Informed choice

My clients often opt for home birth, which I attend and I also carry out all postnatal care. Women often book me for a second pregnancy as they have been disappointed by the care they received in their first pregnancy. Many didn't see the same midwife twice and often felt pressured into an avenue of care that they really didn't want to follow and weren't allowed to make a fully informed choice. A wise midwife called Mary Cronk (MBE) often reminds women that they have the absolute right to refuse any proceedure for any or no reason, I will quote directly from mary as she has a wonderful turn of phrase.

“The law, and good practice is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says no or no thank you. The "allowing" is done by YOU. An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror.

1. 
   “Thank you so much Midwife Sinister/ Mr Hi-an-my-tee, for your advice. We will consider this carefully and let you know our decision.” Sweet Smile!This one is most useful in the antenatal stage, though it can be used in labour. It can just take a minute to consider what you either want to know, or what you decide.
2. 
   “Would you like to reconsider what you have just said!” Fierce glare.This is useful and, for example, applies to the misuse of the word "allow".
3. 
   “I do not believe you can have heard what I have just said. Shall I repeat myself? ”
4. 
   “I am afraid I will have to regard any further discussion as harrassment.”This is used if the person does not respect your decision or persists in pressing the subject.
5. 
   “What is your NMC or GMC pin number?” This is used if 4 is ineffective. If the person asks why you want their pin number, inform them that this is something they might like to consider.
6. 
   “STOP THIS AT ONCE”.This to be used in extremis. I am delighted to tell you that this was used AGAINST me by a woman to whom I had taught it. I was doing a difficult VE (Vaginal examination) and was being too persistent. I stopped at once and learnt a lesson.

Do not argue; learn the phrases and keep them or similar for use if necessary. I am informed that it is usually only necessary to be assertive once or twice to have a much more respectful attitude from the people who are actually your professional SERVANTS. "

Addendum

I have re read my last entry and realised that i went off at a bit of a tangent!

I have decided to take a step back from full independent midwifery. There are several reasons, the main reason is my children. they are still so small and I want to spend more time at home with them. To be an IM means that I need to have childcare available 24/7 so I can head out at the drop of a hat if necessary. this means I need to pay a retainer to our child minder even if i didn't send my son, so she kept his place. to do this I needed to earn a certain level of money just to pay for childcare. This meant I was out working more than I wanted to. Also something always needed to be done, letter to write, notes to file etc. so even when i was at home my mind was else where and I was missing my kids growing up. The third reason is the thing that's affecting us all, the credit crunch. Enquiries have been very slow this year, everyone is feeling the pinch. Those women who have had Independent Midwifery care would class it as an essential but I suspect that if someone hasn't expereienced one to one care in pregnancy and birth they don't realise what a difference it makes to your emotional well being. I hope that one day when my kids can fend for themselves I can get out there and work full time as an independent midwife. In the meantime i get my fill of birth from doing some bank work at a local hospital birth unit and from passed clients who book me if they have another baby.

A change of direction

This week I will discharge my one and only client. I have taken the decision to step back from Independent midwifery for a while and not to take on any new clients (although the bond I have with my past clients means I would happily take them on if they fell pregnant again and asked me to care for them!). It has taken me a long time to come to this decision because I love independent midwifery so much, the relationships I have with clients are very special. They invite me into their homes, give me tea and pour out their hearts, then we wait for the baby, I get so excited if my phone rings in the middle of the night (which is usually when labour starts), and head out on an adventure to meet the baby that we have all been waiting for. Some labours are straight forward and go to plan and some veer off course and we need to go to hospital, but no matter what happens I am there for my client giving them space to make the decisions that helps them stay in control of the situation. Most women say that this control is the most important thing that determines how they feel about their labour. Things were explained and they had the chance to make the right decision for them, even if that was only 2 minutes to talk things over or hours to go through all the options. The time to support a woman to make an informed choice is one of the luxuries that I have working outside of the NHS.

There are many wonderful midwives within the NHS who are incredibly supportive of womens choice however NHS midwives are often restricted by time and resources. In many areas antenatal appointments are reduced, especially for women in their second or subsequent pregnancy. Antenatal classes have been cut back and number of women in each session increasing. This means that women and their partners are not getting the chance to consider their options for labour and birth and the early days with baby. This is the reason that I have decided to concentrate on running informative antenatal classes which are designed for small groups to explore all the area of pregnancy, birth and early days with baby.

Buggyfit

On saturday I attended a training so I am able to teach buggyfit, which is a safe postnatal exercise class, involving power walking and strength training. I am so excited about running these classes. It has been a long time since I was an aerobics instructor but on Saturday I realised how much I enjoy teaching exercise classes. I am planning to start with 2 classes; Monday in Market Bosworth and Wednesday in Hinckley Hollycroft park. These classes are run with new mums in mind so we focus on rebalancing the body after birth, and protecting the back which is a particular area of weakness in new mums. Mums need to have seen their GP for a 6 week check and fill in the health screening questionaire which can be found http://willowtreemidwifery.homestead.com/page05.html along with all other information for the class. Although the class is aimed at new mums mums with older kids in buggys are also welcome and I know of a couple of childminders who are interested in attending too. We do ask that all children are in buggys as the walking pace is quite fast and a child will struggle to keep up. We also ask that mums don't use buggy boards during the class as we focus on good posture and unfortunately buggyboards don't help this.

Now i need to spread the word!!

Well here we go, my first foray into blogging. Hopefully this will be all about midwifery, breastfeeding and any other random musings on related subjects. I plan to highlight relavent news articles and interesting stuff I find online.