and other Workplace Challenges 9

Introduction

In this chapter we’ll think about some of the challenges in midwifery and where they came from. We’ll then cover some strategies to help you advocate for your clients and think about two areas of activism and how you can contribute. This chapter goes on to over bullying, whistle-blowing, grief and mental well-being. These topics are heavy but midwifery is one of the most intense professions I’ve come across and I know when I was training I would have appreciated transparency. I hope these resources will help you if you’ve hit a rough patch and will remind you that you’re not alone. These issues are mostly from a UK perspective; there will be other factors to take into account in di erent parts of the world.

Our history and where our challenges come from

There’s a brilliant book called Supervision of Midwives (Kirkham 1996) which features a discussion of UK lay midwives working around the time of the 1902 Midwives Act. These midwives had no formalized training route and instead learnt from each other and their clients. They were often regulated by the church. When inspecting lay midwives, Medical cers from the newly formed Midwives Board reported being ‘astonished’ by lay midwives’ ‘practical knowledge’ and ‘self-reliance’ and at least one study of the time found that care provided by these working-class, experienced midwives was safer than that of physicians (Heagerty 1996: 17). Unfortunately, many lay midwives were struck o for dubious reasons, like being spotted out drinking (I would have been struck o ), having an untidy house (struck o for sure) and in one case, a midwife was recorded as attracting disapproval as she was ‘found to be engaged in killing a pig’ (Heagerty 1996: 17). Most of these midwives were from nancially poor backgrounds and possibly kept animals for meat as part of smallholdings. I doubt very much that the Midwifery Inspector in attendance did not eat sausages. It was more that what these midwives got up to o ended middle-class sensibilities, which was an issue as midwifery became governed by middle- to upper-class nurses who were deferential to an increasingly powerful medical profession (Heagerty 1996: 16).

The Midwives Act was put in place in part to provide ‘respectable employment for middle class women’ and to make sure working-class midwives and clients ‘conform[ed] to the values and behaviours considered appropriate for them by their social betters’ (Heagerty 1996: 13). Although the original plan was for every midwife in the UK to complete training in order to be licensed, when it came to it, lay midwives had to be invited onto the register too or there wouldn’t have been anywhere near enough cover for births. ‘Trained’ midwives were growing in number, and generally saw the presence of lay midwives on the register to be an ‘insult’ (Heagerty 1996: 15), but lay midwives still attended the bulk of cases and held most of the midwifery experience.

There’s a lot to think about when studying the period around the Midwives Act and our early professionalization. For example, some dismissals were usti ed, and many trained midwives were struck o too. Check out the Supervisors of Midwives book for more. But the point I want to make is that even from the beginning, we were a group of professionals working on the back of a sta ng crisis.

Midwifery changed again when royal obstetrician John Peel wrote a report on maternity care in 1970. This suggested there should be provision for all births to take place in hospital (Drife 2016). Almost overnight the suggestion was enacted, birth was taken out of the home, and domiciliary midwifery services su ered (Drife 2016). Cut to midwifery in the modern day, and we are two thousand midwives short (Royal College of Midwives (RCM) 2022a), 96 per cent of midwives have concerns about safe sta ng (RCM 2022b), midwifery supervision has been taken out of statute and resources are decided upon by a mainly male-led government (Watson et al. 2022). It may be helpful to think about whether our origins have led to this ongoing state of a airs.

It is also important to identify which voices which have gone unrecorded. I assume that our historical workforce included midwives who were Black and brown since I know that Jamaican nurse Mary Seacole set up a hospital during the Crimean War, and expert Black nurse Annie Brewster managed wards in London in the late 1800s ( ueen Mary University of London 2021). However, I can’t nd any records of Black or brown midwives working in the UK around the time of the Midwives Act. I also couldn’t nd any records of L BT IA midwives but given the legal history of this group of people, this is not surprising. It may be helpful to think about how all of the above has led to NHS midwifery care being designed for white, cis-gender, heterosexual women, and the implications of that for clients who do not t into this category. I have found it necessary to pursue education in order to increase my ability to provide equality of care.

In terms of understanding other power structures which have created challenges for midwives, I have learnt a lot from reading Professor Jo Murphy-Lawless, a sociologist working at the School of Nursing and Midwifery, Trinity College, Dublin. One aspect of Murphy-Lawless’ career has been starting the project The Elephant Collective, to remember maternal lives lost unnecessarily, including Bimbo Onanuga and others. Her investigations had a key role to play in securing Ireland’s full involvement in the Con dential Enquiry process which investigates maternal/perinatal death in the UK. I have questions about why maternal/perinatal mortality in Ireland was not being satisfactorily investigated for so many years when the UK system was the gold standard globally, and so close geographically (Murphy-Lawless 2019: 133–41). This, combined with the scant options for home or midwife-led unit birth, and the only recently resolved lack of access to termination of pregnancy services, forms a pattern that ‘the lives of these [Irish] women simply don’t matter very much’ (Ingle and Murphy-Lawless 2019). The impact of colonialism is also something I needed to know about while working as a midwife in New Zealand, especially when working with Maori clients. You can’t serve midwifery well if you don’t understand the history of the area you’re living in, how ‘power makes itself felt’ and how di erent parties might feel about that (Ingle and Murphy-Lawless 2019).

Modern midwifery and why it’s hard to make headway

Mavis Kirkham’s seminal 1999 ‘Culture in Midwifery’ paper presents the concept that midwives take on as much as humanly possible, and do so quietly. This might sound like a good thing but it’s how oppressed groups of people behave and it’s not sustainable. Most midwives believe that we could make some changes by increasing our participation in politics, taking industrial action or simply by putting in more incident reports, but these actions often go against what midwives are taught to do, which is to just to keep going without making a fuss (Kirkham 2007). Activism can be exhausting and midwives need to conserve energy to continue to practise. This means midwives may simultaneously feel guilty for not doing enough organized leadership and/or protest, and also overwhelmed by the demands of giving care. The key question is how we put boundaries around well-being while furthering midwifery as a force that can change the world.