In our first two blog-posts we drew attention to the crisis in maternity care in Britain and Ireland. Our aim on this website is to follow this up constructively by analysing the background to the crisis, to identify causes and, where we can, to suggest solutions.
We’ll start with a book that came out in the Spring of this year, Untangling the Maternity Crisis, edited by Nadine Edwards, Rosemary Mander and Jo Murphy Lawless, with contributions from eleven other midwives and birth activists.
Dervla Murphy in her foreword writes of her own family experience of homebirth. She describes three joyous events and reminds us of the NHS calculation that ‘the most cost-effective planned place of birth is at home’ but says that ‘we can’t join the dots because that would threaten the birth industry’.
In the introduction the three editors consider the ‘toxic culture’ that birth has become. They set out the results of an online survey of midwives and student midwives about their conditions of practice, much of which echoes the recent WHELM study we featured last week. Next they explore the trauma to women and midwives that stems from the very brokenness of our current maternity system but also suggest how institutional practice can change when midwives themselves take up the ‘responsibility of collective dissent’. Finally they look at woman-centred and community-based ways of contributing to a much better birthing experience for everyone.
In their conclusion the editors speak of their distress about the care ‘eked out to childbearing women, their babies and families’. They state that this shortfall in no way reflects the midwives’ personal limitations. They blame it instead on the failure of defective health care systems and lack of accountability so that midwives find themselves propping up malfunctioning organisations at immense personal cost. Crucially they describe the ‘systematic attack’ on the midwife’s role that has been brought about by reducing the agency of individual midwives. They speak of ‘a future of birth that fits with our technical instrumental society … (which) will be but an intensification of the risk protocols and their accompanying algorithms which already suffocate what should be the living relationship between a woman and her midwife.’
Actions that must now be taken are political: moving away from the conventional reformist agenda within the existing institutions that has failed so dramatically, to discover our common concerns about birth and the best ways for protecting the midwife-mother relationship. What all the research tells us is that within the right climate women flourish, as do the midwives who support them.
Two principles underpin the democratic politics espoused in this book, an ‘equality of voice that rejects and rigorously questions the conventional hierarchical order’ and an ‘unconditional ethics of ‘being there’ for the woman’. These are fundamental to health services that truly value a country’s people and which are prepared to turn away from the anti-democratic thrust that otherwise seeks to make a profit out of the need people have for good care.
We will follow up all of these points in more detail in future blogs.
Untangling the Maternity Crisis, edited by Nadine Edwards, Rosemary Mander and Jo Murphy Lawless, 2018, Routledge, London and New York.