Submitted by: Heather Hancock RN RM PhD FRCNA FACM MAPSI am also a voice from down under who joined the list as a midwife and in March I will be starting private practice as a Perinatal Psychologist – and will still be a midwife.
I have had innumerable midwives and midwifery students tell me that they will be seeing me as soon as I start as they have felt marginalised, ostracised, intimidated, battered and badly hurt because of how they have been treated in their practice or because of the dreadful things they have seen women experience – and this is the 21st century………..
I have seen women over the last 12 months of supervised practice who have been left feeling empty, shattered, violated and far worse because of their experiences and not just because of undesirable or adverse birth outcomes. Too many of them experienced births that were deemed a safe outcome for mother and baby, even a normal birth, but within that the mother’s psychological status was not even recognised let alone considered because of competing/conflicting interests between health professionals, outright bullying towards them, aggression and anger, and more……….
My mantra has become —— A safe birth is not enough ——- it is not sufficient to say the baby and mother were ‘saved’, when in reality they will both suffer as the mother is unable to form an attachment to her baby and they can both fall into deep sadness and loss – it is distressing to see. Women carry the burden of their labour and birth for their lives and it will either continue to weigh them down and debilitate them or it can be a joyful affirming memory for them.
Midwifery students are the future of the profession and to see them worn down before they even commence professional practice is a tragedy and often their ‘sin’ is simply being woman centred; midwives who advocate with women and are likewise woman centred pay a heavy price for this as well and they too often are not able to recover from this and suffer for the rest of their lives with a burden of emotional and physical pain.
I have also had medical students share their shock at what they have seen and experienced in the maternity care arena and vow to keep well out of it as professionals.
This is not new – what is wrong with us?
I have avoided naming who did what to whom – the experience inflictions are shared between groups. There are also wonderful midwives and obstetricians in maternity care but sadly not all are wonderful. I have thought about this for so long and considered the possible power of local and national efforts and also been involved in interprofessional teaching between midwifery and medical students but it has not ever been enough.
I think it is time for concerted genuine international address so that the same shared message is disseminated and the same shared strategies are activated globally – it is not good enough for women to be part of this and we can never say births are safe while this continues around and to them.
Sorry for the length – it obviously struck a cord and I thank you for reading this and hopefully thinking about this.
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BIOGRAPHY Heather Hancock RN RM PhD FRCNA FACM MAPS is a midwife and psychologist (specialising in perinatal psychology). Heather has had significant involvement in midwifery research and education including development and coordination of Bachelor and Master of Midwifery programs, and continues to practice as a midwife. Heather has developed home birth and midwifery group practice models of care, worked as a midwife in public urban, rural, regional and remote settings, private settings and women’s homes and conducted evaluations of models of practice. Heather has worked with Aboriginal women and their families in evaluating perinatal health and wellbeing, developing quality indicators for maternity services for Aboriginal women and improving access to continuity of midwifery carer for Aboriginal women in remote communities. Heather has been recognised with Teaching Excellence awards and also been Midwife of the Year; she is a Fellow of the Australian College of Midwives (ACM) and the Chair of the ACM Midwifery Education Advisory Committee. Currently, Heather is an Adjunct Associate Professor at the University of Adelaide and is involved in various national and international journals as a reviewer. Heather is also an Accreditation Assessor for Nursing, Nurse Practitioner and Midwifery with the Australian Nursing and Midwifery Accreditation Council. Heather is a Mentor Researcher for the Rural Research Capacity Building Program (NSW Institute of Rural Clinical Services and Teaching). Heather is co-author with Lareen Newman of Better Birth which has been revised and is being re-released in May 2013 as an ebook.
From Heather Hancock: “The written piece was not a letter it was part of a lengthy international scholarly discussion between obstetricians, midwives, academics, doulas and consumers regarding abuse in maternity wards. We all shared significant concerns about the ongoing abuse, bullying and similar taking place in and around maternity care settings – this piece was one of many and I was invited to submit it to this Blog – hence the points are not vague in the context of the discussion from which it arises. Those of us involved know well the extent and severity of this abuse and the harm and damage it causes and there was a strongly affirmative response to it by many others offline. This was not a sweet little blurb nor was it dishonest, it is an account of what is really happening sad but true. I have fully identified myself in my Biography with qualifications (including B Ed, BA (Psych), Master of Education Studies) from Australian university studies over many years to become a Registered Nurse, Registered Midwife, and Psychologist (completing a Master of Psychology (Health) with a Doctor of Philosophy across education and psychology.”
I loved Heather’s reply. As a nursing student I feel similar feelings that the midwifery students felt. The moment a woman steps onto a maternity floor her body, her vagina, or in the case of c-section, her abdomen, become the focus.
One particularly negative memory I have was when I observed one of many c-sections. The sense in the operating room was that the woman, strapped on a table like a crucifix, was not participatory in her own birthing process; that it was a surgery, not a birth. Despite having witnessed various c-sections before, the moment I heard the cry of the newborn hit the air my eyes I began to fog with tears of joy for this new being and their new parents, showing that life just began again in this very room…but those around me acted as if it was a completely sterile, emotionless, habitual, and robotic procedure. No one took the time to contemplate life or birth. The woman was left behind the curtain as they stitched her back together, while her child was taken away and brought in the corner to the warmer that looked like a giant robot. The doctor rubbed the protective vernix off its skin, administered eye drops right away, picked it up and plunked it down on the scale, all the meanwhile letting it cry, cry cry…It was calling out for his momma and daddy, but no one listened. His first sounds in this world were ignored. Finally when they brought the baby to mom and dad, he was swaddled up like a new package off an assembly line. No skin to skin in sight, with the baby in complete shock and just craving some maternal warmth. The interesting thing is…my professor who has both a PhD and CNM told us nursing students specifically that eye ointment can wait (to enhance infant bonding); keep the baby wet and don’t dry it off right away (insulation and skin protection mechanism); and first thing is first, let the baby go to mom (or if mom is overly medicated, to dad’s) skin! These things CAN be done after a c-section, but they never are. Why are we cutting corners? With the maternal and infant mortality statistics we have as well as rates of postpartum depression and perceived birth trauma, I do not think we can afford to cut any corners.
I also remembed disticntly congratulating the mother, and telling her how strong she was after giving birth. The other professionals around me looked at me for the first time since I was in the room, as if to say, “What are YOU doing here and WHY are you putting such notions inside this woman’s brain? WE did the surgery and its thanks to us that her baby is born.” I almost cried for this woman and for the thought that I will most likely encounter this all over the place once I enter the field this May after nursing school finishes.
I was also very upset to learn that birth plans are seen with disdain in hospitals. The nurses and doctors seem to think that they are “too picky” with how they want their birth to go. I know that when I am a CNM one day in addition to my training as a doula, I will make it my utmost priority to meet the needs of my clients because everyone deserves a happy, healthy birth experience, and to be treated with dignity and high regard. I was also told that “home births are dangerous” when I said that I want to have home births one day.
I also noticed that in my nursing assessments as a clinical student, the woman’s emotional self, spirituality, and history are essentially ignored. I recently learned that medicine ascribes to a “reductionist” method, meaning that providers break down a whole (patients) into many fragments (signs, symptoms, lab values, etc). By following this medical model throughout the antenatal, labor, and postpartum times, we forget that the REAL star of the show is the WOMAN; the amazing, strong, woman.
Whoa! Ultra worthwhile write up. So i’m saving your page today. Appreciate it!
I agree with you that a safe birth is not enough. When you traumatize someone and/or leave them in severe pain for a long period time, the emotional feelings of that experience never goes away. This happened to me 16 years ago and if I think about it more than 30 seconds, tears will well up in my eyes and I will start having nightmares about it again.
Dear Kristina -Thank you for sharing your story and thoughts – birth is truly a day we never forget and it’s so important to make sure we hold that space and honor those moments. I wish you love and healing on your journey.