Around twenty years ago I attended a lecture given by Professor Tim Lang, from City University, London, (introduced as the only professor of food policy in the country), about food security. He told us how seriously the threat of terrorist attack on Regional Food distribution centres was being taken in the US because empty supermarket shelves bring down governments. When asked how the UK was dealing with this matter he replied that that government policy could be reduced to four words, ‘leave it to Tesco’. I have never forgotten his words and now wonder if a modified version of them applies to antenatal education.
Twenty years ago the state took responsibility for offering antenatal education to help prepare women for childbirth and motherhood: a crucial part of a midwife’s role was to be prepared to act as a guide taking into account the mother’s individual needs. Slowly that responsibility has been chipped away and reduced to almost nothing: when there is a shortage of midwives to cover the labour ward, antenatal education is cut. Then, a new mother might have expected to be invited to a course of 6 or 10 group sessions with a midwife, where she would meet other local mothers and be introduced to what to expect in pregnancy, labour and afterwards. The ones I attended, although not always women-centred, were reassuring and, over time, relationships developed: as an older mother who only knew about the world of work it was good to have a safe space to air anxieties and share experiences. Little by little I’ve seen this watered down in many ways. Women have been less available during the day and so some courses consist of one or two days at a weekend; partners have been included, making it more difficult for women to learn from each other, and finally in many areas the NHS commitment to antenatal education has been virtually dropped.
Women are increasingly turning to the private sector if they have the resources, and midwives still give individual education to women when they can. I am often bowled over by the remarkable efforts that midwives make to help and support women who present with special needs of one kind or another, but sadly this sometimes has to be done in their own unpaid time. I would like to imagine a situation where every woman is treated as special and receives one-to-one continuous care from a midwife.
Television has partly filled this gap. As I write I’m waiting to be called as a birth partner to an asylum-seeking woman: when I asked her about her antenatal education she replied that she had watched ‘a lot of’ the television programme, One Born Every Minute, (OBEM). I don’t think she is very unusual. At the same time I received a report by Sara De Benedictis, Catherine Johnson, Julie Roberts & Helen Spiby of a quantitative analysis of OBEM, which includes a very interesting and useful summary of the arguments around the televising of birth over the last decade. The authors are from the disciplines of cultural/media studies, sociology of health and midwifery, and are part of a wider, Wellcome Trust funded, project, Televising Childbirth. Their aim is to understand the significance of televised birth and its impact on women’s health, specifically the representation of women who give birth; the birthing practices and procedures depicted, and how choice and information over such practices and procedures are portrayed.
OBEM is the longest running and most popular UK birth show, commanding up to 3 million viewers. It ‘positions itself as a documentary, although it is heavily edited and often sensationalized, following reality television’s (RTV’s) generic conventions’. For many in the birth community the politics of portraying birth on screen as entertainment, for commercial gain, necessarily involves a distortion of the processes of birth. OBEM does represent in many ways the reality of hospital birth in the UK today, but, as the study found, in several important ways it distorts 'making the commonplace appear “normal” '.
It ‘misses an opportunity to represent different settings for birth and emphasize the available choices of birthplace for women in the U.K. ... at a time when U.K. midwifery and midwifery-led care are attacked under austerity (and) NHS maternity wards in England forced to close 382 times last year and various birthplace options are under threat, we would argue that these representations are problematic’. Choice of birthplace is not evident. Most women are seen being attended by midwives, but the ‘unclear role delineations between midwifery and obstetrics diminishes midwives’ role and responsibility in birth, reiterating a patriarchal history of obstetric dominance over midwifery’.
Perhaps most worrying of all though, is that OBEM shows a medicalised version of childbirth where women have no options and no choice over the interventions they accept. ‘In the seasons of OBEM analyzed, depictions of information giving and facilitating choice around interventions were largely absent…. conversational analysis of OBEM found that healthcare professionals overwhelmingly introduce interventions to women with assertive phrases such as “we need to …" or “we are going to …".'
Their analysis ‘highlight(s) the dominance of the medical model of birth that overwhelmingly represents women as passive subjects, visualized through representations of women on their backs, with limited if any input in decision-making during labour’ .