Potential discrepancies between antenatal teaching and grass-root midwifery care

Ok, so as some of you know, I was in the very fortunate position to be at the birth of a friend of mine.

It was truly magical and moving, on so many levels, and yet I have come away somewhat annoyed at the midwifery system.

As a hypnobirthing instructor and a geek of all things pregnancy and birth, I had read carefully through my friend’s birth plan – nothing was out of the ordinary or seemed short-sighted in any way, which would compromise her or her baby. And yet when it came to ‘the day of action’, the direction from the hospital care left a somewhat bitter taste…here’s how the story goes…

My friend had been labouring at home,  and for the first four hours she was relaxed, focused and breathing. As the hours passed, I could see that things were progressively intensifying.

Instinctively, she ‘felt’ when she was ready to transfer to hospital. 

I could visibly see that each contraction / surge was needing much more focus and was lasting longer.

Upon arrival to hospital again, things were ramping up further, each surge become a little harder to get through… She was coping brilliantly.

To my delight, the reception area was silent and we were seen to immediately. In triage, the midwife wanted her on the bed to be examined. When I informed her that she didn’t want to be examined, we were challenged and made to feel that we were asking for a ludicrous request. 

“Everyone must be examined, otherwise how will we know how far gone she is?” -was her response. “We won’t move her to the labour ward until we know how dilated she is.” She said in another breath.

I tried to explain my background and that the antenatal community advocates that the woman has every right to decline Vaginal Examinations (VE). She huffed off to get the consultant!!

Upon his arrival, he too insisted that a VE was ‘for the best.’ We relented. [Sigh]

The good news was that she was very far along and that it was likely that baby would soon be making an appearance.

On moving to the labour ward, we spent a  ridiculous amount of time answering basic questions; answers that could have been found in the maternity notes – and in my opinion, have no place in the labour ward (what number pregnancy is this? Do you have allergies etc etc)…

Why is there no central database for this information??? They’ve had 6 months to log this in!!! [Second sigh].
While trying be helpful with the labour midwife – answering these questions as best I could – she reprimanded me for being too close to the computer monitor and asked me why I was watching her. To which I replied something along the lines of ‘It’s nicer to speak to someone up close rather than talking over a labouring woman. And that it was my natural curiousity as to why I was observing what she was doing’ – nothing else. She clearly wasn’t happy with me.

A little while later, she saw me going over the birth plan (I just wanted to refresh myself on her wishes) to which she asked me what was I reading, and could she ‘have it’. She hadn’t even bothered to look inside the maternity notes to find her copy (now I’m beginning to get frustrated and can see first-hand, outside of being in labour myself, why midwives sometimes have this bad reputation).

Our next ‘battle’ was whether my friend needed to be continually monitored. Research suggests that being monitored continuously has no increased benefit, than being monitored intermittently with a Doppler. But because of a previous C-section, should we decline ‘we might put baby at risk’. [Third sigh] Yes another conflicting message between antenatal teaching and what happens with the labour team on the ground.

So we relented again.

Within a short while, contractions were becoming quite uncomfortable for her. She was now starting to ask for pain relief. On this point, I was quite firm with her. Considering how brilliantly she had done up until this point and knowing that pain relief doesn’t always work on her, I encouraged her to try a bit longer.

But as time passed, her pleas changed and it was clear that she needed some help. But as she was so far dilated, our only option was to have her waters broken (something that I was personally worried about her having done) but as it was the only option and she really wanted some assistance we consented. [A small sigh from me].

True to the midwife’s word baby came very quickly after that and I got to witness the beautiful birth of an adorable baby – just as I teach, ‘in the most usual way’.

Now that time has passed, I have reflected on the experience.

While the antenatal community, including independent midwives, explain the choices that mums have. In reality, it comes down to the midwife on the day, her knowledge, her experience and maybe the outcomes that she has witnessed first-hand.

There are some things that I wished were different, but in reality what do I have to be annoyed at?

She had a beautiful birth, delivered a happy, calm and healthy baby. So ok, so things didn’t go according to plan… But then that’s why we’re trying to move away from calling them birth plans, but instead calling them birth preferences. 

We have to accept that we have to be flexible, as we’re just not sure, nor can we predict what will happen on the day. 

Go with the flow, use BRAINS

B – Benefits

R – Risks

A – Alternatives

I – Instinct

N – Nothing

S – Smile

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