DELIVERING NORMAL BIRTH : Abstract.

The Edgware Birth Centre.

Presentation by Jane Walker, Project Leader Edgware Birth Centre.

With midwives from EBC: Kay Barber and Kim McCloghry.

Introduction

In September 1997 the Edgware Birth Centre (EBC) began giving care to women and their families.

Set up as a Department of Health Demonstrator Project to test a model of care it has been centrally funded for two years. That funded period came to an end 31st July 1999.

Conditional on the original funding was the requirement to subject the service to an external evaluation. This is being undertaken by Imperial College London and North Thames Perinatal Epidemiology Unit under the auspices of Dr Jean Chapple, and led by Dawn Saunders. A steering group oversees the process of the research. Their report will be completed by the end of January 2000.

Recent years have seen a relentless move towards closure of small units on the basis of safety and cost (without sound evidence to support such policies) Battles have recently been won in Stroud, Crowborough and Oban.

The development of EBC was, in this historical context, a huge achievement attracting national and international attention.

Midwives working at the centre came from a wide range of clinical experiences and a shared philosophy, and an approach to supporting normal birth was developed from day one. This has been critical to building the ethos and attitude to care. Midwifery Supervision is at the heart of the organisation and facilitates the weekly clinical review and critical incident analysis. Open discussion of the strengths and weaknesses of personal clinical practice is not easy. Admitting a lack of knowledge about, for example, the physiological management of the third stage of labour, requires courage and an atmosphere of mutual trust – not criticism and blame. Peer skills sharing is essential as midwives rediscover, or learn for the first time, techniques for supporting a woman anticipating a 'non-managed' birth, 'bodywatching', optimum fetal positioning, use of water in labour etc..

Midwives have blossomed. They have become creative, enthusiastic, analytical and strong. This is communicated to the women who come for care. Workshops help the families to prepare for a non-managed birth. Coffee mornings bring antenatal and postnatal women together where they share stories and experiences. The anecdotal evidence from women is verwhelmingly positive.

Midwifery Assistants keep us all in order and keep the centre running. Their contribution to the overall ethos and success of the centre cannot be overstated. They form strong relationships with the families and often act as 'doula' in a birth. They challenge the midwives about everything!

The birth statistics speak for themselves, but of course are too small in number to have statistical significance. We have suggested that stats be pooled from all such units in the UK, except of course that no one knows how many there are. We have suggested that a 'mapping' exercise needs to be done urgently.

With relentlessly rising LSCS rates and the trend towards concentrating resources in large understaffed obstetric units, the future for normal births, loss of skills and knowledge for supporting normality is alarming. At EBC a vaginal examination is an intervention that must be justified; membranes are never ruptured artificially without very good reason; 6 episiotomies have been performed since we opened (400 births). Senior student midwives visiting EBC regularly tell us that they have NEVER witnessed an interference-free birth. Some community-based midwives are anxious about coming to care for their clients at EBC because they have never seen a woman labouring in water.

There is a danger of polarisation, but even more importantly a serious danger surrounding the loss of appropriate skills and knowledge to support normal birth.

Click here for THE ROYAL SOCIETY OF MEDICINE

This page last updated 8 OCT 1999.

Site maintained by Basil Lee, Forum Chairman.