In the first part of this article, I looked at how and why people come to take a medical-model approach to birth, and argued that there is much to be gained from understanding how cultural influences, medical education and the pressure of client expectations, litigation and many other things can lead some health professionals to take an approach which is a bit less woman-centred and evidence-based than some of their clients and colleagues would like. In this second part, I am going to draw upon some of these ideas and share a few suggestions from my own and others’ experience of working with obstetricians who were actually Midwives in Disguise but just didn’t know it when they met us
1. Understand where colleagues are coming from.
If you haven’t read the first part of this blog post, please do so, but it is very generalised and everybody’s experience will be different. If you want to help facilitate someone’s journey to being a more woman-centred practitioner, get to know them and make it your mission to understand why they might not be taking that approach now. Not because that’s the best way to work out how to sell your idea (though I do believe from watching The Apprentice that it might be lol), but because it is genuinely interesting and hugely valuable to understand people and their journeys and because, if we are truly espousing a people-centred approach, then we need to listen just as hard to proponents of the medical model and hear their voices too.
If we don’t ask about and genuinely listen to colleagues’ stories, how can we expect them to ask about and genuinely listen to women?
The richness of the experiences that I have had talking to women and holistically-focused colleagues about their birth journeys is matched only by the richness of the experiences that I have had talking to more medically-focused colleagues about theirs. One example that I have permission to share is that of a medical colleague who grew up in Africa and decided to train after watching his grandmother serve as the local midwife. It turned out that he was very keen to see the intervention rate lower in the hospital that we both worked at, but felt forever thwarted because the midwives kept asking him to get involved. He taught me something very early on in my career that has remained with me ever since:
2. When you discuss a woman’s care with a colleague, be clear about what you are saying.
My (at the time) obstetric registrar friend pointed out that midwives would sometimes call him in because they felt they had to, for instance because a woman’s labour had exceeded the so-called normal time limits, when they really didn’t feel that intervention was warranted. They would tell him how things were going and, as he saw it, they often sounded a bit unsure about what they wanted and would make the conversation open-ended, leaving the decision to him. “Why ask me and then be upset because I intervene or impose a plan they don’t want?!”, he would say, in his booming voice. “It’s my job to interfere! If you bring me what looks like a problem and make it my responsibility, then I have to step in and do what I know to solve that problem. If all is well and you are telling me out of courtesy, then tell me that and be confident, and keep responsibility! Then I will be confident too. And I can drink coke in the staff room while you rub her back, because you don’t need me to do that. But if you ask me to take responsibility, then I have to do that, and you might not like my decision.”
That obstetrician remains one of my favourite colleagues ever, and over the years I have passed his words of wisdom on to many, many midwives. He taught me the importance of being very clear about roles and responsibilities and in what I was thinking and saying in my conversations with colleagues. He also helped me understand how, if you take ‘what looks like a problem’ to somebody ‘and ask them to take responsibility’, then they may well interpret that as you saying that you think intervention is required, even if that is not at all what you are saying. I have since talked to many people who have appeared to be very medical-model focused but who, when we sat down and really talked, weren’t at all… In some cases they didn’t feel they had the support of their colleagues, or they felt that people were concerned about a situation and trying to pass responsibility on to them and so they (actually quite understandably) chose to act rather than trust.
3. Ponder and invite reflection upon critical events.
Over the years, I have known many people in many fields whose practice has been strongly influenced – for better or worse, though who are we to judge what is good or bad – by just one or two significant experiences, often because they were particularly emotionally traumatic. Like the midwife who was very pro home birth, but only as long as women had a scan, because she had once seen a woman have an APH at home because of placenta praevia. This is arguably even more likely with obstetricians, who are pretty much always going to be present when a woman’s experience is particularly dramatic, traumatic or eventful.
“One emotionally experienced “disaster” can influence the beliefs and behavior of an obstetrician far more profoundly and powerfully than hundreds of normal deliveries. This single phenomenon goes a long way toward explaining why obstetricians cling so tenaciously to the birth rituals that have been consistently presented to them as the only means of preventing those disasters.” Robbie Davis-Floyd.
Again, midwives and birth workers are far more likely to get the opportunity to reflect on this kind of scenario than our obstetric colleagues, and they are also (in my humble experience) more likely to be offered emotional support, which is why we also need to
4. Hug obstetricians.
Many midwives work in environments where they get to hug each other – and sometimes women and babies – pretty much whenever they need to, but obstetricians don’t always get hugs. Or – perhaps even more importantly – emotional support when things go wrong. In some cultures, medical staff are expected to ‘man up’, get out the stiff upper lip and not display any emotion. But it doesn’t hurt any less to have a bad day or a bad outcome. We need to create spaces where all staff can safely ask and receive emotional support, hugs and TLC as and when they need it.
5. Invite obstetricians to see normal.
As I said in the first part of this post, if you only get involved when things go wrong, you can get so used to the idea that birth is abnormal and risky that it is very hard to remember that, in most cases, it all goes really well as long as we don’t interfere. Which means we need to find ways of enabling prospective proponents of the midwifery model to experience what we experience. When I said on facebook the other week that I would consider letting a handful of my obstetrician friends come and sit on the sofa and knit (in order to keep their hands busy) during my home birth, I was only half joking. It is, in my humble opinion, unreasonable and unrealistic to expect professionals to support something that they don’t have experience of themselves. If we want certain colleagues to be more accepting of holistic midwifery care, then we may need (with women’s permission, of course) to let them see what that looks like. And we all know that updating is important too, so they may need a refresher every now and again! I totally understand why some midwives want to bar the door, and we absolutely need to make sure that we only think about this with women who are OK with it (and with colleagues who will be respectful of the environment) but I think this is an important one to think about. If nothing else, we should be offering loans of videos and sharing useful pictures, memes and infographs (with credit to the originator, of course)…
And it’s not just about birth. Invite medically-focused colleagues to childbirth education groups, to coffee mornings, to breastfeeding sit-ins, to anywhere else where there are healthy, pregnant women who can help put the amount of abnormality they see in their work into perspective and serve as a reminder that birth works really, really well and is better left alone in the majority of cases.
6. Invite obstetricians on dates.
OK, maybe not in a romantic way (unless that’s your thing); the kind of dates I mean are those that might also help more medically-minded colleagues to experience midwifery model thinking and being. OK, so you may have to judge this carefully, but you might invite them to come and see the latest birth-related film with you and your colleagues, or – when you meet people who are a bit further along on their journey – to a workshop or midwifery conference. Especially the holistic events, though maybe warn your colleague first! Pick the sessions / workshops carefully, as your colleague may be more receptive if you can find them someone who is very evidence-based, or who shares some of their views, or whose approach / humour / dress sense you think they will appreciate. Encourage them to join you for dinner before or afterwards or, if it’s an overnight event, to hang out at the bar and go to the pyjama parties and the storytelling circles. I am stressing this for two reasons. I personally know several obstetricians for whom this has really helped them better understand the midwifery model, and I also have obstetrician friends who are on a journey and who struggle because they no longer fit in to their medical world, yet they don’t always feel they belong in the midwifery world either. If we want more people to join (and stay in) our world, we need to make space for them in it.
7. Understand the power of personal experience.
Finally, and even though I talked a bit about this above, I want to share one more thing from Robbie Davis-Floyd‘s work in this area. Robbie also co-authored a book called ‘From Doctor to Healer: The Transformative Journey‘, in which she analysed the experiences of doctors who had come to reject the medical model approach and embrace a more holistic, people-centred way of being. The single biggest message which I took from that book is that, in most cases, what changed these practitioners’ perspective wasn’t a rational analysis of the research, or even a long-term relationship with a low-tech midwifery unit with the chance to attend normal births, but a one-off emotionally-based experience which got their attention and caused them to re-think their worldview. Maybe it was the experience of being at one birth, or hearing one sentence spoken at a conference. Alison Barrett writes about this, and please read her article #notallobstetricians, because she also writes about several other really important elements of this discussion that I’ve not had the time to go into here.
We can’t know what the trigger will be for a particular person, and it may be that these one-off experiences only make such a difference because they are part of a bigger journey, but what I take from this is that all of the things I have suggested above – which all expose our colleagues to fundamental elements of the midwifery model itself – will make it more likely that others will be able to see what it is that we see in this approach and why it is so valued by and important for women.
If you have other ideas, please feel free to add them below.
This is the final post in Sara’s 2014 BlogFest, in which I’m writing a birth-related blog post every weekday for two weeks as a thank you to those who have supported the heart-funded element of my work in 2014 and in the hope that others who share my goal of having a source of free birth-related info for midwives, birthworkers, women and families will consider making a donation in order to kickstart my efforts to keep this site and my research-sharing activities free throughout 2015 – please click here to donate, and thank you for caring about women and babies.