Birth abroadCommunity midwife, Elizabeth Way-Rider, visited a 'birth house' in Germany and discovered a natural and holistic approach to childbirth that leads to very little medical intervention.
I was invited to visit the the Gerburtshaus (birthing house) in Soest, Germany to compare their positive, almost holistic care of both mothers and babies in comparison to the midwifery care in the area in which I work. Having been a midwife for 20 years and having worked through many changes in practice this visit really empowered me to be strong in my fundamental beliefs - that the most important thing in our practise is listening to a mother and giving her support, advice and confidence to make informed decisions about her pregnancy, labour , birth and baby and keeping both mother and baby safe at all times through the care they receive. I accepted the invitation hoping to glean ideas from the way midwives in the Gerbertshaus practise their special holistic care with the minimum medical intervention. The Gerbersthaus has approximately 120 deliveries per year, about the same case load that my job share partner and I care for in Chester, working as community midwives. The antenatal and intrapartum (care during labour) care is similar to that we provide in Chester, the major differences being the use of acupuncture and aromatherapy. If a woman has a problem that falls outside the realms of normality, she is them referred to an obstetrician and her care may or may not be transferred to the local hospital. I arrived at Dusseldorf airport and then after a speedy - no speed limit on German motorways - journey to Soest, I arrived at the Gerburtshaus to a very friendly welcome. I was allocated to work with Suzanne and we discussed a busy programme over the following four days that was to include home visits, antenatal classes and baby massage. All the the midwives - Mena van Damme, Suzanne, Bea and Nadin spoke very good English, which made it very easy for me! The antenatal care the women receive is very similar to the midwifery-led care practised in Chester, with all the same antenatal investigations and procedures. Antenatal visits however, are much more frequent and include a greater involvement of partners at every level. Education, education, education The parent education classes were quite enlightening. They always include 'questions and answer' sessions and one of the classes I attended involved the partners painting the mother's abdomen!. One painted a baby, another a clown's face and there was even a cat in a field with a tree! I'm sure that it all has a deep psychological meaning but the group really had great fun and the intimate interaction between the women and their partners was something I had only rarely observed. Acupuncture and aromatherapy are used considerably in the Gerburtshaus. All the midwives are trained in acupuncture and I watched Bea use position, breathing exercises, acupuncture and aromatherapy to encourage a foetus from a breech presentation (bottom first) to cephalic (head first). I was amazed when she told me that using these combined skills they have a 90 per cent conversion rate. The delivery suite is a colourful, well equipped serene place to have a baby. It not only has an aura of peace but also the reassuring presence of medical safety apparatus hidden behind doors. Two midwives are present for each delivery and there is a birthing pool, birthing chair, mats on the floor and many different types of equipment to support mothers while they are in labour. The Gerburtshaus has a 4 per cent caesarean section rate (Gerburtshaus 2002) with a non- selective acceptance of all who want to use the birthing house. This compares to 21 per cent in the UK (NHS statistics 2002). While I was there I was lucky enough to observe a delivery with Nadine
and Bea. The labour was very straightforward and baby Helen was delivered
safely on the birthing chair. The baby had immediate skin-to-skin contact
with her mother and an early breastfeed. At one hour she was bathing in
the Tummy
tub with salt and almond oil, to aid the healing of the umbilical
cord and moisturise the skin. On discharge the mothers are given a pack
containing salt, aromatherapy preparations and other useful items, including
nappy cream for the treatment of nappy rash, made by Mena from a secret
recipe! Suzanne and I went on several postnatal visits that were very similar to the way I practise in the UK. They have fewer visits to undertake in any one day, which allows a greater amount of time to be spent with each new mother and family. The baby massage class was held at the Gerburtshaus in a warm, specially prepared room with cushions, bean bags and relaxing music. Seven mother and babies attended this class and after an hour and a half all the babies took a bath in a Tummy tub. Without exception, they all love the experience and I would never have believed that seven babies could all be bathed in the same room and not one be crying or upset! The whole experience was very calm. After years of midwifery practice, it has been a real boost to my enthusiasm to find midwifery innovations in such a magnificent and encouraging environment . The Gerburtshaus has the advantage of being funded by Germany's healthcare insurance system - the NHS in this country would find it difficult to fund such a n excellent service. I can only compare the service to the previously NHS run (much-loved) GP units - the Gerburtshaus offers all that was good in GP units with a modern midwifery approach. The single most impressive difference to basic practice was the treatment and care of the newborn, with a great emphasis being placed on the baby's environment, mood and handling. The Tummy tub played an important part in this, being used after delivery to clean, calm and relax, following massage and to settle the baby at night. This article was first published in the RCM midwives' journal volume 8 no 2 pages 80-81 Where to next?
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