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Ik wil mijn werk graag goed doen. Kwaliteit van zorg toetsen aan het naleven van regels heeft misschien voordelen omdat je dan iets hebt om te 'meten'. Maar in mijn dagelijks werk loop ik in toenemende mate aan tegen het gevaar ervan: dat aan het eind van de rit het enige dat werkelijk telt de belangen van de zorgverlener zelf zijn. En wat is dan nog 'goed doen'? Vragen hierbij en ideeēn hierover genoeg - lees maar.

zaterdag 2 juni 2012

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.

6 opmerkingen:

  1. mooi gesproken rebekka,

    ik ben trots op hoe mijn zus het heeft gedaan met Luuk. Een volledige stuit thuis tegen adviesen in... Hierdoor hoop ik alleen maar dat als mijn tijd komt dat ik zwanger mag zijn en moet bevallen ik iemand kan vinden die net zo gepassioneerd en wijs is als u, en dat mijn partner zich ook in mijn wensen kan vinden.
    De kracht van de vrouw moet voorop staan en niet de mening van een ander.

    Liefs Lysette van Bommel

  2. Geweldige woorden Rebekka. Hoop dat we in de verloskunde steeds meer jouw kant op gaan
    Nelleke Claas (moeder en doula)

  3. I loved this! It expressed so well how I feel about the work I do to, and what I have struggled with as a labor and delivery nurse, doula, and now student midwife. Thanks.

  4. Dank je wel Rebekka! Deze woorden kwamen duidelijk recht uit je hart. Hiermee bied je vrouwen de bescherming die zij in hun meest kwetsbare situatie zo hard nodig hebben. Ik vind je dapper en moedig!

    liefs Wendy Schouten

  5. Lieve Rebekka,

    Wanneer ga je je eigen opleiding beginnen zodat we van dat kruiperige, protocollen gedoe (zwak aftreksel van de gynaecologie) afraken en glorieus kunnen gaan baren, zoals we bedoeld zijn.

    Vrouwen als jij maken het verschil. Los van de omgeving waarin ze moeten opereren (sorry voor de woordspeling)

    Wist je trouwens dat hoge dosis vitamine C (natrium ascorbaat) bloedingen voorkomt (minimaal 10 GRAM per dag voor, tijdens en na de zwangerschap).

  6. Thank you Rebekka for your presentation at the human rights and childbirth conference. I listened to you in the recording, and noticed in the conference notes that you had a blog, and now I have found you.
    Thankyou for writing this blog. I will link you to the blogs that I write about homebirth and midwifery practice in Australia.