I’ve never been one for keeping quiet about my love for midwives and midwifery. Any hint of discussion in the popular media and I find it difficult to ignore (just like now, when I should be drafting my next job application). This morning for instance, I was unable to leave my parked car and get back to the office because BBC Radio 4 consumer programme You and Yours were having a call-in about the UK Health Secretary’s announcement that 3000 more midwives are going to be pulled out of a hat to meet the massive shortfall in the NHS. This need was also pitched alongside the depressing statement that the UK has one of the highest infant mortality rates in Western Europe.
I spent some time in my car shouting at the radio, tweeting furiously about the Health Secretary’s role in eradicating independent midwifery, stripping students of NHS bursary’s and generally screwing up anything maternal health related during his time in the role, the fact that a rise is infant mortality is also down to the exclusion of vulnerable groups from healthcare due to impossible charges for non-UK/paperless residents etc etc etc My number 2 son who was in the car with me begged to be let out before I continued further.
The UK is often touted as an example of publicly funded midwifery-led care that should be learnt from and emulated where possible around the world. Thanks to Mr Hunt this is a rapidly declining recommendation, yet it still pops up in discussions where midwives are even less valued by the state than they are here.
This report popped up on my twitter feed today. Quoting the excellent work of Canadian midwifery professor Saraswathi Vedam, the report argues for the greater role of midwifery-led birth care in the US. With the usual idealistic view of midwives in Europe, Canada and Zealand – without saying so a particular kind of midwifery from the white folks as this model of institutionalised and regulated health care is. When I read this commentary, alongside listening to the discussion on my radio, I also inevitability think of my own research in Mexico. The long, long long debates and conversations I have with my research partner and friend Cris Alonso about trying to get midwifery even recognised a profession in Mexico, let alone through the doors of a public institution or university. I’ve come to realise how much we (as researchers, policy makers, families, educators) demand from midwives. Whether they be traditional birth attendants in low-middle income setting, or independently practising below the radar in a country that prohibits home birth, or over-regulated, overworked and underpaid in a rich country’s public health system – we want a lot.
Yet at the same time as demanding more (or less) midwives, stretching out their responsibilities and scope, bringing them under ever closer scrutiny, what I ask are we doing for them?
The midwifery models of care across cultures and histories promote an ethics of care, one that centres women as experts in themselves, values intergenerational knowledge and above all a concern for the environment in which women grow and bear children. When will governments, policy makers and users of health services apply the same philosophy to the women who take up the profession and vocation of midwifery? We cannot expect these people to work miracles unless we provide them with the respect, resources, tools, autonomy, educational opportunities and environment to do so. As the hashtag implies #MidwiferyMatters , but certainly no more or less that the midwives who practice it.