Midwifery is catching

If I could, I would. I would apprentice to any midwife that I wanted to learn from and wanted to teach me. In a heartbeat. Anywhere in the country. But that’s not how the path to registration sits at the moment.

I do as much as I can without doing homebirth stuff, but I have been asked point blank whether I am doing them and have been told that I can and will be expelled if I do these things (even creatively - like only attending antenatals or postnatals or meet with people in a midwife/client setting). My city is a very small place and the midwives in private practice (MIPPs) here are well-known so if their names came up on my records it would be noted.

Does it matter what I do in my own time, in my holidays, in another city, or with people who know I’m apprenticed to someone who is a MIPP? Are the lecturers calling my bluff? Can the uni really do that? I don’t know.

Do I want to find out the hard way, and lose my chance of getting a piece of paper that will allow me to do what I want to do? Hell no.

Does that make me a coward, idiot, imposter or irritation? I don’t know.

So I attend what I can, soak up what I can, and plot for the future . I am being mentored by some of the MIPPs I know. I am attending workshops and extending my skills. I am reading everything I can get my hands on. I am questioning every birth in terms of "how would I do this in a home without doctors for backup just down the hall, or continuous monitoring, or those tools or access to drugs".

I am not overtly rocking the boat but I am questioning things. I am trying to get to homebirths as set out by the one federally funded service here. I am making plans for 2010 when I am 30, registered and able to take on the next step in becoming something other than a medwife which seems to be what I could very easily slip into because I am hospital-trained.

In reply someone said: Em, reading your post makes me believe you are inspiring, grounded, focused and
resourceful. In fledgling solidarity.

And further: This is a very kind and powerful thing to say and it’s lovely to hear it. I sometimes feel like a lone trumpet in the wilderness and wonder whether I hear others singing with me, or whether it’s wind in the bushes, ya know? Being a student is hard, walking a different path is hard, ad feeling alone is hard so thankyou for your thoughts.

And more: I hear you, and I’m so very glad that I do.  My partner remarked today how we probably wouldn’t be able to grow grapes in the area that we hope to buy land, the soil is too lush he said, but the vines need to struggle in order to grow sweet fruits - my midwifery ears heard the analogy immediately, I hope yours do also.

My friend and mentor (she probably grimaced at that!!) Lisa has set up a website and it makes for fascinating reading. Birth stories are always so uplifting and when these are happening just a few suburbs away from me it’s all the more exciting.

Have a look at Lisa Barrett - Independant Midwife and be well, inspired is really all you can be. Or nothing, if homebirth to you is how it should be and will be for more people once I and a few others graduate .

Vaginal Birth After Cesarean Predicts Success in Subsequent Vaginal Delivery

Reuters Health Information 2008. C 2008 Reuters Ltd.
NEW YORK (Reuters Health) Feb 05 - Women who have had one successful vaginal birth after cesarean delivery (VBAC) are even more likely to succeed during subsequent trials of VBAC, results of a prospective, multicenter trial indicate.

Dr. Brian M. Mercer, from Case Western Reserve University in Cleveland, Ohio, and colleagues previously reported an overall VBAC success rate of 73% and uterine rupture rate of 0.7% for women with a prior low transverse
uterine incision. However, the effect of a prior VBAC on the risk of uterine rupture has not been clear.

For their current report in the February issue of Obstetrics & Gynecology, Dr. Mercer’s group examined the impact of prior VBAC on outcomes of attempted VBAC in subsequent pregnancies in 13,532 women included in a
19-center registry.

For 9012 women (67%), this was their first VBAC; 2900 women (21%) had a history of one prior VBAC, 1058 (7.8%) had a history of two, 371 (2.7%) had a history of three, and 191 (1.4%) had a history of four or more VBACs.

The frequency of VBAC success rose with increasing number of prior VBACs, Dr. Mercer’s team reports, from 63% with no prior VBACs to 88% for those with one and 91% for those with two or more prior VBACs.

The corresponding incidence of uterine rupture declined from 0.87% to 0.45% and 0.43%.

The rates of other complications — uterine dehiscence, surgical complications, need for transfusions, endometritis, and hypoxic ischemic encephalopathy — followed similar patterns with increasing number of prior
VBACs.

In contrast, the investigators note, repeated cesarean deliveries are associated with higher risks of placenta accreta, trauma to maternal internal organs, and more frequent hysterectomies and transfusions.

"Women planning large families … should be reassured by the increasing success rates and decreasing risks associated with VBAC attempts in successive pregnancies," Dr. Mercer and his associates conclude.

Obstet Gynecol 2008;111:285-291.

So this week was the first week back at university. Weeeeee - back on the old rollercoaster. Timetables, assignments, textbooks and 40C heat. Erk. One of my lecturers is a famous author who I won’t out here but she is inspiring me to think outside of the square regarding women-centred care. This weekend I’m off to Womadelaide to hang out with the Homebirth Network in more 40C heat. 

I’m not feeling I have anything to blog about here. I don’t have amazing birth stories to share. I don’t have anything that is stirring my heart at the moment. I look at the next two years and beyond and wonder where I’m going to find the energy to get through it all. I talk to a friend who has started a year behind me and she has similar callings to what I do, about women-centred care and homebirth and I am sad that she will have to choose between study and her heart. I find the politics of studying to be annoying and frustrating, and I think I’ve developed a hint of "I don’t want to fail so I don’t want to start" with so many things.

This week’s birth was amazing - 4.9kg babe plopped and wriggled into my hands after 2 hours of labour. It was spectacular and fun and great and unhurried from my point of view, and I listened to my woman and helped her birth how she wanted to… even in the face of midwives who laughed at her name, were annoyed that she’d arrived without booking in or talking to them (this was babe #5 so I am sure she knew that she was in labour), and who were surprised when she said no to a gown, any VEs, being on continuous monitoring, immunisation and a whole slew of other things. I also asked the mother whether she wanted to cut the cord after dad declined and she was surprised and then said yes! She said later that no one had ever asked her if she wanted to do it, and it was good that I had.

That’s 18 births I’ve had since I began - 12 normal vaginal births and 6 complex/instrumental. I have to get lots more to qualify so this year will be hard work… but I am still (mostly) loving it.

First week back at university this week. Erk. That’s all I can really say as it was only week 1. I am at uni 3 days a week with Tuesdays and Wednesdays off which is good, and will be better if/when work gives me regular shifts. Assignments are starting, readings to be done, textbooks to buy still and classmates to tolerate. It’s a noticably smaller class this year too which is sad! Placement isn’t until July which seems a long way away at the moment.