From MIDWIFERY MATTERS, Issue No.102 Autumn 2004
Jayne McGovern
I HAVE ONE CHILD. She is nine. My pregnancy was troubled. My birth experience was horrific. The following two and a half years were the unhappiest of my life. I thought that it was just unfortunate that everything had gone wrong. I knew that the system hadn´t helped - the midwives were very prescriptive and authoritarian - but I thought they were just trying to do their job. I was very damaged by the experience, physically and mentally. I wanted four children.
Then I did my midwifery training and I realised that everything hadn´t ‘gone wrong´, but it had never been allowed to go right. Then I qualified and I was expected to do to other women all those things that made it go wrong for me.
Only I wouldn´t. Let me explain.
When I became pregnant I was an educated successful, professional woman. I knew I wanted to have my baby at home because I knew that birth should be a normal social event. I knew this in my gut. I had no other reference point. I didn´t know that such a thing as childbirth outside the NHS even existed. I sought out and attended NCT antenatal classes because I had read about them in fairly mainstream media. These supported my ideas, but still within the framework of accepted NHS norms. So my ideas still felt abnormal; outside societal norms.
When my pregnancy began to deviate from the norm I was concerned, but not unduly. A home birth had been agreed. Suddenly this ‘choice´ was removed. I was told I was too ill to have a home birth, I therefore had to go to hospital. I didn´t want to go into hospital. I desperately didn´t. I even discharged myself from hospital following a collapse in the street. I was told that it would be on my own head should anything untoward happen following self discharge. I was terrified. But even more terrified of being in hospital. I went home and was given grudging care by the community midwives. Slowly they, my husband and my sister pursuaded me of the benefit of having my baby in hospital. They thought they were doing the right thing. They were all educated, professional people, and neither my husband nor my sister knew about birth options without the help of the NHS.
When the birth began to go wrong I was so stupified with drugs that it all took place in a haze of disbelief. The midwives battled hard. The obstetrician made an appearance with the threat of forceps. What should have been a magical experience was reduced to an experience of such desperate misery and horror that it almost defies belief. Postnatally I became ill. Physically and mentally. It was accepted in general as ‘one of those things´.
In my deepest heart I knew that it had all gone wrong. I know how it should have been but time and time again I was told that my expectations had been too high. I was sure they hadn´t. Women can give birth alone. Many do. Why was I different? I would soon come to realise that it wasn´t me that was different at all. And it wasn´t that my expectations were too high. It was that they didn´t correspond with NHS expectations of me.
When I started my midwifery training I started to understand what had happened and I knew then that I had been right. That I could have done it just as I´d wanted, but that the very people who should have been helping me were the ones who were actively standing in my way. As I progressed into my training I started to understand why.
Midwives understand the normal physiology of birth. Of course they do, that´s what they´re taught. Only it isn´t what they´re taught. Student midwives are taught the normal physiology of pregnancy and childbirth as if it is some kind of anthropological adjunct to ‘proper´ learning. We know that this is the normal process but, hey, let´s get real. This is the year 2000, we work in the NHS, this is what happens in reality.
Normal childbirth is not promoted as the natural expectation – it´s promoted as the ideal. As a student therefore, when you get to the wards the difference between the ideal and the actuality isn´t such a shock. Only for me the difference was like a bucket of cold water in my face. Here, at last, I had been given the physiological evidence about pregnancy and labour. I was suddenly uplifted with FACTS and NORMALITY and the two corresponded as I always knew they should. And I was damned if I was going to let the ‘hey, let´s get real´ bunch cloud the issue.
I don´t think I really need to go into any more detail, do I? You can imagine the results. Each day – and I mean each day – I was confronted with a scenario which corresponded to my own experience. And I could see ways in which normality could and should be restored. But no one was prepared either to see the problems or, if they did acknowledge that problems existed, no-one was prepared to do anything about it. As a student midwife I was in reality, totally powerless. Never one to let this deter me, however, I determinedly stuck to my guns when I felt women were receiving a poor deal, and stuck my neck right out on numerous occasions to the extent that I had complaints made against me – by at least two midwives to my certain knowledge and I think by one obstetrician, a very arrogant man with whom I ‘locked horns´ as they say, in a very public way. My enduring sadness was that my midwifery colleagues did not support me. They colluded with the medical establishment. When I finished my course my fellow students, probably without exception, had been assimilated into the system. They wouldn´t ever accept that that´s what happened, although I do think that perhaps at least one or two of them think they might have ‘sold out´. Without exception, all of them said to me,
“It´s not as bad as you think. When that door closes you can practise as you like. You can only change the system from the inside’.
I don´t know if they genuinely believed that or not. I do know it´s a lot of codswallop. Whether you´re behind ‘that door´ or not, in an NHS setting you practise exactly as the obstetrician led protocols dictate. Two of my tutors said to me that they thought I´d suit a career in practice nursing, because that would give me the kind of autonomy I was seeking; I don´t think they were meaning to be ironic but it raised a wry smile with me.
So now what? Independent practice wasn´t an option when I qualified. I had too many other responsibilities. It is an option now. The thought of returning is exhilarating and terrifying in turn. But I intend to try. What lessons have I learned? One of them is that midwives can be their own worst enemies. Those in NHS practice are struggling on a losing wicket. Some of them are so wonderful that even as I write, I can feel a big smile coming to my face. In the most awful places, with the dreadful constraints, they produce a magical environment for the women they are with. Sadly, they are a minority. The majority of the midwives I worked with were highly skilled obstetric nurses, happy with their lot and hugely resentful of the implication that they were not practising as midwives. Of course they were midwives, they would tell me. They knew everything about normal labour and childbirth. They´d been practising for years. The fact that a very significant number of women in their care did not achieve a normal labour and childbirth seemed not even to register, and certainly didn´t seem to stir any curiosity in them. If it did, it was stifled.
And what of the independents? Sadly, the perception is often that of an esoteric band of tree hugging bean eaters. We must wake up to the world and how it sees and judges us. How on earth can women use us if they don´t even know we´re here? That we are just like them? We are women, we know about childbirth. We are not a group of extremists dealing with arcane rituals. We deal with normality and facts. We are safe. We are safer than their best expectations of hospital. There has to be a vast shift in the perception of what pregnancy and childbirth are all about. Unless independent midwives and their like minded NHS colleagues form into a politically cohesive and vocal group, I honestly believe that normal maternity will become just one more ‘minority interest´.
IK updated 1 December 2004