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Enriching Care The Selangor Maternity Centre Experience

Enriching Care The Selangor Maternity Centre Experience

by Lynne Staff

This paper was presented at the Enriching Midwifery Conference, Australia, March 2000 for Birth International.

What we did/do at Selangor

Live the philosophy, breathe it and believe in it — we don’t just pay lip service to it.

  • Communicate this philosophy well to management (all levels) and ensure their continued support.
  • Developed an education program which was comprehensive and centred on individualised care, not on hospital routines and doctor or midwife preferences.
  • Changed the signage.
  • Changed the way we speak as midwives.
  • Stopped doing “routine” vaginal examinations.
  • Stopped “routine” any things!
  • Changed the way we are with women.
  • In addition to medical texts, we bought books and videos which focus on the social model.
  • Share them with the mothers and fathers.
  • Share our personal libraries with one another — between us we have a great collection.
  • Share stories, experiences and expertise with one another.
  • Midwife each other — that includes the obstetricians and they midwife us as well.
  • Get to know the practice managers well and communicate.
  • Host in service sessions for midwives and doctors and invite staff from other hospitals.
  • Utilise any admission opportunities antenatally (or preconception) for education and contact with midwives.
  • Learned how to work with women using natural methods for promotion of comfort.
  • Learned how to work with women choosing warm water immersion for comfort in labour and birth.
  • Encourage vaginal breech birth, vaginal breech birth for twin pregnancy and vaginal birth after one, two or more caesareans, all utilizing active birthing principles.
  • Offer women choice of midwife.
  • Treat planned home birth couples requiring transfer to hospital and their midwives with respect and dignity.
  • One-on-one care during labour and birth — staying with the mother until the baby is born.
  • Ask couples to look in all the cupboards and drawers in the birthing rooms.
  • Close liaison with OT staff to ensure caesarean birth is a positive experience whether it be emergency, non-emergency (not planned) or elective caesarean birth.
  • Offer women experiencing early pregnancy loss or those undergoing assisted fertility procedures the choice of using the maternity centre or going to a surgical ward.
  • Provide postnatal education with one on one and group focus.
  • Designed evaluation tools and surveys which elicit specific information relative to our practice.

Strategies for developing your services

  • Redesign your education program.
  • Try stepping back and not feeling like you have to be doing to instead of being with.
  • Try letting go of the need to be “in control” of what is happening.
  • Change your terminology.
  • Believe in what you are doing.
  • Redo your policy and procedure manuals.
  • Unit meetings should include midwives, obstetricians, paediatricians, administrative services, ancillary services.
  • Midwifery meetings should be separate.
  • Keep tabs on your outcomes and present these at the meetings and in antenatal classes.
  • Redesign your satisfaction surveys.
  • Encourage mothers and fathers to write about their experiences.
  • You write about your experiences.
  • Talk to one another — some things will be easy to discuss — others will be very challenging. Some changes will happen quickly — some will seem to take forever.

Understanding the nature of birth

  • Knowing the importance of your presence.
  • Knowing how to be when you are with women who are experiencing pain or fear.
  • Knowing when to be there and when not to be.
  • The importance of continuity of care during pregnancy, the whole labour, birth and afterwards.
  • Revisiting the birth.
  • Mothers’ and Fathers’ Gatherings.
  • The real function of birthing beds.
  • Knowing your strengths.
  • Knowing your challenges(ers!).
  • Recognising that although labour and birth are a speck on the time line of life, in life, they have the potential to be either something from which a woman never recovers, or the one of most empowering, strong, awesome and unforgettable things she ever does in her life.

© Lynne Staff 2000 This paper was presented at the Enriching Midwifery Conference, Australia, March 2000 for Birth International, PO Box 366 Camperdown NSW 1450

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