Friday, January 11, 2008

Having a baby: outcome versus the journey?

Leigh raised an interesting question the other day after I posted a comment about ultrasound pregnancy scans being available as MP3 files. I was making the point that it is just another way of hooking women into necessary interventions and said that routine scans do not make any difference to birth outcomes for low risk women. Leigh's response was this:

surely its not all about outcomes.. even for a teacher.. I look at this as just an extension of the family photo, and a little way of getting excited about the new member to be..

The outcomes we are wanting are a healthy mother, baby and family. By 'healthy' I mean mental, emotional and spiritual health as well as physical health. Ultimately the two things are interconnected; the journey and the outcome. As a midwife, I feel that pregnancy and birth isn't just about the outcome but the journey as well. This is why I have supported women in the past to do things that may not have necessarily had full medical agreement; because the journey has been just as important to the women as having a live, healthy baby at the end of the day.

But ultimately, outcomes are what midwives are 'judged' on by women and families, other health professionals, the midwifery profession and society in general. It only takes one 'poor' outcome to shatter a midwife's career and life.

What do you think? If you are a midwife, what do you see as the focus of your practice? If you are a non-midwife - maybe you are a mother or father to be - what are the things that mean a lot to you when thinking about having a baby?

Image: 'curve' Per Ola Wiberg


Leigh Blackall said...

I'm not a midwife, but my wife and I are a potential client of one I guess. Here's what I would look for:

A midwife that offers advice, nurturing, and an experienced shoulder for BOTH the woman and the man.

A midwife who can teach us about caring for a baby pre and post birth.

A midwife who can build confidence in us, and help us through rough patches. (this one is quite extensive and a fine line.. lets say the baby wasn't breast feeding well.. say for example, tearing nipples and causing a lot of stress. I would want a midwife who listened to my wife's stress, stayed very close during the problem, observed, comforted, advised, and ultimately accepted the mother's choice and not pressure her into something she couldn't handle at the time). I have seen a number of midwives go hardline and compromise the trust and ultimately their holistic role.

A midwife who will be the maternal force for both the parents if need be. This force, I believe could be done by a man or a woman, but it would take a very special man.

So, I'd be looking for a holistic super person who was politically neutral, listened well, and knew who to balance everyone's emotions.

Sarah Stewart said...

Thank you for your comment, Leigh. I really enjoy hearing a view that comes not only from a non-midwife, but from a chap. What I want as a midwife isn't necessarily what a woman and family want so it is good to see other people's perspectives.

Anonymous said...

hmm interesting terminology here. I don't really know what is meant by terms like go hardline (with a negative intonation) or maternal force (with a positive intonation). They could be contradictory? I would have to tease out of this potential client what it is he means by these terms and what it is he is expecting or wants from this midwife? It is not yet clear to me and that would have the potential to set me up as a midwife to fail. If faced with these criteria in practice....I would facilitate a discussion to improve clarity for myself so I can decide if meeting this brief is possible. I think at the end of that we would have each decided whether we are going to be able to trust each other enough to enter into a woman-midwife relationship.
I vaguely get a sense this man is just not really wanting to be challenged? or perhaps feels uneasy around a relationship developing between his partner and her midwife? Does he trust his partners competence to have a relationship with a midwife and make the decisions that are best for her? Or does he not trust the midwife to care for his partner as she makes her choices? Is he envisaging some sort of conflict? and if so why? Or does he need assurance that he would be embraced, appreciated, considered and included? (Well, from a midwifery point of view... that would be up to his partner).
Help, I'm a midwife but that term maternal force has me worried - I don't identify with it...should I??? as a midwife?
Maternal force sounds like a trick I could pull out of the bag if my children were in extreme danger..? but is it useful in midwifery where competent, capable adults are just having babies - as they do....normally enough?

Sarah Stewart said...

I also think it is interesting what Leigh says about outcomes with regards to teaching. Yes, a vital part of 'teaching' is the journey the student goes on but the bottom line is the certificate at the end of the journey - that is what the student wants and that is what teachers are judged on ( and funded for)- how many students graduated; what their grades were; what levels of satisfaction came from students' satisfaction surveys; feedback from students on teachers' performance, and so on.

Anonymous said...

well they don't get the certificate without taking the journey do they? The cert just shows they have taken that journey.
The same certificate seems to take different people at different stages of their lives on hugely different journeys. Students often moan about the journey or get angry at the teachers as if they didn't know it would be a journey - but it always is. maybe we should emphasize the journey more .... but then they might not come and take the course.
When im avoiding my own study - its usually because I know it will be a journey and I'm not always wanting to go there.

Sarah Stewart said...

I just wish there could be more teleporting on this here journey!

Lorraine said...

Hi Sarah
As a midwife my focus has always been supporting women on their birth journey even if at times it goes against my own philosophy. I believe fear influences many women in their birth choices so I created a program called Birth Beyond Fear which enables women to eliminate their fears and then go on to wiser choices in their birth journey. Many of the women who have used the program are midwives themselves for they also know fear will have an impact on their birth. I am about to launch my website so hope to reach many more women and as the session is now done over the phone or Skype I hope to meet women from around the world and help them eliminate fear in their births.