Lesley Page

One-to-one midwifery: restoring the "with woman" relationship in midwifery.

One-to-One Midwifery, a model of care developed in the United Kingdom, provides a continuous and personal relationship between each woman and her midwife. The organization of care and the outcomes are relevant to midwifery policy in all industrialized countries. One-to-One Midwifery is not solo practice. An important principle of the organization of the practice is to enable individual midwives to take time off and to provide supportive structures for the midwives. Here the implications of One-to-One Midwifery for childbearing women and their families, and the midwives involved, are explored. The One-to-One Midwifery model has particular relevance for Canada because it is very similar to the model of practice being developed in at least two provinces. It may also be of importance in the United States, particularly for midwives working shifts in hospitals who may want to develop a system that allows them to provide continuity to the women they serve.

Human resources for maternity care: the present system in Brazil, Japan, North America, Western Europe and New Zealand.

This article describes the nature of the humanization of birth and the overlapping but distinct role of professionals within the maternity services with an emphasis on the role of the midwife. It describes the status of midwives in different parts of the world, and the common characteristics of work undertaken to restore the role of the midwife. Midwifery is seen as an essential component of effective maternity services. In addition it is important to recognize the important role that traditional birth attendants play in many parts of the world. An appropriate structure including primary and secondary and tertiary care services are important for professionals to play their full part.

The humanization of birth

The humanization of birth conference drew more than 2000 people from 26 countries. This article summarizes the conference. In much of the world women have learned to fear birth; this fear is represented by the increase in cesarean section rates seen in many countries. The humanization of birth may reduce this fear. Yet humanization is difficult to achieve in technocratic societies. It is important to recognize that safety and self‐fulfilling experiences are not contradictions, and that humanized birth is the safest approach.

Midwifery in Shetland and Orkney

Giving the best start and offering holistic health care in womens health and reproductive services in Shetland and Orkney

Caring for pregnant asylum seekers

This summer I provided advice to women working with Legal Action for Women (LAW), based at the Crossroads Womens Centre, which was challenging the imminent deportation of a pregnant woman. It is still difficult to believe that a country like ours which prides itself on fair justice could create a system that is as inhumane as it is to asylum seekers. Often it takes one ‘case’ to portray the extent of the problem; this experience was a vivid reminder to me.

British Columbia here we come

Many of our life transitions are just like the transition phase at the end of labour. Six days ago, I arrived in my new home in Canada. Before that, I went through the feelings that many women experience just before they give birth. A fear and reluctance of moving on and letting previous roles go and entering a new life. Now I am in my ‘new world’ and I am starting to feel excited and ready to move on to my new challenges and responsibilities.

New midwifery for the new millennium

Babies born at the dawn of the new millennium were big news. These new lives welcomed into the world at such a memorable point in time were the symbols of the hope and optimism that the new millennium brought with it. Hopes of a new start — of making things better. Midwives are in contact with this hope and optimism of newborn life on a daily basis and the way we practise will have a great effect on the realization of such hope. Midwifery care and the experience of birth will affect the health of the newborn and mothers bonds of love within the family and the mothers confidence and competence in caring for her child.

Act now to save the midwife

Midwifery and nursing are facing the most acute shortages in staffing ever. It is estimated that there are currently 13000 vacancies in the UK. The Royal College of Midwives estimated that there were about 1000 midwife vacancies in the UK in 1998. This is a significant problem given that there are only 32803 practising midwives (out of 93776 registered), and especially because a recent survey indicated that significant numbers of heads of midwifery felt that the funded midwifery establishment for their trust was not adequate anyway. The shortage is most acute in the Thames Regions (Royal College of Midwives, 1998).

A one-to-one with Alan Milburn

Announcements about the appointment of the new Secretary of State for Health, Alan Milburn, have been accompanied by messages of determination to make a real difference to the NHS. If only I could have a one-to-one with him.

Monitoring the fetal heart in labour: stop and think

The midwife is the only expert in the maternity services who specializes in normal pregnancy and birth. Part of the specialist role of the midwife is to support physiological processes. Clearly, in this regard, something has gone badly wrong with British midwifery. The amount of routine interference with labour and birth, such as electronic fetal heart monitoring, does not seem to have declined in recent years, and the operative birth rate is climbing steadily, despite a mandare from Changing Childbirth initiatives for midwives to take on a stronger role. The National Report of the Audit Commission says that the use of caesarean section has increased in most developed countries to a level that concerns clinicians (1997:43). Through their national survey they found that the use of caesarean section at 11 NHS Trusts varied between 11% to 18% of deliveries. The operative delivery rate of 12 NHS Trusts varied between 13% to 5%. In some teaching hospitals, the rate of caesarean sections reaches above 25% on oc...