Since the inauguration of the NHS, governments have increasingly paid lip service to midwives. We must not let this precious asset be further marginalised
Jessica Raine as Jenny in “Call the Midwife”: The surprise hit reminds us of what we’ve lost
It may look like sepia-tinted nostalgia to some, but the BBC’s surprise hit Call the Midwife is unusual among TV dramas in that most of its storylines are based on the experiences of a real person, rather than concocted from the prejudices and predilections of today’s viewers (viz Downton Abbey). Based on the memoirs of a district nurse and community midwife, the late Jennifer Worth, it shows life in the rapidly changing East End of London in the 1950s and ’60s.
For any birth professional, moreover, Call the Midwife is occasionally an agonising, contraction-by-contraction journey through everything that has gone wrong in childbirth since the National Health Service began: the shadow of the maternity hospital looms, and we see birth move ineluctably from being a normal, family event at home, with the woman at the centre and the midwife in charge, to becoming a danger-encircled, risk-obsessed medical emergency in hospital.
And at a time when teachers report children arriving in reception class in nappies or in nursery class unable to walk because of being strapped into buggies all their lives, Call the Midwife shows us how the district nurse system offered an invaluable opportunity to educate and influence what we now call “at risk” families. The prevalence of home birth meant that women took pride in having their homes passed fit for a home delivery; the frequent home visits also gave midwives and others a better insight into how the poor really lived.
All that stopped in 1970, when Sir John Peel’s report argued that all babies should be born in hospital. He had no evidence for assuming that hospital birth was safer than home birth, but everyone believed him: he was the Queen’s gynaecologist, after all, so he must be right, mustn’t he?
Ten years later the statistician Marjorie Tew discovered, to her immense surprise, that home birth was as safe as hospital even for some “high risk” women, but by then it was too late. Birth had been firmly established as a hospital event and consequently the autonomy of the midwife, a profession based on what anthropologists believe to be the earliest social bond in man, began to be eroded.
In a recent episode, the heroine of Call the Midwife is forced by the superior powers at the local hospital to work there for a spell, enduring the bullying of a high-and-mighty surgeon — a depressing preview of things to come.
At the same time, home visits by midwives and health visitors have been cut back so much that these professionals cannot build up any relationship with families. Today, only one in four women giving birth has met her midwife before.
Throughout history, intelligent, capable women in patriarchal societies have found career satisfaction by becoming midwives. It comes as no surprise that it was an ancient Greek midwife, Phaenarete, who gave birth to the most questioning and inquiring mind the human race had ever seen: Socrates.
Like Socrates, the good midwife is by nature questioning, independent and brave. Like birthing women, she thrives best when given elbow room to do her job properly — a job which is not to be confused with that of the “labour and delivery nurses” familiar in US hospitals. Although 2,000 babies are born in the UK every day, the NHS is short of at least 5,000 midwives. In one confidential survey 89 per cent of midwives said they frequently couldn’t give women the care they needed.
Experienced midwives become disillusioned rapidly with a Cinderella service in which they have to care for too many women and babies at once, and do not wield the decision-making power they used to, so they are leaving in droves. Independent midwives, too, are under threat of extinction because of rigid insurance regulations, which they managed very well without before.
Governments have paid lip service to woman-centred midwifery, but in practice we are handing over control of maternity budgets to commissioning bodies of GPs whose obstetric experience is scant, incomplete and long ago. The media do not help by portraying childbirth tediously and repetitively as a battle between home-birthers swinging crystals over their tummies on one side, versus too-posh-to-push caesarean addicts on the other, for each of these beasts is as mythical as the other. It is sad that, just as watching childbirth on TV becomes a national pastime, we are doing so little to prevent the slow erosion of one of the NHS’s most precious assets.