Your pregnancy, your midwife, your choice


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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