Responsible Care

This is the text that I spoke on june 1. 2012 during the 'Human Rights in Childbirth' Conference in the Hague (the English is 'at first hand'..):


This morning I came in and was introduced to a collegue.
"Everybody's talking about you" - she said.
I asked: "About what?"
She said:"That you are a natural childbirth advocate, and a radical midwife"..


Yes, I consider myself a radical midwife.
But an advocate of natural childbirth? I'm not so sure of that title.


As a midwife attending many homebirths, I have a great opportunity to learn about how childbirth is when it is undisturbed.


And as a person - I am very curious about what happens if I don't 'do' anything..


Are vaginal exams really necessary?
And if we do them, what is the consequence of disturbing the woman, be it as minimal as possible, on the physiology of the birthing process?


And so on and so on..


I consider myself an advocate - ánd an explorer - of physiological birth.


That is where the safety is.
We seem to know só little about human childbirth physiology anymore. Of most mammals we know more!


I mean - look at the average hospital delivery room...should we be surprised that só many women are afraid of childbirth?


And how about the managing techniques we teached ourselves as midwives, 
to speed up labor, 
to control it -
what have we done?


I don't want that anymore!


When birth happens, it 'happens'.
And the paradox is só clear - the more you design the environment to make control of the process easier, be it at home or in hospital - the more you do something to change the process, 
mostly not for the better.


All midwives know that.


Not all midwives are committed to it, for several reasons.
The analysis for that discussion is for another moment.


As for me.
I want to tell you about how I use the guidelines, our VIL (Verloskundige IndicatieLijst).
I use them with respect -
and yet, sometimes, I am prepared and willing to facilitate home VBAC's, or home breech births.


Both situations that, according to our Dutch guidelines, definitely should take place in hospital.


This is why I chose for this:
The VIL is our guideline.
But when it's used as law instead of advice, as a way to coerce women, it's a tool of unsafety.
Protocolized care without taking into account the individual situation of the woman, is bad care.
I don't sell one size fits all t-shirts!


To me it's of great importance to really listen to the woman -
and to the way she assesses risk for herself.
To guarantee absolute trust that she is the one in charge.
To provide her with all the information she asks for.
To be open about this towards other people.. My dream is to be able to do my work as a midwife in close cooperation with gynecologist and hospital, thus creating a network where women can be respected and supported in their choices.


Now should this mean that to my opinion all midwives must be willing to assist breech births at home? Or that all women must be willing to have their breech baby at home? 
Definitely not!
We need to open the dialogue about our own fears, work with it, finding solutions.


But not by hiding ourselves behind guidelines,
or stand as firm as a statue to defend our position.
Not by stabbing each other's backs.
Not by staring ourselves blind on 'continuity of care', 'fastness of referral', 'place of birth'...


Let the woman be in charge - being able to follow her instincts, and support her fully in that.
Trust Her.
That's what I would call: responsible care.


Thank you.