my thoughts on birth suite environments
Most women start off wanting a natural birth when they are first pregnant. They become educated to stay off the bed in labour....yet somehow most will end up there.
'Just pop up here as I need to examine you'....and there they stay. For our convenience.
Don't get me wrong....this is no attack on midwives who work in hospital!! I know the intention and the want of those who practice midwifery is to encourage active labour and a woman to choose to labour where she is most comfortable....but when you as the care provider are physically uncomfortable for what can be hours on end, its hard to be supportive and present, and its jolly difficult to be encouraging. And when you as the care provider can't easily take a foetal heart or a blood pressure or document what's going on it becomes very difficult to do the clinical part of your job.
It's hard enough to find a mattress on a birth suite for the woman to labour comfortably on the ground let alone find something to sit on as the midwife. And if she's in the shower you tend to get drowned. The instinct is to be low as the woman is and this means kneeling or sitting on the cold wet tiles. Or staying out of the room and coming in just to check.
Most women want a midwife close by when they are actively labouring. If you are not there they give up their safe place to be near you. The next thing that happens is she commonly end up on the bed because they know it's easy for you as the midwife and there is no other place to be in the room for a labouring woman to be and feel inconspicuous unless you set up a nest on the floor for them and move the bed out the way.
On top of this the lights don't dim in most bathrooms so you are in darkness or bright light.
And then there is the impaired ability to attend to routine observations if she's not on the bed and especially if she's in the bathroom. In some hospitals you can't listen to the baby's heart rate with a mobile intermittent doppler...only with the monitor that is part of the CTG - and access to a cordless machine is limited by the number on the birthing unit.
This means the woman has to constantly move from her comfy place to what's convenient for the midwife to fulfil her duties as per guidelines. The same applies for blood pressures...it is attached to the wall or the machine that can't go anywhere near the bathroom.
Women typically seek out water. It's for pain relief but also the sound of the running water creates a comforting environment and enables a woman to feel safe to make all the noise she needs to because she can't only hear herself. She doesn't feel so obvious and therefore doesn't feel so watched and inappropriate. It's not normal in every day to make such noise...and some women feel really uncomfortable with what they feel compelled to do...but it's necessary for most labouring women with no drugs on board.
We match our pain or surges with sound. It makes them one with us rather than against us. If we are not feeling safe to make that noise it's not uncommon to not feel safe with the contractions and to start to feel like we are not coping so feel the need for pain relief we never wanted.
For women to be truly supported to have an active labour that does not require pharmaceutical analgesia we need to support midwives to be able to support them. Birth suites have come a long way but we still have so much room to move.
