Sensitive Midwifery - Issue 44 - October 2019

Birth Technology-focused care is another hospital policy that impedes woman-centred care. The latest intrapartum care guidelines in South Africa have discouraged the use of routine cardiotocography for low-risk women who are in spontaneous labour. Fetal-heart monitoring should therefore only be done intermittently using a doppler ultrasound device or Pinard fetal stethoscope. Intermittent auscultation allows women to maintain an upright position during labour, which in turn increases patient comfort, assists with pain management and decreases the duration of the first stage of labour. Making a case for caseload midwifery Another avenue for improving woman-centred care is continuity of care through the caseload midwifery care model. Caseload midwifery is continuity of care by a primary midwife. Midwives who use this model of care work in partnerships or groups. The woman is introduced to all the midwives in the group to enable care from a backup midwife if her primary midwife is unavailable. This helps to allay anxiety in the birthing woman as she has had enough time to get to know and bond with the midwives antenatally. This model has proven to have incredible benefits for both mom and baby. Research has shown that women who have continuity of care by a primary midwife are less likely to have a C-section, use analgesia during labour, or have an episiotomy, and fewer infants are admitted into the neonatal unit after birth. Are we with women? The word midwife means ‘with woman’. It is therefore our mandate to stay true to our profession by continually entering into collaborative relationships with the women entrusted to our care. When a woman is involved in her care during childbirth she feels in control, safe, respected and that her dignity is intact. Midwives should be supported in executing woman-centred care, particularly by receiving the necessary training. Since hospital policies and procedures play a significant role in promoting woman-centred care, hospital management should also ensure that midwives practise in a conducive environment. The most beautiful thing Sanele has ever seen Last year, I had the opportunity to work in an active birthing unit after having worked at a district hospital, and as an obstetric nurse in the private sector. This particular birthing unit practises caseload midwifery. In this unit, woman-centred care is the order of the day. Every woman who comes to give birth has a birth plan, which is respected as far as possible. The mind shift I had to make during that period was massive. I had to unlearn the defensive medicine that had become so inherent during my time as an obstetric nurse. I had to learn to trust the birth process – something I had never practised as a student or even later as a qualified midwife. I witnessed a truly natural birth for the first time in this active birthing unit. I soon learned that a normal vaginal delivery is not necessarily a natural birth: • Natural childbirth is a process whereby midwives allow labour to progress with no interventions. There is a trust in the woman’s body and its capabilities. Normal maternal and fetal monitoring during labour still happens as per the care guidelines. • The space in which the woman is labouring is treated with the utmost respect: people cannot simply walk in at any given time; if you happen to enter the room for whatever reason, you do so very quietly. This allows women to feel safe, helping their bodies to function optimally by producing endorphins and oxytocin during labour. • The woman wears her own clothing, and can eat as and when she wishes. • The woman has a birth companion of her choice. She may choose to have a doula as well. • Warm water (e.g. using a shower) is used for pain relief and the women has the option to get into a warm bath once she is in advanced labour. • Fetal heartrate monitoring is done intermittently with a doppler ultrasound, even when the labouring woman is in water. • The woman listens to her body and adopts whatever position she feels is most comfortable while she is in labour. When she is ready to birth, she births in whatever position her body is telling her to. • Once the baby is born, if all is well, skin-to-skin care is promoted while delayed cord clamping is practised. Natural birth is the most beautiful thing I have ever seen. 29 eSensitive Midwifery Magazine Issue 44