After graduating from my midwifery degree, I sat down with a wonderful local artist, Abbie (check out her stuff at http://www.abbiejmatthews.com if you like the look of it), to chat about commissioning a piece for me that captured the essence of midwifery.
As a student midwife, I had been lucky enough to support Abbie during her first birthing journey, and as a graduate midwife, I was able to be present for her as her second child arrived into the world (please note, this story is shared with full consent).
I had a feeling that she, more than most, would understand the importance of the relationship between the mother and the midwife, and as I expected, the imagery that she produced onto canvas captured everything that I had hoped for, and then some.
In Australia, midwifery students are required to complete a certain number of Continuity of Care, or “follow-through” experiences, where the student begins to work with the woman and her family antenatally for quite a number of appointments, then supports her through the labour and birth, and follows up with her postnatally, to check that all is well.
The “follow-through” component of the curriculum was my absolute favourite thing about the entire course, without a shadow of a doubt. I loved getting to know the women. I loved working with them to find information that they wanted to know. I loved discussing what they were hoping for, and helping them to utilise different strategies in their labour. I loved that I could be a familiar face if they needed one, and I loved that they trusted me to advocate for them, when they couldn’t do it for themselves.
Having birthed my own children in a Continuity of Care Midwifery Model, where my midwife knew pretty much every single thing about me, the concept of the “follow-through” felt so right to me, and I felt so comfortable in that space. Thus, I found it quite challenging when I started working as a graduate on a hospital ward, to find that I had to try and build a similar kind of rapport, very quickly, with women that I had only just met a few moments before.(That’s a whole new skill on it’s own, and a tremendously important one at that.)
While I love working on a ward, there’s no denying my real passion is sparked when I am able to provide continuity of care. I think this is true of many of the midwives I work with, which is why most of us will seek out the women we have met before when we are on the ward.
It’s much easier to provide what women want, when we know what they want. It’s much easier to support them in the way they want to be supported, when we know exactly what that means. And it’s much easier to recognise changes (physical, and emotional!) in them and their babies, even subtle ones, when we know well what is normal for them.
Although it’s difficult to quantify so many of the emotional and psychosocial benefits afforded by a Continuity of Care model, we know the women love it. How? Because they tell us.
I’ve seen cases where women have literally entered transition and pushed their babies out, within minutes of their known midwife entering their birthing space. I’ve watched women, who have been teary, and anxious for the best part of the day, completely dissolve with relief when their “familiar face” arrives. I’ve witnessed women who have been quite reserved and quiet postnatally, simply unload all of their stresses as soon as their student midwife walks into the room. I’m not being cocky and talking about myself as the midwife here. In many cases, I’ve been the “unknown” midwife, trying my best to help a mum, but as soon as the midwife or student that she really knows arrives, THEN the progress happens.
Women labour, birth and recover well when they feel safe. And it seems to me, they feel safest, when they know their caregiver, and their caregiver knows them.
In a hospital environment, it can be bloody hard, creating that sense of safety; what with all the fluorescent lights, and people coming and going, and monitors alarming, and equipment rattling. But there’s no denying, that when there is a familiar support person present, women seem able to grasp onto them as a single point of focus when they need it most, somehow drowning out the rest of the environment around them, which helps them to get on with the business of having their baby.
Continuity of Care is good for them, and it’s good for us.
As a midwife, I find it so immensely satisfying to provide care that I feel is complete and holistic, which, in most cases, is when I know the woman.
And as a midwife, I find this kind of work to be so beneficial to my own practice, because it allows me to really reflect on the care I’m providing, based on the direct feedback from the woman; simply because I have seen her more than once, and usually, she will tell me what is working for her.
I really, truly think that every woman, regardless of risk-profile, deserves continuity of care, at least in some form. But actually achieving that kind of Utiopia, is a whole other kettle of fish.
I know I’m on a bit of a rambly soapbox here, so I’ll step down for now.
I’m interested to hear from you folks that have had children, or have been in a birth support role: have you experienced continuity of caregiver? And if so, what were your thoughts?
Hit me up.