Re: Challenges of private midwifery

A midwife colleague of mine in QLD, Barbara Cook of Serene Births, has recently experienced a challenging time with a client.  This was a situation where she offered to support a planned hospital birth, rather than a planned homebirth for a woman when her care needs escalated, and the midwife's attendance at a homebirth would not meet the standard of care that private midwives offer in Australia.  The client had had a previous caesarean section, and she had found this to be a traumatic event.  In the last paragraph of her blog post, Barbara comments,

“Yet if this woman had been supported well in her first birth with a known midwife she may not have required the caesarean, she now would be in control of her destiny and probably be able to birth at home.”

This is something I wanted to draw on: the choices that women make – sometimes knowingly, but most often unknowingly – in their first pregnancies, and the far-reaching impact that this has on future births.

Many women have a “see how it goes” attitude to their first births, perhaps not realising how important a first birth is in terms of bonding, breastfeeding, attachment, how a woman feels about herself, how she reflects on her birth in years to come, and the choices she makes in subsequent births.

In my practice, I meet a large number of women who feel traumatised by their first births, and I work with them as they journey through their second pregnancies.  The path is usually not smooth, and there are many bumps along the way: fear, uncertainty, doubt, anxiety, tension, sadness, grief, guilt – a whole gamut of emotions.  It is necessary to unpack and process all of these emotions before we can plan for a positive birth.

When women are supported well in their first births with a private midwife, they are highly unlikely to require a caesarean, and they tend to reflect on their births as a wonderful, positive experience.  Whatever comes up in their next pregnancy, they know they can do it (they have done it before), they are considered low risk (previous normal birth is the most likely outcome with a private midwife), and all the care options are available to that woman.  A previous caesarean means that a woman may be viewed as high risk for all of her subsequent pregnancies, with all of the emotional trauma that often accompanies an emergency caesarean when a woman was planning to “see how it goes”, thinking, “it’ll never happen to me”.

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