by Ina May Gaskin, midwife and educationist.
My first chance to learn about British midwifery came when midwifery tutors Cathy Warwick and Kate Newson visited The Farm in the early 1980s, when the caesarean rate in the UK was half of the US rate at that time (25%).
I was amazed to learn how many thousands of midwives were working in the UK. Surely, I thought, such numbers should enable midwives to have a strong influence on how maternity care was organized.
As my conversations with Cathy and Kate continued, I was surprised to learn that the UK system was not set up in a way that permitted midwives to provide continuity of care. I could hardly imagine what it would be like to have to choose whether to work in antenatal, intrapartum, or postpartum care. It seemed to me that organizing care in that way would inevitably deprive midwives of some of the most important tools that my partners and I knew contributed to our low rates of medical interventions.
Not many years later, I had the chance to meet Wendy Savage in London, just after she had been suspended from her post as consultant and lecturer for alleged incompetence after 25 years in medical practice in four different countries. There she was, unpacking her brand new word processor and preparing to write her first book, Savage enquiry.
This was during the period when I was furiously studying the European witch-craze (a historical development that had been omitted from any of the European histories that I had previously read), and here was an obstetric consultant for whom I had enormous respect being harshly punished for being good at her work!
From the first, I recognized Wendy as the kind of obstetrician who worked well with midwives, because she knew that women needed to be able to talk with their doctors or midwives as equals. She did not behave like a member of the ‘establishment.’ All this seemed like a modern-day witch-hunt to me.
I kept hearing about midwives who were severely punished by midwifery managers for acting outside of rigid guidelines that didn’t seem to me to take account of realities. My friend, Jilly Rosser’s case, for instance, taught me how easy it was for a British midwife to be punished for behaving in a way that I would have praised (because Jilly had transferred a woman with postpartum bleeding to hospital in her own car, judging that an ambulance wouldn’t reach her quickly enough).
Space doesn’t permit me to make a full list of the British midwives who have been heavily disciplined by midwifery managers, but how can I not mention the immediate suspension of the exemplary Albany midwifery service following the death of a newborn baby they had resuscitated and transferred to hospital several days earlier, before any full investigation could possibly have been made? No one even thinks of punishing doctors heavily for the deaths of babies, unless, of course, they deviate from the medicalised model of birth care themselves, as Wendy did.
Clearly, most of us midwives are still living in what I call Upside Down World. I’ve been reading about your overstretched and understaffed NHS maternity units, about the recent rise in maternal mortality in London, and the need for an additional 5000 midwives. Is it possible that there could be fewer managers and more midwives if budget constraints are so tight?
I can’t say it any better than the British midwife who recently commented online: ‘Has anyone actually asked us what we think about our role and how it should or should not evolve, or how maternity care could be improved? Or asked the women how they feel about the erosion of midwifery service and its potential impact on care and outcomes? Surely it makes sense for the people who are actually seeing the day to day events in maternity to make an impact on how the service is provided.’ (Birthaffinity 2011)
Speaking of midwives having a greater voice in informing the public (and governments) about women’s needs during the time around birth, it was quite an honour to be the first midwife chosen as a recipient of the Right Livelihood Award (also known as the Alternative Nobel Prize). The amplified voice that I have had since receiving the award has gratified and encouraged me. How good it was to read a headline in a conservative German newspaper: ‘A midwife is changing the world.’
I urge everyone to go to the website (www.imbci.org) and read the 10 Steps to Optimal MotherBaby Maternity Services. Will a UK hospital sign on to implementing the 10 Steps in 2012? That would be an excellent way to start the new year!
Birthaffinity (2011). Comment on How maternity services could be reborn, 8 March. Available at www.guardian.co.uk/healthcare-network/2011/mar/08/maternity-wards-kings-fund-natasha-curry
Contributor: Ina May Gaskin
Photo credit: Jeanne Kahan