Emma Mahony
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I am a mother of three who managed, after a protracted fight with the NHS, to have a wonderful, inspiring, uplifting birth with a private independent midwife at home. I am not a nutter.
I made more than 100 phone calls in the two weeks between hospital appointments to find someone who would listen to my reluctance to go under the NHS knife, to find someone who would take me on to birth my twins normally. I knew that I could do it, but I didn't really want to fork out £2,000 for the privilege. My mother had birthed my twin brother and me normally, so why couldn't I be encouraged to do the same?
After all the puffing and panting, I discovered a secret that too few mothers are let in on: birth can be great. Not an ordeal to be got through, but a powerful beginning to motherhood, a set-up for all the snot, sweat and tears to follow. Every woman in this country deserves what I had. Our mothers had it, so why shouldn't we?
Choice: that awful overused government word. The only phrase I hate more in matters of state is “informed choice”. It doesn't mean a thing. Pregnant women don't have any choice. That baby is going to come out one way or another whether they like it or not. Childbirth is a bloody, messy, unpredictable, painful experience that transforms women from selfish girls-about-town into all-important mother figures. Go ask any therapist. So why, in this modern age of feisty female CEOs, are women being dazzled by the flashing lights and deafened by the beeping monitors into believing that they have “choices” when they waddle in the hospital labour ward (if it is actually open for business)?
And why are so many of the good, experienced midwives who understand that women need kindness and encouragement above all in labour getting the hell out of hospitals? And why are these last guardians of normal birth, self-employed independent midwives, being hounded by the NHS in medieval witch hunts to put them out of business?
Has the maternity profession missed something here? Are they really so busy arguing over money, power and control that they fail to notice the labouring woman in the corner, not waving but drowning in her birth pool?
OK, let's put the weapons down for a moment. No woman is going to be challenged here for wanting to wail at the moon on her birth ball, electing for the clinical certainty of a Caesarean or wanting more drugs than Amy Winehouse on the night before a prison visit. Let's accept that all women are different and like to do things their own way, and wouldn't choose the same pair of shoes on the high street or Babygro at Mothercare. Let's focus instead on how all women are the same, have the same creature needs at this worry-filled time, and how those needs are not being met.
First, the Government is saying all the right things. Since 1993 and the first well-worded document Changing Childbirth, successive governments have made confident noises to reassure women that they are going to be looked after properly. The latest 2005 White Paper says even more of the right things, namely that all women will be looked after by “a midwife they know before and after the birth”. Ann Keen, a Department of Health Minister, says: “This will be in place by 2009.” So much for the theory.
Now for the brutal, bloody truth. This one-to-one care is to be achieved by 2009, says the Department of Health, by recruiting 1,000 midwives. But that's not enough, say the Royal Colleges of Midwives and Obstetricians in their report, Safer Childbirth.
We need a further 5,000 midwives just to offer one-to-one care in established labour - that's just the pushing stage, let alone the pregnancy and post-birth period. So while the numbers don't add up, paying for these midwives is even more disastrous.
According to Louise Silverton from the Royal College of Midwives, the extra £330 million funding announced with a fanfare in January has not been ringfenced, so as the money has started to trickle through last month, reports are already coming back that it's being spent on other wards by the local hospitals.
And how did we get to this stage where dangerously few midwives are looking after far too many women, as many as five in labour at the same time? Christine Beasley, the Chief Nursing Officer, puts the shortage down to the rising birth rate: “The Office of National Statistics suggested that this was a blip at first, but it is now clear that the rising birth rate is an established trend,” she explains. “And the midwifery workforce is ageing. It was part of the baby-boomer population - and many midwives are now approaching retirement. We are recruiting younger people in a more competitive world.”
And at this moment of crisis, when the burnt-out hospital midwives are routinely handling around 170 births each a year in a revolving door of hospital anonymity, the Government chooses to turn on the very last resort left to women such as myself - the independent midwife. These midwives have often been driven out of the NHS because they can no longer practise what they see as safe, women-focused care in the context of a hospital. Many of them are among the most skilful practioners of normal birth in this country - my midwife, Mary Cronk, had assisted at hundreds of successful normal twin births over her 50-odd years on call and tours the country lecturing on normal breech birth. Their possible extinction over an insurance issue that could so easily be solved by contracting them into the NHS as they are in New Zealand, or by just dropping it as a mandatory practice, is a frightening possibility. If the issue is not solved by 2009, all that they symbolise as the “gold standard” of care in this country will be gone with them. As Louise Silverton says: “The NHS should be able to offer this to independent midwives. It shouldn't be a gold standard. It should be every woman's right.”
Make no mistake, this is not just a middle-class fuss. In speaking to dozens of women who have suffered in silence over their recent treatment in hospital, we are all in the same dirty boat. One 19-year-old mother was taken on free of charge by Virginia Howes, an independent midwife in Canterbury, when it became clear that she had been told nothing at all about pregnancy or birth.
The girl saw the difference between her own quick labour in a pool at home (“I felt safe and looked after”) and her sister's birth in hospital five months later (“It felt manic and busy all the time, she didn't cope well with it”). While the 19-year-old went on to breast-feed her baby for six weeks, her sister was ejected the next day, with a bottle given for the baby. She never breast-fed and suffered depression.
Post-natal depression, sometimes triggered by a bad birth experience, is rife. Ruth Weston, 39, who lives on a council estate in Bradford, West Yorkshire, forked out 15 per cent of her annual income for an independent midwife for her fifth child, after the trauma of her fourth. “With my first child I got a lot of care on the NHS, and, ten years on, I'm paying for it, and that's wrong. My five births can chart the deterioration of the service.”
As a student of liberation theology, she believes that the only way forward is for midwives and mothers to join forces, and she lobbies her MP and sends postcards to the local hospital to make her feelings known. “Abortion was legalised over a health issue. This is not a moral issue - a small number of women will go ahead and have their babies their way if independent midwives are lost. It's not acceptable, and it's not fair.” And that small number of women is already increasing as they opt out of the NHS altogether in favour of “freebirthing”. Veronica Robinson, editor of The Mother magazine, who lives in Cumbria, is writing a book on the subject, partly in answer to the number of inquiries that she fields from readers. “These women have educated themselves and are not irresponsible as people suggest,” says Veronica. “I think a lot more women will turn to unassisted birth.” Many of these radical freebirthers are often midwives themselves, she says.
However we fight the good fight, we must not sleepwalk into the nightmare of birth in America. In a country where one in three births is Caesarean and only 8 per cent of women are able to use midwives, 18-year-old girls are said to describe birth as like “having more plastic surgery”. Through the film The Business of Being Born, made with chat-show host Ricki Lake, however, that culture is now changing. The US campaign - The Big Push For Midwives - is being used for the Save the Independent Midwife Campaign here in the UK and the movie is being screened all around the country. “On the internet they have already said, ‘Ricki Lake gives birth naked... Ew, I want to vomit',” said Ricki Lake at the premiere. Popcorn, anyone?
Emma Mahony is author of Stand and Deliver and Other Brilliant Ways to Give Birth, published by HarperCollins (£7.99).
The first screening of The Business of Being Born is on May 14, in Milton Keynes. For other screenings around the country visit www.independentmidwives.org
“One of the most incredible people I have met”
Alex O'Connell recalls how important an independent midwife was to the birth of her second daughter
“This isn't a hotel, you know.” It was a single sentence from the mouth of a maternity ward nurse that summarised the complete lack of emotional generosity that I had experienced during the birth of my first daughter in a London NHS hospital. Not a drop had passed my mouth for 48 hours, and I'd had the audacity to ask for a glass of water. I was still paralysed from the waist down from the epidural. The water never arrived.
A few hours later, I had a bed pan shoved under me and left there for three uncomfortable hours (I'd had an episiotomy a few hours before). This all followed a two-day birth in which I almost delivered in the hospital corridor, for lack of ward beds, and was made to feel like a blundering resource strain. Thank God I avoided an emergency Caesarean by exactly two minutes, because, although the baby was fine, I was told that an NHS deadline is an NHS deadline. As I vomited from an allergy to the drugs they gave me to deliver the placenta, I was told to hurry up as there was a queue outside. I was given no assistance with breast-feeding and drifted off to sleep on the postnatal ward (my husband was kicked out after ten minutes) to the sound of women weeping.
On leaving the hospital (I begged to be let out the next morning but was reprimanded by a young female doctor for being irresponsible), I developed post-puerperal fever, which took two doses of antibiotics to shift. It was no wonder. The bathrooms in the postnatal ward were like a scene from Texas Chainsaw Massacre (the shower, floor and loo seats sprayed with other women's blood). So as well as getting to know baby Mattie in our first fortnight together, I was sweating it out in bed with a temperature and infected stitches.
I was brought up a Roman Catholic and can repress as well as the next lapsee, but 34 weeks into my second pregnancy the terror struck. I'd moved house, so was able to opt for a different hospital but had had a different NHS midwife on every antenatal check-up, and had a deep fear of what was to come. Plus, my baby was breech and I'd been told by the doctor that there was no way that I could try for a natural birth. They would only do a Caesarean. I was “high-risk”, it was explained. It seemed ridiculous when I'd had a trouble-free pregnancy and was carrying a good-sized baby.
Lunch with a wise friend who had had a similar experience and then a successful home birth of twins aided by an independent midwife came in the nick of time. It took one bowl of pasta to change my birthing plan. She put me in touch with Jane Evans, a campaigning independent midwife who is one of the most incredible people I have ever met.
Jane agreed to take me on, driving down from Hertfordshire to North London for antenatal visits, delivering a birthing pool to my front door. She warned me that I couldn't get insurance (the Government won't back independents on this issue) but I had complete faith in her judgment. She encouraged me to have a natural breech birth, recounting her endless success stories and empowered me with information and her expertise.
Her fee of £3,000 was utterly worth it. The birth was hard, painful, long but very rewarding. The baby turned at the last minute. Mattie was able to meet her 20 minutes later (she chose to watch Pingu during the grizzly bit), and Jane let her weigh her new sister Dodie (pictured above with Mattie), which created an immediate bond between the sisters. I recovered super quickly, had no infections, and was pushing a double buggy a week later.
We need to protect our right to have babies how we want to have them, and support our independent midwives, who are brave, underappreciated professionals doing the most important job that there is.
The best money we ever spent
On Wednesday last week, the independent midwife Virginia Howes (pictured right) launched herself off a ducking stool into
the waters of the River Stour in her home city of Canterbury.
She was protesting against the threat of extinction of independent midwives over the issue of professional indemnity insurance.
If no help is offered by the NHS to contract in self-employed midwives under the clinical negligence scheme, they will be forced to stop practising by 2009. Midwives have traditionally been ducked on stools such as this, alongside witches and nagging wives, since medieval times.
Soon after the ducking, Howes marched local news broadcasters around to a client's house, where the woman had given birth hours earlier with Howes in attendance. “Some of the medical profession think that independent midwives are like loose cannons and unexploded bombs,” she said. “But we are very safe practitioners who have our hearts and knowledge with these women.” The proud parents, who had had a long but easy birth at home the night before, showed their baby off to the cameras and announced that hiring Virginia was “the best money we ever spent”.
To support the Independent Midwives Association's campaign to urge Primary Care Trusts to use their services, sign up at saveindependentmidwifery.org
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I have been a midwife for 30 yrs +
I have worked with midwives from the independent sector and those working within the NHS .
Most are safe , vigilant , caring individuals, some however are down right useless.
Its about the skills of the practitioner and the confidence to be the womans advocate
Lyndsay, Manchester, UK
Improvement in maternal, perinatal and infant mortality are more a result of better public health, NOT the latest trend in obstretrical procedures. Clean water, steady food supply, vitamins, antibiotics and pitocin (oxytocin) for post partum hemorrhage save lives -- not epidurals! Look into it.
Marge, Midwest, USA
Following 7 years as an NHS midwife, struggling to keep up with the huge volume of women I was assigned to care for, I have recently become an independent midwife. I now have the time and support to do the job properly. The independent midwives I have come across are the best in the profession.
Kathryn Weymouth, Alton, Hants
Midwives (and doctors to a certain extent) are the experts. Women who think they know better because of what they've read on the internet undermine their work, putting themselves at risk. Stories of successful homebirths are great, but there are more successful hospital births - it's media hyperbole
Lauren, UK,
I can certainly say that Independent Midwives are amazing, I am using Virginia Howes (pictured right ) for the birth of my first baby next month and instead of being scared of labour as I was just a few months ago, I am now excited and ready for the whole experience and that is because of Virginia.
Natalie Tipple, Sidcup, UK
I would suggest that Ms Tuteur obtains the excellent book, "Safer Childbirth? A Critical History of Maternity Care" 3rd Edition (1998) Marjorie Tew. Free Association Books. London.
Ms Tew was a Research Statistician with neither an obstetric or midwifery axe to grind. It is enlightening reading.
Allison Ewing, Glasgow, Scotland
I've had two birthing experiences at two different prestigious Boston, MA, USA, hospitals. The first experience (with an OB/Gyn MD) was so bad that I sought midwifery services for the second birthing experience. Midwives provide superior, more holistic care.
Mary Smith, Boston, USA
It is very, very interesting to note that vets would consider it too risky to move a labouring mother, to disturb her in any way, or to intervene unless necessary to save a life. To do so risks death of mother and baby from stress, or the mother rejecting (and possibly killing) her offspring.
Katie, Lincoln, UK
Midwives do need to stand up for normal birth because people rarely question medicine, even when it can cause more harm than good. Sadly babies also die because of medical misjudgement. Intervention should be used wisely - that is the greatest skill, but often sadly lacking.
Christine, Newcastle, UK
It says nothing good about the NHS that in order to ensure a woman has a glass of water after childbirth, she must first have the 3,000 to pay a private midwife. Perhaps improve the healthcare that is being paid for by taxes so independant midwives aren't the only option for a high standard of care.
Mel, Baltimore, United States
Being "fully informed" in my experience seems like an excuse for midwifes to tell us only the "downside risks" of having babies outside the usual "run of the mill" arrangements. To balance this we must share "risk" eg via RISC designed to inform us of the "upside added value" of homebirthing.Easy.
Mrs.Josephine Hyde-Hartley, Bacup, UK
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