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