For most women, pregnancy is an emotional rollercoaster, with the highs of excitement and hope but also with the dips of doubt and worry. The relationship women develop with their midwives can be a huge support as they navigate all of these ups and downs. This support is greatly strengthened if the woman has the opportunity to meet the same midwife throughout her pregnancy and during and after the birth of her baby.
It has been shown that women who have “known” their midwife or a small group of midwives value this experience. Why?
Imagine it is one midwife, or a small team of midwives who are going to provide care to you and your baby. They share in the excitement of your first antenatal appointment, then gradually build a relationship with you over the following months, listening to and learning your needs, wants and concerns. You have a familiar caregiver each meeting, so the conversation and care progresses, and a relationship based on mutual respect and trust develops. During pregnancy you have opportunities to gather and discuss information, and make decisions about how you would like your care to be planned. You know that in labour when you are at your most vulnerable, familiar and trusted midwives will be with you to support you in the birth of your baby.
When a woman knows and trusts her midwife to understand her needs and those of her family, there is a shift of power toward the woman as she takes more control over her care rather than “fitting in” with the system. Being able to develop a relationship like this enables the midwife to be “with woman”—which is the literal meaning of “mid-wife”—putting a woman and her family at the centre of care and supporting them in their pregnancy, birth and postnatally. The partnership that develops is positive for both the midwife and the woman, as well as her family.
Midwife-led care, either in the community or in hospital, is an option more and more women are asking for, though it is still only available to a small percentage of women and only in some parts of the country. Yet research shows that this care model, in which a woman is more likely to be cared for in labour by a midwife she has got to know, offers numerous benefits to women and their babies. These include a greater chance of a spontaneous birth, feeling in control during labour and initiating breastfeeding. It has also been shown that with midwife-led care, women are less likely to be hospitalised during pregnancy or to experience regional anaesthesia, episiotomy (a cut in the perineum) or an instrumental delivery of their baby.
As a community midwife working with women who choose home birth, this care I am describing is the way I practise midwifery but it is also possible in a midwifery-led unit or with a Domino scheme. As I write this a young woman has just phoned me. She is so excited because she thinks she is going into labour. I am her midwife and I am excited too. We know each other well having met during her pregnancy and I have been giving her care. We have shared stories and cups of tea. We know and trust each other and when I see her soon she will be in labour. I am there for her to create a safe place where she can birth her baby.
I have been with many women in their birth journey and each time it is so very different. Some women need me right there holding them closely, breathing each contraction with them constantly encouraging them until they hold their baby in their arms. Others withdraw and need their space to go deep within themselves to find their own resources to carry them through their journey to meet their baby. Meeting these women in their pregnancy enables me to learn what they may want and need in their labour. Afterward, we have the time to talk and marvel about the birth and we also have time while the woman and her family become used to their new baby and establish breastfeeding before our partnership ends.
The care I am describing—where a woman knows her midwife—can happen both in the community or in hospital care but women need to be aware of it and the benefits it can bring. If midwife-led care is available in your area you may decide that is what you would like. If it is not yet available ask if it can be made available. If we don’t ask for change it will not happen!
AIMSI (Association for the Improvement in Maternity Services, Ireland): Healthy Birth Directory for the West of Ireland 2011 – 2012
Sally Millar is a self-employed community midwife and since 1994 has worked with women in the West of Ireland who choose to birth at home. Sally is also a lecturer in midwifery in Trinity College Dublin.
29 May 2011