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Last summer I looked after a woman in labour (her first) and spent the greater part of her labour lounging in the sun on her roof garden. She was just a floor away when she needed me she could call. When I heard signs that she needed me, I immediately went to her aid and comfort. Every half an hour or so I checked the baby' heart. The labour progressed; the young mother and father massaged, comforted and strengthened each other during the long hours - private, self-contained, intimate. Yesterday I was at another first labour. It was, like most other labours, fairly long and gruelling; the young couple supported each other, drawing on strengths that neither knew the other possessed. They spent hours alone together quietly in their room while my partner and I spent the hours in the sitting room, knitting, chatting quietly, sipping tea, reminiscing about other labours we had attended, discussing the forthcoming election, the state of midwifery, the state of the world. During the conversation I asked myself why we were a floor away from the labouring woman, able to hear her groaning, able to respond immediately if she called or cried out in distress, able to be at her side within seconds. Why weren't we at her side all through? The reason that we weren't at her side all the time, and why I hadn't continuously been at the first woman's side, was that we had felt from each woman that she needed privacy and an opportunity to be alone with her beloved. We had left them to draw on their own resources. Of course we checked the baby's heart and we kept an eye on the mother and her physical condition - was her bladder empty, was she coping with the contractions, was she relaxed and in a good position and good spirits? But coming through overwhelmingly was her need to be alone with the only person who would not be intruding on this intimate experience. This led me to discuss the situation with my partner. She reminded me that when I looked after women in labour in hospital I never leave their sides. If I am hungry I eat my banana/sandwich/chocolate bar in the room with them; if I am thirsty I drink my tea/coffee/slimmasoup with them. I never leave their sides for a moment except for what my husband invariably calls `physical needs relief' (an old busman's term). Why do I treat women at home so differently from those in hospital? Surely some of the women in hospital were in need of privacy just as at home. The reason, I now realize, is because I am protecting women in hospital from interference. Taking a breakIf I should mosey off for a tea break, a coffee break or even a knitting session in front of the hospital television it is highly likely that someone may enter the bedroom that my couple are in "You look as though you are in pain would you like an epidural/pethidine/entonox', the mother may be told, or even `Why haven't you got a monitor on - let's put one on you - please get up on to the bed' or even `You've been a long time, it would be a good idea to hurry things along' So when I came back from my tea break I should find the woman, who had been perfectly all right and coping well with the contractions of labour, with an intravenous drip in situ, her membranes ruptured and well on the way to having an epidural. As for the active position she had wanted to take up and which had enabled her to cope with contractions - she is now lying on the bed, not to be able to get up again until after the birth of her baby. Her labour is being accelerated, her pain increased and more difficult to cope with and her need for strong analgesia is greater. Fine if that is what she wanted but often it is not and so often it happens if she is left unattended by her midwife. Familiarity.The other difficulty of leaving a couple on their own in a labour ward is that they do not know where you are. When I was sitting on Hannah's roof garden or yesterday in Judy's sitting room, the room is familiar to the woman. She can picture me there and she knows I am only a groan away. She is aware if I am sitting on the settee or the lounger; she would be aware if I helped myself to a record to play or got a magazine out of the rack because women know what is going on in their house. That is why they always come leaping up the stairs when the toddler has gone quiet, even though they were not really aware that he was up there in the first place. Privacy - some women need it badly during labour, others like to be massaged and stroked and cuddled. But once again I have been made aware of the huge differences when a woman has her baby at home compared to the hustle and bustle that she must endure at her hospital birth. Perhaps there are some hospitals which have enabled women to have privacy in labour - is there any unit out there where the delivery rooms have a bolt for the doors? Is there anywhere in the United Kingdom where women can labour in private without people barging in, with the most benign of motives, to offer a cup of tea, to see if equipment is free. Even so, each time a woman in labour is interrupted so is her labour. Labouring women need privacy, can they get it anywhere but at home ? June 1987 |
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