How would you feel about having a male midwide

[Lardlizard]

Just interested in the points of view

If a woman is fine with a male midwife, then let her get on with it. Good luck to all!

But if any woman does not want a male midwife, then she should be able to say so without any detrimental response.

She should be asked, at first presentation as confirmed pregnant, whether a male midwife would be acceptable. And she should be able to say "No - no male midwives." and have her choice respected.

Because the pregnant woman, the woman lined up for childbirth, is the important person here, not the male midwife, who should back off if his presence is uncomfortable, unhelpful or triggering, to any woman.

As I said - If a male midwife does not bother you - then I wish you all the best, both of you.

But not all women are the same as you, and there are a lot of women who would prefer a female midwife.

Maybe it was more recent Lass mine are younger than yours but that 10 rule stands true for mine. The community MW will carry out all checks and baby weights until HV takes over unless there are ongoing issues when you remain under community MW until signed off.

Also, women are not aware of what instinctive bodily processes are under way during pregnancy and labour.

It is for the protection and safety of women in a vulnerable state that could so easily be adversely affected by the males around her.

It's not the same as having the baby pulled from you; this can happen purely as a result of failing to progress, for those very reasons.

There are many reasons that slow or totally stop labour-...one very well known one is simply transferring to hospital,and so on,but includes and not limited to, the presence of a male, and the labouring woman does not necessarily have any awareness of her more basic instinctive reactions that control her labour.

Some can't make themselves crap away from home, same process at work, at an unconscious level.

Very basic process of safety mechanism beyond (or rather well before) prefrontalcortex development

Kilbranan Sun 14-Apr-19 21:16:05

Well we can ignore the experience of hundreds/ thousands of women then math because it’s not in a book

But how do we know it is the experience of hundreds/ thousands of women?

I did read the post on midwife labour wards.

I delivered in American hospitals in a private labour and delivery room each time. The rooms were 'homey'. You could have food brought to you and to your labour partner. You could watch tv or listen to music. Each room had a private shower and loo, both pristine. There were two birthing suites with pools and birthing balls - first come first served unfortunately.

I had an epidural the first time, none for the subsequent four deliveries.

Afterwards I had a private room 3/5 times and double room 2/5 times.

For me the private room afterwards made a huge difference.

In all cases it was the standard of nursing care that contributed hugely to my recovery. The post natal nurses were superb. Ante-natal/labour nurses were also superb, with one exception. During each labour I had the same nurse with me until the end of her shift on each occasion, and despite a lot of monitoring the personal touch was there.

I see posts here all the time on the horror of sharing spaces with other women's husbands or partners or extended family after childbirth, and I have to say this would be my own personal worst nightmare.

On the two occasions when I had a double room I found it a bit awkward despite the curtains around each bed. First time around, the woman's mother had a quick fag in the ensuite loo/shower, so nasty around two little newborns, and the second time I think I must have been the roommate from hell as the woman was recovering from a CS and my dear little baby cried a lot and really loudly.

I overheard my roommate the second time relating the story of her delivery to a friend - calling her OB to say she was in labour, doctor advising castor oil and walking, eventually realising she needed to go to the hospital pronto, her hair-raising midnight trip to the hospital in an early summer thunderstorm, her husband parking in the multi storey car park, the pair of them making their way to the pedestrian bridge from the carpark to the hospital, she unable to walk any more, he having to leave her alone and run to find an emergency phone (it was 1998) and summon a wheelchair, a desperate run to the maternity unit with a pair of porters, one to wheel the chair and one to push open doors, immediate admission, baby found to be breach and no option but CS, her own OB arriving a couple of hours later...

The hospital pediatrician who was on duty that morning was the professor of pediatrics (it was a university hospital). He was my family's pediatrician, hence his visit to see little DD, and was assigned to her baby too as she had been admitted when he was on duty. Along with him came two residents (doctors learning their specialty of pediatrics). They chatted (as best she could with all the pain relief) and she mentioned their wild night and that the baby was about three weeks early. He said 'On no, he is full term' and showed her and the residents the crease pattern on the soles of the baby's feet that can indicate gestational age. She was adamant about it, and he let it drop.

I noted several details about her story.
First, the hospital did valet parking at no charge for anyone being admitted in an emergency and also obstetrical admissions. You could drive up to the emergency entrance, hand over your keys, and they would park your car and then leave your keys in an office where they could be picked up and given the location. My OB's office (all male OBs) gave all patients this information at 32 weeks. Little details can make a difference.

Second, castor oil.
Third of course was the miscalculated due date and the fact that the baby was breach.

Her doctor was a woman who had got a lot of things wrong. They were very lucky everything turned out ok.

There are no community MWs or HVs in the US afaik. You could phone the maternity unit any time if there were any post natal concerns, or call your doctor's or MW's office. The one time I had to return was to have a thrombosed hemorrhoid lanced and it was done expertly and to my great relief in a (male) gen surgeon's office exam room with local anesthesia.

My thinking on male v female HCPs is that they have all surely seen bodies before, and that patients are six of one and half a dozen of the other. I would prefer a male HCP any day over somebody's husband a few feet from me visiting his partner and baby, with me having to walk past all sorts of hangers on to get to a loo.

I suspect the same effect you ascribe to the midwife labour unit could be accomplished by providing private rooms, with or without all female staff. I freely admit I have no figures to back this up with, just the horror stories from women here.

It obviously wouldn't have the same effect for the many women on here who are describing the reasons why they don't want a male midwife. Those reasons would not disappear because of the system you describe.

Math the set up is very different in the USA.
In the UK most babies are born via the NHS and even private patients will still have input from community midwives and health visitors after discharge normally unless they also arrange a private midwife as I imagine people like the Royals would. Some mothers need/want more support than others. The community midwife can have a very close relationship with the woman although I'm sure this varies in different areas. I was a community midwife for ten years in a very rural area. Two little girls I had delivered were bridesmaids at my wedding. I attended the funerals of stillbirths. Sent cards on the anniversary. Of course a man can do those things (maybe not the bridesmaid) but the relationship is different. Plus lots of intimate stuff.

When the community midwife came to visit me she wanted to check my sanitary towel and my c section wound in my living room and felt that I was making a fuss about nothing when I hobbled over to draw the blinds to stop the neighbourhood kids playing outside trying to look in (they were excited because they knew I'd had a baby and they wanted to see the baby).

Whilst it is true that HCPs see bodies all day every day, they often forget that what is routine for them is difficult for their patients.

I didn’t see a single male HCP during pregnancy, labour or postnatally. My DC was referred by a female physiotherapist (who visited us at home) to a male paediatric orthopaedic consultant. Otherwise I have always chosen a female GP, dentist, ophthalmologist, dermatologist etc.

I am in the UK. My son was born in 1990. I did not see a community midwife. I had no contact with any sort of midwife beyond the routine pre- natal appointments at the hospital.

Lass I am not disbelieving or arguing with you. No doubt there is a simple explanation - maybe you slipped through the administrative net or something. Some women will have all their antenatal care via the hospital for various reasons.

But to clarify for others, in the 1990's when I was a community midwife my "Midwives Rules" (nowadays there is a NMC code of conduct, online if anyone is interested but it is much less prescriptive) back then were very specific. It said (I'm not quoting directly as I no longer have them) You must visit the new mother twice a day for the first three days and once a day thereafter for ten days and up to 28 days after delivery. You must record the temperature at each visit.

So women were visited a lot back then, and sometimes we were visiting mothers right up to 28 days for various reasons, but might include someone with a premature birth needing support even if the baby wasn't home for instance.

The temperature is an important point as anyone who reviews the triennial reports into maternal mortality might have noted that sepsis (which likely would have been puerperal fever a long time ago) returned as the most common cause of maternal mortality in recent years. (There is much more emphasis on spotting sepsis throughout the NHS now.) There was a case in the papers a while back and one of the errors in the mother's care included the midwife not taking her temperature (she said she had forgotten her thermometer which seems odd as it's the sort of thing that lives in your bag but anyway) and at the inquest the coroner specifically drew attention to the need to check the temperature.
I believe the emphasis on sepsis has hopefully paid off as it is has been replaced as the leading cause in the most recent report and thrombosis/thromboembolism have taken the top spot again.

Also at seven days a heel prick is done on the baby to test blood for phenylketonuria.

Since somewhere around 2000's managers hated that they were paying midwives to cruise around having jolly cups of tea with well women (which indeed we were in some cases) and they were desperate to get the rules rewritten to allow the visits to be cut more flexibility. This means women are likely to get far fewer visits and I do hear complaints about never seeing the midwife or only once. I think it is a huge shame for reasons of the lack of support women get, and for safety reasons, I'm surprised I don't see more horror stories in the press but that's how it is now. I'm not up to date anymore as I haven't practiced as a midwife since 2001, but I think it is a great shame that women are not getting the care they used to get.

www.theguardian.com/lifeandstyle/2008/jun/07/familyandrelationships

2009-2012 report with a strong emphasis on sepsis

www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf

.

Hahaha I had a male midwife. Not by choice, he was on shift but made no difference to me. He gave the spiel about having done the job for 25 years, fully qualified, nothing he hadn't seen before etc. This speech was much more for his benefit than mine... obvs he had been made to feel that he needed to justify his career choice because he doesn't have a vag.

Anyway, cut to the chase - he didn't believe that I was in active labour (because I internalised that pain like the badass I am ) so I had no pain relief and he wouldn't admit me to the labour bed. He told me to go for a bath and within seconds I felt the need to push. Cue a run waddle to my bed and having to hit the emergency button because I'd been left on my jack jones.

Everyone piled in (high risk pregnancy) and he still didn't believe I was in active labour and that I was just 'having contractions'. Then he actually goes to check with an eye roll to the people in the room and oh wait, can't get his fingers in because THERES A BLOODY BABIES HEAD THERE!!

He was sufficiently embarrassed afterwards so I didn't make a big deal out of it. Just glad to have my precious girl and no tearing.

FannyCann

My son was born in the early 90s, 5 weeks early because I had pre eclampsia. He was in SCBU for 2 weeks but I was discharged after 1 week.

We only saw a community midwife once and that was after my son was discharged. I had no post natal checks after I was discharged.

If those rules were being implemented widely I would have thought I would have been a prime candidate for bd visits and extending up to 28 days.

My dd was born late 90s. Again I had pre eclampsia but I discharged myself the day after birth with my dd. I saw a CM twice in the week after delivery and then we were handed over to HV.

So even if those rules were in place they certainly weren't being implemented everywhere.

Both of my obstetricians were men. What’s the big deal with a male midwife. They’re either good at their job or not, doesn’t matter what sex they are.
Worst I had was a female midwife of about 60 who stank of nicotine.

My dd was born in 1995. Perfectly straight forward-home the next day. Had midwife visits every 2 days for the first 10 days. Perfectly normal in our area.

So even if those rules were in place they certainly weren't being implemented everywhere.

I can't account for the interpretation or observation of the rules in different areas but those were the clearly stated instructions and that is what we generally did both in my training area (Oxford) and other areas where I worked. If mothers were going back to the hospital eg to visit the baby we would often arrange for the hospital midwives to do the check whilst they were there.

No doubt some visits got missed for perfectly valid reasons - sometimes we would phone mothers to check if we knew they were doing well and not really needing a visit if we were very busy for example and sometimes mothers were going to be away or whatever so there was a degree of bending the rules for sensible reasons.
The difference now is there is no prescriptive standard and I have heard that some trusts severely limit the number of visits such that midwives can't use their own judgement and decide to do extra visits where they think it is appropriate.

Fanny

You must visit the new mothertwicea day for the first three days andoncea day thereafter for ten days and up to 28 days after delivery. You must record the temperature at each visit

You might not be "disbelieving" but none of what you say happened to me. The first 4 days after the birth I was in hospital. Thereafter a health visitor turned up 2 maybe 3 times. I have no recollection of temperature being taken. She never checked the csection scar or towel

at seven days a heel prick is done on the baby to test blood for phenylketonuria

Pretty certain health visitor never did this either.

I've been mulling this over and I think my answer based on my experiences (never seen a male MW and relatively easy births) is:

Early labour - in hospital where you might see multiple MWs, I'd probably not mind a male but I'd prefer a female at a home birth

Active labour - I don't really care who is with me as long as they generally leave me alone to get on with it

Third stage - I feel like I'd rather have a female pulling a placenta out of me than a male (my placentas tend to be a little lazy), partly because I'm out of the 'brain haze of birth' mode by then and it feels weird enough having a woman doing it

Post-birth - I'd prefer a woman for the first few days while I'm still being prodded and poked but once it's more about the baby than me I wouldn't care.

I obviously can't account for variations in care pp's have had, and nor do I dispute.

I do however know what the "rules" stated and how that was interpreted and governed our practice in the areas I worked.

Before about 2001 there should have been postnatal visits up to ten days in most parts of the UK.
I think Scotland may have had different legislation and rules.

I no longer have my book of "rules" but these are from a 1950's text book I bought for historical interest.
The visits rules really hadn't changed much by the time I was a midwife although I note there is provision for local variation so possibly there was more of that than I was aware of.

Both of my obstetricians were men. What’s the big deal with a male midwife. They’re either good at their job or not, doesn’t matter what sex they are

It’s not about whether they’re competent, it’s about the effect they could have on a vulnerable woman, who for whatever reason wouldn’t feel comfortable with one, and the confidence in her ability to speak up and say so knowing she’ll be listened to, or not being able to voice her discomfort and having to ‘put up and shut up’.
So many posts about the midwives and not enough about the only important person when it comes to childbirth.

I had a male mid-wife for part of my first labour. He was wonderful. The young female midwife who had been assigned to me wasn't very experienced (and not was I). She was slightly chaotic and anxious which rubbed off on us all. Whenever the male midwife came in to check up on things we all felt calmer. He was older, experienced had a very reassuring presence and confidence. It's no coincidence that the baby emerged while he was in the room - I felt calmer when he was there!

I had my first child in 2004, was in hospital for 1 day, and had regular visits from midwife at home, I think at least three times, she supported me to establish breastfeeding.

Frankly, I am uncomfortable around any man who chooses a job involving getting up close and personal to womens' genitals.

I am uncomfortable about power relations between women service users and male gynaecologists.

I am uncomfortable that a strange man is nearby when a young woman is vulnerable, possibly drugged, disinhibited and grateful for any kindness.

My attitude has its roots in bitter experience
(a) a sexual assault where I was left confused and embarressed, wondering 'what just happened? Was that right? is it me? Or did he just.... ".

(b) I had the misfortune to listen to a gynaecologist who, while drunk and in his cups, gave me more information about his attitude to women than I wanted to know.

Totally with you theOtherPamAyres great post.

Sadly it isn't just male gynaecologists with that attitude.

As a student nurse I worked in gynae theatres. One very old school female gynae surgeon refused to do terminations via suction because they were less painful for the woman post op. She felt that women should suffer pain post op as a deterrent.

I wouldn't have wanted her to operate on me despite her being female.