Standing my ground with arms open

At times as an independent midwife you need to transfer a client in to hospital. For us it is normally for more pain relief or simply exhaustion. I my experience we have never transfered in under ‘blue light’ or rather in and emergency situation. This is because it is the midwifes job to see the changes in normal birth before they become abnormal. This is one of our great skills, to recognize this change before it becomes a dangerous situation. Of course each individual midwife will have her own understanding of ‘limits of normality’ but I am sure we all work under very similar guidelines of normality in labour and birth. This is not the point of this blog, this blog is about what happens and point of entry at the hospital.

Depending on where you are, who you are and who you know, this point can be one of great stress and feelings of insecurity on the part of the transferring midwife or simply a welcome breath of fresh air where one colleague can safely and calmly hand her care over to another. In reality it is politics and our clients are caught in the middle of it all.

Working with in our role as advocates for our clients, I have very recently come to understand how important it is for us as ‘independent’ home birth midwives to be as transparent and as open as possible. Here in Spain our job is considered by many as dangerous and unprofessional and if we are to change this we have to put our self up for’ inspection’ in a way. Or rather to say, here we are, we are safe and registered and we are here for the woman’s choice.

 After a deeply upsetting experience I have come to the conclusion that I must do just this, so I have prepared this letter to the head of midwifery of our hospital of choice in the hopes of opening a better path of communication for myself and my clients.

25 Febero 2012
To: Head of Midwifery
Dear XXX,
My name is Krishinda Powers Duff and I am a NMC (Nursing and Midwifery Council) British Midwife working here in Barcelona. I am also a member of the COIB and I work primarily in home birth. I am a well trained safe birth practitioner who works only works within the limits of normality. I work with other Catalan midwives who also members of the COIB and were trained in the UK and we never attend a home birth alone. Our births are always attended by two midwives and as a group we are supported by doctors whom we refer our patients to if they need medical support. We give full antenatal and post natal care to our patients and have a personal relation ship with them.
My colleagues and I have a great respect for Sant Pau Hosiptal and its support for normal birth. We recommend your facility to our patients as a second option if their home birth does not go to plan because we know your staff are usually respectful of a women’s wish for a birth as normal as possible within the guidelines of your hospital. We are grateful for the well trained and respectful staff working at St Pau Hospital.
At times we do find it necessary to transfer our patients from home to Sant Pau but this is never in urgency or in a situation of risk. It is because our patients have decided they want stronger pain relief or because they have labored for a long while and no longer have the energy to continue with out assistance. In these instances we quickly transfer their care into your hospital staffs capable hands.
I have had personal experience of 5 transfers in the last 2 years to your hospital and with each one I accompanied my Catalan midwife colleague. On all of these occasions we were greeted by fellow midwives working in St Pau who were respectful and supportive of our patients wishes for a continued normal birth experience. At each of these transfers I felt a good comradeship between ourselves and your staff .
Unfortunately this was not the case on a recent transfer I made with one of my patients. I transferred in with a non Catalan midwife colleague, from a home birth where the mother had laboured at home with a very long ‘latent phase’ and final spontaneously ruptured her membranes and fresh meconium was present. This was the cause for the transfer although the babies heart beat was always normal and strong, as a safe practitioner I felt that this was cause for hospital transfer. I would never take any risk with my patients and meconium can be a sign of possible impending distress of the fetus.
Before arrival my second midwife colleague rang the labour ward to explain we were coming in and why and was spoken to in a very rude manner and then hung up on. I felt this was very strange but was in the process of supporting my patient so thought no more of it. On arrival my client was taken in for assessment but I was not spoken to by a member of staff. After checking her in I tried to speak to a member of the staff. I rang the bell, the door was opened and I proceeded to try to explain who I was the the cause of the transfer. The midwife or nurse I was speaking to was extremely rude to me, so much so that I was actually shocked by her tone of voice and anger directed towards me. I was told to ”get out” and that my information was not needed, I tried a second time to explain who I was and that I did not want access but that I had my patients bag and the information regarding the transfer. Her response was even more aggressive as she snatched my patients bag out of my hands and repeated again for me to get out.
As this was my first experience of transfer with out the assistance of my Catalan colleagues I felt I had no recourse other than to leave, trusting that my patient was in good hands, which now I feel was not the correct thing to do, but my personal exhaustion and shock at having being treated in such a disrespectful manner got the best of me and I retreated feeling very abused and hurt. This experience is the cause of my writing this letter to you. Not to make a complaint about that particular member of staff but to introduce my self to you and hopefully make a smoother transition for my patients in future hospital transfers.
I understand that to some doctors and midwives that the idea of home birth is strange and thouht to be dangerous but as I am sure you are aware in other countries in the EEC it is a very normal part of the obstetrics system and even available within the social health care scheme . I trained in home birth in England within the National Health Service and I still work with in its guidelines because I feel these are safe and trusted. I am not a rouge midwife nor am I anti medical intervention when it is needed. I simply believe what I was taught in the UK, that birth is a normal life occurrence and that as long as a birth stays with in the limits of normality a woman can birth safely at home.
I hope that this letter helps to assure you of my professional standard and in some way can assist in creating a professional exchange between myself, my colleagues and your staff . I look forward to your response
Krishinda Powers Duff Bsc Hons
NMC Midwife, COIB Llevadora
Obviously it was translated in to Catalan, but you get the point, I hope. Also please excuse the use of the word patient, this is what is used in Spain.