It may sound corny, but I feel I was born to be a midwife. As a child I was always interested in birth but the nearest I got to it was seeing a cat having kittens! I remember wondering then why people went to hospital to have babies, when other animals simply found a cosy place and gave birth there....
At University I did research about women in labour, and pain, and was horrified by the women's reports about how they had been treated. I felt that if I were a midwife I could maybe make a difference.
I trained at a hospital where there were low intervention rates despite the "high-risk" population in the area. I learned a lot. However I never did get to see a homebirth, and there was always the nagging doubt that there was something missing. When I qualified I worked on the Labour Ward for five months. As time went on I became increasingly dissillusioned - I was meeting women I had never met before, experiencing this amazing, intimate event with them and their families, and then not seeing them again - apart from the snatched visit to the post-natal ward. And in professional terms I felt that I was going backwards; my confidence in the normality of birth was being slowly eroded - by other midwives, doctors, and the simple fact that I was in a hospital. I became tired of justifying why I had not broken someone's waters to "speed up labour", or why I was letting women soak in the bath to help ease their pain - the list was endless! Even though I knew that I was a "practitioner in my own right", as is laid down in our " Midwife Rules", I did not feel like one.
Many of the women in labour arrived at the last minute, and I wondered why we weren't going out to their homes and "catching" their babies there, instead of causing them to disrupt the flow of labour and come into hospital, risking having the baby in the car/lift etc. Often these women had deliberately left it to as late as possible to be admitted; what were they trying to say? All the literature that I had read, both critically in my training, and privately, pointed to the fact that for the majority of women - providing everything is normal (which 75%+ are) birth was as safe at home, if not safer, and with all the other benefits such as comfort, nice surroundings, family involvement etc. it seemed the perfect choice.
I then had the opportunity to go to Toronto, Canada, where they did not (at the time) have midwifery as a profession, and their intervention rates are appallingly high. As a result, there was a strong homebirth movement, with "lay" or "self-trained" midwives. Whereas in my training I had to 'deliver ' 40 babies ( and not necessarily have been with them throughout labour ), and attend 40 abnormal labours and births, the guidelines and training for these midwives were strikingly different. They were apprenticed to a more experienced midwife, and had to follow 20 women throughout the whole pregnancy, and 'catch ' their babies at home. Understandably their attitudes to birth were very different. Most importantly, they knew the women really well, and had built up a close relationship with them in the ante-natal period. This seemed to help them recognize any problems quicker, so they could deal with them sooner. The midwives learn, as they do in the U.K. that everything is normal unless proved abnormal, but the Canadian Midwives saw it for their own eyes. They sit through all these normal labours from beginning to end, and see how labour takes it's natural course when it's at home, with no policies or rules to follow.
I was privileged to be at several homebirths. It confirmed all the beliefs that I had had - the women were more relaxed, coped beautifully with their labours and the atmosphere was that of pure trust and confidence in their own bodies and their midwives. Every birth was so unique in all its little nuances. At one birth I was amazed at the serenity of it all, and the other midwife just smiled and said: "What do you expect? We're at home". I re-learnt the skill to trust and follow the mother's instincts and rediscovered my love for my profession. Things could never be the same again!
And they weren't - on my return to England I made the difficult decision to go it on my own. In Britain every woman is legally entitled to a homebirth under the N.H.S, but in many areas it is difficult to arrange: women may face opposition, antagonism and even hostility to their decision, and this erodes their confidence. There is also often no guarantee that the midwife who attends them will be someone they have met before or who will feel happy about doing homebirths, - after all, we are all trained in hospitals.
I felt that the only way that I could work to the best of my ability, and give the most to women, was to be self-employed - or independent. I feel I speak for all Independent midwives in saying that if we could work as we do under the N.H.S. then we would.
I moved to Etchingham in May 1990, and work full-time as an independent midwife. How does it work? The women contact me and I go and meet them so that they can learn more about me and vica versa. Once they have decided to book with me, I do all their ante-natal care in their homes, and at their convenience. Ante-natal visits give me a chance to see how the baby is, and the mother, but it is also a time for getting to know each other, airing worries, answering questions etc. Everything is very informal, I don't wear a uniform, and many times visits will tie up with having lunch, walking our dogs together etc! Needless to say, by the time birth comes around, we are usually good friends as well as midwife/client.
The women call me when they need me in labour, and I stay with them until the baby is born. I stay around for about 3-4 hrs afterwards to make sure everyone is settled, fed and watered, and that the house is tidy, and then I leave the new family to enjoy themselves in privacy.
I visit frequently in the days after birth, but if all is well, I feel it is important to let the women decide when they want to see me. I am always contactable by 'phone, for whenever there is a problem, or if anyone needs a chat. I visit upto 6 weeks after.
If there are any problems, then I will call the Registrar/Consultant at the local hospital, and may transfer if necessary, however like all midwives I am trained to deal with emergencies and carry the appropiate drugs/equipment necesarry. The most common reason to transfer is "failure to progress" which is basically when labour progresses very slowly, or not at all, is not an emergency, and is most common in first- time mums when the baby lies an awkward way around - with it"s back to the mothers.The women will usually be the first to say that they have had enough, and will make the decision to transfer, in consultation with me, to the hospital to have whatever help they feel is necessary. It is the woman making an informed choice, and having control over the situation, that tends to affect satisfaction with the labour- not necessarily on what type of birth she has. I stay at the hospital until they have the baby, whatever happens, but as yet am not allowed to personally catch babies in hospital.
There are disadvantages to being independent - I have to charge women for what I feel they should be entitled to, but I have to pay the bills. I am a professional, and my fees reflect the time and energy I put into my profession. I am also on call 24 hours a day, 7 days a week, so this can limit my social life to some extent!
On the plus side however, I am forever learning from women and their families. Birth is now how I always imagined it to be, and it is a real priviledge and joy to be a midwife.