the midwife`s journal <
31. partnership tested
It has been a difficult experience for me, and I have waited for some time before trying to write about it. I was afraid for the life of a tiny baby, and I was afraid that the parents did not understand what was happening.
In this instance I was caught between two cultures the medical, allopathic way of thinking, and something else that included other therapies and faith. I went away distressed within myself powerless to influence decisions, yet fearing that the decisions were being made without understanding. I was also afraid of the consequences if this baby had died I would have felt somehow responsible. I had failed to convince the parents of the seriousness of infection, and the need for treatment.
I can also admit now, from a safe distance, that I was afraid for myself. Even if I had done all in my power, such an outcome would have placed us in the firing range of those who would like to see midwives practising only under the supervision of medical practitioners, and we would have been an easy target. The womans authority for her own body; the midwife in partnership with the woman; the possibility that a persons decisions may be at odds with what is considered the best, scientific reasoning these are issues which seem clear enough in theory, until the reality of a life situation, in the middle of a cold night when everyone else is warmly and safely in bed, confronts me.
The baby is well. There will be no enquiries or hearings this time. But I realise that I need to think it through, so that I can understand better and be prepared for the next time.
We say that a midwife enters a partnership with a woman, working together to birth her baby. The partnership forms over a substantial amount of time, and becomes strong as mutual trust is built. I think this is where the continuity of midwife carer becomes crucial. Any degree of distrust can cause fear and distress for both the woman and the midwife.
Partnership works well when partners agree. What happens when they disagree?
Women usually look to their midwife for information and advice, and the partnership supports both in making decisions. I am used to supporting a woman in her desire not to have a so called routine procedure in hospital, such as electronic fetal monitoring. Birth is not an illness, so there should be no set routine. The woman should be free to engage in all that her body is doing.
The woman in my thoughts today did not accept my concerns about possible infection. I advised her, and I thank God her baby is well. She had experienced the dreadful consequences of a hospital-acquired staph infection a few years ago. She had suffered severe side-effects of strong antibiotics, and had struggled to achieve wellness. She and her husband had turned away from the medicines of the doctors, and had sought health in natural therapies and traditional healers. She had visited a naturopath and faithfully administered the little white pills and the mixtures in brown bottles. The naturopath had given her natural antibiotics, she said, so she did not need the hospitals antibiotics.
We were in the hospital because her babys waters had broken and labour had begun prematurely. The plan for homebirth had been altered. Our goal was still to birth the baby without any unnecessary intervention.
A doctor at the hospital come into the room and tried to discuss the care. He wanted the baby to be monitored. The woman said no. He wanted her to have antibiotics. The woman said no. He wanted to examine her internally. Again no. He wanted her to tell him at what stage she would allow him to do anything, and she couldnt answer. The discussion was going nowhere, so the doctor left the room. The womans labour seemed to falter at that stage, and she needed to hide away in the shower for a long time to regain momentum.
After several more hours of labour I attempted to talk to the couple about the danger of infection to the baby. The doctor had tried to explain, but I dont think they had heard. They believed the natural medicines that had been administered were sufficient. The doctor had mumbled something about needing evidence to support practice. There was no clear explanation or discussion.
The waters had broken several hours prior to labour commencing. In normal circumstances I would not have been concerned. But why had this babys birthing begun prematurely? What about the history of severe infection? Was there a link?
Its fine to say that a woman has a right to refuse a treatment. She does not have to accept the advice that she needs antibiotic treatment to protect her baby from a potentially fatal infection. But it is the duty of the carers to give her the information which we have so that she can make an informed choice. Does she understand infection? Do I?
I saw my role as providing facts and reasons in a way that was acceptable to the woman and her husband. They were not listening to the doctor. I wondered later, before I knew that the baby was doing well, if I had tried hard enough.
My position is one of privilege I am unwilling to use that position to manipulate a person or to force a decision. Yet I understand that the lives of the woman and her child can be put at risk. I cannot afford any degree of complacency. While asserting the womans personal autonomy, that she needs information so that she can make decisions, I realise that she depends on me, as her trusted partner to provide her with information in a way that she can use it. Each person brings their own experiences into a relationship, and this womans experience with previous infection is something that I have never been through. The turmoil in my mind was accentuated by my own tiredness and subsequent weakness. I rejoiced with them as she birthed her baby, alert and drug free, then progressed to the beautiful stage of discovery and bonding. The wee boys breathing gradually became more laboured, and he was relinquished to the special care nursery staff, oxygen, and medical equipment.
The woman is now a confident mother with a healthy thriving child. She is probably unaware of my deep concerns as I have described them today. She does not need to know how I feel. She made the right decision for herself at the time.