Time and Numbers...

I am not entirely sure why I called this post what I did... I guess that both of these things have become pressing in my life in recent weeks and I cannot seem to separate myself from them as much as I try to.

After stepping into this course in 2006 and thinking that 3 years would take forever to pass, I have been rudely awakened to the fact that time goes faster the further that you proceed into life. I have decisions to make, and fairly big ones at that, as to what I am going to do next year. Ideally I would love to become independent and not constrained by the system and politics but there are obviously the realities of finances and social aspects of my life that I have to consider.

I have options and I am going to keep them open because I know all too well that planning months, weeks or even days ahead is pointless as time has it that things can change and do change in an instant.

The most positive thing is that I am well on my way to completing the requirements of the course and will not be impeded in anyway by the 'numbers'. As much as I hate saying that word, it is a reality that at the end of it all, it has become about a number on a piece of paper. Nevermind that these numbers are women and families who have needs and wants and a wish to be respected. It is one of the most awkward of things to be asked - 'what number am I?' by a woman in labour and even harder to try and take away the focus of it being as such. Unfortunately, it is a result of the way this course is structured and the high demands they place on us. At the same time I whinge about it, I am glad that the numbers are higher than they have been in previous years because I am feeling better prepared and more able to step out with at least some confidence in my judgement and abilities.

And then there is the race against time... If something unforeseeable happens and I don't get my numbers its going to impact on what decision I make in the short term. Seems fitting in that the entire concept of that race is a constant element of birth and the length of time that a woman is allowed to birth. It is becoming less and less.

I cannot wait to finally be qualified, to make an impact on midwifery and more importantly on the women and families that I work with. I love what I do and I love the reality of the challenges that I am going to face however sucky the politics are going to be.

More equations that don't add up

Having a day off, I took myself out with the kids to do some shopping and have my coffee fix and found myself thinking about what I wrote earlier. Talk about living and breathing birth! Following on from my last post...

I made the statement that most primips, if left to gestate, will go beyond their due date. I am not yet entirely sure of all the reasons as to why this happens but I have read in places that it may have something to do with their body not ever having done it before. Obviously there is controversy as to whether or not this is true as there are many multips that go above and beyond their due date too, me being one of them. But it got me thinking anyways...

If the current trend continues, primips who reach their due date will be offered induction of labour. With or without an ideal bishop score, ripe cervix, a baby ready, the cascade will be begin. Time constraints will then impose, that is 'by this time, this will happen and if that doesn't happen then we will do this and if that fails, then we will attempt this for x amount of hours'... in the meantime, baby gets upset, distressed or completely pissed off - answer is caesarean section. If baby is happy, we continue until such time as there is some issue such as 'obstructed labour' , 'cephalopelvic disproportion' or 'failure to progress' and find our way to theatre anyways.

Or maybe its a high head, OP position or deflexed vertex, and maybe the use of forceps or a ventouse will result most likely with an episiotomy. The incline of induction rates means a greater likelihood of deviations from the norm which is inevitably going to lead to either assisted births or sections, increasing the section rate even further.

So then these primips end up with a section and when their next pregnancy comes about, they have minimal options, elective section or (cough, cough) VBAC. VBAC is certainly an option but in a system that has 'ifs' and 'buts' attached to everything, whether it remains an option will be down to whoever the woman sees on the day.

Unfortunately this is becoming the reality and women, although having an option as to what they want to do, by majority, do not realise it or believe it. And more, most place their decisions in the hands of those that do not really care about the well being or future of the particular individual but rather the convenience of booking an induction or section. It has become too difficult to give the power back to the woman and if the woman does have the power, somehow the are tainted and labelled uncooperative or radical.

Looking at it from this angle it makes sense that things are heading the way they are. What I do not understand is why women are giving into it. I know that every individual is different and varies in ideals and preferences but why is it that so few really question or seek clarification and understanding?

So here I am wanting to give the power back to women. I am confronted with a woman who by her dates is only just 40 weeks, a scan at 20 weeks suggests her dates are wrong despite her certainty. Her EDD is adjusted to suit the scan because baby is 'BIG'. On assessment, she has a bishop score of 3, head still high but nevertheless, head down, but induction is commenced regardless. What do you know, nothing happens! Discussion is had, a decision is made - C-section. Reasoning - unfavourable cervix, failed IOL, high-head, post dates (despite her only being due today based on her dates) oh and dont forget the massive baby onboard (even though she is over 6 foot and appears to have decent pelvic space). She agrees without a second thought.

Given my situation and my current role, I debate as to whether I should speak up. I realise that if there was ever time to step in and advocate for a woman it is now and I go in with the attitude that I am informing her of all her options, not just the escape route. Despite what I know, I put myself in her position and know that if someone was hanging outside of my door with choice and options, Id want them to make it known.

And so I go to her and I open her up to the options and I feel like I have fulfilled my purpose as a midwife and everything that a midwife entails...

I get shot down and feel like I am an imposition, stepping on toes and completely out of place. I walk out feeling uncomfortable not because I feel like I have said the wrong thing but because I am lost as to the reasons why anyone would not want options and choice and rather leave it in the hands of those that ''know whats best!"

I did what I felt was right and despite it not having an impact at the time, I can only hope that one day she looks back and remembers that someone was willing to stand strong and uphold her rights and autonomy. I once thought that given the opportunity to do what I did and receive the response I got, Id feel lousy, yet I feel good knowing that at least she was aware that there was a choice regardless of whether she grabbed ahold of it or not.

And so I ponder the reasons why we have become mute as humans and lack the authority and the power to make decisions based on our own choices and beliefs allowing others to abuse us and decide what is ultimately our decision.

Any comments you have in response would be thankfully accepted.

Questioning the obvious and proposing the unlikely...

Despite getting used to the occurrence of getting to work and being made aware of the amount of inductions and caesarean sections, it still gets to me. I do understand that there is a time and place in which they are needed but shockingly, the facts that Michel Odent spoke of are becoming more real and evident. I have been reflecting and addressing my frustration over this and trying to formulate some plan to change this trend particularly as I am due to take the leap next year and finally drop that infamous word 'student' from my title.

I am aware of the mass opinion that I will be up against when I finally do become registered but I am hoping that I continue on the path I have laid and stand strong and make a difference. Obviously it will be a challenge given the politics and legalities of the system but given my incessant need and want to bring birth back to what it is or in todays culture, what it should be, I will fight until the bitter end.

I have grown complete and utter despise for induction and looking back on my own experience, think myself lucky that it went reasonably smoothly. Almost every induction that I seem to witness fails or causes complications that inevitably result in a section. I am close to summing it up in my head - induction = delayed c-section. I choose my words carefully because in the delay between induction and section comes intervention. I am trying to find the words to express what I am feeling in relation to the future of this rather bold and forthright equation because I am sure that amongst the mist and the clouds, there are many that are pushing for something along the lines of - induction = c-section or worse birth = c-section.

The worrying thing for me has been the encroaching nature of the beast on length of gestation. Once upon a time it seemed safe to leave a woman to bloom until 42 weeks. Four years ago, knowing very little and being as naive as I was, I had to beg the doctors to induce me at term + 12 days. They wrote on my notes - IOL for social reasons. Now compare this to what I am seeing today

• IOL from the EXPECTED due date
• Social induction from around 38 weeks
• Failed induction due to unripe cervix (GO FIGURE!!)
• Vernix covered babies at T+ gestation (hmmm)

And thats only the start of it. Although I do not like to generalise, it seems that by majority we have lost touch with our bodies and hence when pregnancy miraculously occurs, we have no idea when we conceived, when our last menstrual period was or even care. I can understand this because sometimes the last thing I want to think about is my period and how annoying it is but what I am trying to highlight is the fact that, our bodies, our cycles, our ability to produce life, sustain it and give birth to it have become second, third, fouth, etc, to higher priorities.

I am deliberately making this point to try and justify in my minds how there always appear to question marks near or around the estimated due date. Deliberately because I want to make the point that its only an ESTIMATE!!!! Normal pregnancy gestation is 37-42 weeks, look in any text or reference and this will be clearly written, yet somewhere and somehow someone decided that that wasn't good enough. We need routine, structure, a timetable!

As far as I can gather the EDC or EDD was only created to give them woman some insight as to when labour may start. I dont think it was ever meant to be THE be all and end all OR the determinant of what will or wont happen. So unfortunately this date has been manipulated in such a way that it warrants the rights of OTHERS to make a decision as to when a baby is born.

I sat up thinking about this last night with the knowledge that primips or first time mums in general will go into labour post their due date and wondered with the understanding that we have, that being that between 41-42 weeks gestation is still safe, what would happen if we shifted the EDD to equal a gestation of 41 weeks rather than 40? Come into play politics and legalities but all that aside, what would be the outcome particularly as I am aware that 40 weeks gestation is an average gestation.

Nothing much changes. There is still an EDD, there is still that date to linger on, there is still room for manipulation. The truth of the matter is, nothing in this world is set in stone, nothing is stagnant, things change. Given that as humans we manipulate and influence so much, how can we be sure that we haven't done the same on the normal gestation of pregnancy? Its obvious we have had an enormous influence on it in a surgical, medical way but I am talking more of the physiological, psychological and environmental way. If the human race has the ability to F*#$ the planet as it has and influence global warming, seasonal shift, pump hormones into the food we consume, control life as far as messing with genes and cellular bits and pieces and possibly initiate many of the natural disasters that have occured in recent years (or months!), whats to say that we haven't done the same to pregnancy, the initiation of labour, a babies' birth??

Food for thought and my need to question...

Thought for today...

I wrote this today in response to another post on our uni discussion board. For some reason it sounded good to me and reflected so much of what I have been feeling in the past two weeks and I wanted to share it...

I don't know how anyone in the position that we are as midwives, could forget how priviledged we are to be a part of the most significant moments in so many families lives. As a mother I can truly say that that single moment in your life when you birth your baby into this world and you become two separate entities, its not only the most beautiful and surreal and amazing experience (for lack of better words!!) but also the most vulnerable, scary and uncertain time because life just takes on this million mile an hour spin and in a solarity moment, your life changes forever. What happens, who is there, the things that are sad, what isn't said and everything else remains imprinted on your life, more than the actual physical act of giving birth because it seems as though we soon forget the pain and the vulnerability that we feel.

To be a part of a woman, a families and a childs experience of entering this world is an honour because not one is ever the same. The circumstances are different, the people are different, the baby is different.

We have to realise how truly priviledged we are to share the beauty of life in its purest form. Its something I cherish and have at the forefront of my mind because without these women and families, I wouldn't be in love with what I do and be completely fulfilled and complete.

I have been showered with gifts and I am only into my second week of placement. I have 3 boxes of roses chocolates from women I have been with and to me, all I did was do what I felt was owed to them. My gift to them for allowing me to be a part of that special time in their lives. I should be the one thanking them, not vice versa.

Thought provoking reading...

I ventured onto a few other midwifery related blogs tonight, one Lisa's - definitely 'the' words that highlight, empower, rejoice and celebrate the power of a woman and her ability to birth. There is not one word, phase or story that could come from Lisa's heart that could demoralise or steal from what is a woman's right. Something that inspires me to be that midwife... the one who is in every sense, 'with women'. I can say this with confidence having not only been lucky enough to have her as my midwife, but also work alongside of her and witness and be influenced by her completeness and commitment to 'true midwifery'.

After a long week of pouring my best efforts into an assignment addressing the care of women with postpartum depression and other mental health illnesses and reading tiring journal articles and reviews that seem to overlook and totally dismiss midwives and midwifery, I needed to indulge in something midwifery.

In doing so, I came across some varied opinions of what midwifery is. Despite these coming from midwives, I was quite shocked to be confronted with almost opposing opinions... that word again... After nearly 2 and a half years you would think that I would be used to the fact that some midwives have this rather strange and deranged idea of what midwifery is (my opinion... for good measure) and yet somehow it still depresses and distresses to say it nicely.

I am lost as to how you could unjustifiably denigrate midwifery to just 'a job' or a means to an end, so to speak. Anyone who has had to opportunity to witness birth, regardless of gender, role, personality or input, would be lying if they said it wasn't one of the most emotional, amazing and fulfilling experiences they have ever been a part of. Admittedly, not all can openly confess to it whilst clouded by memories of pain, choice words, vagina and blood... take these clouds away and the beauty of the birth of a child is something that can only ever be justified by witnessing it.

Maybe its a case of 'seen one, seen them all'... however birth isn't just birth in the literal sense. Birth is what makes birth. It is not just a fragment of time, there is history and future in the making, not just for one but for many. Birth is unique; not one is the same.

And whilst I am laying out my two cents for all to see, why is it that a word such as midwifery- a neutral, empowering holistic one has managed to take on such power, indifference and control, in many instances? Maybe 'with woman' would be better changed to 'with midwife' for the majority because the most of what I have experienced has not been entirely about what the woman wants. Despite the obvious time constraints, protocols and policies in the system, there is not even enough emphasis about informing and empowering women to question and discuss their options.

Two words that kept reiterating themselves during my thought process... reciprocity and autonomy. I have experienced too much 'take' and not enough 'give'. Even the most normal and simple choices such as what a woman wears and what and when they are able to eat and drink are stripped from them. And that is not to mention the lack of consideration for privacy, dignity and respect... you would think that closing a door, pulling a curtain, covering a woman, knocking before entering and ensuring the bitching done behind the nurses station doesn't echo through the corridor to be heard by all, would be common sense. If only...

Childish behaviour has some how has grown legs and left the school yard. Time and energy that could be better spent fighting for birth, for women and for their rights.

As a student, I walk on a fine line. In many situations I have found myself pressured to do exactly the opposite of what the woman wants by midwives, registrars and consultants; to me pressure that was based on little or no indication. One such instance, the words 'infiltrate' and 'episiotomy' seem to ring in the background whilst my conscience beat them down with 'consent' and 'crowning' and 'contraction'... I stood my ground until literally removed to make way for intervention. I was fortunate enough to have a supportive midwife who up until that point placed confidence and trust in me to listen to the woman.

So I end with this, a thought provoking and real statement about who or what a midwife should be... I couldn't put it better myself so will use Lisa's words

Compromising your clients wish for a great birth isn't
our role. Keeping the space is.

To fight or conform?

I have realised over the course of these two and a bit years that it would be quite easy to fall into the monotony of the system - stay quiet, do as your told, don't argue, remain oblivious to something more. And further more, I can understand why so many do. In a world where most would rather conform to the generalised way of thinking, its rare for anyone to be outspoken and question what everyone else sees as 'normal.'

As a kid I never felt I fit in anywhere and it has only become clear to me in recent years as to why... I am not one to conform... I don't take what people tell me as gospel... I question everything, even myself and until I started this course, I did not believe that making my thoughts public would have a serious influence on anyone and more, I really didn't think that I would find a real voice for the voice I have and what I have always called, my 'alternative' way of thinking!

Midwifery has given me purpose and passion and for this reason I have chosen to fight rather than conform. That is, fight for midwifery, fight for women's rights, fight for empowerment, choice and most importantly, the power, strength and ability of a woman's body to labour and birth a child.