Are you pregnant with singletons or multiples? Either way, if you want to be sure you are going to be supported to have a physiological birth by a midwife you might need to understand that layered on top of the already medicalised system are changes that will limit knowledge and as such choice even further.
Recent changes to NMC Standards regarding the number of births to be achieved by student midwives could mean that dependent on the discretion of the senior midwife overseeing a student, the student could meet a woman pregnant with twins, discuss a physiological birth and have two births counted towards their required birth count to fully qualify.
This year, in what I consider to be a knee-jerk reaction by the NMC to the increasing number of midwives leaving the profession and students not completing their studies and qualifying, changes were made to their requirements for including the "Number of births to be achieved by student midwives." That is the number required to become qualified. It was considered important that midwives had the skills to support a labouring woman to give birth vaginally and it was 30-40 SVB's to qualify. Spontaneous vaginal birth or SVB is a vaginal birth even if induced or epidural is used; However, it used to be the case that only a complete SBV counted towards your qualification. A retained placenta would discount that birth.
The pendulum has swung somewhat in the opposite direction. These changes I fear will spell the end to midwifery further.
The recent changes have expanded to "not providing care during the third stage." Furthermore, it permits instrumental vaginal births to be counted. In fact, there is a provision that states, "A flexible approach should be taken to help student midwives achieve their necessary birth count. For example, students can count births toward their requirements even if they are not present at the birth, as long as a spontaneous vaginal birth is expected."
They chose to consider one twin birth as equivalent to two separate births. All the while, there is no specific mandate within the NMC code that necessitates midwives to possess competence in SVB of twins and multiples. A midwife at a band 7 level mentioned to me, "Our expected competence only relates to normal births." I am concerned students and educators may now perceive twin and multiple births as an opportunity to increase their birth numbers.
I can find myself as the sole individual in a room full of healthcare professionals who possess comprehensive knowledge about twin pregnancies. Based on this experience I believe that the key to safeguarding these pregnancies lies in effectively utilising available technology, providing high-quality monitoring, supportive care and competent midwives. Ostetric-led care need not necessarily culminate in an obstetric birth. Every child ought to be given the best chance to benefit from a physiological birth.
If the NMC, the NHS and midwives are not inclined to improve their proficiency in twin pregnancy and birth, I strongly believe it's essential for twin parents not to allow their bodies and babies to be utilised as subjects for educational or research purposes that only seek to benefit singleton births.
Singleton parents out there expecting a baby you ought to be concerned too. As it stands it is unlikely that the twin births they are supporting are in any way shape or form anything close to a physiological birth as you understand it.
There's an urgent need within the birthing community to regard twin pregnancies and births as a "variation of normal." Meanwhile, the NHS is hesitant to enhance its competence in managing these pregnancies due to their non-normative nature. Who is asking us, the twin parents? Who did they consult? Because I for one am not comfortable about any of this and it reeks of the same mentality that goes back as far as Francis Gaulton, where twins are considered a resource for learning. I don't view my singleton births as just a variation of my "normal" twin births. Given the complexity and variability of twin and multiple pregnancies, it's overly simplistic to categorize them as such. This statement can be interpreted differently by different people; it's important to ask for clarification when someone makes this comment. While some may use it to provide reassurance, it doesn't serve anyone's understanding well.
Considering one twin birth as equivalent to two singleton births is woefully ignorant and dangerous. Birth occurs in stages, including 1st, 2nd, and 3rd stages. Even in dichorionic twin labour, the placentas are usually not born until after the second twin. I have only witnessed one twin birth where the sequence was baby, placenta, baby, placenta. Hence, it's not accurate to count one twin birth as two separate births. Make it make sense that they get to practice on us while we benefit not from any practice. I support all types of births, and I approach them differently based on my experience, while it isn't clinical it does include over 30-40 births many of which are twin and multiple. It's not advisable to treat all twin and multiple births the same either. Professor Kypros Nicolaides points out, that there's no one-size-fits-all, he famously said “There is NO diagnosis of twins. There are only monochorionic twins or dichorionic twins.” Good quality competent ultrasound inquiry can help to determine placenta placement and cord insertion points, both I consider important to know yet are often overlooked. Ultimately, I respect an individual's choice to accept or decline monitoring.
Trust me I have seen some terrible behavior in the NHS. Don't expect them to tell you. Ask if your midwife when you are in labour is a student!
If you would like more information and or support, I have many options available to you including my club. I will always listen to how you want to give birth to your baby or babies. I hope I will help you make an informed decision regarding your care and then we can ensure that your choices are respected and you are not coerced.
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