Distractive Practice

medium_3661466756“Please imagine, for a moment, that you are on the labour ward caring for Annie, who is in labour with her first baby. Let’s say that Annie went into spontaneous labour at 41 weeks, has had a happy and unproblematic pregnancy and there’s not a risk factor in sight. She is using entonox and you have just carried out a vaginal examination with her blessing and found her cervix to be completely effaced and 8cm dilated. Although you feel that she is making reasonable progress for a first time mother, Annie is despondent that she isn’t further along and tells you that she wants an epidural. What do you do?

OK, so most midwives would want to talk Annie through the decision; discuss whether she expressed preferences on a birth plan, outline the pros and cons, but let’s assume that she had no preconceived ideas and doesn’t feel like having much of a conversation, because the question that I am really pondering is this:

Is it more woman-centred to (a) nip straight out and phone the anaesthetist, or (b) use all your skills of encouragement and a bit of distraction to help Annie through the next hour or so and aim for a normal birth without the epidural?”

Once you’ve pondered your own feelings on this, you might be interested to read the article in which I first raised these questions.  Although I have to say that, even years after first writing about this, I don’t know that I have good answers!

“I apologise for ending with more questions, but the complex reality of the modern way of birth means that simple answers can rarely be found at the bottom of the page. Can there be such a thing as woman-centred distraction? Or woman-centred timewasting? Or are these concepts contradictions in terms? Does the end, in this kind of situation, ever justify the means, or are these means fundamentally incompatible with the notion of woman-centred care?”

Thank you for caring enough about women, babies and families to ponder these questions with me 🙂

photo credit: Pilottage via photopin cc

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