Sitting at my kitchen table, browsing the news online as I choked down some dinner before a night shift, I hit one of the lowest points of my career. Among the articles was a report about the growing number of heavily pregnant women left alone or sent away in labour, only to face hours of solitary pain or even having to give birth at the roadside on their way to hospital. Like a commuter rubbernecking at a rush-hour car crash, I couldn’t help but scroll down through the indignant comments under the story. Along with understandable sadness and frustration at the limitations of an underresourced, overburdened maternity service, there was a steady stream of vitriol directed at midwives – “a bunch of cruel, twisted gatekeepers”, as one angry person described us.
There was the proof in black and white – we were hated; I was hated. After reading this, I headed out to spend 12 hours caring for strangers while the rest of the world (and my own young family) slept.
Of course, not every portrayal of midwives is as furiously negative, but even the more positive images of our profession in the media are disappointingly one-dimensional. Call the Midwife, perhaps the most widely known current representation, can’t help but come to mind. Despite the writers’ admirable attempts to add some shade to the programme’s light – tackling social issues and even giving Nurse Trixie a drink problem – its midwives are still shown through a nostalgic lens. Cycling down the cobbles of Poplar with capes flapping gaily behind them, these smiling angels dispense platitudes and sweet-tongued sermons on every doorstep. It seems almost sacrilegious to criticise a programme that has become something of a national treasure, but when I look at the relentlessly efficient, smartly smocked heroines of Call the Midwife, theirs is not a world that I recognise.
Some might argue that One Born Every Minute provides a more accurate depiction of modern-day midwifery. The programme is, after all, a documentary series, filmed in a number of real maternity hospitals around England since its inception in 2010. But while its fly-on-the-wall cameras aim to bring the viewer into the labour ward, these “flies” are selective. At its heart, it is entertainment, and edited as such. What we see is actually a clever compilation of the “best bits” of birth – the funniest, the most dramatic, the most outrageous – and the midwives are cast as our unblinking, uncomplaining guides. We see them cheerleading and baby-catching, but we don’t see them worrying about how they will find bed spaces for the deluge of labourers coming through the door, or campaigning for better working conditions at a union meeting, or collapsing in tears after their third stillbirth in a month. Yes, they have machines that ping and an army of hi-tech medics at their back, but they are given little more chance to show the real challenges of the job than their fictional counterparts in Call the Midwife.
Just as midwives are often shown in the media as either cunningly evil or beatifically benign, so there is a dichotomy in the public perception of the actual work that we do. In the reporting of recent scandals such as the spate of bodged births detailed in the 2015 Morecambe Bay report, midwives are often castigated as being hellbent on promoting “normal” birth at all costs. Perversely, there is a widely held opposing view – often found in online forums – that posits midwives as obstetric handmaidens, unquestioningly complicit with doctors and their alleged desires to medicalise and intervene at any opportunity. In these scenarios, we’re seen as either obstinate hippies or collaborators in the patriarchy – we just can’t win.
Either way, there’s a heady whiff of the witch trials of yore, when wise women (including more than a midwife or two) became the focus of their communities’ suspicion, ultimately paying for their knowledge with their lives. Midwives have always existed at that dangerous nexus of female power and fragility – and our presence in that space remains as troublesome now as it ever was.
The reality of midwifery – our identity and our role – is far more complex. Yes, we work hard to care and console, and we smile when it’s possible and appropriate, but we also love nothing more than a good moan – about the system that crushes us with little reward, about our exhaustion, about each other, and even about the odd patient who’s pushed us to our limits. We go above and beyond when a woman requires extra attention, and at other times, just like you, we’d rather be at home, under a duvet. We can be both sympathetic and sharp-tongued, kind but biased. Tender but tired. We are human.
Our work, too, is complex. We possess a vast breadth of knowledge about complicated conditions and procedures. We have to; on the whole, our client base is becoming higher-risk. While the majority of women of childbearing age are still strong, healthy and able to have a spontaneous, vaginal birth, an increasing number of mothers are older, bigger and unhealthier than their predecessors. Obesity, diabetes and hypertension, twin and triplet pregnancies resulting from IVF performed in Britain and abroad, all have become commonplace, demanding competence and confidence from midwives. Asylum-seekers, women with mental health challenges, substance addictions and histories of abuse – we must know how to identify and manage different needs, and we often work with multiple agencies to ensure the safety and dignity of our most vulnerable patients as they make the transition to parenthood. Our work builds a bedrock for lifelong health.
A simplistic view of midwifery does our profession a disservice but, more importantly, it short-changes the women in our care. At its heart, midwifery is (apart from a small but growing number of male practitioners) women’s work – by women, for women – and the tendency to pigeonhole our role reflects society’s broader attempts to label, manage and control the female experience. Our labour – in both the obstetric and the professional sense – is more complicated, challenging, contradictory and beautiful than the world has yet realised.
Leah Hazard is a serving NHS midwife and author of Hard Pushed: A Midwife’s Story published by Cornerstone on 2 May (£16.99) To order a copy for £14.95 go to guardianbookshop.com or call 0330 333 6848
