You are served

On July 19th, 2023 I notified the Nursing and Midwifery Council that I would work one last shift on July 21st and that I would then like to be removed from the register on July 22nd. Finally my divorce papers were served to the other party. The relationship had been dysfunctional for far too long.

This didn’t come out of the blue, it was not a knee jerk reaction, there was no longer any anger, I had just fallen out of love with Registered Midwifery. It was a process of conscious uncoupling for me that started in June 2019. That's when I gave up my full time post as a midwifery sister at a freestanding midwife led unit and set up my business Essentially Birth. At the time, I started to accept that midwifery within the NHS was on a downward spiral and that it was unlikely to recover. The appropriated version of midwifery that exists within the greater medical industrial complex is simply not in alignment with anything I stand for so I had to let go.

There’s no room for celebrating your pregnancy with you anymore. My role became very task orientated. Despite my best efforts, it became difficult to see beyond all the flowcharts and the boxes to tick and to make time for you, your story, your fears and apprehensions, your excitement and anticipation. There are time restraints, yes; but it’s more than that. It’s the conveyor belt approach of hardly ever seeing the same woman more than once. It’s the sheer amount of people you will see in one week only in the part of their journey that you are currently facilitating. Antenatal clinics, postnatal wards, labour wards or even midwife led units; as a midwife you will be stuck in a relentlessly repetitive loop of doing the same thing over and over again. You start seeing a workload; four bookings or twelve antenatal checks or three discharges among your six postnatal women and babies (hopefully not all of them breastfeed because that will delay you); or one woman who has just given birth and another woman coming to the unit in early labour.

Your midwife is likely to feel overwhelmed at some part of her shift, and that’s largely because of the paperwork attached to your journey through maternity services. We all know how to provide the care, and we all love doing that, that's why we became midwives in the first place. That's not our reality though. It’s very likely that your midwife will spend more time with your chart than with you, if it’s not documented it wasn’t done.

Oh, and there is so much to do!

If you are pregnant in any industrialised country today, you will be ‘risk assessed’ at the beginning of your pregnancy and throughout. Potentially you will be advised to accept a plethora of screening tests, interventions and pharmaceuticals . Some of the drugs are ‘just in case’ others are to induce your labour or to address the pain of childbirth. Then you will be advised to have your baby injected with Phytomenadione (Vitamin K). Midwives have become sales people for big pharma and handmaidens for the medical industrial complex and most don’t see it. It’s hard to spot when you work in a health system that is ‘free at point of contact’ and when you don’t need to even try to make the sale. Your pitch is simple: ‘you have xyz risk factors, so you need to take abc’ or ‘we need to do this or your baby is at risk’. The evidence for these interventions is not often strong or conclusive. No intervention is entirely benign and the risk versus benefit calculations are done placing the interests of the institution on par with your interests at best. Yet most people will go for it without question. It's 'free' and they trust the expert who may or may not make the effort to give you balanced information. Frankly, your midwife or doctor may have never taken the opportunity to read beyond ‘the guideline’; and who can blame them, there's hardly time to stay on top of the mandatory training in the current climate and out of guideline care is getting more and more difficult to support even with the best of intentions.

Women who intuitively would prefer not to use any prescription drugs, especially when pregnant, will often do so regardless if they are told by their midwife that it’s for the baby’s benefit. In reality there are few occasions in which the administered substances are actually preserving life right there and then.Yes, they may shift the needle away from the outcome they intend to prevent (sometimes very marginally when you look at absolute rather than relative risk reduction) but in doing so they inevitably introduce a potential for a different adverse outcome, a side effect. Unless a woman asks, she is unlikely to be told that she can choose to accept or decline any intervention and that the intervention itself brings with it advantages and disadvantages. In my opinion medicating pregnant women to the extend that we currently do is contributing to the declining health of our population as a whole (and this really is *just* my biased opinion).

I am extremely well read in birth and the female body. I know the practice guidelines and I have critically looked at how those guidelines evolved. My book ‘7 secrets every pregnant woman needs to hear before giving birth’ explores the evidence around current practices in the United Kingdom and is a great pregnancy companion for informed decision making. The data underpinning each intervention is examined honestly and, despite my biases, it can support a decision to decline just as well as it can support a decision to accept an intervention depending who reads and interprets it in their own context. 

Studying birth has been my calling for as long as I can think. I started my immersion even before my daughter was born. Every single book I could put my hands on that explores birth physiology is on my shelf along with my books about birth interventions, spirituality in birth, the anatomy of movement and books on body work. My favourite areas to work in as a midwife have always been those places in which we collectively held the intention to let birth unfold. After leaving my full time post in 2019 I continued to take shifts in the midwife led unit and supported the occasional home birth as a bank midwife alongside working in my business Essentially Birth. I was happy to have found my middle path not expecting to ever be leaving the Nursing and Midwifery Council register but I can't un-see the revelations that the next four years would bring.