Call the midwife! (to do some collaborative research)


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:

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:

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.


Writing more about less UPDATE #15minAcWri #AcWriMo

I thought it would be worth doing a quick check in as to how my writing challenge has been going mid-term. Tomorrow #AcWriMo begins and it comes just in time for me to tackle some half finished papers that have been on the slow burn! This post will look at how I’ve been using my 15 minutes of acwri and what I’ve (re)learnt about my writing habits, so that hopefully this years #AcrWriMo will be a personal success.

Okay I admit I do not have a massive teaching load this term so in many ways I am advantaged, but to be honest the regular 15 minutes that I have been devoting to the beginning of each day are helping me recognise some habits about my writing (and reading) practices that I think can be maintained even in those busier times. I’m 6 months past my PhD thesis ( 2 months past corrections) and already I’m starting to wonder how I ever got it done in between working and family life. I need to remember – because I have a stack of papers to write!

In the meantime here is how I’ve been using my 15 minute #AcWri so far:

Writing to do lists for the week: 

Everyone loves a list! (or is that just me?) Lists give my life and work meaning and give me a sense of accomplishment. Just like this one, as it is a reverse ‘done list’ a way of reflecting on what I have done over the last few weeks. ‘To do’ lists also keep my  day on track.

Writing Short Blog Posts: 

This longer post has actually taken up 3 of my 15 minutes as I planned it more than most. However what I have learnt is that I can actually write rather a lot in free form within this timescale. Writing drafts or published posts for this or guest blogs gets the ‘stuff’ out of my head and clears my thoughts for the day – a bit like the sitting down version of a morning run. After a couple of days I noticed my word count jumping up from 500, 600, 700. It’s amazing considering for my other ‘proper writing’ I can spend 6-7 hours trying to force out a paragraph or two!


Like the academics I follow for #acrwi advice (@raulpacheco, @thesiswhisperer, @explorstyle) I include reading in my acwri routines. I cannot however read an article or chapter deeply in fifteen minutes, despite my many talents superwoman speed reading is not one! Inspiring blog posts, initial reading of chapters (already identified in my to do list) and abstracts are just about what I can cover in this time – sifting through the “oooh that’s interesting” to the “I do actually need to know more about this stuff to inform my thinking/writing”. What I have found is that only online blog reading previously identified and in the list works in 15 minutes, and my failure has been clinking on links and wandering into the online ocean, only to surface 1 hour later! Not advised ..

Working on application forms: 

I have had various funding and job applications to complete over the last month, planning and proof reading my statements and CVs during a 15 minute spurt has made this a much less onerous task (ignore this sentence if you love a good application form!).

Organising Evernote: 

Been meaning to do this since I handed in my thesis and just never got around to it. 15 minutes works great for a bit of electronic filing and because I stop when the alarm goes off I stay focused and don’t sway into reading tagged material from many moons ago.


This is a tricky one and only works if you concentrate and answering yesterday’s emails on the understanding/acceptance that you will never beat that academic email mountain. If you answer yesterday’s emails and deal with them quickly 15 minutes helps you limit not only the amount of work day time you spend but also that overwhelming feeling that accompanies a full inbox.


I would like  to say to any future students, publishers, reviewers and employers that I do obviously spend full days editing my writing! However fifteen minutes is enough to edit a draft blog post, important email or statements for aforementioned application forms.

Lesson Prep: 

Knocking out a 3-5 hour lesson plan, synopsis and reading in 15 minutes is a great way to start a lesson planning day. Once that is in place you can structure the rest of the day deep reading and writing the lecture or activity you have planned without getting distracted with where you put you comfort break in.

All this counts as academic writing to me and is most definitely serving to clear the decks before what ever long term activity of the day begins. As I approach my second #AcWriMo as a fledgling academic I think the above strategies will help keep me on course.

We need to talk about … Corrections Part 2

15 min #AcWri (though not strictly as I already spent 15mins on another project this morning!)

So to recap – I defended my thesis early summer, it was a very positive experience and was done in such a way that I was able to approach my corrections without too much fear. On the downside I had to cancel most of my summer writing plans and also spent very little time with my family- which was further dampened by having no money to do anything when we were together because one of the lesser spoken consequences of resubmitting with anything more than minor corrections is a substantial resub fee!


I now realise that the secret to a happy corrections process (for me) is a) corrections that don’t require further research or oral exam b) excellent feedback and direction form examiners c) an urge to tinker with the things you found during viva revision and suddenly realised you hated d) affirmation everyday that the ultimate goal is to have a better quality thesis and know you did everything you could to make that happen.

The benefit of the oral viva in the English system is that it is a great chance to have two other perspectives on your writing. because lets face it, by the time you hit those 80,000+ words proof read, edited, formatted and submitted, the one thing you no longer have on your work is perspective! Your supervisor/s also by that point know your work so well they are not always able to spot the obvious gaps either – they too begin to read between your lines. Due to their own research interests and expertise my examiners picked up on things I had felt relatively minor and never asked me about what I thought was key to my whole argument. From this I was left with the realisation that when I think I am being clear about what I want to say, I am obviously not – also like most PhD students I was also trying to say too much.

In the final part of my viva when I was given the outcome and feedback I was so spent that I asked to record the comments on my phone. I had gone beyond being able to concentrate by this point and just wanted to go home and hug my children. This turned out to be a great on the spot record which also included the really positive comments given at the end – now whenever I feel down or receive a paper rejection I have a soothing audio therapy of two established anthropologists telling me my work is original, appealing and my arguments impressive – it works a treat!

The recording also enabled me to begin work on my corrections straight away, which for me was necessary – the planning part at least. It was a way of winding down from the viva prep stress and helped me deal with the confusion of feeling elated and concerned at the same time. When I received the written comments a week or so later I was able to take them in my stride because I knew what to expect and had already begun working.

It was difficult having to explain to nearest and dearest that yes it was over, but not quite. We had all seen the viva as the end point – the day that Mummy returns to casa and earth! So this was difficult to negotiate at first but good for me who was never quite ready to let go of the thesis upon submission.

I planned carefully, received feedback from my supervisor and took good advice from the various online sources, most importantly – STICK TO WHAT THEY ARE ASKING YOU TO DO, NOTHING ELSE… no matter how much the temptation to readdress all those things you are suddenly not happy with, don’t do it. If the examiners didn’t pick up on those things it’s not important – save it for a conference paper or journal paper where you can exercise your demons and reach a compromise with yourself. After all, more people will read a published article or hear a conference paper than will ever read your thesis.


We need to talk about … Corrections part 1

15 minute #AcWri day 4

This is a post that was written in my head a few months back, though I knew that some space between doing and handing in my thesis corrections would be necessary before I sat down to write.

I defended my PhD thesis at the beginning of the summer and have to say it was a very positive and encouraging experience. I felt prepared and both terrified at the same time, I got so nervous the day before that I was almost sick and had nightmares about it for weeks before. On the day my examiners were amazing they brought out the best of my arguments and picked up on things I had not even thought about too much – in a constructive way. Needless to say they did not ask me any of the questions I had prepared for and after nearly two hours of defence I was sure I had passed but not without some type of corrections.

I had the few weeks in the lead up to the viva reading my thesis, finding over 50 typos! And talking to colleagues about their varied experiences and listening to the mega helpful Viva Survivor podcasts run by Nathan Ryder (@DrRyder). Listening through the different ways in which people had prepared for and defended their vivas so really helpful in dispelling myths and making me think more pragmatically about it as a process. The most helpful podcast I listened to was an episode featuring Dr. Fiona Whelan about significant revisions and what it feels like to do them. I realised that this is a topic many people like to shy away from. They always seem to say they passed and then just casually brush over the correction part – no-one wants to talk about corrections!

Together with the sage advice of my supervisor and various podcasts and gratefully honest blog posts I began to view the viva as a the opportunity to have a captive audience with the few people who would ever actually read my whole thesis. Understanding that it was in their interest that I pass with a thesis that I could be proud of I also prepared myself for the inevitable corrections. There was no way I was going to get away with a straight A pass, it’s just not in my nature! I had spent the last of my savings hiring a proof reader so that I could feel safe in the knowledge that my corrections would be content rather than punctuation based (yes despite the 50 typos I later found!). I told my self that at least if they were content based it would be something I could wrestle with and find resolve – unlike my lifelong battle with commas and semi-colons.

I passed with a Bi category which at my institution means revision and re submission with no further oral exam. My examiners explained to me that the corrections were such that they could not be done on the 4 weeks turn-around required of the Ai pass – they reckoned it would take about 3 months in total. They were right it did …

And next post I will explain how it went and how I found a way to enjoy my corrections …


Collaborative Writing -15 minutes of reflection

So here goes, day two of my 15 minute #AcWri and I’m ready and set to go.

I nearly met my goal of 3000 words yesterday (not in 15 minutes of course!) after five straight hours of #SUAW activity in my home office. Today I must work in my institution office and so things will go a bit more interrupted. Over eight years in HE I have learnt to work with my limits, I never plan any heavy writing to be done on site and try not to do admin when working offsite – so far this is working for me.

So that nearly meeting my goal means that I must spend a short amount of time today finishing it off. I’m collaborating with colleagues in Mexico and the US to write a book chapter on alternative models of midwifery care for in Indigenous women in Chiapas. This is my first experience of writing with others and I have to say it is a new joy I have discovered to my many writing practices. I greatly enjoyed writing my thesis and the conference papers and planned articles to come out from it – but it did often get quite lonely. Spending many days without verbalizing to a soul about the ideas I was working through on paper often led me to bouts of self doubt and worry that I had lost my way.

Last year I kept up with some really useful collaborative working insights between @ThompsonPat and @thesiswhisperer during #acwrimo where they generously shared their writing project. They used google docs set to open access that we online observers could see their work developing in action. By doing so they really broke through many mysteries of long-distance collaborative writing, and also provide great relief to myself and many others I imagine about the amount of crap you have to write before you get to the good stuff.

The conversation that happens whilst you do this in a collaborative project makes this such a less painful project. My colleagues on this chapter project are in different countries and come from different academic disciplines – I rarely get the opportunity to do some interdisciplinary writing and this has really made me think about how accessible my other writing (and teaching) is outside of anthropological circles. In the sharing of the formatting and editing stages I have also learnt something about myself – my winding down process from a project is done through the step by step actions in involved in following formatting guidelines. It seems that after the creative chaos of writing and developing ideas what I need is a tick list of things to do that is already set out for me.


Writing More About Less – in 15 mins a day

Every day I turn on a computer, either at work home or my laptop on the move, I purposely set my chrome homepage as this blog page. Originally it was with the intention of reminding me I wanted to maintain the page and guilt myself into writing more regularly. Needless to say, it hasn’t really worked. I have spent most of the year quickly changing tabs or debating internally whether I should just shut the page down as to avoid embarrassment or disappointment.

I think it is time to re-think. In a higher education, where so much of my writing has to have a significant purpose I still believe I need another outlet for my thoughts and ideas. The added factor of a blog being in the public sphere, like my twitter account, means that to some extent I will work harder to keep those thoughts ordered and linked to the things I pay attention to as I go about my daily business.

I have a deadline to meet today for my first collaborative writing venture. I have about another 3000 words to complete by the end of day, so of course I spend my first 20 minutes in the office reading a blog post about writing, instead of writing – for purposes of “inspiration” of course!

Amongst others, my preferred #AcWri advice go-to blog is @ThompsonPat . Her posts are short, sharp and straight to the point. I regularly visited her page whilst writing my thesis and I know find myself going back through her archives for help as an early career researcher and academic.

This morning I read this post on coping with writing anxiety – a great topic as we head on into the new academic year and all writing plans turn into a whirlwind of chaos. Reminding me yet again to get back on that horse of writing more about less for a short period everyday – a warm-up exercise if we must. Reading the post I was also reminded of @JoVanEvery who helpfully begins every September timeline with a reminder of her 15 minute a day #AcWri challenge . Exactly the time it has taken me to click on ‘new post’ and write this down.

So here it is, I’m going for it again – facing my anxiety and trying the 15mins a day writing diet throughout this semester – for my blog outlet and all those imagined posts I write in my head throughout the year that never make it to the screen!


Maternal Memory – a creative interplay between identity and meaning

Throughout the planning, execution and writing up of my PhD fieldwork sociologist Ann Oakley has been amongst my significant influences. Her work developing a sociology of maternal subjectivity and childbearing in the late 1970’s UK context has shaped both the principle argument of my thesis and the narrative approach I have taken in my ethnographic writing. Her two publications Becoming a Mother (1979) and Women Confined (1980) detailed research carried out with 55 women during pregnancy, postnatal and early nurturing stages of becoming a mother. Oakley and her team interviewed the women a total of four times each and she also carried out participant observation in the labour wards, witnessing and documenting the births of 6 out of the 55 births. Her decision to produce two books from this research, one which foregrounds ethnographic narrative accounts and the other an academic response and proposal towards a new sociology of childbirth led me to think deeply about my own writing audience. I was mostly taken with the approach Oakley took in the former, Becoming a Mother, reading this gave me confidence to use verbatim narratives from transcripts in my chapters dealing with the more traumatic and raw aspects of maternal transition. The academic more ‘conventional’ reporting of the research provided me with the foundations of my own principle argument: that maternal transition can be understood as a life event akin to others, and as such it can be distanced from an existing essentialist feminine paradigm and can be explored instead as a human response to change – individual and social (see me practising for my viva there!).

This is why I was extremely happy to see a link to her most recent article on my twitter timeline about two weeks ago. The paper entitled A Small Sociology of Maternal Memory she draws on data from a 37-year follow-up study to explore the key characteristics that maternal memory shares with other forms of memory. As I try to reflect on my own data collection and thesis, my use of narrative and analysis of emotional memory – this paper could not have arrived at a better time!

Oakley reports that as a topic, maternal memory has been studied more consistently in rats and other animals than in women. This observation rings true to my own observations of anthropological work on memory, of which there is an abundance, but very little looking at something as specific as long term recalling of life events such as childbearing and rearing – moreover in a cross-cultural context. Exploring memories of childbirth in much the same way that anthropology has looked at collective and individual narratives of trauma or violence could be fruitful for both sides. This is in part why I keep being drawn to the work of Veena Das when I write about the clinical management of birth in Mexico – where women evoke traumatic experience the violence must be described in their own words and the focus needs to be not on the violent act – but on the person who experiences it and moreover on how they recall it through the passing of time.


Frida Khalo ‘My Birth’

The way in which many patriarchal cultures frame the connection between pain, femininity and childbirth is significant to the social context of recalling events. A surprise fact, for me at least, from the paper’s introduction is that the idea that women are said to forget the pain of childbirth as soon as it is over, was first documented in the bible (King James version John16:21). This historically and socially constituted notion of mother love and maternal instinct has persisted across the Christian world to a point where it is not only retold often within the realms of medical practice but is also a popular rhetoric in the ‘natural birth movement’. A movement which calls upon the feminine paradigm equally as much as the medical model it challenges. This idea that all pain and suffering will be forgotten (and interventions forgiven) once you are awash with oxytocin and cuddling your newborn has served to reassure many a nervous primagravida, and has undoubtedly impacted upon the recalling of memory for those who wish to forget the pains of childbirth. But, what questions does this trope of reassurance raise about denial of experience and social expectations? How does it impact upon how mothers retell their experiences months or even years later, through the contextual reframing of the original event?

For Oakley this tendency to forget the pain of childbirth is also part of a wider construction of framing childbearing women as ‘biological forgetters’ – and therefore unreliable social actors. Therefore, memory or lack of it, comes to define women and their social capabilities:

  • Baby brain 1: memory and cognition defects said to be caused by pregnancy hormones (those pesky rats again!)
  • Forgetting the pain of childbirth soon afterwards – known as the Halo Effect (thanks religious oppression!)
  • Women are judged by the amount of ‘facts’ about birth and perinatal period they can retain – time of birth, weight, length of labour, extent of medical intervention, children’s treatment and illnesses – which are then pitted against the objective factors of health service records (of which human error and social context of recording is inconceivable!).
  • Baby brain 2 – further memory and cognition defects due to the hormonal overload often associated with the aforementioned Halo Effect.

This framing of mothers – and by proxy adult females if we think of how similar ideas are evoked at other stages of the reproductive lifecycle – as ‘biological forgetters’ demonstrates how human reproduction as social practice becomes more about the portrayal of maternal subjects as hindered by their very ‘nature’. When it is better understood as human beings experiencing transition in a world that is inseparable from gendered ideologies and forms of power.