Are we nearly there yet?

Please note: this article is old and out-of-date. It was published in 2003 and is here purely for historical interest.

If one believes in the more radical versions of quantum theory (or watches enough Star Trek), there must be a parallel reality somewhere in which British midwives are very excited about the year 2003.  In this alternate universe, midwives all over the country are planning lavish parties, dancing in the streets with the women they have come to know through being their lead maternity carer, negotiating sharing of on-call time so everybody can enjoy a few glasses of wine.   AIMS and the NCT have got together a delegation of helpers to bake an enormous cake to present to the MPs who stood up for women’s choice, while the first baby born (into the hands of her midwife) within the new scheme will be interviewed by Trevor McDonald for a special programme which will herald the beginning of the BBC’s “birth choice week”.   (During “birth choice week”, ten-year old repeats of Holby City will be shown as an example of negative historical perceptions of birth by screenwriters.)  For, in this alternate reality, 2003 is the tenth anniversary year of the report that made a difference: Changing Childbirth.

Yet, in the 2003 reality that I’m experiencing, there isn’t an awful lot to celebrate.  Many of the schemes set up in the wake of the report have now fallen, or become unrecognisable, midwives are leaving in their hundreds, women whose babies are not arriving in the correct numbers or positions are being denied choices, the caesarean section rate is rising across the board, and brave-new-world interventions are multiplying on an exponential scale.  While there are some small-scale exceptions to this rule, the glittering promise of change for women and midwives has been tarnished by the last decade of reality.  Even mentioning the words “changing childbirth” is enough to elicit a groan from many midwives and birth activists who are tired of the rhetoric and ready for some real change.

Of course, we all have different opinions as to what the answer is.  Sometimes I wonder whether it is because so many midwives are such strong women who all have their own ideas that we don’t get together en masse in order to effect some real changes.  Britain used to lead the way in midwifery; we were the envy of the world, yet the models of midwifery in New Zealand, Holland and Canada are now leaving us behind.

Which must lead us to ask whether it is the system itself that is the problem.  Could we do better by following the example of the New Zealand women and midwives?  Their maternity services have changed dramatically over the last decade as a result of women and midwives working together.  The country has moved from a system similar to the current UK model to one where community-based midwives work independently, but are reimbursed by the state.   Most of these midwives offer home births, but also have hospital privileges and can accompany women into hospital.   A small core of midwives continue to provide care within hospitals, which enables choice for midwives to work in the way they want, and for women to have continuity of midwife.

It might sound like a pipe dream, but the women and midwives over there have managed to achieve this.  Are we ready to do something similar in the UK?  Or have we got to hit real rock bottom before this can happen?  We recently came very close to losing our right to legally practice outside of the structure of the NHS, and I know many people who were concerned that this might be ‘the end’.

For sure, the New Zealand midwives have not solved all of the problems, and no system is perfect.  But a similar model could result in a real win-win situation.  Those midwives who wish to remain in hospitals can do so; core staff will always be needed to offer specialist care to those women who need it.  Midwives who want to work autonomously can do this too, with the additional advantage of being able to directly regulate the volume of their caseload: if women book midwives directly, and midwives are paid directly, then midwives can more easily work part time in a way which enables continuity.  Some of the midwives who have left might even come back, which would ease the pressure on everybody.

Women would have more choice about who was with them during pregnancy, birth and postnatally, and about where they gave birth.  We might even begin to regain those midwifery skills that are in danger of being lost, as women make choices about their experience within a midwifery model which emphasises normality.

I’ve even found a couple of web sites that might help us get moving if anyone else is feeling the time is right for some action.  At www.faxyourmp.com, you put in your postcode and a blank form appears, in which you can write a letter to your local MP.  Let’s not forget the power that letter writing can have; a certain midwifery association asked all its members to write to a certain not-very-nice organisation, which was perceived not to be listening to the voices of women and midwives.  This so effectively blocked their administrative machinery that a representative of the midwifery organisation was asked to call off the letters with an assurance that change would be made.

Another site that might be useful is one run by an American environmental action group, who acknowledge that people are busy, and have a guide to effective actions for change, which can be done by busy people with not much time.  Their address is http://www.2020vision.org/resources/r_activists.htm. While their material relates to action in the US rather than the UK system, they have some useful pointers which could be useful for anyone moved to write a letter or call a radio talk show.

So, are we ready yet?  Have things got bad enough?  I’m hearing people speculate that we might need to ‘lose’ authentic midwifery completely before we can regain it.  Is this how everybody feels?  Do we need to let things get even worse before we speak out?  I so hope that, at the beginning of 2013, I find myself writing an article which describes how the reality of the past ten years has exceeded this small vision of the possibilities.  If for no other reason than we might really see the BBC re-thinking their approach to Holby City and devoting a whole week to positive birth news in celebration of the tenth anniversary of a real change in childbirth.

This article was originally published as Wickham S (2003). Are we nearly there yet? TPM 6(1):23.
photo credit: Visualvalhalla Highway to the stars via photopin (license)

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