good practice
Campaign for normal birth
The Royal College of Midwives (RCM) in the UK is currently running a Campaign for Normal Birth to help change the way that childbirth happens.
Via its UK-wide information service, DPPI receives many enquiries from disabled mothers-to-be about the issue of normal birth. We were keen to find out how the RCM campaign will include disabled mothers.
Normalising birth for everyone
Mervi Jokinen, practice and standards development adviser, said “We believe that midwives should support normal birth practice for all mothers-to-be, including disabled women, unless there are medical contraindications to indicate otherwise”.
As part of the campaign, the RCM launched an innovative new publication for midwives in June 2008 called Ten top tips. Mervi said “The booklet provides midwives with 10 top tips that can be used in their first steps in helping to normalise birth. With this booklet, we want to inspire and support normal birth practice”.
The number one tip for a normal birth is a ‘wait and see’ attitude. The booklet says “The one single practice most likely to help a woman have a normal birth is patience. To do this, we need to be able to acquire more knowledge and experience of normal birth — and know when the time is right to take action”.
Midwives are advised to listen to women and think carefully about whether intervention is really necessary. The booklet says “Women themselves are the best source of information about what they need. However, a medicalised culture of ‘knowing best’ (where the deferential ‘?patient’ is examined mutely) means that we are not good at asking”.
Learning from disabled mothers
The campaign website features a selection of real-life birth stories from the perspective of the midwife. The RCM is actively seeking further stories to assist them in collating practice points from lessons learned, to feed into the on-going campaign.
Mervi explained “We want our campaign to engage people in thinking about the issues. We're aware that we haven't fully engaged with disabled mothers about their needs and experiences yet and would therefore welcome birth stories from disabled mothers and midwives who have worked with them, to help inform the campaign.
“We'd like to find out from disabled mothers whether their midwives discussed the option of home birth with them, what things helped them to have a good birth experience, and what they would have liked to have happened differently to enable them to have had a normal birth”.
For more information or to submit your birth story, please visit the campaign's website at www.rcmnormalbirth.org.uk
Supporting normal birth: a midwife's experience
Ben and Amy are members of my extended family. I have known Ben for over 15 years and met Amy first as Ben's girlfriend.
Ben has been profoundly deaf since birth and Amy has been deaf since having meningitis as a toddler. No other members of either family are deaf. Ben and Amy, and close members of their family communicate using sign language and lip-reading.
On their wedding day Ben and Amy asked me if I would be their midwife when Amy became pregnant. A few months later Amy was feeling poorly, was pale and felt sick, and asked for my advice. I advised her to take a pregnancy test, and to everyone's delight, she was pregnant. An early scan revealed she was pregnant with twins and this was the reason she had felt so sick and unwell.
Throughout her pregnancy Amy continued to feel unwell. She didn't ‘bloom’, but remained deflated and tired. She experienced many of the ‘minor’ disorders of pregnancy, for example, nausea, indigestion, tiredness, poor skin and hair condition, all of which left me concerned about her ability to cope when the twins were born, and whether she would suffer from postnatal depression? The majority of pregnant women are exposed from childhood to stories of pregnancy, including early symptoms and birth experiences. However, as a deaf woman, Amy was excluded from this subconscious source of information.
As Amy was pregnant with twins, she was automatically considered to be ‘high risk’, therefore her care was shared between a consultant obstetrician and me. I offered to provide Amy and Ben with their antenatal care at home. On the few occasions when they needed to see the obstetrician both Amy's father, Bernard, and I accompanied them. He proved to be an invaluable source of communication between Amy, Ben and the health professionals involved in their care, including me.
Accessible information
Amy and Ben felt self-conscious about attending parentcraft classes because they would have required an interpreter, making them different from the other couples. They opted to have pregnancy and birth education provided by me in their own home, with Bernard acting as an interpreter. In order to obtain current information in alternative formats, I contacted DPPI. Ben and Amy found the resources to be excellent.
Unfortunately Amy developed an infection and high blood pressure at 31 weeks, which meant she had to be admitted to hospital and the birth induced. Bernard acted as my interpreter and was present until 45 minutes before the birth. He was always mindful of his daughter's dignity and that this was an important experience for Amy and Ben as a couple.
Once Amy, Ben and I were alone we became a team and worked in partnership to facilitate the birth of premature twin boys with a normal vaginal delivery. We communicated successfully with lip-reading, gesticulation and non-verbal cues.
Both Amy and Ben took to parenthood with ease. Thankfully Amy showed no signs of postnatal depression. Their sons are now 18 months old, well, and full of energy.
My experience with Ben and Amy taught me a lot. I had not realised the extent of the communication difficulties that I would encounter, and had underestimated my reliance on verbal communication and the subconscious preparation for pregnancy, birth and parenthood that occurs by listening to birth experience stories from childhood onwards.
More awareness needed
I believe there needs to be more awareness among midwives about caring for women with unseen disabilities, such as deafness. It also reinforced the importance of treating all women as individuals and adapting the care provided for their needs. The relationship and continuity between the family and the midwife is a key priority.
This article was written with the kind permission of Amy, Ben and their family.
Bev Lynn, Practice Educator Midwife, Colchester Hospital University NHS Foundation Trust/ Anglia Ruskin University, UK