My childhood concept of a midwife included the mental picture of a wise and kind women sitting in the corner of a bedroom and knitting, while the birthing woman laboured with the support of her partner. The midwife in my image somehow knew exactly what was happening, but without being intrusive in the experience of the couple. She might look up at them and smile from time to time, but she would not otherwise interfere. The atmosphere was peaceful, with an undercurrent of excitement. The kind of excitement you might feel as you woke on the morning of your sixth or seventh birthday.
It’s a relatively easy task to paint word pictures of how midwifery and birth could be, perhaps even how they were in some long forgotten time. But is this picture really a childhood fantasy, or do we still have time and opportunity to bring the art back into midwifery and birth?
Ancient pictures of `how birth was’ still exist today, and can be seen in representations of full breasted and wide-hipped pagan Goddesses who squat or kneel to birth their babies, sometimes in the presence of other women. Sadly, these pictures no longer represent reality for many women. Modern culture has been influenced instead by scientific rationalism, by Descartes’ insistence that the body and mind are separate, and by patriarchal ideas which we are only now beginning to challenge.
While we strive to base midwifery practice on the available evidence, analysis of the evidence almost unfailingly points to the fact that quantitative research cannot provide all of the answers and often causes more harm than good with its insistence that we study populations of women and seek general laws. Any midwife who has witnessed physiological birth will attest that there are very few absolute laws which can be applied to all women. I can think of only two which transcend culture and environment: that birth works much better without intervention for the vast majority of the time; and that babies come out. So perhaps it is time to make concerted efforts to bring back the art of midwifery and birth; not just in terms of the knowledge available to women and midwives, but also in relation to traditional forms of art and craft, and with enabling learning in ways that are more true to who we are. I am deliberately basing this article on my own experience of the art of midwifery, and referencing it not with scientific papers, but with the experience and wisdom of midwives and women who practise this art in their own lives.
The Art of Craft
Knitting seems as good a place to start as any. Several well-respected midwives have long promoted the art of knitting to both midwives and childbearing women. I knitted for years before I became a midwife. So I was delighted to hear Jean Sutton describe the influence of the nesting instinct on the way a woman’s body prepares for birth. She suggested that women who could take time out of their lives towards the end of their pregnancy to knit baby clothes and ponder on their experience might be better prepared physically, and perhaps mentally for labour. She explained that knitting and similar activities help to produce the `marshmallow cervix’ which is no longer a common finding of vaginal examination. Although, of course, the `art’ (or should that be science?) of vaginal examination is one which I, along with many others, would like to see getting less attention than the art of assessing progress in labour in other, less invasive ways.
I’ve heard Naoli Vinaver, a Mexican midwife, talk about how modern women need to be more `juicy’ in late pregnancy and labour, and knitting may be a way to achieve this. This is not to suggest, of course, that all women need to stay at home during pregnancy and knit baby clothes! But rather that the space which women may find in spending time on handcrafts may be beneficial. Perhaps we need to be expending more effort towards social policies and practices which would enable women to find this space, rather than forcing them to work throughout their pregnancy in order to support their families?
Ina May Gaskin and I were speaking at a conference together many years ago when I heard her suggest that those of us who were involved in midwifery education ought to be teaching student midwives to knit. We discussed this further over dinner that evening, and I promised to try this out at the University where I worked at the time, and report back. The results were mixed, perhaps partly because the group that I was teaching did not have a shared ideology. (Some loved it. Some considered it unprofessional. Some were struggling to work out which side of the divide they wanted to be on.) Since that first attempt, however, crafting has become an intrinsic part of my independent teaching, especially now that I work predominantly with groups of midwives and birth folk who are likely to value this approach. I have woven midwives into dream catchers on four continents, and frequently raised eyebrows in customs halls as I take bagfuls of craft materials into other countries, so that participants can knit, cross stitch or sew while we chat.
Several women whose births I have attended have realised the value of handcrafts. Sometimes these have been part of ritual work in pregnancy. Sometimes they knit blankets or piece patchwork quilts for their babies. Sometimes they make decorations for the birth room, ties for the cord or bags for the placenta. I have seen some use this for relaxation, and others as a way of coming to terms with the concept of motherhood and meditating on the process of birth itself. Many say that they to notice the benefit of this work on their labour. Perhaps it helps by recapturing and celebrating the nesting instinct. Perhaps it helps them find the space which so many currently lack. Just as those midwives have long thought.
The Art of Learning
We know from anthropologists that many people learn best in circles, and some of my fondest memories of being with other midwives come from sitting in a circle. I once worked with a co-operative of midwives who often spent evenings together around a campfire in somebody’s garden. They would tell birth stories, seek others’ opinions on difficult questions, gain support and reflect on practice. These circles were accompanied by a combination of food, wine, tears, laughter, hugs and songs. I have brought that idea into my own teaching as well, over the years. And I have never attended one such evening without feeling as if I have learned more than I would have done in a week of classroom learning.
How much longer are we going to attempt to ‘teach’, rather than facilitate and encourage learning? When people are made to sit in rows, while a teacher stands at the front and `spouts’ on a topic that few are interested in, students look bored and tired. They watch the clock. But if you swap the bullet points for pictures and add a reassurance that the group is free to knit, question or move if they need to, the situation changes. Even better, seat participants in a circle or semi-circle and add tea and biscuits. The group who have more fun are the group who will have achieved more in terms of personal and professional development at the end of the day.
These are just a few examples from my own experience, and I am delighted to have witnessed many more instances where midwives and others have incorporated art, craft and play into their work. I am re-sharing these thoughts now, some twenty years after I first wrote them, because it is my hope that women and midwives can continue to reclaim the arts of midwifery and birth for the betterment of all. And I look forward to a time where midwives are enabled to learn in the ways which are most effective for them and encouraged to develop their own art. Best of all will be when the presence of a midwife sitting and knitting in the corner of a labouring woman’s bedroom is again a common sight.
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A version of this article was originally published as Wickham S (1999). Reclaiming the Art in Birth . Midwifery Matters 83: 6-7.