Holiday Special Marathon Starts Nov. 25
Modern Midwives Blog
“Abandonment is the successful parent’s lot. We raise them up and let them go, waving bravely even as their wings unfurl. They don’t know how we scan the empty sky waiting for the speck on the horizon that signals their return. The joy lies in their landing, in their coming of own at last meeting them with love and saying here you are!”
Episode 4 dealt with one story line that I would like to focus on – the questioning of Nurse Phyllis Crane’s working past her retirement age and questioning her competency.
The scene with Phyllis and the doctor that was leading the vacuum assisted birth demonstration/ in-service really struck a chord with me. Phyllis was wise when she stated that in her 44 years of experience—when something is new—use caution and ask many questions. Historically we have seen the ramifications when we introduce new drugs, technologies, protocols— without doing due diligence or critiquing the research or impact of these changes. The purpose of doing due diligence is to really appraise and to assess varied things. It is important to assess the methodological quality of a study and to determine the extent to which a study has addressed the possibility of bias in its design, conduct and analysis. It is so important to then truly look at the results and their applicability to your own community or population. Only then can you think would you include, exclude or seek further information or await more research to be completed before altering clinical practice. We know that no research is perfect; however, if the quality is poor—it is prudent to have great caution otherwise we risk harm to women, babies, and ultimately communities (for my nurse midwifery students I share several tools to assist them as they read and assess randomized clinical trials--below are 2 critiquing tools that I find helpful).
We have seen the medicalization of birth rather than the support for normal physiologic processes. The use of vacuum assisted births or forceps can be very helpful; however, I have often seen the overuse of these procedures when I was a labor nurse. I recall one obstetrician that almost never did a birth without using a vacuum to expedite the process for his own convenience. How is it that the majority of births occur between Monday to Friday and during daytime hours? With the increased use of medical interventions for childbirth, such as induction of labor and cesarean delivery, we have witnessed an increasing proportion of deliveries occur during regular daytime hours and during the week. The Center for Disease Control (CDC) reported that if births were equally timed throughout the day, an average of 4.2% of newborns would be delivered each hour. However, the percentage of deliveries is higher than 4.2% for each hour from 8:00 a.m. through 5:59 p.m. for all days of the week. Births that occur out of the hospital are most likely to occur in the early morning hours of 1:00 a.m. through 4:59 a.m. During these same hours, the lowest percentages were observed for in-hospital births. There are varied reasons for the push to ‘clear the board’ within hospital settings with staffing and resources being more readily available, to financial incentives for physicians when they do the birth. The Center for Disease Control (CDC) publishes a data brief which reports on when babies are born. Below is the latest link to the National Vital Statistics Report (January 2023 with birth data being from the year 2021).
In the episode we saw the health officer/MD being offended with Phyllis and her astute and wise comment about caution and questions and instead he took it upon himself to intimidate and punish her. The board decided to focus on Phyllis working past her retirement age. She stated to her friend, Miss Higgins, “I feel like I am being put on trial for daring to keep working…” Then they intimidated her with not attending their noncompulsory refresher courses. Unfortunately, as a Modern Day Midwife we still see intimidation with restraint of trade issues whereby many midwives are blocked from obtaining privileges to practice at an institution if the obstetricians do not want competition—thereby limiting women’s options for varied types of birth providers. As well, most midwives are unable to practice to the full extent of our education in most States. During the show the board of health physicians state they were displeased with the ‘assumption of autonomy’ with Dr. Turner and the Nonnatus House nurses and midwives and I am sure that this will play out more in the coming episodes.
We did get to witness how age, experience, and wisdom could be utilized with Sister Monica Joan assisting with her clinical skills and with Phyllis handling Simone’s birth that was complicated with a shoulder dystocia and increased post birth bleeding. Simone stated that she was grateful for having Phyllis at her birth! “I just needed one solid thing—something that I could touch and lean on…” and it was Phyllis.
You have to love Sister Monica Joan when she accompanied Phyllis for moral support and when she stated she heard no respect in the doctors tone and pointed out to the men that Phyllis was the junior of all of the men!!
As a Modern Day Midwife, it is one of our professional responsibilities to maintain current certification and we engage in the Certificate Maintenance Program (CMP) to maintain our competence. The American Midwifery Certification Board (AMCB) defines continuing competence as demonstrating specified levels of knowledge, skills, or ability not only at the time of initial certification but throughout an individual’s professional career. Individuals who have not completed the requirements of the CMP at the end of their current certification cycle will not be issued a new certificate. Individuals without current CNM/CM certificates may not be able to continue to practice midwifery depending on their state licensing/regulating bodies. Starting in the year 2011 there were no more lifetime certificates and instead time limits of recertification were altered to 5 year cycles in the USA for all Certified Nurse-Midwives and Certified Midwives.
In the episode there were two beautiful twin girls born and their names translated to mean Gratitude and Hope—and that is what I have for my profession. Gratitude for the gifts that midwifery has given to me and hope for expanded autonomy and support of women and their choices with providers, choices with place of birth, choices with their birth decisions. To have optimal care we need true evidence based care which entails sharing the state of the science, sharing options with their pros and cons, and engaging in shared decision making wherever possible.
“Mothers learn from midwives—both do their utmost and pass the baby on with trust, with hope with all the wisdom and the care that is theirs to give. The family is where we are forged and where we come to heal. It is where we can fly back to. It is our magnetic North. The family is the sum of all important things: the sweet, the bitter, the fragile, and the strong. Measured by time together not defined by days apart.”
American Midwifery Certification Board (AMCB)
Center for Disease Control: National Vital Statistics Report
