I am in constant conversations with my midwife and research colleague in Mexico about practices, policy and the state of midwifery worldwide. It is through these whatsapp conversations and frequent skype meetings that, through identifying knowledge gaps and needs in Mexico I learn a lot about the state of midwifery in the UK.
If I have an area of doubt or lack of information (I am after all an anthropologist not a midwife) I often take to the twittersphere and mailing lists I am a member of. It is here also that I get to talk to many sages whom I neither know personally or have ever met. Midwives globally are an amazing font of knowledge, carrying out research and publishing whenever and wherever possible – unfortunately quite often to limited audiences (other midwives or maternal health and birth enthusiasts/researchers/activists like myself). This is absolutely nothing to do with the standard of discussion, it does however have much to do with medical hierarchies, authoritative knowledge systems, patriarchal and prescriptive notions of what constitutes scientific knowledge, reporting of such knowledge and who gets to own that knowledge. It is also to do with time limited studies, natures of collaborations and support given to everyday and academic midwives to carry out research. What high profile publications such as the Lancet publish amazing special editions such as this one and the much celebrated UK Maternity Review the backlash from elements of the obstetric community is massive and immediate – as evidenced in this excellent and balanced commentary by Prof. Hannah Dahlen .
Our current struggle in Mexico is that there are so much knowledge and evidence of good (and not so good) practice amongst midwives. Women across Mexico are attending enough births (also pre and post natal care) a year to gather a solid chunk of measurable variables to finally put the meat on the bones of the well worn and recognised: community midwifery models of care = better birth outcomes, better maternal mental and physical health, fewer deaths, less unnecessary surgery and VAW, strengthened communities all round. Yet these women are so busy doing just that, they have so little time and energy left over to gather the data needed (qualitative as well as quantitative) to evidence their work in the face of a massively overbearing and dominant medical monarchy.
In comparison, though the development of midwifery as a profession in the UK is vastly different to the varied practices and identities in Mexico – data collection, on the things that matter to women and midwives remains depressingly similar and for similar reasons mentioned above. The reason why I am writing this post is due to a request from my Mexican midwife for evidence on the use of Nitrous-Oxide (more commonly known as ‘gas and air’ or by it’s trade name Enotonox) in home births. My automatic response was “sure, there must be loads written about it!” After all, we tend to use the stuff like its going out of fashion whether it be at home or hospital – though reportedly (anecdotally) it is less used in home births as with most medical intervention. So how did I fair in my initial search through the ever faithful google scholar? ………Nothing, nada, zilch … I played with word order, I booleoned, I resorted to a wider net casting of blogs and online magazine sources. The nearest I got were some passing comments on its widespread use (from non-UK papers), and in the UK context guidelines on storage and use, a few posts on the possible dangers of its use (by few I mean 2) and countless birth narrative where women speak about how they felt using it during home birth and/or transfer – all of which useful to me as an anthropologist, little of which useful to store as evidence for ‘scientific’* publication. An addictive substance, administered everyday by midwives and used by women in the throws of birthing and yet there is no exploration of its use in an out-of-hospital birth pain relief or whether it plays a role in the type of birth outcome. Many midwives have an opinion on its use, as do the women who have or may use it, moreover someone beyond my personal circle must care about the role it plays in home birth outcomes. As a response to my request for references said:
It’s been used for many years and as such there is none! https://t.co/EFuIXRGMOM
— Midwifery Matters (@radmidassoc) November 8, 2016
Like so many of the maternal health practices around the world (UK – Entonox, Mexico – episiotomy, everywhere – elective c-section) a practice becomes the norm, the norm becomes unchallenged. Yes Entonox is part of the pain-pain free thesis but that doesn’t mean it shouldn’t come under scrutiny. There are certainly studies done in hospital circumstances (mainly by obstetricians and medical students) so why not in home birth situations? This question I think leads me back to the aforementioned reasons as to why so little evidence is recorded and collected in Mexico and the common opinion amongst midwives wherever they are from:
— Mrs Legend (@SamNash13) November 8, 2016
Anthropology has a great history of working and writing with midwives, the reproductive and feminist anthropology archives are bursting with ethnographic examples. I have spent the last 7 years working in a Faculty of Nursing and Midwifery and have often felt the a warm glow when I see well thummed and familiar ethnographies peeping out from midwifery colleague’s bookshelves. The time I have spent working around midwives in both of my home countries I have also been very aware on time and lack of support that midwives receive for carrying out on-the-ground empirical research. A 2014 commentary in the Lancet argued that Interprofessional Collaboration is the only way to ‘save every woman and child’ (UN’s strapline not mine!). With this post I am fervently arguing that Interprofessional Collaboration between midwives and the social sciences is the only way to save properly robust and challenging evidence based midwifery and woman centred research (my strapline not the UN’s!). We support our midwifery colleagues to be able to carry out even more research improving on the amazing work they already do – and we must listen to them in terms of how we are to achieve this.
*I don’t hate science, I just hate the loaded use of it as an adjective with a hidden agenda.