A Midwife Is A Midwife

A midwife is a midwife. This is something only the naive believe. Thinking that all midwives operate using the same guidelines and with the same goal is unrealistic and simplistic. If midwives were all the same we would seamlessly move in and out of the system un-noticed and unchallenged. Instead in my experience as and independent midwife I am labelled, chastised, talked about, threatened and maligned. All I am trying to do is advocate for women’s choice and protect natural birth. Isn’t that the mandate of all midwives?

So what makes us think that independent midwives are different? Is it the ability to give unbiased information to encourage women to make informed choice? Is it the understanding that some women look at evidence and custom and then decide although they know where it’s coming from it’s not for them? Is it the guts to stand up for choice in childbirth regardless to risk for a well-informed woman? What about the trust in women’s body. The confidence and experience to actually be “with women” in the comfort of their own home and the clinical expertise to ask for help and input from other practitioners only when required.

It’s all of the above.

What makes us think that midwives inside the system aren’t or can’t do this? Well it’s restricted practice. Birth inside the Australian system means protocols, guidelines and policies. Many are not evidence based or well researched but custom and practice. Most midwives know this but still every day do things that “will keep everyone happy”. Or they may circumvent the rules by doing things “under the radar” This includes birthing woman at home inside the system. When it’s neither “allowed” nor catered for. This creates a less than optimum scenario for a woman who may have to lie about what is happening to get the birth she wants and the midwife, having to fudge notes which we all know are legal documents.
Many midwives are working inside the system doing their very best for women but choosing their battles carefully and letting some things go to deal with the bigger issues. Is this the way a midwife should work or is she letting her title of midwife down every time she doesn’t stand up for a woman’s right to lead her own birth or to refuse treatment she feels is unnecessary or undesirable for her. Why do they do this? Because they have no choice practice is restricted and their hands are tied. But a midwife is a midwife.

The system is not about choice it’s about control. All types of birth including homebirth when under the umbrella of the system means you have to pass the myriad of obstacles before you can get the green light to birth at home. What midwife can provide optimum care under these circumstances?

How can students of midwifery hope to get a physiological perspective of birth within the medical model? Students are craving normal midwifery in the community and are unable to access it. How can this be possible if a midwife is a midwife?

What about the Australian college of midwives guidelines? Which midwives are they for? Well midwives inside the system that are already working within the systems parameters so don’t need any more guidelines.

What about independent midwives who are working with women to provide choice? Where are the guidelines for women and midwives to work together and create a unique experience?

Even the midwives code of practice says you have professional responsibility to your employer. I wondered if this were a joke. What about the women? What about your colleagues? When is it we are going to stand together exactly, before or after we’ve done the next 4hrly VE or augmentation due to a “failure to progress”? Australian midwives are oppressed in many ways and until we all stand up and say no practice for the majority will remain restricted.

The final point is: Can midwives all sing to the same tune? Yes they can. Can there be a set of practice guidelines where one fits all? Well Possibly. However the guidelines should work for Autonomous independently employed midwives to protect women who choose to birth at home with risks perceived by the hospital to be unsafe, (but as those of us who do these births know, using well researched practices they can work perfectly).

The guidelines should protect Gold standard one on one woman led care. If the guidelines can’t do this then the answer must be No we need separate specialised guidelines to ensure good practice in the community leaving the restricted practitioners to fend for themselves.Who should be the keepers of these guidelines? Well as we are all registered with a governing body maybe it should be with them. However what of our Professional body? Do they keep all midwives best interests at heart? Hardly if we look at the current guidelines. If they hope to protect and advocate for all midwives then they must totally overhaul their approach. If this isn’t possible then we are left with a split. Independent midwives will have no alternative but to keep their own guidelines within a professional body, which is separate from the mainstream. Is this the future of midwifery?