Last year I have to admit to getting quite despondent about midwifery and how I worked with women. I felt I was giving 110% to the women in my care, being passionate about continuity of care, informed choice and all the other features of partnership between pregnant women and midwives. But it didn't seem to matter what I said and did, women chose to have epidurals, induction of labour and so on. I seemed to loose my connection with women. What happened to the days when I worked alongside women in their homes and hospital to achieve a low intervention birth. I seemed to turn from being a hands-on midwife to a nurse, doing nothing but fiddle with machines. Don't get me wrong, I have nothing against medical intervention for women who need it. And the reason I believe epidural and induction of labour is problematic for women who have no indication for it is that it increases their chances of having instrumental births, cesarean section and all the connotations of that. But it had seemed so long since I had 'fought the fight' so to speak, with women who wanted to do it on their own and considered birth to be a natural event that they took in their stride without any great drama. What happened to women's fortitude?!!
Now, I know I'm going to get lots of comments from women telling me to get stuffed and that they should have their epidural if they want them. And yes, I quite agree. In fact, my question is: does it matter if women end up having an epidural? Does that make me any less of a midwife? Does my high epidural rate reflect on my practice as a midwife? Am I a 'bad' midwife because my alternative measures do not work, and by that I mean things like supporting women to labour at home as long as possible; keeping them upright and mobile; getting them to use water for analgesia. Who am I to say that women should not have their babies when they want them to fit in with their life plans? If they do not mind that cesarean section can be the outcome of induction of labour, why should it matter to me? After all, what's wrong with having a cesarean section?
I have come across a couple of references that show if women have an attitude where they are more likely to accept medical intervention, then they are more likely to have an assisted birth.
Have Women Become More Willing to Accept Obstetric Interventions and Does This Relate to Mode of Birth? Data from a Prospective Study. Green & Baston (2007), Birth, 34 (1), 6–13.
Hulst van der, L.A.M., et al. (2004) Does a pregnant woman's intended place of birth influence her attitudes towards and occurrence of obstetric interventions? Birth, 31: 28-33.
In some ways, this research has been reassuring because it emphasizes that childbirth is not all about me. Doh, you say, it's taken you nearly 30 years to come to that conclusion? No, I have always known that. What it allows me to do is be able to step back and take a more objective view of my role - to put boundaries around my practice, which in turn will guide my reflection and keep me safe from burnout. Yes, as a midwife I walk alongside women, pointing out the way. But ultimately, women are responsible for the decisions they make and I cannot wear their shoes for them.