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Midwifery Feature Articles Uncategorised

All Bodies, All Selves: Anti-Oppressive Practice and Midwifery 

By Dr Alys Einion

At the end of LGBT+ history month, in this powerful article, Dr Alys Einion, FRCM, Senior Lecturer, University of Dundee and Editor-in-Chief, The Practising Midwife, raises concerns about oppression in midwifery practice.  She challenges us all to reflect on attitudes and behaviours in practice to value all people we encounter. 


At the tail end of LGBT+ History Month, the topic of anti-oppressive practice seems pertinent. As we recall our history as Midwives, locally and globally, we can see that much of our heritage is grounded in the support of people who have historically been oppressed and marginalised. Women, minoritised Black and ethnic women and parents, women who were poorer, or immigrant, and people with diverse gender and sexuality are all part of our history. Midwifery as an oppressed profession is perhaps still a very unfashionable topic of debate or analysis, and yet there is ample evidence that it has long been so, particularly in the Global North (the West) and its Europeanised/Colonised ‘territories’. Through the social and political forces that enabled “the corruption of the medical establishment and its historic roots in the demonizing of women healers” (Ehrenreich and English (1973/2010, cover text), midwifery still carries the defensive legacy of being characterised by the establishment as “dirty, ignorant and incompetent” (Ehrenreich and English, 1973/2010 p 86), and despite the plethora of texts, accounts and evidence which shows that traditional midwives, healers and birth attendants contribute to better personal, health and social outcomes, we still do not have the dignity and respect that our profession so deserves. We remain feminised in a patriarchal landscape, and where we do have positive narratives, the midwife trope is glorified in a similar way to the stereotype of the nurse, as angels of mercy, rather than as competent specialists providing essential specialist care, treatment and support to women and families. But as an oppressed group we are also guilty of our own forms of oppression, creating cultures which too often marginalise, ‘other’ or exclude (often through subtle microaggressions) people who do not follow some indefinable cultural ‘norm.’  I believe that action to change this is happening, all over the country, and all over the world, but I also believe that more can be done. We are all complicit in this system, and we all have the power to change our profession and practice for the better.  

What is anti-oppressive practice in the context of midwifery, and how can we practice it? To begin with, we must become conscious of, and take responsibility for, our knowledge, our perspectives, and our need to truly learn to see through the eyes of others. Assumptions and bias are cognitive shortcuts that enable our brains to categorise objects and assign them status as safe or not safe. We have the capacity to move beyond this and to actively develop our awareness of multiple perspectives on our profession, our role, our behaviours and respecting others in their uniqueness just as we respect ourselves. We are perfectly capable of learning each other’s histories (and our own) in order to better understand the lived experience of the now (Nzira and Williams, 2009), which is grounded in diversity and in subjectivity. Where there is commonality, we can find a shared voice. But where there is difference, we can work respectfully, grounded in a healthy curiosity that enables us to integrate a wide variety of knowledges and viewpoints into our own vision. Whilst scientific rationalism offers us many chances to identify ways of addressing aspects of reproductive biology, health and health determinants, along with interventions and care that can be of value to mothers through their pregnancy and perinatal journeys, it is humanistic care, grounded in respect of individuality and autonomy, that is required.  

We can be allies, to anyone. Whatever our own personal, or professional, history and experience of stereotyping, discrimination, exclusion or oppression, we can learn to stand beside those who need our shared strength, or simply our non-judgemental presence. Advocacy is a well-known part of the midwife’s role. But advocacy without self-awareness is an empty term.  

Regardless of our identities and protected characteristics, or those of others, we should be practising unconditional positive regard, and this is something that we can learn. Non-judgmental, inclusive practice is about caring for people as they are, respecting them as they are, and looking at what we have to offer them at any given point in their childbearing journey.  

Midwives have always been strong drivers of action for social justice – from the evolution of feminism which sought to support women to know their own bodies and exercise their rights, to the movements for home birth, to our own fight to protect our status as autonomous practitioners. Anti-oppressive practice means looking further at the places and ways in which oppression is experienced, and by whom, and taking action to counter that. It means learning how to be anti-racist, anti-discriminatory, and positively inclusive, because we recognise that all humans have the right to dignity. It is about understanding the impact of our history of colonialism, social forces, social injustice, stereotyping and prejudice on women and parents, and on our practice, on the very evidence, research and theory we rely on so heavily. It is about understanding the current context of midwifery and childbearing together, the dangers of healthism and other forms of stigma, and the need to proactively address our own behaviours and assumption as well as those of our colleagues. It is also about understanding that the institutions within which we practice have their own histories and cultures, and it is our job to improve them and change the narrative, one piece at a time.  

To this end, I offer this suggestion.  

In any given situation in your role, ask yourself, who is excluded right now? Who might feel left out, or feel as if they are not seen or heard?  Who has not been considered, whose needs not accounted for? Does that BAME colleague, or the colleague with a strong accent, experience discrimination in practice? Are students overhearing homophobic remarks from staff or patients? Does anyone feel excluded from the team’s professional and social activities? 

How might this person be experiencing this situation, given what I know about them and the social and societal forces affecting them? If this mother is affected by homophobia, or that mother by sizeism and weight stigma, or this family by being refugees, or that mother by racial injustice, how can I tailor my care to support them most effectively? What do I need to know to do that? Who needs to be involved? How can I humbly guide this person to have the best possible experience of childbearing whilst I have the privilege of working with them?  

 We are walking histories, roadmaps of every prejudice or assumption that closed off or changed our route through life, or affected how easy or difficult our path might be. All bodies, all selves are different, yet we are all here, together, walking, stumbling, dancing our way forward through this vast and complex terrain of life. Be the person who sees the barriers, and helps others over or around them, or even better, one of the people who helps to remove them.  Challenge language or behaviour that needs to be challenged. Role-model respect and inclusive practice. Where oppression exists, get involved, organise, and change the script. Medicalised maternity care would have you working like machines, speeding patients along a conveyor-belt of care, never having a moment to connect, to share the experience, to experience the true nature of woman-centred, person-centred midwifery. It would have you too afraid to speak up, for fear of risk to yourself and your own career. Let me say this to you. Action cures fear. The very legislative framework which underpins our practice, The Code, requires us to practice in an inclusive, anti-oppressive manner. If you are working according to The Code, and the law such as the Equality Act 2010, then you are unassailable. If you are using evidence to support your action, you are doing what is required of you as a midwife.  

Whatever setting you work in, however many complex needs a mother or family might have, every single one of us belongs to this maelstrom of humanity, and deserves proper care and recognition. So, my final abjuration to you is this. If someone tells you they are experiencing any form of oppression, believe them. Believe in them. Act in every way with the only assumption you are allowed to make – the assumption that their experience is true, and valid. Because it is.  

Every LGBT+ History Month, I am grateful to know how far we have come in countering the social injustices, exclusion and discrimination which affected, and ruined, the lives of so many people like me. I am grateful for all those who spoke up, stood up, and put themselves on the line so that you and I could stand with less fear and more pride in who we are. Every day of my professional life I am grateful to the midwives, activists, mothers, parents, legislators, researchers, academics, authors and others who fought to secure legal, professional status for midwives, and to build the profession we enjoy today. All bodies, all selves are cared for. That is midwifery. That is who we are.  


Ehrenreich, B. and English, D. (1973/2010) Witches, Midwives and Nurses: A History of Women Healers. 2nd Edition. The Feminist Press.  

Nzira, V. and Williamms, P. (2009) Anti-Oppressive Practice in Health and Social Care. Sage Publications.  

Dr Alys Einion, FRCM,  

Senior Lecturer, University of Dundee. 

[email protected] 

February 2024