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Association of Radical Midwives website: www.midwifery.org contents email:[email protected] National Co-ordinator editorial Sarah Montagu Thoughts on Transfers 2 16 Wytham Street Oxford, OX1 4SU 01865 248159 articles from Wigan mobile: 07946 392728 Living in Hope, Dot Parry 3 [email protected] A Waterbirth Denied, Deborah Byrne 5 Magazine Co-ordinator Working within an Orthodox Jewish Community, Dot Parry 7 Margaret Jowitt Midwifery and Judaism, Sarah Montagu 8 29 Albert Street Female Genital Mutilation, Deborah Byrne 10 Ventnor Isle of Wight PO38 1EU 01983 853472 articles from elsewhere [email protected] Nitrous Oxide, no laughing matter, Andrea Robertson 13 Telepathy in the Birthing Room, Anna Reeve 19 Membership Struggling in the Dark, Vanessa, student midwife 20 Ishbel Kargar 62 Greetby Hill Homebirth – A Father’s Experience, Christian Stretton 21 Ormskirk L39 2DT Letter to My Mum’s Midwife, Tez 22 tel/fax: 01695 572776 An Unusual Normal Birth, Andrya Prescott 23 [email protected] Creative Midwifery, Andrya Prescott 24 Treasurer and webmistress Linda Wylie business 4 Darley Place National Meeting report 25 Troon KA10 6JQ 01292 316596 news and views gleanings nettalk: transfer experiences 30 Local Groups Co-ordinator Wendy Blackwood breech transfer 32 11 Hazelhurst Grove home criteria 34 Ashton in Makerfield NMC Homebirth Circular 35 Lancs WN4 8RH 01942 205935 local groups 46 [email protected] Press & Publicity Lynn Walcott 01635 578138 [email protected] ARM Helpline Sarah Montagu 01865 248159 07946 392728 copy deadlines The views expressed in this publication Jan 1 for Spring issue are those of individual contributors and Apr 1 for Summer issue are not necessarily those of ARM as a Jul 1 for Autumn issue whole. Oct 1 for Winter issue Information on the events page is limited to basic details. Any further elaboration will be charged for at the usual rate. Advertising is accepted at the discretion typeset on Adobe software by of ARM. Margaret Jowitt ©Published by the 01983 853472 Association of Radical Midwives printed by Orphans Press, Leominster 16 Wytham Street Oxford OX1 4SU ISSN 0961-1479 01568 612460 reg charity no: 1060 525 Summer 2006 ISSUE 109 Midwifery Matters 1 Transferring to What? The ukmidwifery list on yahoo groups is a veritable into play: we humans seem to thrive on the bustle and cornucopia of raw midwifery feeling and wisdom and I gossipy excitement associated with impending disaster. But look forward to reading and gleaning the ukmidwifery list the adrenalin rush doesn’t benefit the woman; she be- for each issue. comes common property, an object of curiosity, and Two threads leapt out at me this time, the first topic cannot escape, she is the focus of threatening attention. I concerned a transfer for undiagnosed breech presentation. wonder whether this mental trauma is at the root of It could be described as ‘from beautifully delighted to crash PTSD? Everyone involved can make a difference in the way section’, and the second topic concerned how independent they behave towards a woman whose labour needs help. midwives are treated by their hospital collagues when The transfer from a quiet peaceful labour in a birth transferring in with a client. centre or at home to a consultant unit can be a nightmare; In the breech transfer account there was a distinct lack contractions often stop altogether and this is also the time of teamwork. The NHS birth centre midwife had prepared when that curious phenomenon of cervical reversal can her client for what would probably happen at the consult- occur. Will this lead to raised eyebrows and disbelief or an ant unit, saying that in all likelihood labour would continue acknowledgment that the woman is in increased need of normally but her client would be in a place where more emotional support? Who should provide her care? The help could be given if needed. But on transfer an emer- person she knows or strangers in a place that was not her gency caesarean was carried out by a registrar with no first choice for labour? Which will be the least stressful? further discussion and the midwife was devastated. All too often a midwife who, only an hour ago was consid- If that same midwife were to encounter another ered competent to deliver a woman alone, is sidelined and undiagnosed breech, a baby that seemed to be descending her client feels abandoned. well, albeit in an unusual presentation, what would she do? It is this sort of scenario which leads to complaints Would she follow the birth centre protocol and transfer, from women. I would hazard a guess that there are more knowing that her client may then have an unnecessary complaints when continuity of care is disrupted than when caesarean section, or would she let normal birth proceed the transferring midwife remains actively involved. We and risk losing her livelihood through not following should be questioning the assumption by some hospitals protocols? that transferring in during labour means handing over care She could ‘do good by stealth’ and pretend that there completely; how much more important it is to maintain wasn’t time to transfer, that the mother was too near continuity of care when a labour is compromised. And delivery to risk a move. (But she’d better make sure the when obstetric intervention is required, the woman still documentation supported her.) If the mother and baby needs her own midwife beside her, to ensure that any did well, she might ‘get away with it’. Her supervisor might consent is informed consent – and obtained in a sensitive consider that she needed a period of supervised practice, manner; and she needs a familiar face beside her. In the and her employers might take her out of the Birth Centre case above it sounded as if a normal breech birth would as an example to others to show that the Trust will not have been possible but the registrar’s fear led to what tolerate insubordination. But if there was a tragic out- might be called the ‘Hannah – Section’ reflex (regardless of come, she might well find herself hauled up before the the fact that Hannah says nothing about undiagnosed NMC. Should she be struck off the Register? Would you breeches). There is a strong case for requiring Trusts strike her off? What would you do in similar circum- automatically to issue honorary contracts to any midwife stances? transferring in precisely to ensure continuity and prevent Transfers in labour set alarm bells ringing for good litigation. reason: the odds in favour of normal birth have lessened If there is an adverse outcome the scapegoating begins. for whatever the physical reason for the transfer; normal The obvious target is the midwife who transferred in. It is birth is less likely at consultant units; the transfer itself will easier to blame her because she is the outsider. She may have interrupted the flow of the labour; and fear will have not even be employed by the Trust. If she is independent entered the equation – fear being a powerful force against and the Trust has no control over her practice, referral to rational behaviour. Even if we have tried to expunge the the NMC may seem a logical step for managers anxious to word ‘failure’ from our midwifery vocabularies, it is difficult be seen to be ‘doing something’. Independent midwives to find another word to put in its place – it is true that the are reported to the NMC almost routinely and yet their woman will not have the birth she had hoped for in the statistics would be the envy of any NHS Trust. Supervision place she had planned. The disappointment of dashed is failing independent midwives and the women they serve hopes remains for the woman and the midwife. It would if it is over-reliant on NMC Fitness to Practise committees. be helpful if the admitting hospital could help alleviate this Are independent and independently minded midwives in their welcome instead of reinforcing the disappointment carrying the can for the failure of the NHS to provide a – and this is possible, there are good transfer stories. safe and welcoming haven for women whose labours need And what you might call the Casualty factor can come some help? Margaret Jowitt 2 Midwifery Matters ISSUE 109 Summer 2006 Working in Hope Dot Parry These are my thoughts and feelings on the way through the I suspect that the re-organisation is connected to the reorganisation of my local maternity services. way that junior doctors will no longer be worked for September 2005 ridiculously long hours. This has the knock on effect of It has been decided by my local strategic health author- making neonatal units hard to staff. There’s also the issue ity that we need to re-organise our maternity and of training for juniors – with a falling birth rate the neonatal services. At present we have 13 sites across doctors are not seeing enough babies come through the Greater Manchester providing maternity care, many of neonatal units to get a firm grounding. which have an on-site neonatal unit. I work at Hope I also suspect that there is a notion that the maternity Hospital which is a maternity unit in Salford, a separate city services can be more efficient if concentrated into bigger but part of Greater Manchester. We have a popular centralised units. I thought we had tried this before and consultant delivery unit, a fabulous neonatal unit and an realised it didn’t work. I thought we were supposed to be amazing alongside birth centre. I’m told that some pio- putting more services within the communities they serve.