Churchill Livingstone 2008
It seems par ticularly ironic that just as midwives in Australia are forging ahead with continuity of care models, in the UK, the flagship of midwifery continuity (the Albany Midwifery Practice) has been closed down by King's College Hospital amidst an outcry from the local and wider community (as is clear in this and previous AIMS Journals).
This excellent book, edited by three midwives who have worked tirelessly and effectively to improve care for women, is inspirational. The preface, written by UK midwife Tricia Anderson during the last year of her life, encapsulates why a trusting relationship between the woman and her midwife is the bedrock of safe, positive birth for women and midwives. Tricia describes her epiphany: 'My epiphany came one day when I met a woman in the supermarket with a toddler who said, "Hello, don't you recognise me. You delivered James..." and I had absolutely no memory of her at all'. Tricia's poignant stories about deep engagement, listening and sharing show clearly and simply how relationships based on trust build in emotional safety for the woman which increases physical safety for mother and baby. For example, one story tells of a woman and her partner who felt so damaged by their first birth, in an institution among strangers, that they avoided antenatal care during their next three pregnancies. Meeting Tricia and establishing trust enabled them to receive care late in their fifth pregnancy, through birth and postnatally. All Tricia relates is supported by the chapter s in the rest of the book. It seems that all women and families can benefit from being cared for by a known, trusted and sensitive midwife, but for some families it is vital for them, in order to avoid damage through birth, or further damage following previous trauma or other disadvantages.
As the title suggests, this is a very practical book, covering the meanings of continuity of care and what we know and don't know about its impact on families and midwives, how to provide caseloading care and other models of continuity in urban and rural settings, what midwives need to sustain these ways of working, setting up caseloading in the community and in large maternity units, working for change with midwives and obstetricians, costing midwifery continuity models, how to better evaluate continuity of care models, and working politically for widespread change in maternity systems.
One of the problems cited in the book is that the importance of knowing and trusting a midwife has been undermined by this becoming a 'choice' issue, rather than valued as a component of safe, effective midwifery care: '...knowing would give a depth of clinical care that would enhance assessment and increase safety, not only physical safety but social safety' (p35).
Another problem is around how services are costed: 'our services are set up to only manage short term costs. The longer term implications, including less morbidity, increased breastfeeding or lower levels of distress are usually not factored into the costs of the service as these are not directly impacting on anyone's "cost centre" or budget' (p39). This lack of over view is surely anathema in a world of decreasing resources.
A further obstacle often cited is that of sustainability for midwives. Yet, what we do know suggests that appropriate caseloading is more sustainable for midwives than team midwifery models, and that this is largely to do with levels of control and autonomy, and social suppor t at work and at home.
All the chapters are fascinating, relevant and helpful. Highlights for me are the chapter by the three editors on bringing continuity of care into mainstream maternity services, and the chapter by Christine Cornwell, Roz Donnellan-Ferandez and Anne Nixon about bringing midwifery group practices into a large maternity hospital. At the time of writing, these groups were providing care for 1000 of the 4600 women, regardless of risk. It is extremely heartening to see that this can be and is being done, with excellent outcomes.
Leader ship is of course vital: 'Woven through [the] chapters are subtle and not so subtle messages about the vital role that leadership plays in making change happen, bringing people along with the change and making the changes acceptable to the majority of stakeholder s across the service' (p163). As we know well at AIMS, the value of midwifery leaders with a 'can do' philosophy cannot be over stated.
A chapter by Barbara Vernon from the Australian College of Midwives stresses the importance of being political and taking every opportunity to promote midwifery and raise awareness of its enormous potential contribution to improving public health.
The editors bring the book to a close by discussing how we can develop midwives for the future: 'We need midwives who are competent and confident with clear vision, political consciousness, energy and passion. We seek an independent and collective self-confidence that will see us through the labour of developing new systems and into the ultimate achievement of giving birth to midwives, managers, organisations and health systems that embrace midwifery continuity of care' (p 218).
Hear, hear and the sooner the better.
Palgrave Macmillan 2010
This is one of the best childbirth books I have read. Without a doubt. This is a book about what it means to be a midwife, and what it is like to be cared for by a midwife able to be truly with woman. I would recommend it to anyone and ever yone interested in making birth a wonderful and empowering experience.
Every page is filled with empowering and supportive thoughts and language and every chapter is written by someone who has inspired me, people such as Nadine Edwards, the late Tricia Anderson, Ruth Deery and Billie Hunter. This book contains a huge amount of information, yet remains an accessible read, it is well referenced and provides a huge resource for further study too.
The book opens with a thorough look at maternity services and explores the political context and the organisation of the system alongside the concepts of normality and safety. It introduces the thought that the relationship between midwife and mother should be two way and is of vital impor tance for successful care.
Chapter two, 'The less we do the more we give' by Nicky Leap, is simply wonderful. Nicky tells us that midwives need to believe in women, even when it seems like the odds are stacked against them, and more importantly that confidence must be communicated clearly to the woman. She also stresses that 'our expertise as midwives rests in our ability to watch, to listen and to respond to any given situation with all of our senses.' This is holistic midwifery at its very best.
My personal favourite chapter is the fourth, where Mary Cronk explores the concept that a midwife is a professional servant, employed by the woman (either directly or indirectly) to care for her. Mary asks us to remember that anyone providing a ser vice is a servant, that a midwife has a profession, and that therefore a midwife is a professional servant, like it or not. Mary challenges midwives to free themselves of the notion that they have power over those they care for, to stop 'letting' and 'allowing' because she explains that a midwife has no right to 'presume a power' or to 'use that power to control women.' What this chapter does wonderfully is to explore the real role of the professional servant, and look at the historical and political context which encouraged midwives and women to forget that the relationship is one of a woman employing a midwife to care for her, and shifted the power from employer to employee.
Mary argues very convincingly that the root of so many unsatisfactory midwife-mother relationships is a situation where employee is ordering employer about. It simply doesn't work, and those midwives who build successful relationships are those who, consciously or subconsciously, gently empower women to make their own decisions. Mary goes on to explore the issue which is often used as an excuse for retaining power, that some women 'want to be told what to do.' Mary suggests that this is because they expect to be directed and they may not be used to having their opinions even sought, never mind valued. Some women may even find not being told what to do quite threatening because they have no idea how to do otherwise in such a situation... However, rather than the common solution of assuming control, Mary encourages midwives to use sensitivity and to support the woman to increase her decision making and to always explore the woman's wants and thoughts as part of the process. I can't help but wonder if every midwife was to practise with these principles at the front of her care, how dramatic the increase in normal and empowering births would be. I have a feeling that approach would do more to reduce the inter vention and caesarean rate than any other measure we know about, and it is so simple, it costs nothing and it is a tool available to every midwife should she choose to use it.
The rest of the book is equally good, with chapter s covering supporting women with increased risk, cultural expectations, loss, disadvantage, and all focussing on increasing the quality of the relationship between mother and midwife and all giving the midwife tools to help her build that relationship and work with the women they are caring for.
I would recommend this book to every birth suppor ter and every woman, and I think it is an essential text for midwives. I'm sure even the best will find something to learn, something to use, or a way of fostering good midwifery amongst their colleagues.
If you want to escape the stresses of twenty-first century maternity services and enjoy a good historical novel, I recommend this one. Set in the fourteenth century, the plot centres on the life of a village midwife widowed by the plague. It is a life full of dilemmas and hardships. There is intrigue, violence, sex and pestilence in a fast moving plot.
The details of medieval life are fascinating and the midwifery details are correct, as we would expect from a well known midwife. This is a thoroughly good read and would make an excellent present for anyone interested in midwifery, medieval life or a good story.
This is the first of what promises to be a fascinating series of historical novels, each with a midwife as the central character. The book is self published and very inexpensive, it can be ordered from Amazon. I expect that a major publishing house will pick it up soon, at which point the price will double.
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