Firstly, it describes a general attitude a low-tech and individualised approach where the practitioner does not manually intervene unless there is a genuine need to do so, and a genuine desire from the woman that this happens, following honest discussion of the situation and options. ![]() In relation to midwifery, it appears to be used in at least two ways. There does not seem to be a clear theoretical definition of what ‘hands-off’ practice means, although it is a term whose meaning is fairly obvious to most people. The trend towards the kind of hands-off approach practised by midwives like Nita, however, can now be found in midwifery practice in all of these countries – and others – and it is this trend and some of the questions it raises for us as midwives that I would like to explore in this article. New Zealand has a unique story of midwifery autonomy, while slightly differing political and practice stories have played out in Australia, the US, Canada, the UK and other countries. Perhaps inevitably, the exact nature and form of these movements varies geographically. The past few decades have been characterised both by increased medicalisation of pregnancy and birth and by the various responses to this from those who do not consider it appropriate, including the natural birth and midwifery movements. Nor has this been universally successful. The application of the principles of Western medicine during pregnancy and childbirth has not, of course, been universally popular. Although a large number of other approaches to conceptualising, diagnosing and treating health and disease still exist, the principles behind Western medicine have continued to gain momentum and, as midwives know only too well, have more recently been applied to the care of women in childbirth as well as in the care of sick people. Later, Western medicine was revolutionised by the work of people like Semmelweis and Lister, whose work on germ theory and antisepsis helped prevent the transmission of disease and, from this point, the principles of Western medicine both expanded and gained a firm footing as the dominant approach to healing in the industrialised world through the development of bacteriology, vaccination, pharmacology and surgical techniques. Early European medicine, for example, was characterised by the theory of ‘humors’, which healers attempted to rebalance with the use of cathartics, purgatives and bleeding. ![]() “You work with some midwives who do everything, they do VEs every four hours and have their hands doing all these things when the baby comes, and then you go out with the ones like Nita who are different … and they hardly ever do those things, and you think, well that’s great, and that’s what I want to do … but how do I learn when to do it and not? … and how do I get the practice when I don’t want to subject women to more VEs than necessary? … I’m really conscious of that…”Ī wide variety of philosophical positions and practical trends have characterised approaches to health and birth throughout history. Yet while Kiera’s heart is with the kind of approach she sees Nita use, the practical reality of how she can reach that place herself is a different matter: She described her placement with Nita as “ welcome relief” from some of her experiences in more medicalised areas of practice. ![]() Her outcomes are excellent, and women and student midwives love her. She always seems to know instinctively when a baby needs a little help to be born, yet feels no need to keep her hands on the baby or perineum at all times. ![]() She is well-versed in what has become known as ‘hands-off’ practice, is expert at knowing how women are progressing in labour by watching, listening and feeling their baby abdominally and only occasionally suggests vaginal examination. Nita has been a community-based midwife for over twenty years, and has more recently moved into independent practice. Please be aware that new evidence is emerging all the time and some of what is in here may have been superseded by the time you read it. Now more than a decade on, we have reposted it here. Hands-off midwifery and the art of balance is an article that was published in 2009 (Wickham 2009).
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