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The Role of a Community Midwife…Where Does it End? (Mother & Baby Magazine)

There is never a dull moment when it comes to midwifery. Alison Clarke, a community midwife in the East Riding of Yorkshire, sits down to tell us many tales of home births including the time a dog got hold of the placenta.

So where does their role end? Community midwives see all normal pregnancies in their area. They deal with ante-natal (before the birth), post natal (after the birth), and some deliveries. This means that the midwives naturally create strong relationships with the women and their partners.

Alison passionately says that her favourite part of the job is that she feels like part of the family in most cases. “I really like the continuity, the fact that you see the same ladies you know most of the way through. Then you see them again afterwards with the babies…setting off on a nice way of family life.” She also adds that now she has been in the role for a long time, she is seeing the babies of babies she has previously delivered; the second generation, and hopes to see the third.

Being a community midwife for 30 years, Alison has seen a fair few home births, each carrying with them unique stories. She was once called out to a birth in Hull, she arrived at the address realising it was a communal house inhabited by a huge family. When the lady was close to delivery the whole family were in the room to witness the birth as part of their commune. “There wasn’t much space to put anything, so we put the placenta in a bag on the floor and carried on looking after the lady and the baby. I suddenly looked down and the dog was there dragging the placenta around the room and nobody had noticed!”

Alison admits to seeing the weird and the wonderful in her job and says that as long as it is safe for the mother then she is happy to do as they wish. “Sometimes you are in odd situations that you wouldn’t perhaps want yourself to be in, but you’ve got to accept that it’s the woman’s choice. Sometimes what they think of is normal isn’t always what we think of as normal.”

Alison trains student midwives as part of her job helping to give them the practical experience they need. She says how she loves this part of her job and creating bonds with them whilst passing on her knowledge is enjoyable. Alison explains how one student was very keen on doing a home water birth. Again the whole family were there with the mother and her partner. After the delivery she says it was lovely and peaceful. “All of a sudden the little girl said ‘I’ve got a rabbit would you like to see it?’ It was four in the in morning, we’ve got a new mum and a baby in the birthing pool and the little girl is bringing in her menagerie.” An amused Alison goes on to say that the student was utterly shocked, this was her only experience so assumed it was a normal home birth.

Alison’s post natal role, along with other community midwives, is essential. She ensures that the parents are coping with their newborns and creates a relationship where they feel as though they can contact her for any advice. This is especially important as it means that the mother will gain a lot more trust in her midwife.

This is where the job differs greatly from a hospital midwives role. They come into the hospital for a shift and see different women, not always for the delivery, then come in the following day and do the same thing again. They deal solely with the labour aspect of the pregnancy. Alison says. “Obviously you don’t get to know the client as well and there isn’t a great deal of continuity. That’s what the ladies complain about the most, they can be in for two days and see maybe six different midwives.”  But, in the hospitals the midwives get to see all types of pregnancies, complicated and normal.

Since starting her three years of midwifery training in 1982, Alison’s role has changed greatly due to government recommendations. She explains how this has mainly affected the ante-natal care she gives. The NHS used to run clinics with one to one time with the consultant. “It cut down on the amount of people not attending as they didn’t have to travel out and take time and effort and people just sometimes didn’t go. That worked really well and it was nice as well as we saw the normal ladies but also the ones with complications.” However, this was stopped as it wasn’t considered good use of consultant time.

Although, the changes aren’t all bad when it comes to resources. Alison explains that now they have scanning machines so all women can be screened for condition such as Down’s Syndrome. This is a big step up as it allows the women to be prepared for potentially complicated scenarios in their pregnancy.

With the current NHS cuts Alison worries about her job as she doesn’t think that they will continue with community staff forever. The cuts have already started within her every day job role, with more clinics rather than home visits. She notices a huge change in the relationships with her clients and says. “A lot of the things that you see and what you’re looking for depend on what you see at the homes.”

The role of the community midwife is very important to pregnant women, but will the stories of unique home births die out as huge cuts happen in the NHS? No other role would be able to provide such good ante-natal and post natal care.

Sidebar

The role of the midwife has been brought into the limelight recently with two television programmes appearing on our screens.

• One Born Every Minute – This Channel 4 documentary follows the midwives and parents-to-be at Leeds General Infirmary. It gives an emotional insight into the hospital environment and the realities of giving birth. Shown Wednesdays at 9pm.
• Call the Midwife – A period drama set in London’s East End in the 1950’s. It follows a newly qualified midwife working alongside nuns in the deprived areas of the capital. Shown Sundays at 8.30pm on BBC One.