birth stories to me from friends and relatives giving rise to concern but they were just that, ‘stories’ which often become embellished over time. As a midwife it was usually easy to discuss these anxieties and offer appropriate support. However, women are now ‘living through’ the ups and downs of a number of births via the media, which are edited for entertainment value, and do little to allay the fears of pregnant women. A quick scan of the programme’s forum postings shows that women are shocked by some of the content, which leaves them stressed and anxious. It is clear that midwives need to be aware of the impact of these shows, rather than avoiding watching them (as a lot of us do). We should be in a position to try to explain what has happened if women ask. I hope every midwife watches these reality shows with a critical eye, again we can learn from observing care from a different perspective. Although private and NHS provision might differ, all midwives want to offer the best service they can. In the NHS, it might not be one-to-one care that midwives wish for, but women need to be able to feel they have access to a midwife whenever they need one. Better communication is fundamental, informing women about what they can expect from the NHS so they can make a decision to engage private services in light of this information. Lawrence (2012) reported that women are paying independent midwives to support them during hospital birth providing information, arguing their case and being a constant presence during labour. This raises the question of advocacy. Why might NHS midwives have lost this skill? Is it that they lack the resources, the ability to promote normal birth or fail to listen to women’s needs? Even in light of limited resources there is still a lot of good will in the NHS, only last week I heard that midwives who are experts in home birth are providing voluntary support for inexperienced midwives in an attempt to increase the service. This echoes the feelings of Cathy Warwick CBE, General Secretary of the Royal College of Midwives, who stated that great work is being done by midwives in relation to increasing home and water birth figures (Dabrowski, 2011). Has midwifery changed so much that the NHS cannot provide women with the care and support they need or have women’s expectations changed? Either way the service needs modernising to meet these needs and this can only be done if there are adequate midwives available. It appears that women want the traditional role of the midwife back, to communicate effectively and encourage them to make their own choices. Let us make sure these are in our everyday practice and remember that midwifery will always be a labour of love regardless of who provides the service. BJM