It should be about informed choice, not coerced compliance
Two things have been going on in my life recently:
Firstly, I teach antenatal yoga on a Thursday night, and usually I come home feeling wonderfully zen, at one with the world.
Secondly, through many conversations with two friends who are student midwives, and through a lot of birth companion jobs this year, my respect for midwives has grown enormously. I understand that they are working under enormous pressure and fundamentally want the same as most pregnant women want: a gentle straightforward birth with minimal intervention.
Last night that all changed, and I drove home ranting loudly at my passenger about why on earth people go into the ‘caring professions’ when they just don’t seem to care about bedside manner, the way in which they deliver news or advice. And when you get incredibly fond of may of your clients, in the way I seem to, it’s inevitable that you get pretty defensive when you feel they are not being looked after.
So in the last few days I have encountered a wealth of horror stories which only serve to disempower pregnant and birthing women, and which I just can’t see helping anyone. There are several mums who’ve been told they ‘have to have’ x, y, or z – no debate, no consideration of the pros and cons, and certainly no acceptance that these women might have other opinions. There is another who was ‘treated’ to the story of the midwife’s mother’s death, with a strong implication that the same could happen to her. There’s the obstetrician who gave a woman drugs in labour (I was there – I saw it), with no chat about it – when I pushed her, all she said was ‘medical advice recommends this’. Guess what? The drugs caused a cascade of intervention, baby’s heart rate dropped and the mum had an episiotomy in order to rush the baby out.
I know that there are 20% cuts within the health services, and whatever anyone says, maternity services are not exempt. I really do understand that means that the professionals have to deal with more people, more quickly, and that there’s a double whammy in that the birth rate continues to rise. I know profoundly how hard it is as a midwife to keep one’s morale in a very difficult working environment – honestly, I do know all these things and it’s the reason why I have resisted applying for midwifery training for so many years.
But a kind word and an acknowledgement of a woman’s autonomy costs nothing. I can’t even see that it should take any more time at that rushed appointment. Because I’ve seen that in action too. A very gentle ‘our policy says that we recommend a certain course of action, but if you feel that you would like to do differently, that’s fine and I’ll support you’ is wonderfully empowering. And I believe that it works in everyone’s favour: the woman trusts the midwife then, and the relationship becomes mutually satisfying, even if it’s only for 10 minutes.
One of the stories I was told last night was hair-raising in its careless dismissiveness. We currently have two doctors in the group, and both of them acknowledged to me what I already knew – that what this woman was being told was inaccurate at the very least.
Surely it can’t be that hard to suss out which inviduals would like to have some say in their care, and which ones are happy just to be told what to do?
95% of the time I am so careful that I don’t remove the trust women have in their care-givers during pregnancy and labour. I don’t believe that that would be a constructive thing to do. But in the cases that I heard last night, the care-giver did that very effectively themselves – leading to a woman going into the birth of her baby frightened and insecure – and thus increasing the chances of labour not going well.
And we’re in a very bad place when the care-givers might give care in a physical sense, but they don’t care. And that makes me really, really sad.