The Highland Midwife - Episode 3

The final episode of the three part documentary on Scottish rural midwifery finished this week and it was another great episode. We were introduced to another three mothers to be and their wants and wishes for their birth and feelings about midwifery care they received throughout pregnancy.

As in my two previous posts my reviews usually focus on the three stories and the key points I take from them as a student midwife studying in Scotland.

First I'd like to talk about Sian's journey to an induction and long (in regards to time) birth process. Induction is always one of those things talked about quite lightly and for some women seen as a normal process to give birth. In my experience inducing labour should not be promoted unless for some medical reason, as shown here. The mother's Graves disease increased the challenges of pregnancy and birth on her body and on the baby and it was important that this was monitored and a plan put into place. By discussing this with the woman it can include them in the discussion and ensure they still have a feeling of control and empowerment when it comes to birth planning.
Inductions can take a long time. Inductions can be unsuccessful (I hate the term 'failed induction' - like it was someones fault!). As shown by the show once a induction is termed favourable, an artificial rupture of the membranes (ARM) can be undertaken. I though the explanation to the women about all procedures undertaken during the show were excellent. Communication is paramount when any type of intervention is undertaken in a woman's labour. The use of the hormone drip, and FSE were explained and overall the introduction of the medical staff to assist the birth was all explained to mum and undertaken in good time.

In my experience the process of induction can be controversial, but I'll save that for another blog post, or twitter chat!

Meeting Carrie and her experiences with Morven as a midwife was an absolute delight also. Not being able to feel contractions was certainly a new situation I haven't heard of. I've heard of people labouring in their back or sides, or only feeling contractions in latter stages of labour, but not feeling any contractions and dilating also silently was new to me! Absolutely the right path of care was again undertaken for Carrie, extra precautions when she felt tightenings and referral to the CLU was important due again to her remote locality. In the end her labour progressed well, again after an ARM, and baby girl was born quickly thereafter. I have experienced quick labours myself undertaking an ARM at 6cm dilation only to have the baby born 2 minutes later. Second time mums who have experience of quick first births will be monitored closely after ARM as it usually isn't too long until baby arrives.

Finally to Claire and her homebirth transfer. I felt inspired by every point of her story. Being supported to have the homebirth she requested after feeling a loss of control after her first birth was empowering. The care undertaken by her midwife Hazel was also empowering. Hazel's explanation of the homebirth kit, inducing labour naturally and cervical sweep was fantastic. The communication between midwife and mother was informative, honest and individualised.
My only annoyance was the use of language by the narration when discussing mum's choices. 'Risk' of homebirth could have been 'challenges' of homebirth. The homebirth being 'judged as dangerous' and so transferred could have been put that 'Claire needed further medical intervention'. It didn't help paint a positive light of homebirth. It also showed the reality that labour can be a long and tiring process and that transfer for pain relief is also sometimes needed.
Nevertheless the decision to transfer to hospital was 100% correct, especially after the diagnosis of a shoulder dystocia at the birth. Although this can be managed at home, in my opinion, it is best to be in a place with the resources to hand should the situation grow critical and intervention be needed. I am glad Hazel made the call and that Claire, after labouring brilliantly at home, was in the right place at the right time.

Birth is unpredictable and it just shows that every mother to be needs individualised care based on their preferences, previous experiences, underlying medical conditions and family requests.

The show has put Highland midwifery in a wonderful light. Shown the reality of rural midwifery and the challenges faced day to day by midwives in Scotland.
I hope it returns for another series and I hope you've enjoyed my little comments!

Until next time,
Ruth

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