MIDIRS Essence > April 2010 > Midwifery News

Maternity care and the family

Originally posted on Apr 2010

- by Duncan Fisher, Honorary Fellow, Faculty of Health & Social Care, University of Chester.

Discussions are underway between the University of Chester, the Royal College of Midwives and various regional Senior midwives to organise local meetings of midwives, and then possibly a national event, to look at maternity policy in the light of the new political interest in ‘family’. This piece is a contribution to getting the discussion going.

The Channel 4 documentary, One born every minute, presented a dire spectacle of fathers at the birth – incompetent, ignorant, behaving totally inappropriately. Women without the support they need from a midwife instead have to make do with fathers, some of whom are actually making things worse. Grantly Dick-Read, author of Childbirth without fear (Dick-Read 1950), stated unequivocally: ‘The totally unprepared man has no place at the birth of his child’. The key role of anyone attending a birth is to provide a quiet, reassuring and supportive environment. To ensure this, the people women choose to have with them at the birth must have information and training, and this should be a routine part of maternity care. At present anything goes.

How can we let this reckless approach to birth happen and what must we do to change things?

For almost all of the last 200,000 years, mothers have given birth to babies within their families and from the very first day of their baby’s life, they have shared the care of their babies with others in the families, usually other women but sometimes the men too, depending on the particular situation the family is living in. But last century, we did something completely unique in human history; we took the birth out of the family and put it inside an institution that cares for sick people. The maternal mortality rate plummeted 60 times, but birth was ripped out of the environment where it had been for the previous 200 millennia.

The tension between birth as a medically managed event and a family event is as strong as ever. The recent termination by King’s College Hospital of their contract with the Albany Midwives, a beacon of community based midwifery practice, sparked the first street demonstrations for a long time in favour of models of maternity care that are closer to community and family.

Hospitalised birth – where the mother giving birth is designated a sole patient – is problematic even from a straightforward health point of view, because the health of mothers and babies is not an individual thing, but a family thing. Members of the mother’s family have a strong influence on everything, from smoking, infant feeding, mental health, pain control in labour, to when a mother is admitted to the maternity unit. In some families the influence is destructive, in most the influence is positive and could be more so with adequate support and information. When the family is involved in interventions to promote breastfeeding or smoking, we don’t just see an incremental change in effectiveness, we see success rates doubling and tripling (Burgess 2006). But these approaches remain rare; we are trapped in the ‘mother as patient’ model where it is simply not procedurally viable to connect with anyone else, whatever the benefit to health.

Grantly Dick-Read observed this way back in the 1950s. Writing of fathers in particular (who were all husbands – supposedly – in those days!):

‘The importance of the husband’s attitudes towards, and understanding of childbirth, cannot be exaggerated...Her health and happiness during pregnancy, and certainly her approach to labour, will be influenced for better or for worse by harmony or discord that she feels in her husband’s mind.’

He says of the father at the birth who is knowledgeable and able to provide practical care: ‘These men cannot be superseded in the value of their service by the most patient nurse or obstetrician’ (Dick-Read 1950). The same can be said of any family member who is with the mother.

The new political interest in the family emerging from all the political parties is a new opportunity for midwifery, because family based maternity care is the kind of care that midwives can and want to provide: familiar surroundings, kindness and reassurance from professionals, the family knowing their choices and being able to exercise them, more individualised care with fewer protocols, time for the family to bond after the baby is born. The Conservative Party has published a maternity policy that focuses strongly on family aspects of care, including engagement of families in health issues such as breastfeeding, mental health and smoking. The government then published its own policy in March also using the family narrative, Maternity and Early Years: making a good start to family life. Government has been much influenced by the Kids in the Middle campaign, backed by 30 national children and family charities and by agony aunts from almost all the newspapers and magazines in the UK. Kids in the Middle questions the lack of focus on family relationships when a baby is born.

All of this is an opportunity for a new push to achieve long-standing but elusive goals for maternity care, namely care that remains close to mothers and their families.

I told a story when I debated all this with Michel Odent at the RCM Student Midwives Conference this year:

I took my young daughter rock-climbing a while back. Before she set off up the rock face, with me hanging onto the end of the rope, I received 15 minutes of instruction – how to hold the rope, how not to get it trapped, how to support her on the way up and down. This preparation was imperative, as my ignorance could really hurt her. And yet, prior to this session, I had absolutely no knowledge at all. Why should I? My family is not a family of rock climbers.

Birth is the same. How could anyone be let into a birthing room without basic knowledge? To be in a state of stupidity is reckless. But how am I even supposed to know this, if no-one tells me? If mothers chose for their partners to be at the birth, and most will for the foreseeable future, then maternity services have to make sure those partners are informed.

My opinion is that the NHS should accept that antenatal education is beyond the scope of its resources – there are plenty of alternative community based models that could supply such education, such as the National Childbirth Trust and others. Antenatal education should be replaced by much more focused communication of key health issues to the mother and the key members of her family. The Conservative maternity policy proposes a specific antenatal appointment for the mother, father and/or other key people in the family, an idea firmly based on the evidence that this will make a big difference.

Babies need families that function well in the collective task of caring for children. Maternity services need to support the beginning of this process.

References

Burgess A (2006). The costs and benefits of active fatherhood: evidence and insights to inform the development of policy and practice. London: Fatherhood Institute. Available from: www.fatherhoodinstitute.org/download.php?pID=4475.6 [18.03.10].

Childbirth without fear Dick-Read G (1950). London: William Heinemann.

Duncan Fisher | Honorary Fellow | Faculty of Health & Social Care | University of Chester | Photo credit: Duncan Fisher

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