Showing posts with label midwife. Show all posts
Showing posts with label midwife. Show all posts

Friday 10 October 2014

Should Midwifery have its own National Board?

A massive change in the way health professions, including midwifery, are regulated

Four years ago Australia underwent a huge change in the regulatory system that oversees health professions. A National Registration and Accreditation Scheme (NRAS) was created.  This change saw the consolidation of 75 Acts of Parliament and 97 separate health profession boards across eight States and Territories into a single National Scheme. The National Scheme sets a minimum standard for safe practice by health professionals. This minimum standard can be and is, augmented by states, professions and institutions. 

The National Scheme is overseen by the Australian Health Practitioner Regulation Agency (AHPRA); each profession regulated by the National Scheme has its own board apart from nursing and midwifery who have the one board. The Nursing and Midwifery Board is responsible for the regulation of midwives which involves setting midwifery policy, standards and guidelines; managing midwifery registration; dealing with complaints against midwives; and assessing overseas midwives.



Midwifery coming of age as a profession


Whilst for many decades midwifery was seen as a nursing speciality, there has been an increasing recognition of the differences between nursing and midwifery. Australian maternity services and the way midwives are being educated have been changing dramatically in the past two decades in response to consumer demand and an increasing body of national and international evidence on the importance of midwifery models of care in meeting women's needs and resulting in cost effective, best outcomes for childbearing women and their infants (Barclay et al. 2003; McLachlan et al. 2012; Renfrew et al. 2014; Sandall et al. 2013; Tracy et al. 2013). There has also been increasing recognition of the necessity for midwifery to be developed as a separate profession. 



The National Registration and Accreditation Scheme (NRAS) is under review


The review is being led by Mr Kim Snowball, and the public consultation closes today, on the 10th October 2014.  Our Australian College of Midwives has submitted a proposal for a separate Midwives Board to the review: 



Why we need a Midwifery Board!

The ACM has provided a list of concerns about the current combination of both nursing and midwifery professions under the current board in their document above.  They also identify that midwifery must be regulated by midwives in the form of a Midwifery Board, in order to ensure that:
  • Midwifery practice issues are assessed and regulated by a full Board who are both credible and cognisant of the issues in the provision of contemporary, safe maternity care
  • Issues associated with privately practising midwives and eligible midwives would receive attention from individuals who are appropriately qualified and experienced
  • Complaints are managed in an appropriate and timely manner which includes the application of the principle of natural justice i.e. to be judged by peers who are competent to make a judgement
  • Protection of the public is increased through the nimbleness of a midwifery focussed Board thus improving responsiveness to emerging issues associated with rapid escalation
  • There is an increased understanding of the regulatory context for midwives in private practice providing a fee-for-service model
  • Community representatives who are aware of the relevant issues for childbearing women and families are recruited to the Board thereby ensuring accurate assessment of practice-related issues for midwives
  • Cost effectiveness is achieved by appropriate regulation and protection of the public
  • Data collection about practising midwives is improved, which will improve workforce planning
  • The issue of midwifery invisibility in the legislation, and its consequences, would cease 
  • The Nursing Board would be free of the time consuming complexities of midwifery issues and able to concentrate fully on the important issues for nursing.

Do you support an Australian Midwifery Board? 


If you do agree that midwives should be regulated by midwives, please make your voice  heard by writing to Mr Snowball by close of business today, the 10th October and attach the ACM submission:


or write a letter outlining why you think midwives should have our own Board and email to: nras.review@health.vic.gov.au

Share the ACM submission with colleagues, even if they are not ACM members, and encourage them to make their own submission.


Any questions about the NRAS Review or the ACM submission, please contact Sarah Stewart, ACM Professional Officer: sarah.stewart@midwives.org.au or phone (02) 6230 7333.  

Tuesday 3 June 2014

A midwife's personal journey into supporting birth honestly


Elly Copp is a guest blogger today.



 Photo: Elly Copp

Elly is a hospital midwife working in a birth centre in the south-west of the UK.  She is also an integrative therapist in private practice in Bristol and where she lives, in Somerset.  I first 'met' Elly on twitter over a year ago and liked her approach to midwifery, women and birth. I was interested in Elly's many 'hats' and how she managed to work within the system with her approach to women and their families. I invited Elly to write a piece for this blog to share her rich understanding and experience and here it is.

Enjoy!

Elly writes:

"I recently attended a conference on “Attachment, Loss and Significant Change” which taught me such rich and relevant information that I have been able to synchronise all my learning for the first time. This experience feels like a culmination of years of process which has made a direct and immediate improvement to my work as a midwife and mentor.

The two presenters, experts in their fields, shared their knowledge with us:

Sir Richard Bowlby, spoke about his father, Sir John Bowlby and his work on attachment theory. He identified the key needs we all have in order to survive our life, which begins as early as birth. By the third trimester, a baby is equipped with senses, feelings, reflexes and a personality. We are born ready to make contact with our parents. Attachment is a core need and initiates in us a sense of belonging and feeling ok in the world.
Conversely, the effects of not having our needs met in the early days and not being ‘seen’ just as we are, is likely to have long lasting effects on health and relationships. Considering the impact on a baby when she loses her mother temporarily or permanently will have us all unsettled as we don't like the idea of it or how it felt when that was our experience. As midwives we are in a prime position to assist at these moments of a person’s life: mother, father and new baby, the evidence is there and now our challenge is to bring it into our daily work. The rewards for us as individuals will fuel more courage, compassion and love we have for ourselves and the women we meet.

The second speaker, Dr Una Mccluskey, talked about the roles of care seeking and care giving and the dynamic between the two. In our world these are the roles of ‘mothers’ and ‘midwives’. Midwives with good attunement antenna will pick up the ‘state’ a mother is in and will consider the next appropriate step. Dr Mccluskey says it's what the care giver does with that knowledge which is important. In order that she does that effectively, a midwife has to be aware of her own state, her own ability to regulate her internal system. This ability to self-regulate takes attention, commitment and support.

When fear diminishes, the ability to explore and be curious expands. That is true for midwives and the women they care for.  When we model our own state we see it mirrored and replicated. In her book “Why Love Matters" Sue Gerhardt looked at effects of being and feeling loved. When young people experienced no or poor attachment the consequence on their internal regulatory system was an inability to find equilibrium and resulted in negative, anti-social behaviours. What is known is that we do not manage so well in life if we have not felt the feeling of being loved and cared for, cherished, touched and cuddled by our mother or a mother like figure, a person who will stay with us long enough to understand us and regulate our internal state, and will keep coming back to us, again and again.

Watching film clips of mothers and their babies interacting and learning the theories behind this brings to life vividly the need for a secure attachment from the start, as well as feeling empathy for the newborn, the impact of a secure attachment for the baby on lifelong health is absolutely clear.
I consider myself very lucky , because I have been involved in some very profound births .I am often moved to tears and have the sense that I have been appreciated at a very deep level of the mothers'  being. These spiritual births where I feel a connection with the mother often come after she has experienced a traumatic time in a previous labour and birth .My understanding is that these women had been holding their trauma in mind and body and are very relieved to be able to let it go and feel pleasure, happiness and wonder in a birthing environment. It is my quest to remain open, available, curious and exploratory and I offer these mothers the same, and work very hard not to move myself or be manoeuvred or coerced by others into a fear state. The ability to translate that knowledge into practice is transformational and meaningful for the mother, the father the baby, the midwife and the student midwife.

As a midwife of 20 years, I am familiar with the realm of labour and birth and work in a birth centre where the environment is spacious. I learn here, and carry that knowledge to other places I go to, such as the delivery suite or ante /post natal ward for example. Even in a different environment I bring with me the assumption that this doesn't have to change a woman’s ability to birth and bond, and the baby to attach. When the environment is out of our control, we can still make it work, as everyone needs a supportive and companionable attachment system wherever they are.

A recent birth demonstrated to me how it is possible for a mother to change her physiology and emotional state when the people she has supporting her are present, being in the now, mindful and observant. I wish to share this with the intention that midwives reading this will be motivated to make their own deliberate but subtle and invisible switch in their own understanding and response. All the names have been changed to maintain confidentiality.

As a hypnotherapist, I am familiar with the mind and how it works, the limbic system, the cognitive brain and how the two are affected by each other and the environment. Dr Stephen Porges describes the neurophysiological foundations of attachment, emotions, communication and self-regulation so well in his book “The Polyvagal Theory ". It is quite manageable to digest and process the theory, the difficulty is making theory useful practically in such a busy environment where risk is calculated and expectations and therefore stress is high.

"Help for the Helper" by Babette Rothschild discusses how roles can get confused when boundaries are not maintained, the mirror neurones in our brain mean that before we realise it, care seekers are mirroring and mimicking the care givers own state.

It is significant that working in a fear state a lot of the time is not helpful or healthy for us, and has a part to play in burnout. We have a real vested interest to self-care and ensure we regulate our systems frequently to maintain our health. This is extra difficult when we are working a shift pattern which is pre-arranged for us. Add to that the variety of work needing to be attended to, which can be acute and immediate for a short or prolonged time, plus no breaks and the situation for the midwife can become untenable.

When a midwife is in fright / flight mode herself she needs to become aware and notice it quickly so she can shift it. Her brain will prevent any connectivity or attunement as long as it it is focused on anxiety. In such a situation the midwife cannot create a safe birthing environment; instead she becomes distracted and loses focus. No one is grounded, no one is self-regulating. 

Dr Mccluskey stated that in supportive relationships, a genuine response must match the depth of the other person’s situation; Women will know it if we show mixed messages. The words need to match our actions for us to be seen and trusted by the women in our care to have faith in us She states: " we are all hard wired to care for other people, to seek care for ourselves and to pursue interests " As midwives in a work environment where the care we give is increasingly scrutinised and critiqued retrospectively, seeking care for ourselves and pursuing interests can be the aspects where we are not so successful, and therefore less able to self-care. In addition our workload becomes greater and visibility around each other is reduced.
For a mother, when the fright /flight brain is in ascendance, dissociation from the self, the body and the baby will result (as a survival technique), it will not be easy for her to experience an empowered birth. I believe that when doctors, midwives, anaesthetists and health care assistants operate collectively from this place of flight/fright, disconnect is a constant presence.

When women can be in a calm and regulated state there is sufficient capacity for them to utilise internal resources, to stay exploratory and look for ways to cope. Ultimately they give birth in an engaged and connected way.

When a midwife successfully regulates her own internal state, the woman she is with can be in touch with her own skills necessary to deal with any upset. We are facilitating an environment within which a woman can build her own competence in the world, which is what she will simultaneously be passing on to her baby. Having worked in a birth centre since 2008, I have found my own ability to problem solve and find solutions has expanded and that is apparent in the confidence I have and pass to the parents I meet.

I am also a Bowen technique practitioner (Bowen is a way of working with the fascia and muscle spindles which rebalances the body via the vestibular system). During a Bowen session, a body can restore health and vitality to the best of its ability. There are clear parallels between Bowen and birth, because the same environmental conditions are required for best outcome. Michel Odent commented " an ideal situation for a mother to birth in is where there is as little interference to the mother’s natural process as possible: speaking, feeling cold, feeling unsafe and bright lights are stimulation which is not conducive to giving birth."

What seems to be happening during a Bowen session is that the body is allowed to re-orient to a memory of a previously healthy state or an original blue print of health. Many of the moves are made on areas significant during embryological development (John Wilks, The Bowen Technique). Like the mind and its ability to move from a fear state into a calm state, the body can do too, physiological changes occur when liquid crystals in the cells which hold memory and have the capacity to register a new experience which are highly receptive to change are touched.
Sheila Kitzinger writes about birth crises and the effects on bonding with the baby as well as any future births. Where a woman has experienced a shocking birth experience and felt helpless and out of control, that memory of helplessness stays with her. If she does some work to recover from her trauma, restore her self-esteem and confidence, she can experience healing in advance of her next birth. If she's doesn't, her bonding and attachment with her next baby will be negatively affected
Sir Richard says:
“If she doesn't recognise that state and therefore remains static she cannot release the dynamic energy needed to give birth to her next baby. She becomes stuck in her thoughts and in her muscles. This is visible in the way a mother uses her body in labour, during and in-between contractions, her posture, her eye contact and how she expresses herself and receives support”.

Putting all this into practice is sometimes straight forward and sometimes very complex. The woman I met called Suzy* and her husband John* seemed initially to be quite a simple care in labour, part of my daily work, but moved into a more complicated area as she moved through her labour and some details emerged.

Two years ago. Suzy had been in labour with her first baby in the pool, and out of the blue, the midwife became worried about the baby's heart rate. Suzy was rushed and hurried along a long corridor to the obstetric theatre where her daughter Imogen was born by forceps. It happened fast. Suzy and John were handed Imogen after a while when she was dressed. There were no other concerns about her health; the perceived concerns about her wellbeing during labour had not affected her wellbeing at birth. This aspect was never discussed though, and the couple were not given any more information about what had happened.

Suzy and John decided to have another baby a year later, but Suzy was very worried about how the birth would go during the second pregnancy. She only told John about this, he was as supportive and kind as he could be. He couldn't see they had any choices.  Suzy started her labour in the early hours and they drove to the birth centre, she wanted to use the pool again but was plagued by lack of confidence, worry and fear about it. She questioned herself so much that she couldn't actually think any more. It was a busy night and the couple met 4 different midwives over 4 hours. Suzy began to panic that her contraction pattern was spacing out. She started to think that this was an impossible situation for her. She was kneeling and closing her eyes a lot of the time.

I entered the room and saw a lovely and supportive man talking gently to his wife and introduced myself and my student who is gentle and kind and softly spoken.

My colleague who was leaving thought that the birth was imminent so we waited for some signs; it was 07:30 am.

We watched and attuned to Suzy and through John we learned about their experience with Imogen. Suzy said it was awful, she had been worrying about it, she didn't want that to happen again but she was frightened it was heading the same way.

I am very careful about discussing previous births with couples because my experience is that it can detract from this baby, but on this occasion, the nature of Imogen's birth needed to be spoken about out loud because the residual fear seemed to be stopping Suzy from giving birth. It felt like an elephant in the room.

My thinking is always how do I give the woman my full and complete attention, my whole person support without judgement or a set of conditions - as well as give her free reign to find her own path to birth her baby. I wonder and worry that I may be perceived as unsupportive, disinterested or lazy. In "Birthing Normally” Gayle Petersen details birth stories where she has attuned herself to women’s fears and needs and in doing this, has enabled the mother to birth her baby herself without any interventions. Whilst Gayle knows the women she describes, I am unfamiliar with the women I meet and not knowing them I cannot know their preoccupations and concerns.

Nine o'clock now and I observe Suzy in a pickle, she is wanting it to be over, saying she can't do it and becoming increasingly negative, defeatist and a little self-centred; rejecting Johns loving support. In my calm state I am wondering how to move Suzy out of her fear state and back into exploratory without being dictatorial or overbearing.

Where is that internal space for her to connect with herself, find her resilience and prepare to meet her baby? Dr Mcclusky says we are moving inside ourselves with other people all the time, and that self-regulation goes on as background music. "We are born with the expectation of being met as a person” resonates within me, and I want that for Suzy so that her baby receives that meeting.

Meanwhile Suzy is becoming more despondent and closer to giving birth (9cm dilated). Is analgesia the right thing to offer? Is that kind and appropriate I ask myself? Maybe, but I think not is my internal answer.
After another of Suzy's desperate outbursts that "she cannot do it", I realise she is overwhelmed and I ask her 3 questions very carefully.

What does she need right now - she answers “not to feel any of this”

What does her baby need right now - “to be born quickly”

How can the two align?  A pause and then - “I had better get a grip", said with a sense of authority and humour.

John smiles at me, as if we have made a breakthrough, it feels like she has moved from her fear state to her maternal and problem solving state.

That is the moment the labour changes, because 30 minutes later and without any pushing at all her baby's head is born in the pool, the membranes are intact and still over his face when Suzy brings Harry to the surface.

We were all in tears, moved by her capacity to change and in how by releasing something negative from her past she became free to move energetically and give birth so smoothly.

A few hours later, we chatted it over and she said last time her birth had been taken away from her, she felt she had lost a part of herself which she hadn't realised until this birth. I told her what had been going through my mind about analgesia, and she agreed she had been thinking that too - I reflected how we had synchronised. She loved having so much skin to skin with her baby because that had not been included last time, and she valued us as helpers and enablers whilst we saluted her for her courage and commitment to her baby.

To conclude, I do not say that having this understanding will mean all births are going to be smooth or straightforward, but I do believe that seeing a woman for who she is gives her choices and with those choices she can make the best decisions for herself and her baby.
 
The approaches I use incorporate my knowledge of hypnosis and Bowen technique, directly and indirectly. Sometimes I use touch, and sometimes calm and reassuring suggestions. The midwifery training itself did not give me a good enough education to understand the minutiae and nuance of what birth entails. I was shocked when I was in labour with my first baby that my training had not prepared me for the realities of birth and what resources I needed. It has taken years of work and application, critique and evaluation to reflect on what holistic means and how to see women holistically. It is a journey not encouraged within the hospital system and finding my own identity has been a hard slog but one I could not avoid. My passion has stemmed from a mixture of sources and is maintained by the appreciation I receive from women and their families as well as colleagues and students. When a mentee says "all we are told about is litigation and self-protection" I worry a little bit more about the lack of self-awareness and acknowledgement these fledging midwives are being trained in.

The other motivation is personal: as a daughter, wife and mother of four, I have to keep working at all my relationships - and in trying, my efforts will be seen, and I will be met as a person. 

You can contact Elly via her email eleanorcopp@me.com and she tweets as @EleanorCopp

REFERENCES

Bowlby,EJM. (1997) Attachment: Volume 1 of the attachment and loss trilogy. (1st ed) UK:Vintage publishing. 

Gerhardt,S.(2004). Why love matters: how affection shapes a baby's brain.(1st ed.)UK:Brunner-Routledge.

Kitzinger,S.(2006). Birth Crises. (1st ed.).UK: Routledge.

McCluskey,U.(2005).To be met as a person: The dynamics of attachment in professional encounters.(1st ed) UK:Karnac. 

Peterson, G. (1984). Birthing Normally: a personal growth approach to childbirth (2nd ed.). USA: Shadow and Light.

Porges, S (2011) The Polyvagal Theory: Neurophysical foundations of emotions attachment communication self-regulation. (1st ed) USA: W.W.Norton and company.

Rothschild,B.(2006) Help for the Helper: self care strategies for managing burnout and stress.(1st ed ) USA:W.W Norton and company.


Wilks,J (2007)The Bowen Technique: The inside story (1st ed) UK:CYMA LTD.

Sunday 27 May 2012

"midwives' views" etc have NO place in our literature. Bugger their views!”


The other evening I posted this article to twitter.

“Women who plan to birth at home with midwives are more likely to receive Evidence-based Care http://fb.me/1puDpq2un

The article described research that found that first-time mothers who chose to give birth at home were not only more likely to give birth with no intervention but were also more likely to receive evidence-based care that women who gave birth in hospital despite care by the same midwives. (BIRTH 39:2 June 2012)

There was an immediate reply tweet from a female obstetrician who has the twitter name @obgynkenobi


Obygnkenobi  tweeted:  “primips should not then home birth according to recent bmj RCT. This article is level 9 evidence. Sorry.” 

I responded:  er no, that's not what that study showed at all

Obygnkenobi  tweeted: “p0s [nulliparas]: increased risk of adverse outcomes if home birth. Please don't make me get out of bed to get the ref. it's cold.”  

I responded: "the BMJ study showed a miniscule increase risk to the neonate with a primigravid woman birthing at home"

Obygnkenobi  tweeted: “let's not just pick and choose which evidence suits us”.  

I replied:  “birthing at home is still far safer than driving with your child in the car or having a swimming pool in one's back yard”

Obygnkenobi tweeted:  "I'm not debating the safety. I'm debating the article that stated that homebirth midwives were more likely to use EBM [evidence based medicine]” And further “Yes, the absolute risk is low but if EBM is the master we all serve, primips should not home"

I wrote back:actually, the researchers said that people needed to be aware of the risks, not that they shouldn't”

Obygnkenobi tweeted: “because clearly, "some" midwives choose whichever evidence is more appropriate to their aims”  

I asked "clearly"? why clearly?"

Obygnkenobi replied:  "b/c some mws (and drs) don't practice EBM. Interpreting evidence based on proving a point"

That comment reminded me of the way people responded to a very poor study that changed practice overnight, so I repliedHmmm, I guess the Term Breech Trial is a good example of your point. So many so quick to jump based on such flawed research” 

Obygnkenobi responded: “probably true to a degree. However I know many skilled docs who won't touch a breech” 

To that I commented: “then they're not skilled with breech; over decades I've seen many breech births & brilliant doctors & midwives; now fear rules”

Obygnkenobi  tweeted: “It's not just the medicolegal aspect but the trial confirmed what they had always thought”. 

I was confused by that statement, so replied: “sorry, you've lost me here” and when I thought more about what she said, I asked: “so you think they stopped doing breeches because the skewed trial confirmed what obstetricians thought all along?”

Obygnkenobi responded: “no but it probably was one of the factors #beforemytime"

I was confused by this comment too, because surely, understanding why we do what we do involves knowing one’s history and ensuring that what we are doing is evidence based. I am also aware of how one’s own cognitive bias leads us to perceive and interpret things from our own viewpoint, which is what happened with the Term Breech Trial. Cognitive bias was also happening in response to the BMJ article, so I tweeted in response “the biggest issue is ensuring the evidence is robust and real - we know how easy it is to find what you are looking for”

Obygnkenobi  tweeted: “So there IS a role for using our brain!! Who'd thought!”

I didn’t recognise this at the time as sarcasm, but I did feel confused so said: “and I'm not sure what this was in relation to either?? erk - I've missed something :( and I was enjoying this conversation”

Obygnkenobi replied:  “EBM raises a difficulty: either use our brains or use evidence. It's ok to use either but don't dress it up as EBM if it's not”

I fully agreed with that statement about evidence based [medicine] care being a difficulty, I was experiencing that in this conversation and replied: “very much so!”

Obygnkenobi  then tweeted: “precisely. And that's why the article with "midwives' views" etc have NO place in our literature. Bugger their views!” (my emphasis)

I was surprised and disheartened by that comment and replied: “I find that comment depressing :( “

Obygnkenobi responded:  ok. How about: ebm and individuals views should not coexist in the same article. Better?” and then “individuals views are ok, so long as they're not gusseyed up to look like evidence. It's all good really.”

I didn’t respond to those two statements as it was 1230am and I was not wanting to say anything that could be misconstrued or appear rude.

The next day I tweeted:  @obgynkenobi I'm curious to know if you read the actual paper?

I haven’t received any response to my query. 

This morning I tweeted: @obgynkenobi “did you see this? Term Breech Trial 10 years on” 

That article is worth reading as it revisits the criticisms of the Term Breech Trial and highlights the fact that there has been an increase in maternal deaths with the rise of caesarean section surgery for breech presentations following that study. 
The abstract states:
Abstract:  In 2000, the Term Breech Trial was published, and its authors recommended cesarean section as the safest mode of delivery for breech-presenting babies. Criticisms of the trial were raised at the time, which the authors dismissed. Since then, maternal deaths have been recorded among women undergoing cesarean sections for breech presentations. Accordingly, those initial criticisms deserve to be revisited. (BIRTH 39:1 March 2012)
Not only did the BMJ article that Obgynkenobi had referred to earlier in our twitter conversation Perinatal and MaternalOutcomes Perinatal and maternal outcomes by planned place of birth for healthywomen with low risk pregnancies: the Birthplace in England national prospectivecohort study   not say women having their first baby should not give birth at home, they concluded: 
“Our results support a policy of offering healthy nulliparous and multiparous women with low risk pregnancies a choice of birth setting. Adverse perinatal outcomes are uncommon in all settings, while interventions during labour and birth are much less common for births planned in non-obstetric unit settings. For nulliparous women, there is some evidence that planning birth at home is associated with a higher risk of an adverse perinatal outcome. A substantial proportion of women having their first baby who plan to give birth in a non-obstetric unit setting are transferred to an obstetric unit.
These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth. For policy makers, the results are important to inform decisions about service provision and commissioning. The relative cost effectiveness of the different birth settings will also be of interest to policy makers and is being compared in another component of the Birthplace Research Programme.
Further research is needed into the avoidability of adverse perinatal outcomes, the effect of staffing and service configuration on outcomes, and more detailed analyses of transfers from non-obstetric unit settings. It is unfortunate that routine maternity information systems are not currently of a sufficiently high quality to enable the analyses presented here to be repeated without carrying out another large prospective cohort study.”
I also retweeted the article that sparked the twitter conversation:

I tweeted: @obgynkenobi in terms of evidence based practice, did you actually read the article about midwives use of evidence and place of birth? 

There is still no response, but it is Sunday!   

I would like to think that we can have good, intelligent conversations about evidence and practice without denigration and dismissive behaviour.  

Interprofessional collaboration in Delivery Suite was the subject of a research project I did in 2008. Attitudes like those displayed here by this obstetrician fit the model of Negative Interprofessional Interactions and stereotypical behaviour. This model is linked to low social and emotional intelligence of the midwives and obstetricians together with adverse outcomes for women and their babies.  Obstetricians and midwives don't feel good about these negative interactions either. I certainly feel very disconcerted with the attitude of this doctor towards midwives and our practice and the misinterpretation of these three studies.