jane Sandall wrote:
> 
> I completely agree with the comments below from AIMS about shortages of
> midwives. When I did research into Burnout in a national sample of
> Midwives in the UK, the most important predictors of burnout were long
> working hours and low job control.Snip>>>
> Qualitative work also indicated that midwives who were working in teams,
> in both hospital and community who shared a caseload found the work gave
> them little feelings of accomplishment, because they never got to know
> women. The team system depersonalised midwives to women and vice versa,
> and the midwives felt they had little control over how they organised
> their work. Snip>>>>
> I think what we are seeing is the result of midwives disillusionment
> with what has happened following changing childbirth. Midwives are still
> low paid, maternity care is becoming increasingly dominated by obstetric
> intervention and attempts to provide real personal care or continuity of
> carer and midwife led care have been meanly or under resourced.
Snip>>>
> I'm not sure how low we have to go, or what tragedies have to happen
> before this issue gets tackeled?
>  --
> Dr Jane Sandall

I don't want to sound pessimistic, as I always try to look for solutions
but having been in the profession of pain relief since 1949, I am not
optimistic that we can produce change head on. Many years ago I changed
my focus when I realised that much of my patient's chronic pain was
resisting
treatment because it was due to social causes rather than disease or
trauma.

>From my observations, and those of countless midwives, doulas and
mothers
who communicate with me, most interventions, labor pain etc., are due to 
social conditions and virtually nothing to do with inherent genetic,
bacterial,
physical abnormality or inablity of the mother to birth a healthy infant
without
undue discomfort and distress. Indeed there is considerable evidence
that a natural birth has the potential to give extreme pleasure.
I know there are many instances where this appears not to be so, but I
am referring to the popululation as a whole.

The core of the problem seems to me in the manner in which
establishments
continue to rear, and educate mainly males with the desperate need to
control and dominate. I can understand why they do so, but this is not
the forum to
discuss the why's and wherefores of the traditional medical model
of resisting change. It is not unique to medicine, but fortunately it is
not genetic as other cultures such as the Nordic countries have shown.

The solution in my opinion is not to try and change directly, by all
means 
continue to try, but I have seen little change in the fifty years that I
have
been practising, from direct confrontation or even educating the
practitioners.
Most change
in my experience comes from competition resulting from consumer demand
following
the consumer being appraised on the benefits of a particular treatment.
(Viagra
comes to mind!) The swing towards providing better facilities in
hospitals 
for birthing mothers came about because of the wholesale departure of
many
middle class mothers to private birthing centers run by midwives. That
certainly
happened in the eighties in Hawaii and elswhere, much to the
consternation
of the orthodox medical establishment. They didn't lose any time before
so called "natural birth" was available in hospitals nationally.

The solution is to hire PR professionals or solicit women with PR
experience
who have benefited from midwifery skills to educate the public. At the
same time raise the funds and expertise to form the equivalent of the
Royal College of Surgeons etc., to provide the kind of evidence based
research, training, admittence
requirements and bestowing of certificates, degrees etc., that are
essential
for midwives to elevate their standing in society.

I don't know if midwives can convince obstreticians and regulating
authorities
that they have a unique and equally, if not more needed contribution to
the
birthing profession. But I think that it is certainly possible to
convince the 
public that midwives have the kind of skills and loving expertise that
would transform 
the experience of birthing mothers from that of a technologically
dominated 
nightmare to that of a truly natural experience.
Rayner Garner
The Nurturing Center


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