From MIDWIFERY MATTERS, Issue No.104, Spring 2005
The following is part of a talk I gave at a conference in Summer 2004. I had
a different talk planned for the day but stayed up until 4.30 in the morning
after my husband told me that the original was too twee and not honest enough.
I would like to share with you the journey that I made to get me where I am
today. It's very personal, it's not research based and, basically, it is my
story.
I am Malaysian born but arrived here 13 years ago at the tender age of 18 to
embark on a English teaching degree. I started my midwifery training after having
my third child and qualified from my direct entry midwifery course in September
2002. I have never worked within the NHS maternity services. I have a small
caseload and practise in the Sussex, Surrey and Hampshire areas. I live in Midhurst,
West Sussex with my midwifery widow husband and five young children, two of
whom I had during my midwifery training. (My classmates used to joke that I
hadn't been paying attention during the fertility classes!) Thus I was on both
the giving and receiving end of midwifery care simultaneously.
I am often asked why I decided to become an independent midwife. Certain events
guided me towards independent midwifery, but I decline to work in the NHS for
other reasons.
A Bullying Culture
The first and biggest reason has to be the bullying that is so endemic in the
NHS. I was bullied during my midwifery training. When I transferred universities
half way during my training, I had no idea that I didn't quite fit the mould
of the university's idea of a student midwife. I was singled out and my performance
was scrutinised minutely. I was made to hand in work which others didn't need
to, subjected to unfair allegations by one tutor, accused of being non compliant
and was even kicked out of the course for what was actually an oversight on
the midwifery department's part (albeit for only half an hour before the official
letter was retracted). Being an active member of ARM surely did not help; at
the beginning of the course one tutor advised my cohorts that ARM was not the
type of association they would want to get involved with.
I am sure my story is not the only one. I have heard many a tale of students
having difficulties with their clinical mentors. Finally they muster up enough
courage to approach their clinical tutor to seek assistance only to realise
that the link tutor and clinical mentor are great chums. "Apologise for
the fuss you have made and just keep your head down", they are told. They
carry this with them for the rest of their training. Rock no boats and you will
sail through your course. The problem is that once they qualify they are still
keeping their heads down! It took me a year to realize that I was being bullied
and a lot longer to accept that it was not my fault. By this time I had lost
my passion for midwifery, I was merely concerned with getting my numbers and,
when women and babies are reduced to being just numbers, I knew that the NHS
had finally got to me. This is why I felt I couldn't go back into the NHS.
A Brave Decision?
Often when I tell people that I am an independent midwife and that I have never
worked in the NHS, I get comments like,
"Gosh, you're brave, aren't you?"
I would like to address this misconception. I do not mean to offend, I have
a deep admiration and respect for my colleagues who work in the NHS but, seriously,
what I am doing is not brave. It is brave is to carry on working in an environment
where you are almost coerced into participating in the routine abuse of women
and babies. It is brave is to plod on, risking the midwifery registration that
you have sacrificed years to obtain, by adhering to unfounded hospital guidelines
and, even worse, potentially risking lives. It is brave to risk working in a
culture which may cost you your dignity, integrity and self respect so much
that you are unable to see another way.
The NHS thrives on martyrs. It needs them to survive. I believe that the maternity
services are in a parlous state and can only function because midwives, who
are generally women, allow themselves to be made martyrs.
Why Independence?
I have told you why I couldn't work in the NHS, I haven't quite told you how
I went into independent midwifery. The answer is quite simple. Two words. Mary
Cronk. What a formidable three syllables they are.
I'm sure we all know who Mary Cronk is and I was honoured to have got to know
her during my student years (It's amazing how quiet the labour ward became when
Mary arrived). I was a Mary Cronk groupie and I am sure I am not the only one.
I got to know her quite well and subsequently had her as my midwife for my fourth
and fifth pregnancies. After qualifying, Mary made sure that I kept practising
by asking me to do some antenatal and postnatal visits for her. I even attended
her labouring clients as a second midwife. To be honest, at this point I was
still entertaining the idea of working in Body Shop, which you must agree, dire
as it sounds, is still not quite as bad being tempted by the bright lights of
Tesco.
The final crunch came when a midwife friend asked me if I would be her midwife
for her first pregnancy, and this links in rather nicely to the title of this
piece - Leap Of Faith - because that is exactly what it felt like when I was
there in the bedroom of my first client, attending her in labour.
Let me explain why I call that event the leap of faith. I managed to qualify
as a midwife without having witnessed a single physiological third stage - needless
to say I never even facilitated one during my training. The only homebirth I
had attended was my own, which really doesn't count as I had to be present there
anyway. I never had the opportunity to carry a caseload. In short, most of the
labours and births that I had seen had been managed - the emphasis was on intervention
rather than a full understanding of birth physiology. Research was used to limit
midwifery care, not to liberate it.
When I attended my first client in labour, I had very little experience of physiological
childbirth. I was very aware of this and so was my client, but we did share
a total faith in the birthing process and in each other. I had an absolute faith
in my client's ability to listen to her body and respond to its needs. In turn,
because we had spent months getting to know each other even better, my client
trusted that I was there for her all the way, not just for the duration of a
shift.
First Birth
Just briefly, for those who are curious to know the outcome of her birth, I
have been given permission to share this with you. She laboured beautifully
at home. She went through a horrendous transitional stage and birthed her baby
girl into her own hands, assisted by her partner who had witnessed what a strong
and amazing woman his soulmate is. I was on the other side of the room, separated
by the bed, which she was on, just trying to get a good view of the magical
event! Her partner caught the placenta and cut the cord himself - eventually.
What I will carry with me for the rest of my midwifery life is something my
client once shared with me. My client predicted that her baby would be born
when her calendula flower went into full blossom. When I arrived to attend her
in labour, the flower was still closed but by the time I left the new family
early the next morning, the sight of a calendula flower in full bloom just outside
her front door greeted me. That was when I realized how magnificent women are
and how blessed I am to be able to do what I do. I was finally healed.
Lack of Experience?
I would like to just comment on my lack of experience of normal childbirth.
One common remark from student midwives asking me about going into independent
practice directly from qualifying is: "Oh I don't know. I really need to
spend some time on the labour ward so I can get more experience under my belt."
I would really like someone to clarify just what experience they feel they need
to acquire. Experience in how to leave a woman with her one hour old baby because
you have to spend an hour and a half filling in hospital notes on the computer?
Or perhaps, experience in transferring inappropriate clinical habits into the
homebirth environment?
When you qualify, you are deemed competent to practise as a midwife in any given
environment. Upon qualification, if you feel that you are not competent enough
to be a midwife, then you really ought to question the integrity of the institution
which trained you. There has been a lot of whispering about how the current
provision of midwifery education does not equip student midwives with the skills
necessary for them to fully carry out their role. Personally I would go as far
as questioning selection criteria for student midwives.
However, let's not confuse competence with experience. Competence is what you
have when you qualify and experience is something that you gain, given time
and the right type of environment. You will not get experience in the physiology
of birthing and homebirths if you are in the labour ward, witnessing births
in a culture of medical dominance. Many obstetricians have never witnessed a
normal birth, but we do not think it makes them lesser surgeons. Why should
you need to be immersed in the medical model of care in order to practise real
midwifery? You certainly would not learn how to drive from bad drivers.
Peer Support
The other reason why I felt that independent midwifery was the only way I could
practise is because independent midwives support each other. I had a very challenging
time during my training. The support of independent midwives kept me going.
I found this support lacking in NHS midwifery. The feeling of sisterhood is
very strong amongst independent midwives and, to me, this is very important.
As midwives we are guardians of pregnancy and childbirth, and we are often honoured
with the opportunity to witness the birth of a new family. Sometimes, giving
so willingly to others can leave us feeling drained. This is where the strong
circle of emotional support is so essential. This is a luxury is not usually
available to midwives in the NHS model.
Coping with Limitations
My independent midwifery practice is still very much in its infancy and it has
been a very steep learning curve. Often I find there are unexpected gaps in
my knowledge. The beauty of independent midwifery is that I am not afraid to
admit that I don't know something and ask questions. Being able to identify
my limitations knowing that my peers are not going to judge me actually makes
me a safer practitioner.
Autonomy is no longer just a word that I read about - I actually practise it. I can practise the way I want to, not how the CNST and risk management squad have decided I should. I have been able to develop my own model of midwifery, based on listening to the wisdom of women, guided by the collective knowledge of enlightened midwives, informed by research - but not enslaved by it. I am a midwife and my role is to be with woman - not with local policies and protocols. Susan Burvill has talked about how the hypnotic effect of 'risk' has dominated midwifery practice. It is so enlightening to work in an environment where women are not seen as statistics and risk factors.
Childbearing is a highly emotional time for most women and this can be reflected
by how they interpret their birth experience and retell their birth stories.
The women who engage my services are no different. Most are a pleasure to work
with and a few have been challenging. Many have endured and achieved more than
I thought humanly possible. I am blessed to have learnt so much from each one
of them. When I embark on that journey with a childbearing woman, it is like
taking a leap of faith. I leave my baggage at the door and I suspend all disbelief.
I am embraced into the heart of her family. She may recount the birth story
to her offspring in years to come and, if I am truly blessed, my name will be
remembered. Not many people can say that their job makes them feel that they
can save the world. I would like to thank them all. Every woman who shares her
magical journey with me makes me a better a midwife. My path to becoming a midwife
has been a rite of passage for me, and an affirmation of the true potential
that every woman possesses. I truly look forward to the next forty years of
my midwifery life.
May we forever be humbled by the strength of women and may midwifery always
be ours.
Updated LW July 8, 2005