A while ago I posted in a prominent facebook group, Matexp, a group intended to improve maternity services.
I suggested that the profession should be split: those working in obstetric-led settings to be known as as obstetric nurses, and those in midwife-led settings as midwives.
I can see now how wrong I was. I was wrong to suggest that hard working, dedicated midwives working on labour ward day in day out, who had trained extensively to gain a whole myriad of midwifery skills, should be called nurses. I was wrong to think that the profession should or even could be split, that it would even be possible to make that divide. There are so many overlaps between high and low risk, so much blurring of the boundaries.
I was also delighted reading the comments that there are so many midwives who love being on the ‘obstetric’ side, who feel and act and respond as midwives. Also the comments of how to facilitate normality in this setting. It made me feel optimistic for the profession.
At the same time, I went into the profession to be a midwife midwife, not an obstetric midwife. To put the woman at the centre of care and the system around it, not the system at the centre of care and the woman around it. This was what I was promised by the University, three years of training to be an autonomous midwife. To be there with her in her choices, to allow her body to do what it needs to do within the realms of safety, to allow it to push when and for as long as it needs to, to practice the ‘art’ of midwifery and of being ‘with’ woman, being highly skilled to know when it is safe to continue, not by some clock, some partogram, some tick box, but by experience and taking the woman’s wishes also into account.
And it has changed so much in the fifteen years I was a midwife. Yes, I have left, the system and I just couldn’t seem to see eye to eye somehow. We have been seduced by filling in VTE forms, cannula forms, catheter forms, partograms, tick boxes tick boxes tick boxes, pushing for a statutory amount of time, care by rote and by the clock.
Which isn’t to say that this care isn’t valuable, that many women appreciate it. That of course there is a place for this kind of care, some women and some midwives don’t want the physiological side of midwifery, sometimes it’s not appropriate. And of course the couple need a midwife to be with them, to advise them, to help them breastfeed and how to look after the baby. They need a friendly face, someone knowledgeable, someone on their side, who will talk them through things and keep them informed. To me this is good care, wonderful care even, but it’s not autonomous and it’s not the ‘midwifery’ in the sense that I perceive it and the way I wish to practice it.
I don’t want to offend anyone. There are marvellous people doing this work. People who should call themselves midwives, because that’s what they are and what they have trained for, I see that now. But to pretend that it is all the same, that it’s all midwifery, is just not true. That we should be skilled in all areas, that we should want to work in all areas, is short-sighted. Some do, some don’t. That working in an area led by doctors (which is well and good, sometimes and often this is what is needed ), is the same as being an automonous midwife, is just not true and is feeding students and midwives a lie. It is setting them up to be disillusioned with what they see.
So in short I am having trouble speaking my truth. I want everyone to be happy, I don’t want anyone to be offended, I recognise the massive contribution labour ward and other high risk midwives make to the profession. I would in no way suggest that they are not midwives or that they don’t do a fabulous job.
But maybe it’s time to call a spade a spade and say that for me, the midwifery of labour ward or recovery or theatre, is not where I wish to work. Because yes, it feels more like nursing than midwifery to me. I know these are generalities and do not apply in all cases, there are lots of wonderful examples of good care out there, but this is why: it does not always feel like the woman is at the centre of care, where there is discussion and autonomy – for woman and midwife – around care. Where the woman, midwife and doctor decide together what would be in her best interests, where the woman is given choices, within the realms of safety of course, rather than following a blanket policy. Where the woman, not the ward, not the midwife, not the doctors, are at the centre of care. Where she is consulted, where there is consent every single time, where VEs are done on need rather than rote, where the woman is regarded as an active partner rather than an unwell patient. If these things are happening where you work, I am truly happy for you. If you are instrumental in making them happen, I am even happier for you. But the truth is, it’s not the midwifery for me, and I know I am not alone. I don’t feel I need to be made to feel bad about that. And I know from listening to many many women, that a lot of these things are their concerns also.
There, I’ve said it. It was hard. This is my truth. You do not have to agree with me. You are entitled to your opinion so long as you also respect mine. I accept that there are always two sides, probably more. I accept that this may not be how you feel or how you work or what is happening at your unit. I would love to hear your comments, from midwives and from women. How has your experience been? Are you happy with how things are? How can we make things better?
Rachel Weber now works as an emotional healer helping people with critical overwhelm, trauma and depression. You can read more about how she works here.