“There are 3 precious things which I hold fast. The first is gentleness; the second is economy; and the third is shrinking from taking precedence over others.” Lao Tzu.
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.
I’m looking forward to another homebirth this year with Lydia. She was the first midwife I’ve had who never told me to push (or where to put my legs etc)… And how lovely and easy it was!
What a great resource!
Good Luck Gauri!
lovely. The exquisite balance. Putting it to the test now…preparing for a homebirth – expecting to trust and watch and let nature flow…and still gathering all the back-up synto, oxygen, sutures etc for the what ifs!
The reason that Ancient Art Midwifery Institute’s course is so difficult is that it takes great confidence in the birthing process and great courage to go against the norm, and be an authentic hands off midwife. My students push through the wall of fear, to the other side of that bell shaped curve…..and they know what to do and when and they know what not to do and why.
What I love about your post is that you admit how hard it was for you to overcome the medical model, fear based education and you transitioned. I appreciate that so much. So many of the midwives who started around the time you did, never made that change and still act as if it is a midwife against birth battle, striking preemptively….instead of acknowledging and respecting that birth is a normal function of biology…..and that birth really belongs to the mammas who should be making all the decisions.
—— Thank you for caring enough about the mammas and the babies to put their best interests above yours! I applaud your integrity.
My favorite phrase when asked, by both doctors and midwives, what they are being paid for if they stand by an “do nothing,” is: “does the lifeguard on the beach get paid if no one needs rescuing?” That response was given to me after a quick prayer and grounding myself after a doctor in Chicago confronted me in a very flippant manor after my Waterbirth Workshop.
“So,” he started off, “you have just told us that I am virtally useless at a birth, doing nothing, watching with my hands in my pockets, no vag exams, she gives birth by herself, lifts the baby up out of the water, the placenta slides out on it’s own and I don’t cut the cord or remove the baby and I discharge her when she determines that she is ready to go home and climb on her own bed and she takes the baby with her with cord and placenta probably still attached! So, Miss Harper, will you tell me how I can justify my fees?”
I love to see the lightbulb go off and hear the laughter when I retort back with the lifeguard comment. I usually add that the lifeguard has had extensive training and experience and is there specifically for the purpose of “guarding” the space. If he or she sees a shark in the water, they quickly get everyone out, if the person swims out past the bouyes, they get signalled to come back to safety and if they have trouble and appear to be stuggling, the lifeguard springs into action. The same with the “trained medical attendant” at birth who knows normal. The problem that I have encountered teaching in hospitals these past 20 years is that fewer and fewer graduates of medical, midwifery and especially nursing schools have ever, if even once, experienced or witnesses an undisturbed normal birth and have no idea what the actual impact is of the physical, pharmacological, psychological and spiritual interventions that occur in almost every single birth. We have blindly accepted the abnormal and labeled it NORMAL!!
It’s so wonderful to receive such an extensive response from you Barbara and what a wonderful way to illustrate the concept of being available and yet “Doing Nothing”. I am possibly the only midwife in my group of independent midwives who practices undisturbed birth and certainly drive my obstetricians crazy!
Thank u for your quiet compassion and leading.. I will be learning how to look after women in labour and lets hope I learn your way first so that I do not have undo what I learn!!!
I am so excited and inspired by your ways.
You already have the compassion Ginny.
Gosh Karen, sounds like you are doing amazing work ther. My friend Lydia loved working in Saudi when she was there for a year as the women were so appreciative of her compassionate care. Influence is achieved one small step at a time!
Thanks for this Marianne, so true and so hard to unlearn all those things and uphold them when we are in the system. Right now I am focusing on teaching women to trust the process so that if I am not around during labour, hopefully the midwife who is will pick up on that and intervene less……..its a start!