hospital birth

 Last week I attended my first hospital birth as an IM and the last birth of 2024. Because of how the birth panned out my midwife buddy and I we separately did a 10h++ shift each to support the client throughout. It is one of the benefits of hiring an independent midwife, we are there every step of the way. And even when the main midwife, my colleague in this case, needs a break, the quality personalised care continues.


It was interesting to be back in a hospital environment after a couple of years away from it. There was a familiarity and almost a comforting feeling walking the long corridors once more. This was not a hospital I had worked at, but they all can look very similar. I remembered the camaraderie present in midwifery teams, the little guesses about who will deliver when/how, the certainty that you knew what you were doing because you were following the script, the safety of knowing the team was around in an emergency, or the shared responsibility that made complicated cases easier. I walked down to the cafeteria with my head high, for a moment feeling I worked there. But then I remembered the not so good things. The clicks, the gossip, the disrespect of women referred to as “room 2”, “the induction”, “the 36 weeker”; the pressure from colleagues to conform; the fear of the disapproval you would get from some doctors when presenting a case from a woman that had declined all sorts; the laughs when yet another “hypnobirther, tree hugging, mother earth” woman ended up with a CS disregarding their part in it.


While there I did not see any of those things, our client was treated with respect, her choices upheld, and her options presented clearly. However, I myself felt some disdain from some of the members (not all!!) when trying to retrieve my client’s placenta for encapsulation, which is a time sensitive issue. On the other hand, I was treated with respect by the midwives and doctors in the room, I let everyone know who I was and why I was there, but noone showed an interest in the alternative work we do, which leads me to believe we are still outcasts. Recently I have heard of IM colleagues being mistreated by their previous hospital trusts, which saddens me. Of course I am not there to speak of independent midwifery, the lead NHS midwives focused on building a relationship with our client which is great. My role was to make sure our client’s choices were respected, that she was given clear information, that she had a second opinion if she needed one, and to step in if I witnessed any unsafe practice.


Our client did amazingly. Her case is a gentle reminder that medical interventions have a time and place, that as IMs we are not fighting an “us against them” battle, that our homebirth expertise does not exclude medical help. And that day was also a reminder of the NHS midwife I once was, fresh, nice and a bit compliant!


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Resources For Fetal Heart Monitoring

1.When did we start monitoring babies in labour?

For more high quality evidence around fetal monitoring please visit Kirsten website here, an obstetrician with a PHD in CTGs. https://birthsmalltalk.com/

In this post she discusses intermittent auscultation: https://birthsmalltalk.com/2023/08/23/what-is-intermittent-auscultation/

Hear her talk about the lack of evidence behind CTGs in this podcast: https://open.spotify.com/episode/1eXZY973Oxbs1ducavpSAk?si=872f8c4077be4ba5

Post on the history of fetal heart monitoring: https://birthsmalltalk.com/2023/08/09/listening-to-the-fetus-the-history-of-fetal-heart-rate-monitoring/

Cochrane review comparing CTG to intermittent ausculation (CTG increases interventions
): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/full

Does CTG use improve outcomes for high risk women? https://birthsmalltalk.com/2024/10/16/the-story-behind-our-paper/

2. How should we use intermittent auscultation in labour?

These are the NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

Midwife researcher and lecturer Rachel Reed has a brilliant article and podcast about this where she unpicks the evidence around the recommendations for intermittent auscultation protocols here https://www.rachelreed.website/blog/listening-to-baby-during-labour

and podcast here: https://open.spotify.com/episode/3sJeIR3xUOr20EBRGilHxl?si=818537594dd04457

The WHO recommendations for intrapartum care: https://iris.who.int/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

3. How does intermittent auscultation detect fetal distress?

For more on normal and abnormal heart rate monitoring watch this explanatory video: https://www.youtube.com/watch?v=Ni48bbtiZgs

4. What happens if there are concerns with the fetal heart rate at a homebirth?

NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

5.What is better for fetal monitoring in labour: a Doppler or a Pinard/fetoscope?

To read about the research and the experiences of midwives using a fetoscope/pinard antenatally and in labour check these links out.

Short facebook comments compiled in this magazine here: https://www.midwiferytoday.com/mt-articles/wisdom-of-the-midwives-issue-131/

Midwives perceptions of fetoscope vrs Doppler Tanzania https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1736-y

Midwives experiences of Pinard use Norway https://www.sciencedirect.com/science/article/pii/S0266613822000407

Defense of fetoscope article by American midwives

https://hearthandhomemidwifery.com/blog/fetoscope-a-tool-of-the-midwifery-trade#:~:text=Fetoscope%20uses%20go%20beyond%20just,birthing%20person%20and%20the%20baby.

A Cochrane review that compares Doppler and Pinard use in low income countries: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008680.pub2/full

For a compilation of research that compares the use of Doppler to Pinard check this link: https://www.cochranelibrary.com/content?templateType=related&urlTitle=%2Fcentral%2Fdoi%2F10.1002%2Fcentral%2FCN-01110791&doi=10.1002%2Fcentral%2FCN-01110791&p_p_id=scolariscontentdisplay_WAR_scolariscontentdisplay&_scolariscontentdisplay_WAR_scolariscontentdisplay_action=related-content&p_p_lifecycle=0&p_p_mode=view&type=central&contentLanguage=

6. What if you decline some or all fetal auscultations?

Is fetal monitoring essential?: https://birthsmalltalk.com/2024/11/06/myth-busting-3-fetal-monitoring-is-essential/

7. What to bear in mind about intermittent auscultation in labour?

Examples of womens experiences of fetal auscultation in labour: https://www.sciencedirect.com/science/article/pii/S1871519224002658#bib14