March 22, 2003

Midwifery in Jersey

Despite the warnings I had been issued about not mentioning water birth or home birth during my workshop in Jersey, the midwives here turned out to be similar to those everywhere else - keen to promote normal birth and wishing that they could offer more midwifery care (including water and home births) to women on this island.

Jersey is 11 miles by 7 miles and has a population of 88,000. It is closer to France than Britain, and the southern most island of the United Kingdom. The economy revolves around banking and tourism - Jersey is not a part of the European Union, has no VAT and is a tax haven with very low rates of personal tax. They are trying to limit immigration, as you can imagine!

The health system here is interesting. All medical care is private, and people pay £18 (approx AUD$54 ) per visit to see a GP. Those who cannot afford it are able to get care at the hospital. The GPs are keen to do most of the prenatal care (lucrative!) yet they are happy to let the midwives manage the births. This means that the midwives rarely know the women whom they will meet for the first time during labour. There is a midwives clinic at the hospital, so some women get midwifery care all along, and others are specifically asking for this, even though they could afford to see a doctor.

The rates for interventions are similar here to those elsewhere - caesarean section rates around 25% , high rates for epidurals and too many inductions. The familiar story from midwives everywhere I travel.

One midwife pointed out that the potential for litigation makes providing informed choice very important and that this could be useful in forcing change: if women know that services are available elsewhere (e.g. water births) they may well demand that they be offered here too. A very good idea - the need to make sure that women are aware of all the alternatives can be used not only to push changes, but also to protect midwives from censure and women from unnecessary intervention. It is a subtle idea and one that midwives are not always willing to adopt, but it is nevertheless an effective strategy.

I am looking forward to learning more about Jersey tomorrow. It is one place I would like to visit again, next time with a bit pf spare time to have a good look at the lovely old buildings and the countryside. It is a very attractive place!

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