IT’S THE MORAL SIDE
The words of an anonymous student midwife who this week wrote on the association of Radical Midwives Facebook page (with permission), I asked if I might reproduce it to underline the moral dilemma our profession seems to be in.
“Hope this is okay to post. I’m a first year student and I’ve just had my first labour suite placement. It’s making me rethink this entire degree. I went into this course knowing about the intervention rates and the way women are treated . I then had the best possible community/continuity placement and thrived. Going from that to the labour suite has been a shock. It’s not the clinical stuff, in fact I’ve been praised for how well I’ve done in obstetric emergencies. It’s the moral side.
Women not treated as if they have opinions in their care, women surprised when I ask them what they want, women stripped of autonomy and dignity, no informed consent. It’s horrendous. It’s as bad as my Birth worker friends told me it would be when they said I’d struggle and they were right.
In labour suite it seems birth happens to women, they have no say. It’s horrible, it’s so horrible.
I managed three of my seven shifts. Every shift has had me actually having panic attacks afterwards. I had a night shift last night and I’m meant to be on tonight and I’m not going in because I haven’t slept a wink, my brain refusing to switch off the things I have seen.
I want to be the type of midwife that supports women to have autonomy and informed choice. How am I meant to do that if I can’t get through the toughest placement. Any words of wisdom welcome.”
The pain and dilemma of this young woman are shocking, she emphasises the dehumanisation of labouring women, the “othering”, the destruction of our profession.
We are called midwife, an Anglo Saxon word. mit – with and wif – woman. We can no longer call ourselves “with woman” if we are not aligning our selves with woman but with the doctors, with the medicalisation of childbirth, with the Guidelines, with the Policy – she’s right, it’s the moral side.
Where are the feisty midwives who work alongside doctors companionably but keep them contained so that medical excesses are held in check? Where are the midwives who have been around for ever? Who have home births in their professional memory? Have they become extinct?
In Twitter today Croyde Medical – makers of Birth Pools, Birth Balls and authors of “Transforming Maternity” say “The majority of work midwives carry out involves overseeing obstetric intervention”, how true but how wrong. Who is now with woman? Is she left abandoned ? Her poor husband/partner/Mum/sister expected to support her meaningfully despite feeling frightened and inadequate?
Why are midwives not standing up to the coercion? Are they not able to support each other? Obviously not, they listen to the “Bundles” – Saving Babies Lives Bundle, OASI Bundle – all well meaning and hopeful Bundles of care based on Obstetricians career paths and held together by the scantiest of evidence.
Saving babies lives bundle relies on fetal monitoring (no evidence), everyone involved in the care of this woman being “up to date” with fetal monitors and the interpretation of printouts – complete nonsense, shown time after time to be so. More ultrasound scanning (again no evidence), cessation of smoking – lots of evidence but how do we get women to wean themselves off one of the most addictive substances on earth? We could try setting them up with a midwife who gets to know them and cares about them (its called continuity of midwifery care) .
OASI – well intentioned but when you stop women from moving about and they are anaesthetised of course they are going to hurt themselves. When a woman is roaming round her own bedroom/sitting room/bathroom she doesn’t push if it’s going to hurt her body, in 22 years of our Birth Centre in Tooting we had ONE woman who gave birth lying on a bed. The rest were on all fours, standing leaning forwards, on their side, standing entwined in their lover’s arms, in the Birth Pool, leaning against the bannisters, leaning on a work top – anywhere but lying on their back on a bed. Given a choice women make wise and sensible decisions – they protect themselves.
We have to make relationships with women. This is the only way we are going to lower maternal and fetal mortality, the evidence is there. Since the Saving Babies Lives Bundle came into being it seems to me that infant mortality has risen (16% in the past two years). We have to stop believing everything educated white men (with vested interests) say and go back to the source – women. Continuity of Midwifery Carer works – well proven and easy to set up if not complicated with enormous Teams (5 is the maximum) and ridiculous “rotas”.
Good to see Wendy Savage piping up again. A letter from her in the “Guardian” says it all succinctly and sensibly - 27/05/2024
Maternity Services are failing mothers and babies, and it’s not just down to austerity (Guardian 18/05/2024). . Those readers are correct, there is a fundamental problem with our maternity services which need radical change. As the World Health Organisation stated in 1985 ‘Birth is not an illness’ but the NHS services treat childbirth as if it is.
In 1992 after years of campaigning, birth activists were delighted when the Select Committee chaired by Nicholas Winterton made far-reaching recommendations about re-organisation. The government responded by setting up a working party chaired by Julia Cumberledge . They reported in 1993 that women should be at the centre of care, midwives should have a greater and more autonomous role, there should be continuity of carer.
Various schemes were set up but without money to change the system., the government changed and after many years of an obstetric run system it was hard to achieve change. However one successful example, the Albany Midwifery Practice in Peckham in 1997 contracted with Kings College Hospital. The published results of the first 1000 births were excellent. Women were enthusiastic about the care they received. Breastfeeding rates were high, home births over 40% and birth outcomes better than other midwifery practices. In 2009 Kings terminated the contract despite a huge outcry from women (see Closure by Becky Reed and Nadine Edwards published by Pinter and Martin). An independent Enquiry by CMACE did not recommend closure. A retrospective study of all births during the 12 years again had good outcomes.
This unaccountable action is a scandal and should be overturned.
What women and midwives need is this model of care adequately funded and supported. It would solve the shortage of midwives, and the poor care reported by successive enquiries. We do not need another enquiry.
Women need to reclaim birth .
