October 29, 2002

Are midwives really "with women"?

What a day I had yesterday! A very long 7 hour train trip starting at 6.00 a.m., across England from the North East to Wales, so that I could speak at a Conference outside Cardiff in the afternoon organised by the Bro Morgannwg NHS Trust.

There has been severe storms the day before, which caused havoc on t he roads and with train services, and the program had to be rearranged and some speakers had trouble getting there. This was fortunate for me, as I was only able to hear the afternoon session myself. Luckily, Mo Harris, Research Midwife from Derriford Hospital had her presentation changed to the afternoon and this was one presentation I really needed to hear.

Mo was reporting on a study that she has undertaken on “one to one” midwifery in practice. With perimission from all concerned, she positioned a black and white video camera high in the corner of several labour wards and made continuous recordings of a number of labours. In all cases, the midwife was responsible for only one woman at a time, meaning that she was able to stay with the labouring woman throughout the whole labour and birth - the “gold standard” that is held up as the ideal situation for midwifery and midwives.

Each video tape was transcribed and the activities being undertaken in each minute were tabulated, then analysed. Mo was able to show us video clips, some with sound, to explain her findings, and they were astounding.

All the women were on the bed and all had the baby’s father present. Some had another person as well, often the woman’s own mother. The midwife was most often seen in the corner, writing up her notes on a table that meant she had her back turned to the woman. Some women had epidurals and one had severe problems that mean she needed special care and close attention. The analysis showed that midwives spent very little time actually “with woman”, even when they were in the room. Most time was spent writing up notes. The midwife allocated to the woman who required close monitoring because she was at very high risk spent 43% of her time out of the room, taking breaks, talking to other midwives, or performing other unrelated tasks!

Several scenes showed the reactions of the fathers - overwhelmed and unable to cope. One woman is literally tearing her hair out (?transition) - the midwife is out of the room and the father puts his head down on his hands, clearly distressed. On several occasions, when the monitor revealed the baby’s heart rate dropping, the midwife still failed to interact with the woman or her partner - just made a few comments from the corner where she was writing up her notes. On one occasion, the woman’s own mother goes for help, when the monitor is registering a low heart rate and the midwife is (again) out of the room. Conversations with colleagues, such as the doctor when he is called in, take place in the corner and excluded the parents. If the handover occurred beside the bed the woman was included, but this was uncommon and the videos showed a huddle in the corner with the woman straining on the bed to hear what was being said.

What does this study tell us? It is very clear that midwives are not interacting with women, not comfortable providing physical support and poor at communicating with the woman and her partner. It is clear that women are still being confined to bed, that they find epidural insertion very stressful and that the needs of fathers are being completely overlooked.

I was shocked and very disturbed by its content and felt desperation that we could ever change this around without a massive change in the culture of midwives and midwifery. Mo still has this study going on and has now filmed in 9 maternity units. She has also taped doctors at work. In summing up her presentation, Mo suggested that perhaps we do need to employ doulas since midwives clearly don’t have time (and perhaps the willingness) to provide the personal, up close comfort that women need during labour. She also wants the system to be overhauled so that midwives don’t have to document everything so closely, or could do it in a more efficient (and less time consuming) way.

I was pleased I could leave the participants of this Conference with some images of a very normal, woman-centred active birth - if we had finished with Mo’s presentation I fear that we would have all gone home is a huge depression. I hope to find out more about this study and that the tapes can be re-jigged somehow to make them into training materials that can be used to sensitise midwifery managers and the midwives themselves into reviewing their practices. My god, it is very much needed!

Posted by andrea at October 29, 2002 09:38 PM

Comments

Hi Andrea
This sounds a most interesting study you are referring to here and I would like to follow it up as part of my research for a paper I am writing. Do you have a reference for Mo's paper or perhaps an email contact for her?
Many thanks
Adela Stockton

Posted by: adela stockton on April 29, 2003 11:29 PM

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sorry - please note ammended email address - thanks!

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