what a midwifery model of care could look like ... a strengthened partnership
DESCRIPTION
New Zealand put in place a Midwifery Model of Care in 1990. Everything birth and midwifery advocates wanted has been the maternity system in New Zealand. What was hoped for: more natural births (or physiological births), more choice, informed consent, respect for pregnant women, continuity of care, a partnership model with primary care midwives, primary care midwives who continue care when secondary care is necessary ... great system. What could possible not work out? Simple ... the partnership model is weak and ineffective. The result ... a rise from 12.9% to 30% of caesareans since, more complaints against midwives and the unexpected ... women 'choosing' elective cesarean births and epidurals for pain relief. We can have a strong partnership in maternity care only if we grow a skilled birthing population. It's a wonderful idea to believe a woman should choose what she wants at her birth. It's a great idea to know what a woman wants from her birth provider. However, there is absolutely NO societal expectation that families bring a good set of skills to their birth. Why is this important? Birth choices are not always available. Choices often change. Choices have to be for 'saying no' to medical care and 'saying yes' to more medical care than necessary. Choices are varied and many so which ones are really important to a woman? It's great if women are informed and respected. Sometimes a woman is being respected but doesn't appreciate it. Some women are informed, make decisions that they regret months later. Very, very few women have the birth they 'want' or 'plan' but instead have the birth they have. We use terms like 'having a baby' or 'giving birth'. Instead we need to say 'you are going to 'do' your birth'. Doing your birth occurs over time. Skills are what you use to fill your time of doing your birth. Skills are what you do to cope with both the internal and external sensations or situation. Andrea talks about how she strengthened her partnership with her general population clients. Clients know they will create a Birth Plan about what they 'want' and what they 'expect' of her as a birth provider. Clients are expected to learn birth and coaching skills and use them.TRANSCRIPT
Strengthening Partnership
thru Birth Skills
Achieving a better balance
Midwives & Magic:Beliefs & customs concerning motherhood still
survive....There was a belief that a midwife had certain
powers which enabled her, in an emergency to arrive in time for the birth....
....One story was told of how a young husband went, at night, to fetch the midwife who was in bed. She told him to go home and that she would be with the wife in time for the birth.
He returned by the shortest route. When he reached home he found the midwife at her post. Asked how she had travelled she replied that the broomstick was still the best method of transport.
Evening Post: 15 Sept 1938
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Here’s how I saw it ....
Choice:Making ‘choices as the only
expectation for taking responsibility puts unnecessary pressure on all birth practitioners to ‘provide’ outcomes based on ‘choices’.
2000....women weren’t choosing what I would have chosen!
Supporting choiceAs midwives we support women’s choice…What we didn’t expect is that they wouldn’t necessarily choose what we would
bringing skills to birth:
Pink kit - Hypnobirthing - Active birth -
Birth Information – there is an abundance of.
Facts however are not actions.
Choice of Birth – too often changes...but then what?Skills are always with you...give
you the know how & adapt to every situation.
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Andrea
Suzi
It took time to…..
stop trying to improve normal birth outcomes
wake up to if women and partners, take skills to birth they self reduce intervention
see with more positive birth experiences, there are many happy side effects only one of which is more normal births
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InternalWork
Massaging the vaginal wall muscles laterally and posteriorly in preparation for childbirth. It does not just involve the perineum.
Objectives: To create more space in the mid pelvis and outlet.To create less tension in the vaginal and perineal tissue.To increase women’s knowledge and confidence to deal with second stage.
Internal massage
Faster second stagesLess forcep and ventouseDecreased incidence of perineal
traumaLess fetal compromise.Less psychological trauma for
women.
Factor that inhibit expulsive breathing in second stage:
• Tension inside birth canal i.e. unable to relax soft tissue
• Baby a bit snug and inner tissue stretching
• Leaning forward and bending the baby’s passage
• closing off the bottom of sacrum by sitting on it
• lying in an anti-gravity position (side & back)
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AndreaSuzi
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Emergency Caesareans
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Andrea
Suzi
Epidurals for AnalgesiaEpidurals
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%Suzi
Andrea
Nelson Hospital
Every pregnant woman deserves the skills to know how to birth
Every expectant father deserves the skills to help his pregnant partner give birth
Birth will happen whether you have skills or not.
Skills give you the cutting edge ability to do the activity of giving birth well and in every situation.
YOUR BABY DESERVES YOUR SKILLS
Skilfully working with your baby’s effort to be born will give you wonderful birth memories and free you to immediately parent with confidence.
(Wintergreen – Director – Commonknowledge Trust / Pink Kit)
You have the control & choice to relax and reduce tension:
The conscious tightening in response to pain
The unconscious tension not in awareness until pointed out
The structural tension of soft tissue which affects pelvic bone mobility
The stretching tension caused by baby stretching soft tissue
SKILLSusing skills throughout women will
self-reduce all interventions! Skills homeopathy
Shiastu acupressure acupuncture TENS massage water
PethidineEntonoxEpidural
Why Dad’s should be hands on:
• Men’s greatest fear is being laughed at/made a fool of.
• At time of birth – men experience highest oxytocin level – so best window for making an emotional connection with baby
• if father involved in child’s life for first year = more likely to stay involved for rest of life
• 80% of prison inmates have absent fathers
The Happy Side-effects: For Midwives
Skills = common languageCommon language = less stress over which midwifeSharing skills=more balanced partnershipSkilled birth population =supports midwivesLess negative feed-back
What did your mothers tell you about birth?
Using the pelvic clock between contractions softens the pelvic inlet allowing a stuck baby to again move thru the birth passage.
Optimal birth space within our birthing body...Soften & Open
• Hip lifts = more room side to side
• Sacral Manoeuvre = to move bottom of sacrum out
• Kates Cat = maintain sacral mobility
• Letting down reflex relaxation = anterior lip
• Thai massage = assist baby into pelvis
