Neighbourhood Midwives

Why is working as a caseload midwife so important?

Posted in: Blog.

I am very lucky, I have experienced both the joy as a mother of having a midwife I knew really well attend my babies’ births and I now work as a midwife who knows the women she cares for.

Before I was even pregnant with my second baby, I knew that I wanted a different kind of midwife. I had previously given birth in a large obstetric unit, cared for by a variety of unknown midwives and felt that the whole experience was impersonal and that I was ‘processed’ through a birth machine. I knew that I wanted to give birth at home second time round and it was really important to me that I knew who was going to walk through the door on the day I was in labour. I was very fortunate that I met Kay at an information evening on waterbirth and she agreed to be my midwife when I became pregnant. Kay provided all my antenatal care at my home and she cared for me when I had my third baby as well – even better, all of this was provided free on the NHS! Kay got to know not just me, but my whole family.

My two homebirths were a family, social event, not a medical emergency and I remember those days as filled with joy and laughter. To feel no worries about having a stranger in my home, who may not understand my needs for a calm and undisturbed birth, to be silent and still and to respect my wishes. Kay and I had done all the ‘getting to know you’ in the preceeding months so there was no ‘relationship building’ in labour, just her sitting quietly and being present. I didn’t want or need lots of verbal or physical support, just knowing she was there was enough for me. She knew that my husband had chosen not to be at the birth, she knew that for us it was the right decision. She knew that I had chosen a physiological third stage and not to give my babies Vitamin K, these were informed decisions that we had discussed at length in the antenatal period. So the whole experience was on my terms in my home, in which she was a welcome guest, but a guest nonetheless – I was not a ‘patient’ in a hospital room, needing permission to make decisions.

Fast forward some years, I now have the privilege of attending births of women who have chosen me to be their midwife. I liken my role to being part of the supporting cast in a play where the woman is the lead. She is the star of this particular show, and my role is to make her the most important part of this ‘show’. She is the one making the decisions, she and I will have spent lots of time talking at length about her hopes and dreams, her fears and dreads, what is important to her, what makes her tick. What values are important in her family, her relationship with her partner, how much help does she have if she has other children. To learn about how her family dynamics work, does she have family close by, help from her parents, siblings etc? All these things are discussed and thought about long before the actual birth. So when the actual call comes, I am excited and eager to walk the journey of labour to birth with this woman and her partner, an event that has been planned and looked forward to.

Being invited to be present at the birth of a new person into the world is a very special privilege and although I have been present at hundreds of births now, I still get the birth high – as my dear friend Liz says, she and I still have obsessive birth disorder! That first glimpse of the top of the baby’s head as they make their way into the world is magical, to watch as a woman’s body opens up to birth her baby is still an amazing experience. Oxytocin is very intoxicating indeed! And through all of this, the knowledge that this everyday miracle is part of life, part of the life story of this woman and her family, makes it very ordinary and normal. Making tea, toast, running a bath, washing and drying a woman, snuggling a new mother up in bed with her baby and then slipping out into the breaking dawn is a quintessential midwifery experience, it has been going on for hundreds of years all over the world. In the dawn hours when all I see are taxis, emergency vehicles and milkmen, I think of all my sister midwives around the world who are doing the same work as me. I sense the feeling of sisterhood, even though they are all over the planet, they all know the feeling of deep satisfaction, knowing that they made a difference to that woman, that family, that birth. This is what keeps me getting up in the night, getting out of my warm bed, going out into the darkness and driving to support women in labour – women I know and trust and who know and trust me in return.

EMJ 15/6/15