I continue to be a full time midwifery lecturer and aim to have one or two midwifery clients per year. I had one midwifery client in 2001. She came to me via the NZCOM web site ‘search for a midwife’ facility. She was an amazing woman, taking everything in her stride. She really reaffirmed the wonder of birth and what women can achieve when you let them get on with it. She had prolonged rupture of membranes and I had to consider how I would react to that situation with regards to testing for haemolytic strep B. I was just about to swab but she beat me to it and went into labour. However, I didn’t broadcast my management because it went against the hospital guidelines. This illustrates the tension that independent midwives face when working in the hospital environment. As always, I come back to evidence and woman’s choice, as well as very good documentation.

I was delighted with how the birth went in the hospital. The staff were wonderfully helpful and I felt very welcome. The reason the woman didn’t have a home birth was because she lived 1 ½ hours in the country, half an hour down unsealed road. She felt it was too far away from hospital. I would have supported a home birth but would have made sure I worked with another experienced homebirth midwife. I feel a lot more confident about taking a woman into the hospital but still believe most women are better off at home.

One episode of evidence searching and questioning of practice came about because she was rh. negative, and didn’t want to have anti D. This was the first woman I had come across who felt like that. Ironically, I also had to give a lecture on anti-D to students, so my practice informed theory and theory informed my practice. I am still unsure about how I feel about the issue and was very relieved that she didn’t need anti-D.

The baby became quite jaundiced at one point and symptomatic. On reflection I wonder if I should have taken a SBR but the woman would have been very reluctant to go back into hospital and the baby came right after 24/36 hours and lots of feeding.

I booked another very interesting woman who moved away when she was 34 weeks gestation. She had had 4 cesarean sections and wanted a VBAC at home this time. I did a lot of soul searching about this lady. Originally, she agreed to birth in hospital but then changed her mind. I checked her old notes and didn’t think there would be a physiological reason why she couldn’t birth vaginally. She had an adequate pelvis. I gave her lots of material to read and started to make a care plan with her, and planned that she document her decision. I felt confident about my management up to the point she left Dunedin. I found out that midwives who took her own had questioned my practice, but I stand firm in my belief that women should be ‘allowed’ to make up their minds as long as they are completely informed about all the risks and benefits. If I had felt it was outside my scope of practice, I would not have gone along with her. A wonderful example of questioning practice and evidence, and the more complicated issues we face as midwives that I can share with students.

I worked an early shift in QM on Christmas Day, which I thoroughly enjoyed. I was second midwife at a birth, which was great fun. I did some suturing for the first time in years. I was anxious about this, but the practicing I have been doing with students stood me in good stead. I have heard that the woman healed well, so I was very pleased about that.

Professional development plan