the midwife`s journal <
18. welcome to the world
The magazine which comes with the Sunday newspaper has a lead story entitled 'Welcome to the world'. A baby girl - we know it's a girl, because the outside wrap is pink - tightly swaddled in the way only a midwife or doctor can do it, sleeps on the cover page. A picture of quietness.
The reporter, a woman who reveals that she has now experienced birth form both sides, spent a week in a large maternity hospital here in Melbourne, and during that time witnessed the birth of four babies. These births, and the environment in which they took place, form the subject matter for the story. The easily-flowing prose, accompanied by some pretty good photographs, tell me that the reporter has used the opportunity to observe well.
The final paragraph shocked me.
What kind of a world would that be? Are birth and pain synonymous, both to be avoided if at all possible?
How can this reporter's supposedly impartial tale of what she saw be in any way linked to the stories I have been telling? Stories of women who are empowered through the birthing process to reclaim authority for their own bodies, their own lives. Stories of triumph as women learn to overcome physical and emotional barriers, and welcome their offspring into their homes. The turmoil, fear and detachment described by the journalist are sensations quite alien to the experiences of birth as I know it, even though we are of the same time and place, and that hospital is one to which I accompany women if the need for medical care arises.
In reflecting on the startling differences between mainstream maternity care and the model I have chosen, I am immediately drawn to consider the role of the midwife. The midwife who admits the woman to the little room in the delivery ward. This midwife, a total stranger, is the one who tells the woman she is "only two centimeters dilated". What does this mean to the woman? The midwife is the one who "bustles back and forth, hovering hen-like over the woman, timing the contractions." She manages the gas, the TENS machine, the fetal monitor, and the administration of an injection of narcotic pain killer. She also offers encouragement and support. This midwife, whose technical and personal skills have impressed the reporter, then "deliberates on whether to call the obstetrician - call too early and they (doctors) are left hanging around and get angry; call too late and complications could set in".
The story tells us that baby Jim arrived before the doctor, who blamed the traffic. One might ask why he was called in the first place? And what are those complications that threaten to set in if the doctor is called too late? The fact that this birth took place at a well-equipped tertiary-level hospital, where at the push of a button the midwife could summon the help of skilled medical practitioners, makes it all seem like a sick joke. At nearly 10 pm the highly skilled surgeon is called from his comfortable suburban home to rush to the hospital, park his car, and run up the stairs. He arrives in time to officiate at the ceremony of cutting the cord, sign some papers, and go back to bed. He may have similar calls through the night, then next day be at the operating theatre early to begin life-saving operations. And this mercy-dash was for a well woman with a well baby, 'normal' by all definitions. The midwife called him because that's what she is required to do. The midwife was stressed about when to call him because her role at the birth in this place has more to do with assisting the medical practitioner than being a midwife practitioner herself.
Midwifery is described as woman-centred care, a partnership of trust. I wonder if women receiving maternity care ever describe it that way? The woman who is lying on a small bed in a small room. She stays on the bed because there is nowhere else to go, and because her partner is glued to the vinyl armchair, and because she can reach the gas mask, and because the monitor tracing doesn't work so well if she moves. She jokes self-consciously about all the wires protruding from under her frumpy hospital night gown. The noisy suction apparatus is switched on before her baby's head is born. Then the slippery mass of baby is hoisted by the midwife onto her chest. The woman is the passive recipient in a charade that is played out around her. And, I remind myself, this is 'normal' birth!
Has no-one here heard about non-medical strategies that reduce the woman's need for pain-killers? What about the continuous fetal monitoring, so frequently used inappropriately, shackling the woman to bed and immobility? Technology rules. The midwife takes on a dual role - the high-tech 'keeper of the machines' overshadows the remnant of the 'with woman' philosophy. And the woman barely rates a mention.
The beautiful cover-girl, a picture of quietness, represents the way our society likes to see a baby. Very quiet, very clean, very still. A little pink face surrounded by a heavy bundle of blankets and wraps. The vernix, blood and liquor are washed off at the first opportunity. The momentary skin-to-skin contact immediately after birth cannot last. The baby must be checked, weighed, measured, labelled, bathed, processed. The little bundle that is handed back to the woman some time later is quite different from the soft slippery little person with arms and legs and fingers and toes and a very special smell. The little bundle looks like something that really belongs to the hospital.
I am grieving as I reflect on the way our society welcomes babies into our world. The journalist's rejection of what she saw was well-founded. She thought she was seeing birth, so she was ready to give up on birth. Perhaps if more people were to reject the disempowering, high-tech, interventionist model of birth which is offered in main-stream maternity care there would be a reclaiming of the woman's authority for her own body. And perhaps midwives would seek ways of empowering women to birth and nurture their babies.