Saturday, 29 September 2012

CALL THE MIDWIFE (SHE'S NOT A NURSE)

Call the conductor (she's not a therapist)

I rather admire the trade of midwife, at least as nowadays construed in the United Kingdom.

Ágnes Geréb

Since hearing of the deplorable treatment of Ágnes Geréb at the hands of the Hungarian medical-administrative complex, I have done what little I can to spread the news of how she is being martyred. I have posted about a couple of times on Conductive World:



Between times, I have added briefer update notices on Facebook too, the latest only two days ago:
GERÉB ÁGNESMidwife's saga drags onhttp://www.vancouverobserver.com/world/europe/hungarian-midwife-agnes-gereb-changing-worldWas not returned to jailStill under house arrest'The freedom in a country can be measured by the freedom of birth'

http://www.facebook.com/conductive.world/posts/453812234662795
Not a lot, but what else might one do?

Training conductors, the midwife way

Over 1996-7 Chas McGuigan and I were constructing a course to train conductors at the University of Wolverhampton. We faced a number of problems, including:
  • our course was to be autonomous, i.e. free of the control of the PAI, the first such – bringing both the burden and the liberation of having to design everything from scratch
  • it was to be a degree course, so not really 'conductor-training' (despite the common parlance) but conductor-education, bringing the necessity of incorporating validated practice into an academic structure
  • genuine professional autonomy and responsibility demand that students should start out on their subsequent careers by having passed-out transparently on every competence taught – they should not have progressed at any level without having mastered less than all the practical competences required.
But where to find a worthwhile model? Certainly not in British 'teacher-education'.

At the time my daughter was studying to be a midwife. I was most struck by how midwifery approached the same questions and – to cut a long one short – I photocopied much of her course's continuous assessment Chas and I altered some of the words to suit the conductor trade, and we produced the first prototype of what was tostructure much of our own course's practice countent under the name of their Conductive Log.

Having been thus involved in midwives' professionalism I stil feel a certain emotional connection with it when its growth is stunted as in Hungary, and am positively interested when Grand Principles are called into play, as in Denise Tiran's article published yesterday day in Positive Health Online:

Might more general parallels be drawn?

Summarising the recent history of British midwifery Denise Tiran quotes the official position that
...care should reflect childbirth as a normal bio-psycho-social life event and that women should be offered 'choice, control and continuity...
It seems agreed, however, that continuing change is still needed –
Maternity care needs to change to reflect consumer demands, and there needs to be a concerted effort to facilitate a return to the normality of childbirth.The Maternity Matters report (DoH 2007) aimed to ensure that all women have the opportunity to choose where to give birth, and the Birthplace Cohort Study (NPEU 2012) favourably compared risk factors for women giving birth in midwife-led units or at home with those for birth in consultant-led obstetric units. There is also an urgent need to reduce obstetric interventions in order to minimize long-term morbidity and to rationalize expenditure at a time of limited resources. The High Impact Actions for Nursing and Midwifery (NHS Institute 2009) identified Promoting Normal Birth as a key issue for change; the Maternity Improvement programmes (NHS Institute 2011) acknowledge that interventions carry a greater risk of complications than non-interventionist care. Caesareans now account for over 30% of births in some areas (Birth Choice UK 2011), despite increased morbidity for mothers and few apparent benefits for babies, and cost almost double that of a normal birth (NHS Institute 2009).
This is not just a trend that is British. The ICM (the International Confederation of Midwives) is invoked to stress that birth is a normal physiological process, and midwifery practice is identified as being both
...a science and an art which is holistic in nature and grounded in an understanding of the social, emotional, cultural, spiritual, psychological and physical experiences of women, whilst being based on the best available evidence (ICM 2011).
'The ICM believes that midwives should be the primary providers of maternity services, empowering women to take responsibility for their own and their families’ health through individualized, continuous care which facilitates women’s informed decision-making. The ICM and World Health Organisation define a 'midwife' as 'a responsible, accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on her/his own responsibility and to provide care for the newborn and infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should include antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care. (ICM 2011)
Conductors and midwives

I do detect a continual parallel between one possible future conductors' professionalism and the line traced by British midwives, and further substantive reason not to cleave to the model of therapy.

Alter some of the words in the above quotations from Denise Tiran's paper to suit your image of conductors and what they are involved with, and judge for yourself.

References

Sutton, A. (2012) Hungarian 'witch-hunt': advocate of home births jailed and suspended, Conductive World, 11 February 2012
http://www.conductive-world.info/search?q=gereb&updated-max=2012-02-11T07:05:00Z&max-results=20&start=1&by-date=false

Sutton, A. (2012) Intrusive medicalisation of childbirth: a continuing Hungarian tradition, Conductive World, 18 March, 2010
http://www.conductive-world.info/2010/03/intrusive-medicalisation-continuing.html#comment-form


Tiran, D. (2012) The impact of 'Call the midwife' on the public’s view of midwifery, Positive Health Online, no 199
http://www.positivehealth.com/article/women-s-health/the-impact-of-call-the-midwife-on-the-public-s-view-of-midwifery

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