Dear Soo and list members,
Just a thought - would the discussions you are trying to set up on a
separate list work within this forum, it seems they are ideally suited?
Kind regards
Carmel Collins
Adelaide, Australia
-----Original Message-----
From: Soo Downe [mailto:[log in to unmask]]
Sent: Sunday, 3 June 2001 08:03
To: [log in to unmask]
Subject: Re: Guidelines for midwifery led care in labour
Dear Maggie,
I would be very interested in exploring your ideas
about physiological birth based on a midwifery
philosophy. This is a passion on mine, and I am trying
to set up ways of making this embodied knowledge overt
and accessible so that midwives and women can begin to
believe in it again. It seems like the idea of
salutogenesis (the generation of well-being - the
opposite of pathogenesis) may offer some solutions.
With Jane Sandall I have set up a list which is trying
to bring people together to discuss ways of finding
our about birthing within a midwifery philosophy. This
includes ways of trying to find a kind of evidence
which doesnt only work for populations, but for
individuals. If you would be interested in this,
please contact me on [log in to unmask] (this goes
for anyone else who is interested in this topic).
By the way, I am sure that Jane and Helen would agree
with you.
best wishes
Soo
--- Maggie Banks <[log in to unmask]> wrote: > Hello
list members
> I have spent the last week trying to compose a
> letter to Jane Munro & Helen Spiby, the authors of
> the Guidelines for midwifery led care in labour that
> appeared recently on the list. (I have actually lost
> their email so would appreciate this being forwarded
> to them if they are not on the list.)
>
> I wish to acknowledge the huge amount of work that
> has gone into this project but I have to admit to
> feeling very uneasy about the result. I have made an
> assumption this list is not just about resource
> sharing but also about debate and the exchange of
> ideas.
>
> To introduce myself I am a home birth midwife and
> writer in New Zealand. I have had the opportunity to
> develop a belief system around birthing that is not
> governed by obstetrics (as it was when I worked in
> the hospitals from 1969-1990). Since 1989 I have
> been taught about 'normal' birthing by the women I
> have cared for in home birth as I have gone about
> providing sole midwifery care (which is how we term
> 'midwifery led care' except it is done in continuity
> of care).
>
> The underlying theme of Jane's and Helen's
> Guidelines seems to have been to pick apart
> obstetric practice in the hope of exposing what
> midwifery care is all about, rather than looking to
> how it is that women birth; what their needs are and
> how a midwife can impact positively within the
> relationship. The issues of birth environment;
> nutrition in labour; positions in labour and birth;
> rupture of membranes; placental delivery; care of
> the newborn in the Guidelines are all worked to
> counter the negative effects of interference. If
> indeed midwives do believe in birth as a real or
> potential physiological event why is so much
> emphasis placed on gathering evidence to show
> obstetric care is detrimental to normal birthing?
> Why are the physiology; biology and sociology of
> childbirth not the focus of these Guidelines?
>
> To give a small example - the physiological means of
> assessing the unborn baby in the labour situation
> has been ignored. Instead the RCOG guidelines for
> monitoring has been adopted - a regime which will
> undoubtedly ensure that the woman is disturbed in
> the physiology of birthing. Isn't it more
> appropriate to evaluate the unborn baby's wellness
> state in a way that does not interrupt the woman in
> her labouring? The noting of a baby's movements in
> pregnancy is a well-accepted assessment of the
> unborn baby's wellness and integral to both
> midwifery and obstetric practice. The majority of
> babies whose mothers are neither sedated nor
> anaesthetized in labour continue to have periodic
> movements. This phenomenon is based on my own
> experience of nearly thirteen years of caring for
> women in spontaneous and non-medicated childbirth at
> home. My observations are supported by the
> literature that confirms the different behavioral
> states that exist in pregnancy, where healthy unborn
> babies have distinct periods of sleep and activity,
> continue to be present in labour. [1]; [2]; [3]. In
> labour, as in pregnancy, the unborn baby's movements
> are accompanied by accelerations of the baby's heart
> rate. Again, these are a sign of the baby's wellness
> and are a normal, healthy response to the normal and
> healthy stresses (not distress) of labour.[4] The
> difference between the Medical and Midwifery Models
> of Care is that the former values machinery to
> assess and verify movements of the unborn baby [5],
> [6] whereas the latter validates verbal feedback by
> the woman and/or visual or tactile observation by
> the midwife.
>
> Very simply put - if midwives do believe in
> physiological birthing, Guidelines that attempt to
> frame evidence based and appropriate practice should
> reflect activities that at best enhance the process
> or at worst do not interfere with it.
>
> I contemplated not writing and then not sending this
> posting as I am from a different birth culture than
> the obstetric environment but I was driven to do so
> for one reason. If we are quiet about such
> Guidelines that silence can be taken as tacit
> approval. While the authors have stated their
> intention not to be prescriptive, the practice
> reality so often actions such Guidelines in a
> prescriptive manner and they become standard
> practice.
>
> My thoughts are offered in the spirit of universal
> midwifery.
>
> Regards
> Maggie Banks
> website www.birthspirit.co.nz
>
>
----------------------------------------------------------------------------
----
>
> [1] Griffin RL, Caron FJ van Ciijn HP. (1985, August
> 1) Behavioral states in the human fetus during
> labor. American Journal of Obstetrics and
> Gynecology. 152 (7 Pt 1): 828-833.
>
> [2] Yarkoni S & Hobbins JC. (1987) Intrapartum fetal
> activity. Journal of Perinatal Medicine. 15 (3):
> 316-322.
>
> [3] Banks M. (2000) Home Birth Bound: Mending the
> broken weave. Hamilton: Birthspirit Books. Pp
> 98-100.
>
> [4] Rabinowitz R, Persitz E, Sadovsky E. (1983,
> January) The relation between fetal heart rate
> accelerations and fetal movements. Obstetrics and
> Gynecology. 61 (1): 16-18.
>
> [5] Maeda K, Tatsumura M, Utsu M. (1999, December)
> Analysis of fetal movements by Doppler
> actocardiogram and fetal B-mode imaging. Clinical
> Perinatology. 26(4): 829-851
>
> [6] Baser I, Johnson TR, Paine LL. (1992 July)
> Coupling of fetal movement and fetal heart rate
> accelerations as an indicator of fetal health.
> 80(1): 62-66
>
>
>
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