Silence is Never Golden- Midwives and women speaking out

In the recent Ockenden report about a UK maternity trust it was pointed out that midwives and staff had been prevented from speaking out. In this article Kathryn Gutteridge, Consultant Midwife and psychotherapist, discusses the issues of speaking out in the current health climate.

 

Silence is Never Golden- Midwives and women speaking out

The saying ‘Silence is Golden’ is fascinating.  It is thought to hail back to the ancient Egyptians although the first recorded example of this is seen in the writing of British poet and author Thomas Carlyle.  He wrote of the phenomenon ‘speech is silver but silence gold’ in his book Sartor Restartus and he attributed it to be taken from a popular Swiss or German saying of the time. But the very basic meaning of silence is golden is that it is better to say nothing, but is that always the case?

Silence may be deadly and have dire consequences, it allows others to take power from us and holds us in a state of uncertainty.  I have experienced being silenced throughout my lifetime; some of you know my story and how I suffered sexual abuse over the best part of my childhood and young adult life.  Carrying a secret like that has many consequences that are complex and life limiting.  For instance, I have to carry the effects of complex PTSD, depression and sometimes suicidal thoughts, not only that I have experienced acute trauma symptoms in response to some pretty innocuous life events.  Yet I have managed to have a successful career and on the surface a life that seems pretty much okay.

If only. When I first started speaking out about surviving rape and sexual abuse it was in the late 1980’s and I was treated dismissively and with disgust.  I understand that because at that time no one spoke out and least of all a healthcare professional.  It was ‘bad taste’ to talk about our own personal life and certainly when I trained as a psychotherapist in the late 1990’s debate was still ongoing about the therapist’s story complicating that of the client.  However, as time has moved on and we are now in what is supposed to be a ‘post truth’ era we are encouraged to put our own needs and truths on the table as equal to that of others.  From writing and speaking out I founded SANCTUM Midwives a closed network of midwives who have contacted me over 25 years with their own stories of silence.  It is evident that the experiences of these women have never been heard and they are still struggling to this day with the impact of their own abuse.

As a midwife I observed many things over my career however one thing stands the test of time and that is listening to women, building relationships with them and also having truthful discussions.  One area of midwifery that was to become very much part of my role as a consultant midwife was to become an advocate for women who weren’t being listened to.  This did not change throughout my career and even at the very end before I retired, I was to see the consequences of this upon one woman who was hounded and pilloried for choosing not to take a path that she did not agree with.  I have tried to be a peacemaker when there seemed to be no solution for a woman and her clinician reaching an impasse.  There is always a way to find common ground and our maternity systems have the capacity to do this however the middle ground has become the norm.

It is worth having a look at our history here.  From 1905 midwives were trained and delivered care to the majority of pregnant and childbearing women, in fact up until 1920 there was no provision for antenatal care.  In the 1930’s as a response to rates of maternal deaths, obstetrics aimed to improve recognition of problems that occurred before labour started so that maternal deaths would be minimised.  At the same time pharmaceutical advances gave us antibiotics and iron products, both of these developments saved women’s lives.  Wholesale movement of all births to be managed in hospital happened in the 1960-70’s after Sir John Peel advised; that facilities should be provided to allow 100% hospital delivery (Department of Health and Social Security, 1970) without any evidence to support this.  And so now we have decades of hospital births, decreasing numbers of midwife led births and hospitals asked to reduce bed capacity so that the NHS can provide care outside of hospital.   All of this in spite of the very best evidence supporting midwife led care saves women’s lives (Brocklehurst et al 2011).

I remember reading an article written by AIMS founder and birth equity campaigner Beverley Beech.  She recounts her own introduction to birth in the 1970’s when she observed the complete lack of consent required for any treatment that is deemed to be appropriate.  In fact, AIMS challenged the Medical Defence Union on its statement printed inside the notes of women: “The Union does not consider that a maternity patient need give her written consent to any operative or manipulative procedures that are normally associated with childbirth. When she enters hospital for her confinement it can be assumed that she assents to any necessary procedure including the administration of local or general anaesthetic” (Beech for AIMS 2005).  We have moved on from this in healthcare one hopes but it is always useful to see how we have arrived at this current position of maternity care.

I write about this because it is important when speaking out.   Women have been encouraged to use hospital settings for antenatal care and birth for many reasons but many of them are not based on sound evidence.  Acute hospital setting maternity provision in 1960-1970 was proposed to offer safety for women’s health and that of her baby. However, encouraging all women to use hospital services has meant that we have lost the ability to prioritise who needs what when.  We have created a maelstrom of chaos that is pinching from Peter to pay Paul on an hour-by-hour basis.  Whereby having choice, control and compassionate care is more by luck than any planning.  Better Births (2016) in England was a glimmer of hope on the horizon, it might just be possible to offer women continuity of care with relationship-based midwifery that could have benefits not just for the woman and her baby but would also increase job satisfaction levels of staff.

Coming back to silence and the suppression of words and thoughts.  After the recent publication of Donna Ockendon’s report into the care at Shrewsbury and Telford Maternity, it was clear to me that the Trust had failed to listen to the voices of parents over many years.  The resultant fact was they were dismissed and disregarded as important.  After fighting to be heard they were finally given a platform that vindicated their claims of poor and inappropriate care and many other failings.  It resonated with me in many ways.  Being treated as if you are not important, as if your voice was a lone cry and that you were making a fuss about nothing was a theme I could see here.  I was also disturbed to see in the report that several staff had asked for their names and statements to be removed in the last week of Donna’s work.  This is more concerning perhaps demonstrating that staff are still scared to speak out when they have concerns.  A real damnation of a service that is trying to restore public confidence and national reassurances.

Just as the voices of the Liverpool 96 in the Hillsborough Tragedy were dismissed for decades.  Just as the silent voices of victims of Jimmy Savile at last found their voice after his death.  I also feel that my voice was never heard clearly until after my abuser died, after all he was the adult in my home and as such, in society he was attributed both power and voice.  We must listen to all of the voices that are screaming to be heard in this post Ockendon report.  The media are very good at exercising their right to report freely and to express their views, however the media must also take responsibility for misrepresentation.

I believe that midwives have been misrepresented as a group over the last decade mostly by the media but also by public figures.  This has silenced many midwives and their voices are lost in any debate.  In fact, the singling out of ‘normal birth ideology’ has come from this and created a belief that midwives are practising midwifery that is both dangerous and without any scientific basis.  This silencing will be detrimental to women and birth in fact I would say it is already so.  Midwives have given their entire commitment to adapting their practice both prior to the pandemic and before so that women and their babies could receive the best care possible based upon evidence. And as the implementation of more recommendations are put in place so will midwives adapt to ensure this happens.  But you will not be surprised that many midwives are retiring early, taking prolonged sick leave, resigning even from the profession they thought would be theirs for decades.  If they have spoken out with a different view they are hounded and called out for voicing their opinions.  If a midwife suggests that normal birth is not a definition but a physiological anatomical state, she is scared that she will be side-lined and bullied into submission.  We cannot allow this.  It is opinion and as such should have the applied freedom of speech that it deserves.  Enforcing women to receive a model of care or intervention is different and yes this should be called out.  This is power and coercive control in its medical conformity.  I cannot and will not ever subscribe to that.

There are so many parallels at play at the moment in maternity settings.  There is a power struggle ongoing.  There are political and sociological manifestations that will determine the future of midwives and maternity.  I have always been a friend to the voice-less and I have always despised bullying and other mistreatment.  It is unusual to see those elements targeting a whole profession and yet that seems to be the case.

My final thoughts on this

This blog is a mixture of observation and personal experience but grounded in my profession and love for midwifery.  I have never thought that I was the only professional needed by women and it pleases me to say that some of my best friends were my consultant obstetric colleagues.  We worked together in a team, we listened and learnt from each other, but more than this we respected each other and still do.  They support normal birth or physiological birth; they supported me and also respected my expertise. I knew I could call on them to support me when a woman requested help such as a planned caesarean in the absence of medical indications.  They knew me and trusted me and my training in midwifery, some of them even used my skills for their own childbearing journeys.  Why does the media ignore these stories, why do they filter out the birth experiences of women who have only positive to things to say?  Why has the media highlighted and encouraged misrepresentation that only midwives insisted on normal birth when in fact it was just as much the entire medical team involved in that decision making?  Money, power, intimidation?  You decide, I have my own opinion and it is simply put; bad stories make good press.  The victim is always seen as the individual and the collective as the wrongdoer.

There is another element at play here of taking on a largely female professional group.  That is, we are easy targets, we are busy mothers, wives, partners, midwives and multi taskers.  We are midwives in the main because we love what we do and want to help those in our care.  We give often more than we receive so we have become a convenient target.

Hold fast my midwife colleagues.  Women need us now and surely will in the future.  Perhaps I should be retired into silence after all I am no longer a practicing clinical midwife but the child in me is shouting out ‘silence is never golden’.

Kathryn Gutteridge

April 2022

References

Beech, B.A.L (2005)  Choice – an abused concept that is past its sell-by date.  ISSN 0256-5004 (Print) AIMS Journal 2005, Vol 17 No 4

Brocklehurst, P., Macfarlane, A., Marlow, N., Mccandlish, R., Mccourt, C., Miller, A., Newburn, M., et al Perinatal And Maternal Outcomes By Planned Place Of Birth For Healthy Women With Low Risk Pregnancies: The Birthplace In England National Prospective Cohort Study  2011 – Bmj https://www.bmj.com/content/343/bmj.d7400

Carlyle, Thomas (1831) Sartor Resartus https://en.wikipedia.org/wiki/Sartor_Resartus

Cumberlege J (2016) The National Maternity Review. Better Births: Improving outcomes of maternity services in England. NHS England. https://www.england.nhs.uk/wp-content/uploads/2016/02/nationalmaternity-review-report.pdf

Ministry of Health (1970) Domiciliary Midwifery and Maternity Bed Needs: the Report of the Standing Maternity and Midwifery Advisory Committee (Sub-committee Chairman J. Peel), HMSO, London

SANCTUM Midwives Facebook https://www.facebook.com/Sanctummidwives