In childbirth, nature should be left to take its course and interventions should only take place when something goes wrong, veteran midwife Margaret Abela tells Cynthia Busuttil

Women, according to the manager of midwifery services at St Luke's Hospital, should be given enough information to enable them to take decisions during childbirth.

"Many mothers are afraid to take a decision and they leave everything in the hands of medical professionals. We need women to be empowered, know exactly what is happening, and be able to take informed decisions," said Margaret Abela, who has worked in hospital - mostly as a midwife - for just under 41 years.

"In North Europe, especially Scandinavian countries, women tend to participate much more in decisions and there is a lower induction rate. In the Netherlands 30 per cent of women opt for a home birth."

Ms Abela, for example, is opposed to induction unless something is going wrong in the pregnancy.

"Childbirth should not be planned. Some women may be opting for elective induction so that the birth will fit into their plans or because there is pressure from medical professionals."

She is critical of the hospital's policy of breaking the woman's waters when her cervix has dilated three centimetres. "This is not on and, in order to avoid being induced, women should not go to hospital very early on in labour."

Another practice she frowns upon is finding out the sex of the baby beforehand, as this can sometimes lead to disappointment. "Mistakes have happened and there have been mothers who became depressed as a result. One mother who was told she was having a girl was embarrassed when the baby was a boy as she only had pink baby clothes."

Although Ms Abela, who is also the secretary of the Midwives Association, is not against home births, she is not in favour of pushing the practice, although she believes that midwives should have a greater role throughout pregnancy and childbirth.

"We need a system under which the midwife taking care of the mother sees her throughout her pregnancy and goes into the delivery room with her. She should continue taking care of her after delivery, even when the mother returns home."

Ms Abela believes that couples who have difficulty conceiving should first exhaust all the natural family planning measures before opting for other procedures such as IVF. "Recent research has shown that those who use natural family planning are likely to get pregnant more easily, in a shorter time and without incurring all that expense."

But Ms Abela, who also teaches natural family planning, says many couples are unaware of their most fertile periods and make the mistake of having sexual intercourse at the wrong time.

"You find couples who are devastated because they have been trying to for a baby for a while and nothing happened. But when they start keeping charts and these are interpreted, we find out that they were trying on the wrong days."

One of the problems might lie in the fact that quite a few couples do not think of having a family until later in life, and then when something goes wrong they immediately seek help. "I tell couples to try not to leave it to the last minute, because if there is difficulty in conceiving they might not have enough time to correct it," she says, adding that she believes the ideal age for women to have children is between 26 and 30.

Natural family planning can also be used as a means of contraception, but there has to be a commitment. "The woman would need to take her temperature daily, the moment she wakes up, before even uttering a word, and then know how to interpret it. Some people find it easier to use contraception."

With her long years of service, Ms Abela knows a thing or two about childbirth, having seen countless babies come into the world. She has also seen many changes take place at the hospital over the decades.

Something that she could not stand when she started working in the maternity wing was the fact that babies were kept in the nursery, away from their mothers.

"The mother would have carried the baby for nine months, given birth and then could not see her newborn whenever she wanted to. We only took the baby to the mother for feeding, but otherwise we did everything else. This was not right because mothers did not even know their children when they left hospital.

"The fathers were even worse off, unable to see their newborn child except through a glass partition.

"We would lift babies out of their cot so the fathers could see them. It was like a puppet show and I thought it was embarrassing."

Sometimes a baby would be put down in the wrong crib. Not only was this dangerous because of the chance of cross infections, but it would create chaos inside the hospital when a mother did not find her baby and think he had been stolen.

Around 20 years ago the controversial rooming-in system was introduced, allowing babies to stay with their mothers.

"Some people had argued that midwives wanted the rooming-in system to save time, but this was not true. Mothers were given the time to get used to their babies and the opportunity to ask questions and get help."

Today mothers sometimes ask for the baby to be taken to the nursery so that they can rest. "Women are supposed to be better prepared for labour and we are making childbirth easier, so why are they saying they are unable to take care of their babies? What are we doing to them? I think we are making them suffer more because we are forcing labour; we are inducing them."

For Ms Abela the move to Mater Dei Hospital is a bittersweet experience. On one hand she is excited about the new hospital and the new facilities but on the other felt some nostalgia when she left the old place behind. For the past few years she has been working at the new hospital as a migration facilitator.

"There are many memories associated with St Luke's," she says pensively. She will never forget seeing the first baby being born when she was 21.

Some of the most beautiful experiences were with couples who had struggled to have a baby. "There were women in their early 40s who thought they had started menopause, only to find out to their delight that they were pregnant for the first time. One mother became pregnant with twins after giving up on ever having a baby," she recalls.