It saddens me how often writing around birth fails to look at the economic and political context in which we work. Yet that context so often determines what we see and write about. It influences the ideas that underpin research, books and comments on social media platforms.
I used to think there was some sort of ban on the word 'capitalism' in writing around birth, yet the longer, if woollier word 'neoliberalism' has entered our narrative. Now I don’t think we suffer from aversion to the C word, just a lack of curiosity as to how things got to be as they are.
Capitalism is our context, it forms the lens through which we see and much of our language. We don’t see the economic system that surrounds us and shapes our lives and interactions, just as fish don’t see the water in which they swim.
Within capitalism, economic growth and profit are key. Commodities must therefore be developed and sold. This applies to services as well as ever expanding technology which is developed, marketed and advertised. So, within our economic system, the answer to a problem is either individual effort (workers should work harder, usually expressed as “midwives should …”) or a product to be purchased.
There is a great deal of 'midwives should' writing and it is added to daily in books, articles and theses. Yet midwives are required to do so much that they are breaking, they cannot do much more. Calls for kindness, compassion, resilience and other virtues are addressed to midwives. Yet those midwives do not receive kindness and compassion and have scarcely time to smile and welcome each new client with whom they have fleeting, timed and closely programmed contact.
Then there are products. There is always something more which should be used: a new computer programme, new screening tool, new means of monitoring, even new management system. Such things are costly, rarely evaluated and usually mean more work for midwives. Then there are the apps and monitoring systems that are marketed directly to women with no acknowledgement that their safety has not been properly evaluated, or that they carry the risk of increasing anxiety and intervention. All these things need discussing within the midwife-mother relationship, yet there is no time or acknowledgement of the need for such discussion.
I am not against kindness or compassion, nor am I against technology and new inventions where they truly help families or midwives. I am against exploitation and midwives are increasingly being exploited.
Midwifery is rooted in values which are very different from those which underpin our present economic system: relationships, care, generosity, support, and the building of confidence and trust (Kirkham 2017). We know these work. We are surrounded by a system which values cost saving (i.e. meanness especially in staffing), fragmented services, trust in things rather than people and is perpetuated through fear. Thus midwives are forced into 'checking not listening' (Kirkham et al 2002). Midwifery values are basic human values and are shared by many other groups who are equally frustrated by our present dominant economic values. Once we are aware of the economic and political context within which we work, we can build alliances with those who share our values. Together we could have the strength to bring about change.
Kirkham M (2017) A Fundamental Contradiction: the business model does not fit midwifery values. Midwifery Matters 152, 13-15.
Kirkham M, Stapleton H, Thomas G and Curtis P (2002) ‘Checking not listening: how midwives cope.’ British Journal of Midwifery 10, 7: 447-450
My thanks to Sara Wickham and Anna Fielder for comments on an early draft of this blog