There is, among midwifery circles, much controversy about what birth means, how it should be attended to and what midwives should DO! So today I shall muse about midwives and their ‘doing’ and/or ‘not doing’ .
When I was trained as a midwife 30 years ago I was taught to actively manage labour within a specific time frame. There were many things I was taught to do, including observation, monitoring with manual, then electronic equipment, vaginal examinations, delivering the baby, episiotomies and suturing, and delivering the placenta with active management of the third stage, to name but a few. We had to perform a certain number of episiotomies in order to qualify (horrors) and then stitch them up, under the senior midwife’s watchful gaze and curt instructions. And while, looking back, it may have been necessary to learn most of these skills it has also took me 15 years to unlearn the compulsion to manage, control and perform interventions that are unnecessary. I have learnt to trust birth.
On the other hand, there are instances when a birthing woman may need our sound clinical observation, may need us to mobilise into taking clear action and performing interventions. Let me illustrate. Last week a mother I was assisting with her birth laboured for several hours and made no progress, while her body was urgently attempting to proceed with the labour. Transfer to hospital and closer observation revealed a baby in distress and a caesarian section was a timely intervention for both mother and baby. While this week, I helped a mum, lets call her Sarah, who had undergone a caesarian for her previous birth for dubious reasons. This time, after extensive antenatal preparation, Sarah laboured smoothly and efficiently and gave birth naturally with little assistance, lifting her beautiful boy onto her chest after he was born. The joy of self discovery and empowerment Sarah experienced was very moving.
Midwifery guidelines and protocols are there to serve midwives and women, not the other way round. A ‘Hands-Off’ approach is always better if possible. The joy of being a ‘Hands-Off’ midwife is in knowing when not to intervene and in knowing when intervention is necessary. A Hands-Off midwife trusts birth to be a spontaneous, physiological process, and her confidence in this process imparts confidence and safety to the labouring woman. It also imparts trust that the midwife will assist, consult, or transfer when the process is impeded and becomes unsafe for whatever reason.
Gentleness is sure to be victorious, even in battle, and to firmly maintain its ground. So with gentleness I can be bold, with economy I can be liberal, and in shrinking from taking precedence of others, I can become a vessel of the highest honour.