I’ve recently been writing and talking a lot about birthing revolution. And there’s been some GREAT discussion. That we NEED a maternity care revolution here in Australia is very obvious. Women need choice. Women need autonomy. Women need their knowledge and power to be acknowledged and respected. But something, someone, has been missing from the conversation. When talking about a maternity care revolution, it is really important to remember this: Midwives are women too.
We need a maternity care revolution because “women’s business” is being run by the patriarchy
Now sure, not every single midwife is a woman – there are an increasing number of male midwives getting around. And not every obstetrician is a man – there is a huge number of female obstetricians these days. But the obstetrical system is inherently patriarchal. And midwifery is inherently “women’s business”. Midwives embody millennia of female knowledge and power. Obstetric culture, by its very design, is set on stamping out female power. Women are at the bottom of the totem pole – midwives are one rung above the birthing women they serve, with babies, obstetricians, hospital boards and registering bodies holding more power. Yes, that’s right – babies hold more power in the obstetrical system than women. Just think…How often are things done to the woman because “it’s best for the baby” without a single thought or discussion about what is best for the woman? And how often are women told that what happens to them, and the risks forced upon them, doesn’t matter because “all that matters is a healthy baby”. “The system” holds the power and wields it over the women caught in it.
We need a maternity care revolution because midwives are increasingly being forced to be “with obstetrician”, “with CTG machine” and “with hospital policy” rather than where they belong: “with woman”
The current obstetric culture harms midwives. And not just the independent and lay midwives who are being hounded to extinction, but the hospital midwives who are no longer able to be “with woman”. The midwives who are trying to protect women from unnecessary obstetric intervention. The midwives who are standing at the door to the birthing room telling the OB that all is well and that the woman simply needs a little space and time. The midwives who are trying to balance their responsibilities to their employer with their responsibilities to their clients. The midwives who are trying to make birth a more positive experience for the thousands of women birthing in hospital. The midwives who are increasingly unable to practice true midwifery.
The CTG machine midwives are required to pay a significant amount of attention to. Image courtesy of Wikimedia Commons
We need a maternity care revolution because midwives deserve choice and autonomy too
So how does this inability to actually practice midwifery affect the midwives? We know how it affects birthing women (lack of choice, fear based (s)care, non evidence based recommendations etc) but what impact does this have on the midwives themselves? While we might say that midwives have the choice of where they work - homebirth, hospital, birth centre, for a private OB etc this “choice” is really just an illusion, just like women’s choices are. Many midwives can't, realistically, attend homebirths due to the risks involved with having no insurance and vexatious reporting. Many also need the security of ongoing income and regular hours (especially if they have children themselves). So you have midwives who are limited to working in an environment that is not truly supportive of them.
Midwives deserve to be able to support their client wherever the woman wishes to be, including at home. Image courtesy of Wikimedia Commons
And what of the new brand of midwives – medicare eligible, practising “rights” in hospitals, “allowed” to practice privately. Is this new choice, for women and midwives, really adding to the choices available? Does this make true midwifery care more accessible? Or is it simply a case of hospitals wanting to be seen to be “giving” women the choices they are asking for without actually handing over any of their control? These midwives need to enter into collaborative arrangements with obstetricians and hospitals. It is exceptionally clear who holds the power in these arrangements. If an obstetrician or hospital decides that they do not wish to support the midwife’s practice they can withdraw from the arrangement leaving the midwife, and her clients, high and dry. The obstetrician does not need any reason to withdraw support – it may be from a genuine concern about practice, it may be that they simply don’t like homebirth or it may be that they just don’t like the midwife. If a midwife has concerns about the OBs practice she is essentially stuck with the options of finding another OB who will support her and her clients or being unable to provide services under medicare eligibility or within the hospital. Women receiving care from a medicare eligible midwife are often finding that they are still bound by the “same old” policies. These midwives are also finding that they are unable to fully support women in their autonomous and informed decisions or they risk being unable to offer their services at all.
We need a maternity care revolution because hospitals will make vexatious reports against midwives who support women in their informed choices but will brush aside women’s reports of bullying, coercion and assault perpetrated by OBs
We need a maternity care revolution because women deserve to birth without fear and midwives deserve to practice without fear
The system controls women through fear. Birthing women are forced to conform and consent through fear – the “dead baby card” is a widely used ploy to get women on the “just think of the baby” bandwagon. Midwives are also forced to conform through fear. Fear for their jobs. Fear of a vexatious report being made. Fear that their client will be treated poorly if she transfers to hospital from her planned homebirth. And a fear for the future of midwifery practice in Australia.
The mother - baby dyad is talked about a lot – with very good reason. What is good for mum is good for the baby, because happy healthy mums tend to raise happy healthy babies. Women who enter motherhood feeling strong and empowered are able to fully realise their capabilities and will parent confidently. But let’s not forget the midwife - mother dyad. Strong and empowered midwives, who can practice true midwifery without the influence and control of the obstetrical patriarchy, will help to ensure a future of strong and empowered mothers. Strong midwives, strong mothers, strong babies.
"We need a maternity care revolution because midwives are increasingly being forced to be “with obstetrician”, “with CTG machine” and “with hospital policy” rather than where they belong: “with woman”. THIS IS BANG ON, LIZZIE! Can't love this article enough! x