Powerful influences at work

Hi,





I`ve been reflecting alot about the influences that some midwives face on their practice and whether it is possible to stay strong and fixed to a philosopy of practice.





Some midwives face the influences of women at booking, so if your philosophy is homebirth but the majority of women you are in partnership with want a hospital birth then you have to ensure you have an access agreement to the local hospital. Once you sign that access agreement the midwife may then be bound to following the policies and protocols of that unit once she steps into it.


What if the midwife`s philosophy of care doesn`t fall in with hospital protocols and policies?

Another influence on the midwife`s practice can be Section 88, the referral guidelines, just how binding are they? There are levels of referral, 1, 2 and 3. Is informed consent obtained if the midwife says, "Well I should recommend that you see an obstetrican but I don`t really agree with it so I don`t think you need to see one."



The hospital routines and those little unspoken, not in writing, rules can influence practice. Such as trying to avoid complications during the night because a theatre team will have to be called in. This may result in an early intervention which may have not been necessary.



Tiredness and fatigue can have an influence, if a midwife has too large a caseload, the pressure to `get them delivered` can force the issue of overuse of ARM, Epidural and syntocinon and can also influence that there are more inductions than are necessary. It can be easy to start in practice with the idea of limiting your caseload but as I know from experience it is hugely difficult to turn women away and before you know it you are swapped.

So how can midwives stay strong to their philosophy of practice?