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Rapid Responses: Rapid Responses published:
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Independent midwives
- Emma A Mahony (16 June 2009)
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Acknowledgement
- Allison Shorten, Brett Shorten (22 June 2009)
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The Value of Independent Midwifery Care
- Pauline Elizabeth Dawkins (22 June 2009)
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demand all you like, but........
- Bob Bury (24 June 2009)
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Emma A Mahony, writer and mother of twins home
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Sadly,the headline to the BMJ article has been picked up by the press under the banner of Using Independent Midwives three times more likely to result in Stillborn babies - despite the number of statistical questions surrounding the piece. As a mother of twins who used Independent Midwives because my local NHS hospital insisted term for twins was 36 weeks, and I would have to give birth in theatre with 12 people present - plus I was offered the first baby normal birth and the second one by Caesarean - I was in a position where only Independent Midwives would help me to have the normal physiological birth that I wanted. That we had to transfer to hospital because labour wasn't progressing fortunately did not interfere with the outcome because the independent midwives were co-operative and supportive in the hospital environment - but very much of the view that I - the client - was in control. This sort of study harms the possibility of other women having this superb level of care, because it scaremongers a vulnerable profession which is already struggling for its life in the private sector. Until the NHS see sense and welcome the model of Independent Midwifery care, and also offer to include them where appropriate in their Bank Midwifery services (if the IMs agree) then this country will be far poorer. These studies should be published with thumping great Caveats because they cause more harm than good, and shame on the BMJ for publishing it all. Competing interests: None declared |
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Allison Shorten, Senior Lecturer School of Nursing, Midwifery and Indigenous Health, University of Wollongong, Brett Shorten
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We would like to thank Professor Jane Sandall for providing us with important contextual information regarding midwifery in the United Kingdom. Her insights were of great value in the preparation of our editorial. Competing interests: None declared |
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Pauline Elizabeth Dawkins, Part Time Lecturer The UWI School of Nursing, Mona, Kingston Jamaica
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The article by Allison Shorten (BMJ 2009; 338:b2210) published on June 11, 2009 is a timely reminder that as modern technologies advance, professionals must remain patient focused to continue providing patient centred care rather than be consumed with the need to use technologies for its own sake. Long before the institutionalization of modern support systems and its accompanying technologies, trained midwives have been at the forefront of providing safe and effective antenatal delivery and postpartum services to women of child bearing ages in all corners of the earth. It is critical that developed countries give cognizance to the diversity of their population and not lose sight of the overarching need for women to continue to have a reasoned voice in determining what suits them, having had the benefits of consultative and collaborative advice from the professionals. From the perspective of a small island state in the Caribbean, we are resource constrained and as such, rely heavily on the clinical expertise of our midwifery and family nurse practitioner workforce to deliver high quality, safe and cost effective maternity services to our population. Ante-natal, delivery and post partum services are largely undertaken by these nursing personnel in primary and secondary care settings with appropriate referrals, follow ups and home visits as required following 24 hour discharge from hospital for normal deliveries and 72 hours post Caesarean section. Home deliveries for first, fourth and subsequent pregnancies are not encouraged and/or supported, due to inherent associated risks but are facilitated where the woman exercises the right to choose after the risks have been explained. All things being equal, it is incumbent on professionals to facilitate and support the desire of the woman to be provided all midwifery services and care in a community setting rather than be subjected to the dictates of professional bent on employing modern technologies whatever the costs. Your Sincerely Pauline E Dawkins Competing interests: None declared |
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Bob Bury, Consultant Radiologist Leeds General Infirmary LS1 3EX
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The authors say that we must meet: 'the challenge for mainstream services to move beyond the rhetoric of policy documents and provide the type of services that women demand' Well, up to a point yes. But if the service they demand is support for home delivery regardless of the level of risk, then I'm sorry, but the answer should be no. This is another illustration of the general assumption that patient choice is paramount. Given that we can't afford to provide everything that we would like to provide in health care, and that difficult choices have to be made, spending large sums of money to indulge the whim for home delivery even where we know the risks are high is clearly an irresponsible use of public money. Our duty is to offer clear medical advice to clients and to provide the appropriate treatment, but we don't necessarily have an obligation to fund those who choose to ignore it. There - a nice bit of old-fashioned paternalism and arrogance from a crusty old consultant. Competing interests: wife and daughter are both midwives. |
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