Molly O'Brien RM, BSc, AHBM
With over 20 year of practice under my belt, I’ve become an experienced midwife. I’m also a hypnobirth and birth preparation teacher, an associate university lecturer, have created courses for midwives, campaigned for midwife led birth units and been a passionate student and enabler of normal physiological birth. I love my job but like most midwives working in maternity care institutions, I was frustrated by the obstacles to providing excellent care, and sad for the many women whose birth experiences bring them painful rather than joyful memories.
Levels of frustration fell dramatically in 2010 with my appointment as a senior midwife in the Norfolk and Norwich UCH Midwife Led Unit (MLBU). Working in an environment that supported the physiological process, gave me an opportunity to practice and hone the skills I feel are the essence of midwifery. Outside the obstetric unit it was easier to offer birthing women the freedom to achieve an undisturbed physiological birth and full time work in the MLBU gave me the opportunity to attend hundreds of undisturbed physiological births. It also gave me the opportunity to make a systematic exploration of midwifery skills and observations that can help resolve long difficult labours caused by malposition.
Observing and listening to women who were struggling with a difficult labour caused by a suboptimal or malposion provided numerous clues to help make an early diagnosis and apply techniques I’d developed over many years to resolve problems. I found I no longer needed to rely on the commonly used but unreliable tools of abdominal palpation and vaginal examination.
The techniques and strategies that emerged from this time helped me revolutionise my own practice. I began to regularly witness dramatic progress as I put them to use in “difficult labours”. So did other midwives and obstetricians in our hospital! People would say “Molly, I see you’ve worked your magic again”. I’d reply, through slightly gritted teeth, “this is not magic, these techniques and skills are based in science - Biomechanics- the study of human movement”.
Resolving malposition gently using harmless interventions based on biomechanics should be part of midwifery and obstetric training. It is a travesty that vital components of anatomy and physiology of the female pelvis, how it works in pregnancy and birth and how the baby navigates the way through, are excluded from education affecting practice and the development of gentle and effective solutions.
I left clinical practice in April 2018 to teach the course I developed for Birth Professionals. I’ve taught ‘Biomechanics for Birth’ to hundreds of Birth professionals in the UK and in Spain and Chile and received an almost universally enthusiastic response.I'm an autodidact, continually immersing myself in articles and books that add to this knowledge, mainly from the sports and physiotherapy arena. Current projects include developing an advanced course to train midwives to teach other professionals and a book on the subject, working title ‘Applying Biomechanics to Childbirth’. I also ask course participants to complete 3 observational accounts of their use of techniques learned on the course, partly in preparation for my advanced course and partly to build a body of case studies.