From MIDWIFERY MATTERS, Winter 1999, Issue No. 83
Sara Wickham
MY CHILDHOOD CONCEPT of a midwife included the mental picture of a wise and kind women sitting in the corner of a bedroom and knitting, while the birthing woman laboured with the support of her partner. The midwife in my image somehow knew exactly what was happening, but without being intrusive in the experience of the couple. She might look up at them and smile from time to time, but she would not otherwise interfere. The atmosphere was peaceful, with an undercurrent of excitement, such as the kind you would feel as you woke on the morning of your sixth or seventh birthday.
It's a relatively easy task to paint word-pictures of how midwifery and birth could be, perhaps even how they were in some long-forgotten time. But is this picture really a childhood fantasy, or do we still have time and opportunity to bring the art back into midwifery and birth?
Ancient pictures of `how birth was' still exist today, and can be seen in representations of full-breasted and wide-hipped pagan Goddesses who squat or kneel to birth their babies, sometimes in the presence of other women. Sadly, these pictures no longer represent reality for women who live in cultures where the Goddess has been usurped. Many modern women have been influenced instead by scientific rationalism, by Descartes' insistence that the body and mind are separate, and by the advent of Christianity, some proponents and aspects of which have not been entirely positive for women.
While we strive to base midwifery practice on the available evidence, this very evidence almost unfailingly points to the fact that science cannot provide all of the answers and often causes more harm than good with its insistence that we study populations of women and seek general laws. Any midwife who has witnessed physiological birth will attest that there are very few absolute laws which can be applied to all women. I can think of only two which transcend culture and environment: that birth works much better without intervention for the vast majority of the time; and that babies come out.
So perhaps it is time to make concerted efforts to bring back the art of midwifery and birth; not just in terms of the knowledge available to women and midwives, but also in relation to those forms of art which have traditionally been associated with women's lives, and with enabling women to learn effectively and to become more self-aware. I am deliberately basing this article on my own experience of the art of midwifery, and referencing it not with scientific papers, but with the experience and wisdom of midwives and women who practise this art in their own lives.
Knitting seems as good a place to start as any. I can think of several well-respected midwives who like to promote the art of knitting to both midwives and childbearing women. Jean Sutton describes the influence of the nesting instinct on the way a woman's body prepares for birth; women who take time out of their lives towards the end of their pregnancy to knit baby clothes and ponder on their experience may be better prepared physically, and perhaps mentally for labour. She explains that knitting helps to produce the `marshmallow cervix' which is no longer a common finding of vaginal examination. Although, of course, the `art' (or should that be science?!) of vaginal examination is one which I, along with many others, would like to see getting less attention than the art of assessing progress in labour in other, less invasive ways.
Naoli Vinaver, a Mexican midwife, feels that modern women need to be more `juicy' in late pregnancy and labour, and knitting may be a way to achieve this. This is not to suggest that all women need to stay at home during pregnancy and knit baby clothes, but rather that the space which women may find in spending time on handcrafts may be beneficial. Perhaps we need to be expending more effort towards social policies and practices which would enable women to find this space, rather than forcing them to work throughout their pregnancy in order to support their families?
Ina May Gaskin suggested at the Midwifery Today conference recently that those of us who were involved in midwifery education ought to be teaching student midwives to knit. While not completely opposed to the suggestion in theory, I remain to be convinced that I would get to do this more than once in practice! Ina May challenged me to teach a session while knitting myself in order to illustrate the value of patience and this may well be an idea worth developing. I suspect it may well fit more logically into the vision of midwifery education recently completed by the ARM than in current systems of midwifery education. And if anyone who finds sitting still for extended periods easier than I do would like to try this, I would love to hear how it goes!
Several pagan women I have attended have realised the value of handcrafts, often as part of ritual work in pregnancy, and have used this as a way of coming to terms with the concept of motherhood and meditating on the process of birth itself. Anecdotally, they seem to notice the benefit of this work on their labour; perhaps by recapturing and celebrating the nesting instinct in this way they find the space which so many women currently lack.
We know from anthropologists that women learn best in circles, and some of my fondest memories of being with other midwives come from my time in `women's circles' in the USA. I know a group of lay midwives who often spend evenings together around a campfire in somebody's garden, telling birth stories, seeking others' opinions on difficult questions, gaining support and reflecting on practice. These circles may be accompanied by a combination of food, wine, tears, laughter, hugs and songs, and I have never attended one such evening without feeling as if I have learned more than I would have done in a week of classroom learning.
How much longer are we going to attempt to `teach' women (rather than facilitate their learning) in ways which are designed to help the male brain function? My colleague, Lorna Davies, illustrated this recently by comparing two adjacent classes of students. The first were sitting in rows, while a teacher stood at the front and `spouted'; these students looked bored and tired and were, no doubt, watching the clock. The next classroom contained midwives who were seated in a circle around a table which itself was full of papers, articles, mugs and biscuits. These midwives were engaged in animated discussion of an inquiry-based learning trigger and were an integral part of the process of learning. The group who were having more fun are almost certainly the group who will have achieved more in terms of personal and professional development at the end of the day.
Midwifery education does not need to follow the male-orientated teaching ideal, and I have recently been involved in a couple of sessions which have used role play as an art form through which learning can be facilitated. I taught a conference session with Trish Anderson where we had an hour and a half to attempt to teach the art of evaluating research. We identified early on that it would be extremely boring - not to say unproductive - to use the `acetate-intense approach' and instead discussed how we could make this more interesting and useful to participants.
We ended up with a session which seemed to work better than we could ever have imagined, where I played the role of the nice-but-dim midwife trying to plan and carry out a research project (which involved finding out which sweeties made midwives happy!) while Trish acted as my research supervisor and, along with the audience, threw questions and a large amount of spanners in my direction. Midwife teachers who witnessed the session said that they could literally see pennies dropping around the room as the session unfolded. This is not to say that we have found the definitive approach to teaching research methods, but that using a more artistic than scientific approach may have been pivotal to this group's understanding of the issues.
Another session I recently took part in involved three midwife teachers playing the parts of practising midwives (complete with uniforms and badges) `handing over' a ward full of women to a group of second-year midwifery students. Most of the women had physical and social problems, and the students faced three very different midwife stereotypes. They met Charlotte, the newly-graduated midwife who thought all of the women were `lovely' and quoted the evidence at every available opportunity, Maureen, the experienced and world-weary midwife who judged all women on their social background (including the drug user who didn't deserve to have a baby at all) and the very sensible Sister Righteous who diplomatically refereed the disagreements between the other two midwives.
We felt sure that this session generated far more discussion on the issues of culture in hospitals and attitudes towards women than a `chalk-and-talk' session would ever have produced. Here, the art of role play enabled students to focus not only on what care the woman on our imaginary ward needed, but also on issues which are relevant to them and the ways in which they might be addressed in practice.
As I was preparing to write this article, I was watching television, and my attention was drawn to a trailer for an item which claimed to be about reducing stress by using the body's own electrical energy field. I eagerly waited for this part of the programme, and was rewarded by the news that scientists had `proved' the existence of an energy field around the body. It was news to me that the auric field (or however one chooses to encapsulate this) was ever in doubt, but I was still keen to discover whether the BBC was offering information about energy work, therapeutic touch, or any of the other alternative and gentle therapies which involve the body's natural energy and the art of connecting with another person.
Instead, I watched in horror as the producer of the programme - a self-confessed stress-sufferer was hooked up to a machine whose electrodes, when placed near her ears, emitted a microcurrent which supposedly reduced her stress levels. Nobody discussed the issue of potential side effects, or suggested there might be other ways of using the body's energy to reduce stress. I felt like I wanted to find that woman and give her a hug. Although she said that she did feel her stress had been reduced by the machine, I wanted to ask her whether she couldn't instead take a day off and lie on the sofa and read a book, or find a massage therapist to ease her tension. The final statement in this part of the programme was to note that the manufacturers of this device are hoping to release this technology to the mass market in the near future. If we are not careful, even the art of touch will be usurped by science and technology.
Touch is, for me, one of the most vital arts for midwives to use in their work, as is a knowledge of the body's energy and ways in which we can help women to increase positive feelings and rid themselves of tension and negative energy. Judy Edmunds, a midwife from Washington State, USA, speaks regularly on the subject of touch in midwifery, and suggests that the midwives need to use touch, but only when their intent is good and with the highest welfare of the woman in mind. While she practises the art of touch with the women she is with, she feels it important that we use touch not just to extract data but also to enable an exchange of energy between midwife and woman.
There are so many ways of bringing the art back into midwifery, and these are only a few examples from my own recent experience. Midwives and student midwives writing in this issue talk about their views and experiences of different aspects of the art of midwifery, and we offer these pieces to other midwives in the hope that they will continue the debate which surrounds the art and science of midwifery. We believe that art is a vital component of midwifery practice, and of women's experience in general. It is our hope that women and midwives can reclaim the art of midwifery and birth for the betterment of all. And we look forward to a time where midwives are enabled to learn in the ways which are most effective for them, are encouraged to develop their own art, and are again invited into women's bedrooms to sit in the corner and knit.
AH updated 8 February 2000