women marching with flags
Birth, Human Rights

A letter to midwives who have lost their way

Dear well meaning midwife,

I’m sure you found your way to this role through good intentions. I imagine you became a midwife through a passion for women, or a call to contribute towards positive change within the birth world. Somehow though you seem to have lost your way. Can you see? Can you recognise that in your attempt to change a patriarchal system, you have become part of the problem – but you don’t have to be.

You can stop reporting women to social services for believing in their bodies and their ability to birth their babies without your help. It is a woman’s human right to choose a wild pregnancy and/or freebirth. Maternity services are not compulsory.

You can stop infantilising the women who ask for your support during their pregnancies, and those who invite you into their sacred birth spaces. They don’t belong to you and they are not little girls you can judge to be good or bad. They are whole women who deserve to be treated as such.

You can stop acting as the gatekeeper. Stop “allowing” or “not allowing” women to make choices that they know to be in their best interests. And what is best for a woman is best for her baby – because nobody cares more about the wellbeing of a baby than its mother. It’s not your job to ensure women are making informed decisions. It’s your job to offer balanced information and above all trust women. They are the gatekeepers, not you.

On that note, you can stop lying to women about the options that are available to them or giving them false information. I’m tired of hearing women tell me, “I didn’t know”. They didn’t know that they could say “no”, or that they didn’t have to go for that scan, or accept that vaginal examination. They didn’t know that your policies aren’t always evidence-based or in their best interests. Do you see how coercive this is?

You can take the time to recognise and examine your personal bias. There is a reason why black women are five times more likely to die in pregnancy and birth than white women, and it is not because their bodies are broken. Acknowledge the systemic racism in maternity services and do the work to change it.

You can brush up your knowledge on what constitutes informed consent before going back into work again. When you carry out intervention without informed consent, it is assault. This might help… 

informed consent definition

“For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
The meaning of these terms are:
Voluntary – the decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family.
Informed – the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead.
Capacity – the person must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision.
If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.
This is still the case even if refusing treatment would result in their death, or the death of their unborn child.”

This isn’t about bashing midwives. I know that wonderful women-centred practice happens. But it doesn’t happen enough. I see midwives fighting for change, but I also see midwives who prop up a system that thrives on hurting women. If you are not fighting against the abuse of women in maternity services, then you are part of the problem.

What can you do instead? Offer women all the information, not just part of the puzzle. Respect women’s bodily autonomy above everything and call out anyone who doesn’t. Trust and believe in women, their bodies and their instincts. Support women who are finding creative and intuitive ways to birth safely in a world that does not care about them. That is what being with women is all about.

Uncategorized

Why it takes so much more than just hiring a doula to have a good birth

 

As we hear more and more about doulas, it’s easy to get the impression that having a doula will somehow magically lead to having a better birth experience. It often feels like one of the things on the ‘positive birth’ checklist; hire a doula, do a hypnobirthing class, read a birth book etc. and it’s true that having a doula can significantly reduce the risk of interventions and birth trauma, but that is largely due to the work that a woman does with her doula, and by herself, during pregnancy.

What we have learnt from women

Through our years of working as doulas in Greater Manchester, we have come to realise that birthing within the maternity system can and often will come with complications, barriers and difficulties. One of the best ways to combat these hurdles is to know what’s coming. Knowing how the maternity service works and knowing their policies gives you a head-start and also shows you that there are other options, such as birthing outside of the system. Knowing your rights and your options are the first steps to having a positive birth. A doula can support you in learning all of this, provide you with information and books on the subject, they can give you information about how the system works and how you can navigate it, and tell you all about the birth process, but it takes you to make the difference. 

Women who have had a traumatic birth in the past often come to us believing that their body failed them and that they need to do something different this time. Hiring a doula is a great start because it gives them the space to talk openly about what happened last time, a place to wonder whether those things were necessary or completely unacceptable, a place to cry and ask questions. Once women learn and start to believe that the process of birth is not inherently dangerous, and is not a medical event, it leads to an awakening that is incomparable. Getting to this point though takes a whole load of courage and openness from that woman, and when that woman is heard, she can find the answers she’s been looking for. So many of the women we listen to were having a perfectly normal, healthy pregnancy and labour until it was interfered with by medical staff, and realising that sometimes complications in birth are caused by the interference is key to protecting themselves against it. Their body did not fail them, the system did.

We have been programmed to think that authority means safety, but in so many instances we have been proven that in fact, the opposite is the case. When we trust someone else’s word over our own feelings of discomfort, we are left feeling violated. When we look to someone else for the answers, especially in birth, we are handing over our control and ignoring our intuition. We often hear in women’s stories that the parts that felt the most traumatic are when they went against what their body was telling them, and just did what they were told – so far I haven’t met a woman who regretted following her body. Our intuition is what has kept us alive and safe for so long, and birth is such a private and personal event that it makes very little sense to look for external approval or guidance. When we trust women, birth is safe. A doula is often the only person in the birth room who is solely focused on you, as the birthing woman, and having someone who completely believes and trusts in your body at that moment can make a huge difference to the energy. Questioning the authority of medical staff is necessary to get the birth you want, because going with someone else’s flow will inevitably lead you down a path that makes you uncomfortable or feels wrong. You ARE the authority, and you DO know best, even if you have never birthed before. Birth is a hormonal event and a normal bodily function – if you were monitored, observed and examined whilst trying to have an orgasm it probably wouldn’t go very well, would it?

Birth is led by the hormone oxytocin – as are orgasms – and for oxytocin to be released it needs the right environment. For women to release oxytocin they need to feel safe, warm, unobserved and undisturbed, so when you put a labouring woman in a brightly lit hospital with a bunch of strangers, unfamiliar loud noises and smells, and continue disturbing her with monitoring and examinations, it’s no surprise that birth takes longer or is more difficult. When birth is undisturbed, endorphins are released to match the intensity of labour as it builds – this is what makes labour pain manageable. When we interfere with the body’s natural pain killers, we cause more harm than good. Understanding what birth needs is a great foundation for planning where you want to give birth, and who you want to be there. Doulas can be really helpful in supporting you to navigate the maternity system when you are “going against medical advice” or just declining what you are being told is “how they do things”.

What we wish women knew before giving birth

We wish that all women knew that they were in charge of their body and their birth, that they didn’t have to agree to anything that feels uncomfortable or compromise with medical staff. We wish that women knew that birth doesn’t need to be fixed or monitored or sped-up and that they have the right to say no or to seek the care they are not being offered. We wish that women who have had traumatic experiences knew that they were not alone and that what happened to them was not okay. We wish that women weren’t expected to be “good girls” and do what they are told even when it feels wrong and that it’s okay to be “difficult” or “bossy” – in fact, that shows a belief in yourself, and the ability to assert your boundaries!

The work we do is to create the space for women to ask questions, to speak up and use their voice, to take what they need and to take back their power. We listen to women’s traumatic birth stories, we help them to write birth plans, we share information and experiences, we are behind them when they are navigating the system, or choosing to birth outside of it, and we have that unwavering trust in the birth process and in the woman in front of us. 

We support their choices, we hear their voices and we are privileged enough to witness their power.

But ultimately, what makes a positive birth is a woman who is ready to go deeper, to question what she is being told, and is fully supported in her decisions.