Sustaining rural midwifery practice

When considering the issues of sustainability my colleague Sarah Stewart has been blogging about issues for midwives in sustaining practice. She has identified discontent amongst some midwives about the annual recertification process in New Zealand which has only been in place for the last three years. She also questions how midwives are supported and sees mentoring, particularly E-mentoring as a possible support for midwives to help to sustain them and enable them to continue in practice. She also mentions communities of practice as a possible support for midwives.

I was a rural Lead Maternity Care (LMC) midwife for around 15 years, from the start of our modern midwifery autonomy in New Zealand until I changed direction a little and ventured into the education field around 4 years ago. I still do a little rural LMC midwifery as a rural locum. I provide holiday relief or backup to several rural practices in my region and nearby. I have just completed my Master in Midwifery degree and my research looked at how midwives informed practice, finding that communities of practice had a strong influence on information sharing and supporting rural midwifery practice.

During my 15 years as a rural LMC I never had regular days off. I took days off when I had a quiet day but was still on call. I had holidays when I could and some years did not have a holiday at all. When I did take a holiday it was always for at least one month. I found it took me at leas two weeks to get my head out of the job and relax and probably took me at least twice as long as that to settle back into the job when I came back. This was during the years that my children were growing up and at times it was probably pretty tough on them and on my husband. None the less I loved the job and still do. It is my love of midwifery that sustains me most I think.

What I did not love was the continual battle that I felt I was fighting. When I worked with colleagues who shared my beliefs about childbirth I felt much more supported in my practice. Too often I felt that I continually had to justify my profession and myself with the world. With GPs who stated that homebirth was unsafe, with facility management who, rather than supporting often seemed to be trying to undermine what I was trying to achieve. With the media and public, whenever something happened in childbirth somewhere in the country and every midwife seemed to be blamed and had to justify there existence. This was not my usual experience but when it did happen it was very tiring and took most of my energy and enthusiasm for the job.

So my thoughts on how to sustain midwifery practice would be to make sure that you work with other midwives who share your beliefs about birth and work in a similar way to you. Let go and don’t believe you have to be all things to all people. It is women who are having babies not us. We should be able to prepare women so that they can do the job with or without us, as long as we know that our colleagues will support them as we would. Make sure you make the connections with other midwives who can sustain you and will share their knowledge with you as you will with them. Try to establish links with other midwives who can provide a locum service for you to have a break when you need it. If you do not have colleagues like this in close proximity to you then use online sources such as this to make connections with them and communicate regularly. Never lose that belief that this is a really important, satisfying, wonderful job that you do.

I am truly interested in what others think about this. How can we sustain midwives in practice? Our communities need midwives, how can we fill that need when it is not there or support midwives to continue in practice when it is there?

elective caesarean increases breathing difficulties for babies

A recent TV One Health news item speaks of the increased risks of breathing difficulties for babies with elective caesarean sections. Particularly when these are performed early, that is before 39 weeks.
This is information gathered from a large Danish study. They found a nearly fourfold increased risk of breathing difficulties in caesarean babies delivered at 37 weeks, a threefold increase at 38 weeks and a doubled risk at 39 weeks. Babies who have breathing difficulties usually need to be transferred to a special baby unit and are monitored in incubators with oxygen provided. This is another risk which has been identified for women who are choosing or being advised to have an elective caesarean section.

A French study published recently "Postpartum Maternal Mortality and Cesarean Delivery" reported that caesarean section increased the risk of the mother dying after having a baby more than threefold.

This growing evidence of the increased risks to mother and child of having a caesarean section as opposed to a vaginal birth are very concerning as rates of caesarean section continue to rise. Recently published figures from the United States report a 30% national rate of caesarean births. The most recently published national rate in New Zealand was 27% but it is very likely that it too is now 30% or higher.

Can we as a society afford this level of intervention in childbirth.Is this an issue for sustainability? Think of the resources that are involved in this level of intervention/

I am not suggesting that any mother or child be put at risk by withholding necessary medical care and intervention, but where does it stop. Clearly we are not reducing risks for women and children by increasing medical intervention. Instead we are raising risks to the health and wellbeing of the mother and her child.

Can we turn this around? Midwives we need to help and support women to have confidence in their bodies and ability to birth. We need to provide sensitive caring support and information to women. We need to have faith ourselves in the process of birth and to share our faith with women and those who will be supporting them during the birth of the child.

Sustainable babies

Photo from http://www.flickr.com/photos/worldofoddy/1171997881/

There are times in our lives when everyone wants to give a present to celebrate a special event. Times such as birthday's, Christmas, engagement, wedding and a baby's birth. We search around for an appropriate something to send to the important person. How many of these gifts then end up gathering dust in cupboards, advertised on "Trade Me" or "E-bay" or dumped in the rubbish? How many of these gifts are useful or good for any purpose?

I want to talk a little about gifts which are given for babies, but first I would like to share an old tradition that used to occur in Scotland when I was growing up in the 1950s.


I grew up in Scotland and life was full of superstitions and old traditions, for example when a bride left for the church she threw pennies out of the window of her vehicle for the local children. Everyone gathered around in anticipation and scurried to get their share. I think this was something to do with guaranteeing fertility in the marriage.

On first seeing a newborn baby it was necessary to cross the baby's palm with silver. When a new mother took her baby out in the pram for the first time people would come up and greet her and slip a coin or two into the pram. Those old Silver Cross Prams had a deep well which soon started to rattle with the money gathering in the bottom of the pram. This was often use to start a savings account for the new baby. When a new baby was expected family and friends started knitting or sewing however these arts are less common now.

Nowadays people often buy new babies a basket of goodies, full of lotions and powders and creams and shampoos. The manufacturers of these products outline how they benefit the babies skin and produce research to support their claims. We need to remember that they are trying to sell their product and the research has been conducted with this goal in mind. New born babies do not get dirty. They do not need all these lotions and potions. In my experience babies need, and love, to have a bath. All they need is warm water. After the bath a gentle massage with some pure almond oil, without any additives is relaxing and calming for the baby and is a nice way to care for the babies skin. Other oils such as olive oil can also be used but almond oil is less greasy. It is best to avoid using peanut oil because of the potential for allergy to this product.

Nappy wipes are a relatively recent addition to list of must haves for a new baby. Originally introduced as a handy way to clean the babies skin when out and about they now seem to be used universally at every nappy change. This is neither good nor necessary. A damp cloth with plain water will clean the babies nappy area just as effectively, reduces the babies exposure to chemicals and reduces waste in the environment. Women used to cut up old soft nappies or use muslin squares for this purpose.

The debate about cloth versus disposable nappies still seems to rage on. I think this is something that future generations will find very hard to understand. How could we possibly think it is OK to create this mountain of garbage so unnecessarily. What do you think about this? Why do so many parents feel that they have to use disposable nappies? Why not give a gift of cloth nappies, or maybe give a gift of an offer of help with washing these? If you are thinking about cloth nappies this is a lovely very simple little pattern for woolen overnaps. They need to be made out of pure wool but can be machine washed. The more felted the wool becomes the more waterproof the overnap is so old woolen overnaps are really desirable. Using these allows the babies skin to breath while still providing some protection from dampness. Babies nappies should be changed regularly as contact with ammonia from stale urine and bacteria from babies stools is a cause of nappy rash.

Baby Pilchers knitting pattern

Size 10 or 12 needles depending on your knitting
One ball double knitting wool does one pair, (large ball does two pairs)
Hank of natural does 3 pairs
Cast on 80 stitches
10 rows ribbing (holes half way)
(for larger size cast on 85-90 stitches).
Continue in plain knitting.
Knit two together on each plain row until one remains
Fold over band at top leaving space for cord
Sew up point in the middle leaving space for baby’s legs depending on the size of baby.

And then there is the gift of babies bottles, and sterilizers and formula. For a very few parents these might well be necessary. For most, help and support and positive encouragement to breast feed are better and healthier for the baby, and definitely better for the environment. Providing a meal or two for the new family, offers of help with shopping or housework might be much more useful gifts.