Midwifery is catching

I’ve been wondering about a few things recently.

• The purple line and its relation to dilation - meaning that lots of VEs were done on women as they progressed through labour to see whether there was a correlation. 
• Why we wait until 10cm to be convinced that a woman is dilated.
• Where the 10cm rule came from.

"There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix."

I’m curious to hear more on this topic and when I’m done with my current paper, I’ll look into it some more.

I’m developing a style of practice that is being hands off and observational, which is often in conflict with the hospital system that I am learning in. I get that I am a student and that I have to learn before I can be. I also get that I am the midwife I will be in the future; it’s in the heart and soul, not in the textbooks, but I need the knowledge and skills to catch up to that passion. But wow it’s hard going to be trained in The System when I don’t agree with so much of what I have to do.

I think if I ever get bored or completely disenchanted of being a midwife (yes, that’d mean "after I’ve graduated" and "after I am a midwife") (and possibly "shortly after Hades freezes over"), I’d like to specialise in something like maternal fetal medicine. That’s where I spent a day last week - following around an amazing woman who is responsible for providing midwifery, women-centred care for women and babies who come under the heading of "complicated heavy duty stuff related to pregnancy" at the Women’s and Children’s Hospital here in Adelaide.

The day started off simply enough - feeling each other’s approaches out, working through some basic stuff, and getting ready for the day. That was after I struggled to find the lovely Beck, as she is a bit of a nomad around the hospital, and I’d been less than prepared in contacting her yesterday to make sure I knew what the plan was for today. Anyway, I met up with her and got a crash course/refresher in the things that go awry for both mothers, and their babies. After a few visits and file collections and trips to the lovely basement (I love basements of buildings! They’re so gorgeous and interesting and out of the way of your average Joe Public!) we had a much needed coffee and a chat about stuff. The afternoon had us attending the hospital round for complicated cases and there was a huge range of issues covered, none of which I can cover here for privacy’s sake. But I was also amazed at the dial-in of people from Darwin Hospital, who had a really rare case that was a lot like a really rare pair of cases that the WCH had recently regarding the umbilical cord (I think - at this stage I was short on food, water, oxygen and brane cells so I can’t really remember) and it was fascinating seeing the video conferency technology applied to medicine as well.

I love learning and I love learning about complicated issues as well. So today was fascinating for me. I also got to see situations where technology is needed, and is the sole reason that women remain relatively healthy and babes join us earthside. Whether I agree or not with the amount of effort that goes into this, when people are homeless and bankrupt and unhealthy, is a matter for another post but it was a good reminder that hospitals do amazing work when they are needed.

A long long time ago, I wrote a post about how much a homebirth cost. It is my most popular post by far and I am feeling the need to update it.

*EDITED* to add that these costs are not for private births per se - the ones Anna gave me are for New Zealand and not for Australia.

The costs that I quoted were from enquiries in Sydney, so let me upate for Adelaide. Rumour has it (as in, I’ve never felt the need to ask midwives directly but people who have had homebirths have hinted around these numbers) that a privately attended birth here will cost $2,000 - $3,000 rougly: a little less here, a little more there, up to $4,000 one person reported to me (but that included a few extras). The hire of a birth pool is usually extra to this. 

A few of the comments have questioned the $50k figure I put on business costs. I wasn’t clear there but I will say that those costs would be that high to cover the cost of self-insurance if that’s the way that I wanted to go.

Anna gave me me some New Zealand figures to work with:

4 births a month @ $2,000 each roughly, from the NZ government = $8,000
$900 in business costs a month = $7,100 / year
If I assume one month off a year, that’d be $78,100 a year

Homebirths cost $400 more to the midwife because of the calling in of a second midwife so potentially up to $17,600 less, so $60,500 (but perhaps this is balanced out by being the "second midwife" occassionally?)

So there you go, an update and a reflection of how it might be in Australia if we ever had a homebirth policy! 

Please go and read about this and see what you think.

Add to this - if you want a physiological third stage in a hospital setting, the words "lotus birth" will guarantee that no one severs the cord. Even if you have no intention of keeping the placenta until the cord falls off on its own, it will keep people from cutting cord, which is one of the only ways to insist on letting the baby get its full compliment of blood.

In a recent post, I received a number of comments about words that make me think. I have a few words to add to that list, and will make another post when I have had a chance to think more on the "why" as well as the what but I wanted to respond to a comment left on my post:

Abortion makes me think bad thoughts.
Your blog seemed so cool until I saw your ‘blog links’ and abortionclinicdays was listed there. For one who wants to do no harm to a woman in this over medicalized day and age, supporting messing with her cervix and removing a living being, long before it’s time, seems antithetical to midwifery. Not to mention the very misogynistic notion of artificial medical contraception which abortion providers count on to fail in order to fulfill their quotas of extinguished human beings who will never get a chance to ‘choose’ anything.

This, rightly so, made me think. What is it about abortion that fits in with my approach to women and pregnancy and birth and motherhood and choice and… oh wait, that it’s right there. All of those things are tied together and the "choice" bit means, to me, choice about whether to continue with a pregnancy for WHATEVER reasons. Afterall - who am I to judge? 

I believe that a woman has a choice regarding her body and her pregnancy. Regardless of what analogie I use here, I am screwed, so I won’t - I’ll just state that I believe in a woman’s right to autonomy and that until the fetus can survive outside of its womb, it has no inate right to life and therefore abortion is not "wrong". I may be making a rod for my back for posting this but as a midwife, sometimes I will come across discussions with women about contraception, about life choices, about managing fertility and also about abortion - or early induction to birth a babe not meant for this world, or supporting a woman through the birth of her child who has already passed.

I am a woman and I have womanly friends, some of whom have had abortions and some of whom have come to me for advice about them, just as they have about IUCDs and nappy rash and all sorts of things. I celebrate this aspect of it and am open minded about these things! Just as I support a woman’s right to choose where she births, so I also support her right to decide IF she births.

I find it interesting that my commenter thinks that abortion is antithetical to midwifery. If my ethics are surrounded by respect for autonomy, beneficence, non-maleficence, and justice, how is supporting choice for reproductive decisions the antithesis of midwifery? Do you, dear reader, consider it outside my balliwick as a midwife? Should I not have an opinion because I am training to bring life into this world?

If you’ve not had a chance to read the blog which the commenter was upset by, please go and do so. It is amazing how not black and white the whole issue is and while in some ways the blog can be confronting and challenging, it is always an insightful read. My commenter here is open about her religious convictions and if she has not already gone and read ACD, she should as most of the stories talk about the women trying to reconcile their choice with their faith - a seemingly impossible task but one which they do achieve to varying degrees.

The part about relying on a failure to achieve a quota seems a little left-field and yes, contraception is not 100% reliable but given that ACD is an American site and the situation for abortion providers over there is horrible and confronting, I’m thinking that people working there don’t do it for giggles or the money. They do it because they want to - also for their own reasons.

Next time: why I think we should stop making such a fuss about pregnant women, my views on the China/Tibet/Olympics triad, and what I had for dinner.