Midwifery in the UK has had challenges for a long time and has taken a battering in recent years. Have we lost our direction and purpose? In this passionate article, Lola Ornato, Midwifery Education Fellow, Middlesex University, questions our faith in women and birthing people’s bodies and calls for returning to the basics.
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‘Faith is a supernatural gift from God that allows us to believe without seeing……….’ I can’t remember the rest of the phrase but as a little girl growing up in Nigeria, this is the mantra that I chanted along with my friends in our catechism class as we prepared for our first holy communion. As a Christian, faith is a big part of my life, having a belief that is not questioned but accepted as the truth. I’m not saying this is an easy thing to do and in the world in which we are living at the moment it can certainly be vey difficult to have faith in anything.
You might be wondering why I decided to talk about faith in an article about midwifery but I believe that faith is a really important part of our profession. Not necessarily faith in a religion, but that pure unadulterated belief in something that cannot be shaken no matter what.
Midwifery is in crisis. It is that simple. I have been a midwife for 21 years now and this is the worst that I have ever seen it. Staffing is a major problem, burn out is at an all time high and the women and birthing people that we look after are locked in a system where medicalisation of birth and high intervention rates are the norm. There have been documentaries about the dire state of maternity services, birth trauma reports and many an article on the dangerous staffing levels. We continue to write policy after policy and introduce more ways in which we can monitor and control women and birthing people’s bodies without much thought for the often irreparable damage we are causing.
Midwifery in the NHS is for the most part following an obstetric model of care that ironically has nothing to do with midwifery at all. We have lost our way and at the root of this is our complete lack of faith in women and birthing people’s bodies. Maybe the question we should be asking is did we have this faith to start with? The human body is truly amazing and for the most part works without any outside help. In times of illness there is of course a need to nurse a body back to health but why are we applying this rule to pregnancy and birth? Pregnancy is a normal, physiological process that should be respected and nurtured. Sadly, modern maternity care means that it is often a time of stress and worry seasoned with an overload of information and for many dotted with tests and confusing results to decipher.
What happened to being able to trust the body, to having faith? Why is it that we think that the minute a woman/birthing person becomes pregnant they are a ticking time bomb? At booking appointments women/birthing people are offered screening tests to confirm their EDD, blood tests for conditions that they may or may not have due to family histories, consultant appointments for their age, race and weight to mention a few. The implication is that the pregnant body is a broken one that needs fixing. Instead of implying women/birthing people’s bodies are defunct, why are we not telling them how capable their bodies are? Why do we continue to strip them of what little faith they might have had instead of helping them to build it up? We need to take a step back and think about the message we are sending to women/birthing people. When we put everyone in a category of risk until proven otherwise, we are telling women/birthing people that we do not believe in them, their bodies and their ability to give birth. Perhaps the harsh reality is we we don’t. But surely this is not the fault of the people we serve and more to do with a combination of the system within which we work and our personal beliefs, fears and abilities. As midwives if we do not believe in the people we look after can we truly say we are qualified to look after them? Women/birthing people who want to give birth at home, go past the dreaded due date, decline tests or anything else that doesn’t fit with the status quo are accused of endangering their lives, or worse, still the life of their unborn child. For some who have a good support system, they will ignore these threats and follow their instincts but so many others are coerced into decisions that often result in long term physical and mental health problems. Acton (2008) talks about the importance of us having faith and, just like I stated in the beginning of this article, she means faith in the body’s ability to give birth. She goes on to state that if we don’t have this faith it is often replaced by fear. This is evident in some of our practice that is not governed by evidence but rather a fear of an often small chance of an adverse outcome. Wickham (2023) illustrates this perfectly in her book Plus Size Pregnancy where she discusses how outdated measurements such as BMI can lead to scare mongering and unnecessary intervention for women of a certain weight.
Over the last few years, I have been working on racial equity and decolonising the curriculum and what I am learning is that some things might appear to be contributing towards making a difference but they can be superficial and short lived. In order to truly make a difference you need to dig deeper. In the same way when I think about the lack of faith in the pregnant body, I have looked further and think of our journey as young girls and the attitudes to our bodies growing up. When I look back on the education I received as a young teen starting her period, I can honestly say that I received very little. My saving grace was as someone who has practiced the Billings Ovulation Method of fertility management since my late teens, I have learnt about my cycle and menstruation in better detail and I do not doubt that this has influenced my beliefs about the female body. But how many of us get this kind of education? How often are we told that our bodies have to be regulated with medication without any investigation into whether there was anything wrong with us in the first place? Is it any wonder that after several years of seeing our bodies as a problem, we continue with this narrative in pregnancy? On the other side of pregnancy, we are faced with the menopause and another period of uncertainly, lack of information and worry.
Gailey and Russels (2015) explore in their film the important role midwives used to have in society and explain how the priority shifted in the 17th century towards male dominated technology. By the 20th century medicalised birth and faith in science had increased greatly. The film also discusses the importance of positive birthing experiences and the negative impact traumatic births may have on children in later life. The recent birth trauma report also highlights the suffering of women/birthing people following substandard care. As midwives we simply can not go on like this. We need to question what it is we stand for. I hope we can go back to the days where we learnt about the how the body works, when we took the time to palpate an abdomen and listen with a pinard, where we sat in a corner silent as we awaited a birth and where we did home visits and got to know our clients. I do acknowledge that these things do happen for a lucky few but we need to do better.
It is important for me to point out that I am by no means advising women/birthing people to ignore medical advice or not to attend appointments and I acknowledge that there are people who will absolutely need the help of medical professionals in their pregnancies. But as a profession that claims to be ‘with women’ we need to be able to go back to the basics of midwifery and leave the umbrella of the obstetric model in order to support our women/birthing people by giving them true informed choice free from coercion and empowered by faith.
References
Acton, K. (2008) ‘Clinical care in labour: do you have the faith?’, British journal of midwifery, 16(9), pp. 566–566. Available at: https://doi.org/10.12968/bjom.2008.16.9.30894.
Gailey, T. and Russell, J. (2015) Midwives, Lullabies and Mother Earth. San Francisco, California, USA: Kanopy Streaming.
Wickham (2023) Plus Size Pregnancy what the evidence really says about higher BMI and birth. Birthmoon Creations. Available at Amazon.
June 2024
Lola Ornato, Midwifery Education Fellow,
Middlesex University