THINK…an open letter…

Physiological 3rd stage, breastfeeding the pla...

Physiological 3rd stage, breastfeeding the placenta out. (Photo credit: Wikipedia)

Dear Maternity Care Provider…(Obstetrician, Midwife, Maternity Nurse, Health Care Support Worker, Lactation Consultant, Doula, Antenatal Educator…And to myself, not just to you…)

You have knowledge, experience and skills that support women daily and those of you in the medical maternity services save the lives of thousands and millions of mothers and babies across the world…thank you…

You have knowledge, experience and skills that you are educated to use and perhaps scared into believing are always essential, whether through pressure from insurance companies and policy makers or simply too long on the ward and not enough time in the community experiencing natural, joyful pregnancy, birth and breastfeeding…isn’t it time that you went out from your clinical space to sit on your hands quietly and watch a mother birth her baby without your help…?

Pregnancy, labour, birth and breastfeeding may not always be easy, may not always run to a timetable…but before you step in with those life-saving essentials, take a breath…

Please THINK…why do you work in maternity care…what drew you to this profession…to this vocation…?

Please THINK…what does this woman, this mother, in front of you, need?  Right now.  What is it that will best serve this mother in this moment?

Please THINK…I know that I talk too much, and therefore I must listen too little…it is habit, learned behaviour…I am working on THINKing more before I speak…LISTENING before I THINK…Join me in breaking the habit…Please THINK…Please LISTEN…

THINK…

T… is it true?  A mother came to class recently and told me that her doctor measured her height and the distance between her hip bones and pronounced a concern that she may be too small to birth her baby vaginally…This mother is not of white Caucasian descent and tells me that she is in fact taller & wider of hips than many of the women in her own country…Her husband is of the same ethnic group and the men too, she assures me, are shorter and slighter of build than men in the UK…But *it is a hospital measurement*…apparently she was told British women average 5’4″ and this mother is just 5’1″…But women in her country give birth vaginally all the time she tells me hopefully…And I try to reassure her, to tell her to keep faith in that knowledge, because measurements based on a predominantly white Caucasian cohort will not reflect the facts of her own heritage…This mother has a little over 6 months of pregnancy left and now one of her main tasks will be to unlearn that comment…To ignore the medical need to measure & compare at 20 weeks…perhaps again at 34 weeks…Is it TRUE?  Can you show me hard facts that account for all other variables and indicate that smaller women find it hard to birth their babies vaginally?  Can you show me hard facts that indicate that her baby, with her genes and those of the father with the same ethnic origin is likely to be too large for her pelvis and prevent vaginal birth…does the birth rate in her own country support your fearful comment on her stature?  Is it TRUE…?

H…is it Helpful?  A friend of mine had her baby, all went pretty well, and then came breastfeeding…it wasn’t instant, like lots of mothers she needed to learn the art, and so did her baby…but someone working (and they did not make their role clear, which itself is unhelpful) in the post natal room told her that she would not be able to breastfeed properly because her nipples were too big…Fortunately, my friend had been to some positive about birth and breastfeeding groups and asked me to visit as a breastfeeding mum for some mother-to-mother support…Luckily, she went on to breastfeed successfully, but the damage had been done, her confidence was rock-bottom and her breastfeeding journey had a bumpier start than it needed to be…THINK…before you speak…is it HELPFUL…?

I…is it Interesting?  And if it is, interesting to you…or to this mother?   Why is it interesting?  Does it appeal to morbid curiosity…and so could it be scary or even terrifying to a woman carrying a baby in her belly right now?  Is it drama filled?  Could it stress out this hopeful mother?  Most of us know a story about a mother who went into labour and had contractions for 3 days and then had her waters broken and then was induced and then had to have a caesarean birth after all…What sort of birth is this mother hoping for?  Do you have any concrete evidence that she won’t be physically or mentally capable of achieving that birth?  Do you have an irrefutable reason to suspect that her labour will last for days instead of hours?  Still need to tell her this story…?  Is it INTERESTING…?

N…is it Necessary?  Does this woman NEED this test, this vaccination, this vaginal examination…?  Or is it policy?  Is it recommended but not mandatory?  Did you make it clear this mother has a choice about the care you are offering her?  Recently, many women have willingly received the Whooping Cough vaccination…and yet shockingly, some of them were not offered the injection but simply told they *needed* to book in for it to be done, and many of those and others who chose it remained ignorant that they were in fact receiving a triple vaccine…and was it necessary?  Or could they have chosen…?   In labour, a woman moves & moans rhythmically in her birthing pool and you can see the purple line creeping up the natal cleft and hear her vocalisations deepening and intensifying…you’ve listened in to the baby between rushes and all is well but you haven’t checked her dilation yet…you ask her to leave the pool (her sanctuary) because you *need* to do an internal examination…Do you?  Does she want to leave her water?  Does she want you to examine her?  Does she know that she can refuse you?  Is it NECESSARY…?

K…is it Kind?  A mother I know had a long labour, not excessively so, but long all the same and through the night…and a full 2 hours of pushing…so she was a little tired but still elated & smiling as her baby came earthside at last  and into her arms…her birth plan asked for a natural third stage (physiological third stage  & delayed cord clamping)… the midwife practically whispered “You’re very tired, let’s just manage this stage…” as she slipped the syringe into her thigh…No doubt the midwife was acting out of perceived kindness to save the mother some time and shorten the process…but did early cord clamping for that injection of syntocinon reduce the blood transferred to her baby and affect its iron stores?  Did the management of her third stage increase or prolong lochia? Will she always wonder if she could have finished what she started naturally…?  Is it KIND…?

I promise to LISTEN more and to THINK before I speak…will you join me?

Will you commit to THINKing more about the mother in front of you and what she needs right now, not what protocol & policy state, but what is true for her, helpful at this time, interesting to her ear & her heart, necessary for her health or that of her baby, and what is kind to this woman, to this mother…?

Can you THINK…?

I believe you can…I believe you will…

Blessings & Prem

OMx

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