Thursday, July 20, 2006

Career Quandrary II

Thank you to everyone who left thoughtful advice at my previous post on Career, Canby and pending poppets. One of the nice things about a blogging community is putting the swords down, posting something personal and feeling like you are in a cafe getting well-meaning and often wise advice from a group of friends.

*Holds Latte to one side, hugs various bloggers in turn*

We headed out on foot to find some dinner. An Antarctic blast hit us, inexplicably coming from the east, gushing down each horizontal street we crossed and threatening to drive us onto the main road.

We talked. We found no easy solution to anything. We found common points of agreement, and identified that much is out of our control.

We ate well at a local Vietnamese place. The discussion itself was what mattered. By the time the main course arrived, a fantastic vegetarian hotpot with a light peanut sauce and fat crunchy snow peas, I was lifting.

There is a paradox to the fact that a child will change our lives so profoundly; on the one hand we won't be going out much so having bars and cafes nearby should be less of a priority. On the other hand the very fact that it will be harder to go out makes having such venues for adult respite close at hand so attractive.

I look at a nice spread in the bush, on the city fringes, and think 'that'd do'. I look at nice calibungs 200m from High Street and think 'that's the ticket'.

Who can tell? When our little hobbit is old enough to appreciate such things we may want to go live in London again, for a few years. Before I hit my teens my parents had shown me Borobudur, the Louvre, skiing in Switzerland and Gunung Kinabalu. I treasure all of those memories, they were highlights of my childhood. The idea of spending a few years exploring the great old cities of Europe with our child is one of my more misty eyed dreams for parenthood.

All we need for the next few years is a comfy house with a good roof, functioning heating, space for the cats as well as the poppet, and ideally some friends or family who'll drop over and have a beer from time to time...


Shelley said...

You've made me wish I had some more direction in my life.

Anonymous said...

No worries Armaniac.

About post-baby lifestyle and obstetric choices - let me just say, by far the worst thing about being an expectant newbie parent is that everyone wishes to give you advice (sometimes even if they've not had kids). They will hear your determinations and sneer and snicker. "You want to go out after you've had a baby? Pah!" You'll get your own ideas of routines and what you can fit in and how settled you like your bub to be as time goes on. I was very active at first, and got less so as my boy got older, but I would have felt caged if I'd stayed indoors!

With obstetrics, it's one of those woolly areas of girl choices. Some want natural birth at any cost, whether they can manage it or not. Some folks feel that the more qualified the doctor the better their chances of non-complicated pregnancy and birth. Some women are just plain terrified about the whole birth thing, and that's absolutely fine. I've spent years campaigning for our local birth unit, which is a blend of options, so I do know something about it, so if you want some stuff to think over, here it is. If you are sick of advice, ignore it!

My opinion is that with obstetrician-led care the focus is on the baby more than the mother. As Zoe said, they are trained to avert emergencies, so tend to work on a risk model. Many are interventionist by nature, and scared of being sued. You are much, much more likely to experience induction with a private obstetrician. This usually means you require an epidural and end up with a caesarean for failure to progress or foetal distress. Caesareans are bad because they are major surgery and have raised the morbidity and mortality rates for women, even as they've lowered them for babies. Not all these interventions are necessary or desirable. Some women really do get fitted around the doctor's leave, in other cases it's just that the doctor is a hyper-vigilant worry wart not prepared to let the baby come out of its own accord. This is not to say that in a reasonable number of cases the baby really does need to come out, nor to say that you won't have a natural birth with an obstetrician. And nor is it the case that an obstetrician can prevent tragedies - you are very exposed to tragedy when you become a parent.

Midwife-led care focuses more on the woman (with the goal of a healthy baby of course), but is usually done in consultation with GPs and obstetricians. (There's a great birth centre at Royal Women's in Melbourne). The obstet checks out the mother at least twice, and the GP monitors subsidiary conditions like diabetes, but the midwives do all the basic tests and measurements. In the best programmes the midwife who has been checking you out is part of a team that will be the one that catches the baby when the time comes. In all midwife-led programmes, at the first sign of significant problems you'll be referred to a specialist for closer medical management - risks are just not worth taking, and that's what those ultra-qualified doctors are for.

With midwife-led care the relationship that builds up over the pregnancy (you join such programmes within the first four-five months or you miss out) has been proven over and over to lower intervention rates and to lift outcomes, even if the woman does require specialist medical support. This is because the mother is more secure and reassured with her support person, more knowledgeable about the labour so she trusts her body better and the midwife knows the mother well enough to know when there really is a problem and can call in the emergency folks ASAP. She is also likely to cope better with the fallout from an emergency intervention.

My personal choice is for midwives to lead the whole thing and be there at the beginning and the end, but there's a team of obstetricians that I know at my local hospital who are there if needed. When trouble strikes, as it has for me lately with miscarriages, I know those doctors are there, and that's when I really want them, but mostly I want my midwives.

Ultimately, I think fears about childbirth are very real, and that any choice a woman makes is valid. Some women feel it's really important to have a natural birth, in which case midwife-led care stands out as your best chance. Others feel that they don't care what happens, in which case your standard labour ward, with GP-led care, is just fine. Some are simply terrified and want an elective caesar, and for them the only option is an obliging obstetrician. Then of course there are the 10-15% of women for whom the presence of a wise and cautious obstetrician is absolutely vital for their own health and that of their baby.

Does this help?

Anonymous said...

Oh, and by the way, if you can't get into a midwifery/birth centre programme your average labour ward is just fine and dandy and in big cities like Canby and Melba they have nice things like birth pools, double showers, double beds. No one is gonna make you give birth on your back with your legs in the air, and nobody forces you to take drugs, but they do come running with them if you want them. And you can just turn up! No appointment needed! And get fantastic midwife support! All on Medicare!

Armagnac Esq said...

I shall forward your comments to beloved for her consideration. She has already booked an Obstetrician, but may be amenable to considering all of the options.

The take on it she's been given is that midwives are better when things go well, but Obstetricians are better if things are going wrong.

I don't know enough to judge that for myself.

She has already met her Obstetrician a couple of times, so he will know a bit about her when the time comes.

Sorry to hear of your recent stuff and fingers crossed for you...

Anonymous said...

Yes, that's a fair assessment of the divergence btw midwives and obs - but remember, things go absolutely right in at least 98% of cases.

Fingers crossed. My recent stuff is fine now.

Armagnac Esq said...

Good to hear! You should blog it... if you do have a blog, btw, you can now leave your link with blogger.