Your pregnancy, your midwife, your choice


07 Apr

How important is the pregnancy journey?

Pregnant with my second child I didn't hesitate to return to One to One and was excited about getting my antenatal journey underway. Talking to pregnant women and mums I've met since having my first child, I have been shocked that 'The Birth' seems to be all people talk about; where, how long, how traumatic etc. I actually felt a bit shy about saying mine was a wholly positive experience which even straight afterwards I had no anxiety over the thought of repeating.

I feel that it’s the pregnancy journey that gets really overlooked by mums talking about their experiences. You carry your child (some breeze through it and some really struggle) every day and night for 9-10 months. They remind you of their presence with their little nudges and turns for over half of the length of your pregnancy and yet all the attention is focused upon the relatively tiny period of time it takes for baby to be born. I get it, I know it’s the main event and what every mum to be is waiting for but it still shocks me that the care you receive in the year leading up to it is forgotten. For me this was one of the highlights of being with One to One.

Granted, I have nothing to compare it to. I have been pregnant twice and used One to One as my maternity provider from booking at 8 weeks both times and so I haven't sampled the antenatal care provided by my local NHS trust. However I have been shocked when friends tell me of their experience (which they have also found positive). They sit in clinics waiting for their 15-minute appointment and if they're very lucky they see the same midwife a few times - sadly though they know that this person is unlikely to be present at their baby's birth. All the necessary checks and tests on mum and baby are done and they are sent away until next time. There is nothing wrong with the care they get at all. In fact it is the national model we feel lucky to have, free and accessible to all.

However my experience could not be further from this. I wait at home for my lovely midwife who I see at all my appointments to come. She is so flexible with her availability so that my husband is able to be there at every appointment and that he, in his hugely important role as Dad-to-be, is also included and involved. We are treated as a family unit from booking. His role is valued even if that means that appointments take place of an evening or weekend. I am shocked by how many fathers are excluded from hearing the tiny heartbeat for the first time as it happens at a pre-allocated time in the middle of a weekday where their employer doesn't have any legal obligation to allow them to attend.

When I ask my friends how on earth they manage to get through all the information and their questions within the 15 minute appointment, they say that it is a bit of a rush. My appointments with One to One are always a minimum of an hour over a cuppa where I am able to ask all my (sometimes stupid) questions and where more importantly I get told lots more info than I could ever get off parenting websites about what is happening with the tiny life inside of me. Also as my midwife gets to know me, she knows what type of things I'd like to know, what my own concerns are and how I cope with those strange pregnancy related things that happen to us all. This is one of the key things of being with One to One which you just sadly don't get with the local community midwife team. My midwife knows ME. Not as a pregnancy statistic. Not as a 'risk factor', but as a pregnant woman. She knows what is normal for me.

When you've had your baby you get advice (wanted or not) every way you turn, all conflicting and all ultimately pointing to the fact that every baby is different. If this is the case then every human is different. Every pregnant woman is different. So why oh why are we all expected to fit into the same structured version of maternity care and labour? Having a professional clinician who knows my ‘normal’ and me seems like the most logical, natural thing in the world. We build that relationship over the whole pregnancy with more frequent visits and checks as the pregnancy advances. As 'The Birth' approaches unlike so many of my friends, I feel calm and collected about what will happen, the fact that I am in control and have the right and confidence to question everything that may happen wherever I choose to give birth. For me because of the fantastic antenatal care, birth is something to look forward to and embrace as I am fully informed about what happens and how to make the process as smooth and comfortable as possible. It is one of the most powerful things a woman can ever go through and yet sadly for so many women it is one of the situations where they feel most powerless and out of control as a stranger takes the control of their birth. Being with One to One empowers you as a parent, both as a mother and a father.

This is the reason I chose One to One.

So many people think that One to One is just about the Home Birth. Home Birth happens because you feel confident, in-control and empowered to make your own decisions and be in your most safe and comfortable environment to bring your child into the world. Ultimately though, I know my One to One Midwife will support me in whatever decision I make about where and how to give birth with no judgement or negativity. It really doesn't matter what your birth plan is or how you intend to deliver. The care you get throughout your entire pregnancy and in those first 6 weeks postnatally is what makes One to One such a fantastic option.

People often ask 'what’s the catch? It sounds too good to be true'. I’m almost at the end of my second One to One pregnancy and I've not yet found it.

Post by Louise, One to One service user.

17 Aug

Why do I want the Continuity of Care that One to One Midwives provide?

Why do I want the Continuity of Care that One to One Midwives provide?

Supporting Statement to my Funding Application for Individual Care by Alison Dunne

Dated: 7th February 2013

I am now 21 weeks pregnant. Following a couple of unsuccessful pregnancies, we are feeling very excited that our much wanted baby is growing stronger and stronger. I had my 20 week scan a week ago. As far as they can tell the baby is healthy and has a strong heartbeat. It’s our first child. I am a 44 year old woman; my husband is 49 years old. I am doing all I can to maintain my good health and was quietly satisfied when the midwife told me recently that my blood pressure is better than some women half my age!

I first came across the different models of midwifery care in the NCT’s (National Childbirth Trust) book ‘Your Birth Year’. I knew instantaneously that the ‘continuity of care’ model – in which I would be able to build up a personal relationship with the same woman who would support me throughout my pregnancy, the birth and in the early days of parenting - was what I needed.

I am hoping for a home birth. In Ormskirk there is a team of eleven community midwives. You have a named midwife who you see throughout your pregnancy and in the very early days of parenting. However you don’t know which one of the team of eleven community midwives will attend you at the birth of your child. This alarmed me as soon as I heard it. I wanted to know the person who helped me birth my child beforehand.

I have met my midwife twice now and have found her pleasant and interested. I met two different midwives from the hospital team at my 12 week and 20 week scan and had good encounters with both of them.

However the anxiety that I probably would not know the midwife who attended the birth of my child has persisted.

What could I do about it?

I decided to try to get to know as many of the community midwives as possible. This is my motivation for attending Aqua Natal classes at Ormskirk swimming pool. It is run by one of the community midwives. It is the reason I intend to join a Parenting Craft course. I don’t need to as I am enrolled on a National Childbirth Trust ante-natal course. From this perspective it will just be repetitive, time consuming and a waste of NHS resources. However it gives me a chance to get to know another community midwife. I also go to pregnancy yoga classes at the Moorgate Sure Start Children’s Centre but the midwife who runs these is retired.

So in spite of all of my best efforts there was still only a 3 out of 11 chance that I would know the midwife who attends me at my birth and 2 of them I would only have met in a group context.

What else could I do about it?

I decided to explore the possibility of hiring a doula. A doula is a female care giver who not a midwife, but has had a basic training in labour and birth. Her job is to provide emotional support and a constant reassuring presence. I wondered if hiring a doula might be able to provide the continuity of care that the midwifery service does not provide. However, on further reflection, I realized that I wanted the doula to advocate for me with the midwife, who I probably would not know, at the birth of our child. I understand that the midwife would have my notes but this is no substitute for a real relationship! I needed a series of face to face conversations in which the midwife and I could come to mutual understandings. I have been reading Michel Odent, the obstetrician who founded and ran the birthing unit in Pithiviers, France. He repeatedly talks about the need for woman to leave their rational mind and let go into more instinctual parts of themselves in order to birth successfully. This makes sense to me. But how could I do this if I am establishing a relationship with someone whom I have just met for the first time and is playing such a key role in this crucial event? It is too much! The need to talk to her and built up some sort of a relationship and mutual understanding would go against the primal need to let go. I thought that maybe a doula could do that on my behalf, having built up knowledge of me, and I could get on with the work of letting go. It was the best option that I could come up with but is messy, rather than satisfactory. Nothing can replace direct communication and a real personal relationship. Going through a third party is, by its’ nature, susceptible to complications and difficulties.

Hiring a doula is an expense that we genuinely cannot really afford at this present time but would stretch ourselves to meet because of the importance to us.

What are my other reasons for wanting continuity of care?

In the reading that I am doing, I becoming aware that while medical interventions in birth can be life saving and are therefore to be welcomed, often they are necessary because women cannot properly relax and therefore benefit fully from the free release of necessary birthing hormones and their other inner resources. (This is why I am hoping for a home birth. I know that I will be able to relax and let go better at home, in a familiar environment in which I feel an element of control).

I am nervous of medical interventions. A friend of mine had a forceps delivery which has caused him permanent brain damage. I therefore deeply want the opportunity to discuss what to do in the event of a medical emergency with the midwife before the birth, when a medical intervention would be the best option and when to try to see if other methods might work first. This will not be possible if I cannot properly meet the midwife who will be present at the birth. Such a discussion at the time of giving birth would go against my need to let go. My rational mind (my neo cortex) would be activated. This would then impede the flow of birthing hormones which come when a woman allows her primitive brain to dominate. In order to relate to a midwife in the event of a medical emergency in a way that we both felt happy with – the path of co-operation and mutual understanding – I would have to have met her first, talked through my fears and gained an understanding of what she needs to do and why.

Michel Odent talks about the need for privacy and quiet for women to focus while giving birth. I can well imagine that I might need that. How can I know that a stranger will give me that? She would never have met me before, will have no real knowledge of me (notes are not real knowledge of a person!) or reason to trust me…why would she be confident to leave me alone for periods of time if this is what desire? I have had fantasies about the midwife chasing me with a Doppler, me shouting at her to ‘leave me alone, I can’t relax!’....all these fears could be attended to if I could give birth in the company of a woman with whom there has been the chance to build up some mutual understanding and trust beforehand.

While all this was going on, I attended a NCT Home Birth Group in Liverpool. I expressed some of my anxieties. The facilitator of the group, herself a mother and a doula, told me about the One to One Midwifery Service. She said that she wasn’t sure but she thought that they may now be operating in my area. Seizing on the chance that they might be, I filled in the online expression of interest on the One to One Midwifery website. Jo Parkington, the Clinical Director of One to One, responded with a letter saying that ‘we are not commissioned (contracted) to provide our service in your area which means we are unable to accept referrals and provide your maternity care’. The letter went on to say ‘I have been in discussion with commissioners in your area to resolve this issue but this is a slow process. I urge you to contact your GP and request that you are able to choose a maternity provider that meets your needs. If your GP agrees to support your choice they can contact me on the mobile number or email address below.’

I went along to my GP at the Ormskirk Medical Practice, with a copy of the letter. Fortunately, and to my great appreciation, he was responsive. I popped into the surgery a few weeks later to find out how things were going. The receptionist, who is always friendly and passes on all messages, spoke to the Practice Manager. The Practice Manager telephoned me last Wednesday and gave me a full and open update of how things stood. The Medical Practice would be willing to make an application on my behalf for Individual Funding for One to One Midwifery care. I couldn’t believe my ears – I might be able to receive what I need!

I telephoned Jo Parkington, the Clinical Director of One to One. I hadn’t made contact with her since I first received the letter and I wanted to tell her what had been happening. I had a long conversation with her. Now I want their service more than ever!

My husband’s cousin has very recently given birth. It is her first baby. She is trying to breastfeed. She saw the midwife on Sunday and was concerned that she would not see her again until the following Wednesday, feeling that she needed more support. Both her mother and my mother-in-law said that visits were more frequent in their day.

Apparently mothers are visited on average three times by NHS midwives in this area, following the birth of a child. (Women in Wigan are visited just once.) One to one midwives visit on average ten times, more if necessary. Obviously I would much prefer the latter level of support and the enormous reassurance that I would benefit from in knowing that more support was there if I needed it.

Part of me feels a little guilty that I am asking for something out of the ordinary. What right have I to a Rolls Royce service? Then I think that for centuries woman have known the woman who attended them at the birth of their children, usually it was their mother or another close relative. There would have been much opportunity to discuss the birth prior to the event and to be supported by the same woman in the tender days of early parenting. This knowledge silences the voice which says that ‘I should just get on with it and stop making a fuss’ because in reality I am not asking for anything extraordinary at all. It is only in recent years that we have expected woman to give birth in the company of strangers. My mother-in-law gave birth to her second child at home in Kirkby in the mid sixties. She said that the fact that she knew Nurse Murphy before the birth helped her to relax. Nurse Murphy was evidently a strong community presence. This reminds me of the current television series ‘Call the Midwife’. Midwives in the 1950’s in the East End of London were known to women before, during and after the birth.

Should what I am asking for be only available to a privileged minority of modern women, especially when their well being during pregnancy, birth and in the early days of parenting so affects the well being of future generations?

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