Last Saturday, 11 May, was International Nurses Day, so take a bow all you nurses out there. I wrote in one of my early blogs of my background as a nurse and my appreciation of the work nurses do, but today I want to take that further and give my attention to midwives. Again, in the interests of probity I declare a self interest: after completing my general nursing training, I qualified as a midwife at the Royal Women's Hospital in Melbourne!
Midwifery seems to be flavour of the month on TV at present as Call the Midwife and One Born Every Minute are both screening at present. It is interesting to see these as a historical contrast with work in the East End of London in the 1950s where most deliveries were at home with limited facilities compared with hospital deliveries in the current period. As the series of Call the Midwife has progressed, however, more births have occurred in hospital settings. In both series, the stars of the delivery rooms (along with the mothers and babies) have been the midwives as they prepare the mother for birth and encourage and monitor her and the baby along the way. And in return they have the privilege of being present at one of nature's special events, over and over again.
It is not my intention to take a position on home births compared with hospital births as I think in the current Australian context this is an area with entrenched, and sometimes fanatical, views for and against so that neither side really listens to the other and neither seems to be prepared to come to any sort of agreement on what might be possible. Birth is a natural process that women have been experiencing for as long as humans have existed, but it is not always safe for either mothers or babies. We have all heard the tales of women giving birth in the fields and then resuming their work but I don't think this is what most women want.
I think most women want to be supported, nurtured and guided through the process of birth and for that reason, in most cultures, birth has been women's business and often particular women have specialised in giving this support to others. These women were self taught, learning 'on the job' by observation. Some may have been quite effective in what they could do but there was a high rate of maternal and infant mortality. The modern practice of midwifery grew out of this support for women, taking advantage of the advances of nursing care and medical knowledge that have come about since the mid-Nineteenth Century. For many years they attended home deliveries because few people could afford hospital care, but with the growth of universal health care they are now more likely to work in hospitals although where hospital care is not readily available, they continue to work in the community.
I took some money and clothes collected from some of our families when I visited a clinic in Bali, Bumi Sehat, run by an American midwife, Ibu Robin Lim, who has a program of antenatal care for women in the local villages. If the pregnancy is straight forward, when the baby is due, the women come to the clinic and the baby is delivered as gently and calmly as possible in clean environment. The parents stay for a couple of nights with their new baby ensuring that the mother is able to feed the child before returning to the village. This centre is training midwives to continue and extend the work. If there are likely to be complications with the birth, the mother is transported to hospital, but this is a last resort as the cost to families is prohibitive. The clinic has been very effective in reducing the maternal and infant death rate.
Midwives run antenatal clinics in hospitals and then attend the births although it is usual for the doctor to actually deliver the baby. As One Born Every Minute shows, the presence of an experienced midwife is greatly appreciated by the women in labour and their families, as the midwife is able to answer questions and reassure them all as well as guiding the labour and monitoring mother and baby. Observing the differences in the series from the UK and the USA it is apparent in the latter that the woman is much more active in labour, moving around, perhaps using the bath and generally using as many natural methods as possible to get relief from the discomfort and pain. In the American hospital the women seem to be more passive and tend to have epidural relief almost as a matter of course...different countries, different approaches!
Midwives, you do a great job, and women everywhere should salute you!