the midwife`s journal < contents

23. midwives to our society
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Today we are celebrating Mother's Day. I have received messages of love from the family. I feel snug in the new dressing gown with teddy bears all over it and the soft lamb's wool scuffs. Mother's Day comes conveniently at a time when the days are getting colder and last year's winter gear is past its best.

Bec is preparing a special dinner, Josh has some brownies in the oven, and Paul is still asleep after a late party last night. Mizz will phone - she is probably feeling lonesome today, having moved so far away.

Yesterday I was with a group of women. The sixty or so of us sat and talked and listened to each other until we were tired out. The program was organised by the Maternity Coalition, to review what has happened in maternity care in this State in the past ten years. We gathered in the hall of a primary school in a bayside suburb. Surrounded by the artwork of young children, bold forms and strong colours, I was struck by the contrast with the soft, exquisitely delicate infants that I see and hold. I was reminded that it is a very brief interval in the woman's life when I, the midwife, am with her; that the child grows and moves past each milestone; and that the lessons and memories of each successive stage contribute to the realities of the next experience. I was reminded that the children who proudly create these gaudy works were babes in arms a few years ago.

I looked around the women in the gathering - the mothers with little ones in their arms, the midwives, and the 'others'. I pondered on the older women of the gathering, those who I suppose are past 45 years of age, both midwives and 'others' who seem to have no personal or professional involvement in maternity care.

Those of us who are midwives are each committed to effecting change in our profession and de-medicalising pregnancy and childbirth. One is a leader in the homebirth movement, is strong and confident after many years of independent practice. Another, who came here from England travels from Gippsland to attend meetings. She works in a country hospital. One recently attended her first homebirth with me. Some have been leaders in the profession and are in private practice. A couple are managers of maternity units, seeking to implement new models of midwifery care into the system.

Most of us have children in their late teens and twenties. Most of us studied midwifery in the '70s. We have all been influenced by teachers such as Lamaze, Leboyer, Kitzinger, and more recently Odent, Wagner, Caroline Flint and Nicky Leap and many others.

We have all experienced the intrusion of ultrasound and other forms of prenatal testing into pregnancy. 'Quickening', the time when a woman first feels the movements of her baby, is no longer an important date to remember. The grey flickering screen of the ultrasound shows not only movement but a heartbeat, and that is often prior to quickening! The woman can take home pictures, even videos, far more concrete than that small fluttering feeling.

We have all participated in continuous fetal monitoring, when the labouring woman is no longer the focus of attention. The piece of paper rolling out of the machine, and the sounds picked up by the transducer are what everyone, including the woman herself, pay attention to. Instinctive patterns of behaviour which optimise the progress of the labour - walking, moving, ignoring outside interferences - are over-ridden by the fascination with technology. Physiological influences specific to labour, the woman's endorphins and other hormonal supports, are blocked hormonally by adrenalin, and chemically by narcotic and other medications. It is no wonder that we have seen rising rates of operative childbirth. By the time the decision is made to take the baby by forceps or caesar, the woman is thanking the good doctor for rescuing her and her baby from their dreadful state. Technology has replaced touch. Machinery has minimised the value of a woman's role in this quintessential female experience.

I can understand why midwives are looking for something better, whether they work in hospitals or in the community. I find it difficult to understand why more midwives don't question the system, don't feel dissatisfied with the excessive imposition of medical technology into the birthing processes of well women.

But it was the other women in the gathering who drew my attention. These who are devoting time and energy to the work of the Maternity Coalition. Women from professional and academic walks of life - a teacher, a sociologist, an anthropologist. What has kept their interest in childbirth? Why do they want to be consumer advocates?

I think that one of the real difficulties in bringing about change in maternity care is hearing the voice of the consumer. The Birthing Services Review made an effort, and there have been some changes made, but researchers tell us that consumer satisfaction rates are low. New mothers don't have lots of energy to lobby their politicians and write letters to the newspapers; they find it difficult to attend meetings; they are often too tired to even take time to reflect on their own experiences and needs, let alone think about changing the world. And new mothers don't stay new mothers for long - in a few brief years it's the committees from the school that are looking for workers on fund-raising projects.

As I talked with the women who are my contemporaries I found that most of us had been involved in the childbirth education associations of the '70s and '80s. Childbirth education where we talked about the stages of labour, learnt how to relax, practised our breathing, how to make the best effort of pushing when lying like a turtle up-turned, and lots of other strategies of varying value. The husband was the coach. The effort and commitment the couple made during the pregnancy was supposed to pay off in the form of a 'natural birth'.

Most childbirth education here in Victoria takes place in hospitals now. The classes may include technical information on epidurals, and a whole range of issues that are seen as important to the expectant woman or couple. Someone has summed it up as "what we will do to you when you come here". Community-based childbirth education classes have all but disappeared.

The few strong women of the Maternity Coalition have held on to a dream. They have moved beyond the mothering years of their own experience, and now they are working to become a voice for those who are least likely to speak up for themselves - the recent mother and her baby. They see the danger of a society which denies the wellness of the childbearing process, and takes from women their authority for their own bodies and lives. The increasing medicalisation of childbirth is one aspect of social change, and its effect is carried on throughout the continuum. I am grateful to these women for holding on to their vision, for acting as midwives to our society.

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