18 things I have learnt in 18 years as a midwife

I have learnt a thousand and one things from birth, birthing women and birth workers but had a stab at my 18 favourites to share with you:

1. Birth is extraordinarily amazing; it still makes me go WOW
2. You learn more from the births you attend than any text book or blog account
3. Never reach too far into a birthing pool; there is a point where you will fall in head first
4. Birth positions should suit birthing women; the often portrayed birth image of the passive women lying on her back, pushing her baby uphill as the doctor/midwife heroically directs and delivers still makes me livid
5. You never sleep as well when you are on call for a birth (and you sound like a bleary dolt when you answer the phone at 3am)
6. Institutional birth language is unacceptable – There are no ‘incompetent cervixes’, only incompetent descriptors. There are no ‘failure to progress’ labours, only a failure in care, support or ability to meet an imposed deadline.
7. Beware the colleague who presents their opinion as fact; the more confidently they assert their opinion the more suspicious you should be. Question everything.
8. You can never have enough towels at a birth, they can be used in innovative and interesting ways
9. If in doubt go with common sense. It makes sense to not clamp or cut a cord before it has stopped pulsating, it makes sense to keep mum and baby skin to skin, it makes sense to be mobile and upright during labour, it makes sense to eat and drink when you need to – generally it makes sense not to interfere unless there is a need.
10. Vernix is the best moisturiser in the world – don’t wash it off but rub it in!
11. We need to stop being so cervix obsessed – they are beautiful but they don’t read the book on how fast they need to open to keep health professionals happy. Vaginal examinations should be an exception not the routine. Observe, be quiet and be patient.
12. Watch where you stand when a women is labouring and her waters are yet to break (and always keep an extra top in your bag)
13. Never be in awe of the (so called) ‘experts’, only of birth and birthing women.
14. Your sense of smell is a tool you will use more than you think; a midwife can identify liquor over urine at 10 paces and blindfolded
15. ‘It’s just the way we do things here’ is the worst (and most dangerous) excuse for poor behaviours and questionable practice. Don’t follow the crowd – be a goat not a sheep.
16. We need to stop fragmenting birth; I look forward to the day when breech birth is just birth; VBAC women are just birthing women and waterbirth is when you get wet.
17. Scrubs are the clothing of surgery, emergencies and high drama TV. They may be more comfortable for staff in hot busy labour wards but I believe they send hugely negative subconscious messages to women hoping to avoid all of the above (especially the high drama TV)
18. Everything is possible. Nothing is impossible


Overdue Breech

I was reminded via twitter this week of my clumsy attempt at comedy when speaking at the fabulous CCSU MidSoc conference earlier this year: “I am, like many others, a little frustrated at how long we have been waiting for the RCOG to revise and update its guidelines; they are so overdue if they were a baby they would have been born by emergency caesarean section by now” (don’t worry I’m keeping the day job…).
The current RCOG breech guidelines were published in 2006, a whole 10 years ago. Only 1 other green top guideline is older (Tubal Pregnancy, 2004) so why is the breech guideline taking so long when there have been several good pieces of research and mounting evidence that a change of guidance is required?
We all know that change in healthcare can be really slow; like a massive ship trying to change course with a reluctant captain who rather likes the view as it is. But there are rather telling examples where change has been rapid. When the Term Breech Trial (Hannah et al, 2000) published their controversial results of their breech research in 2000 the number of vaginal breech births declined dramatically across the world. In the Netherlands, caesarean section for breech rose from 50% to 80% within 2 months of the publication of the research (Reitberg et al, 2005) and it has been said that no other research has impacted an area of clinical practice in such a short period of time.
It appears that the good captain had already plotted the course and was just waiting for the green light to turn hard right, full steam ahead. My obstetric colleague whispered that it was a relief that they would not be called for the odd ‘difficult’ vaginal breech in the middle of the night again; much easier the planned caesarean at 10am.
The move to surgical delivery for all breech babies at the turn of this century could not be more neatly presented as an example medicalisation of childbirth. Breech was redefined in a moment as the abnormal, dangerous and in need of obstetric intervention and rescue. And women’s birth choices were effectively removed.
The ship needs steering back on course; vaginal breech is a safe option for some women according to the current evidence, but I fear there is some reluctance in some quarters. Medicine, who advocates the authority of research to guide clinical practice, appears distracted and unconvinced when presented with current research that supports vaginal breech birth as an option. Local breech clinical guidelines reviewed and updated with the most up to date evidence, are not signed off as they don’t align with the 10year old breech RCOG guidelines. And I continue to hear that women are still being told they are ‘not allowed’ a vaginal breech birth or that there ‘aren’t staff with the skills’ to support their choices.

In this age of medical dominance the RCOG is a powerful and influential body which can make a difference. The draft RCOG breech guidelines I was able to review and comment on earlier this year were a huge improvement and will be a game changer for women and advocates for women’s birth choice (surely this is everyone??).
So I look forward in anticipation to these overdue breech guidelines. I know there are stirrings and that labour is imminent; not normally one to interfere, in this case I would offer these breech guidelines a stretch and sweep to move it along a little swifter – just give me a call.