Book Reviews

ISSN 0256-5004 (Print)

Complete list of book reviews on the AIMS website

AIMS Journal, 2009, Vol 21 No 2

Birth and Power - A Savage Enquiry revisited by Wendy Savage

Middlesex University Press 2007
ISBN-10: 1904750583
ISBN-13: 978-1904750581

Reviewed by
Shane Ridley

Find this book on Amazon
image of Birth and Power

In the mid-80s, I was working in the Health Service and was myself in my 30s. I have vivid memories of Wendy Savage being suspended from her job as a Consultant in Obstetrics and Gynaecology at the London Hospital. When I say 'vivid', I mean that I was aware that she was a woman, in a man's world (hospital consultants) who was facing losing her job for allowing women to have their babies as normally as possible. To many she became a heroine - a woman whose name was whispered with reverence.

So when, many years later, I was given the opportunity to meet her, it was with a certain amount of trepidation! I guess it happens when we get to meet famous people. A friend had recently, coincidentally, given me the book 'A Savage Enquiry - Who controls childbirth?'1 to read. Wendy Savage wrote this in 1986, dedicated to 'the women of the world who face the uncer tainty of childbir th with such optimism and courage'. It is a sad statement of our time to read the write-up on the back cover of this book and wonder about how much has changed in the last twenty odd years - '... she (Wendy)... takes issue with the medical profession which, in still seeing bir th as their domain, resists women's demands for more control over pregnancy and birth.'

To remind you, or to inform you, Wendy Savage was a Senior Lecturer and Honorary Consultant in Obstetrics and Gynaecology at the London Hospital from August 1977. She was suspended from her clinical work on 24th April 1985. A public enquiry finally completely exonerated her and on 24th July 1986 she was reinstated. She was suspended for allegedly being a danger to her patients and the enquiry centred on five patients for whom she was responsible. It soon became evident to everyone that the real issues were medical power and practice. In the 80s, 88% of the obstetric consultants were men and they dictated hospital policy; only 1% of women had babies at home; and induction of labour and caesarean sections were rising inexorably.

Wendy Savage says that she has learnt that women need to be able to talk to their doctor as an equal, to be informed and encouraged to make up their own minds about their pregnancy - including whether or not to continue with it. She recognises that women need to feel in control of the bir th process. It is refreshing to read about her thoughts on her career and the influences upon it. She really means that she learnt these things.

She believes pregnancy is normal unless there are indications that something is wrong. Each woman is individual and should be able to plan her care for the best result. Above all she took on the medical establishment and exposed them and the system for what they really were. That brave act must have made it easier for so many women to improve their experience of pregnancy.

Maybe what I saw and remember from the 1980s was that simple act of a woman beating the establishment.

I asked her a few questions when I met her for the first time. Did she have any regrets? She explained that although the whole episode of her suspension was very difficult she had no regrets, and on the positive side she wouldn't have been elected to the GMC if it hadn't happened.

I asked her how she came to hold the view that pregnancy is normal, unless there are indications otherwise, given her medical training? She told us that in 1958, the midwives trained the doctors. They took the junior doctors out into the 'district' to watch the home bir ths - she attended 87 births in two months. She compared the home births to those in the hospital - where women had caesareans and inductions and shaving and enemas! For her the impression about just how amazing women are has never left her, and has made her the kind of obstetrician who is ever reluctant to intervene in a woman's pregnancy.

She briefly reminded us of the Cranbrook Committee recommendations in 1959 to set a target of 70% of confinements to go to hospital; also the Perinatal Mortality Survey of 1958 which gave outcomes of bir th in different categories. My aside - it's ironic that whenever targets are set they are thought to be right; years later they are often acknowledged to be wrong - don't we ever learn? We could shor tcut the process and not have any targets!

How much are the problems Maternity Services face are down to the gender of professionals, I wondered? Wendy says she sees it as more of a loss of control by professionals and the ascending control of managers. She reckons that younger obstetricians are more likely to listen to the woman, but universities think that it is a waste of time to sit with women in labour. She highlighted the loss of midwife power in the 1950s and 1960s.

I asked Wendy what she thinks that AIMS should be doing. She told us forcefully that AIMS needs to continue to campaign to change the system and get in there with the Department of Health, pushing for new facilities to move midwives out into the community and reducing the numbers of both midwives and births in hospital.

And finally, what would she like the future to look like? With no hesitation she said 'midwives acting as independent midwives in the community paid by the NHS - no managers but working in groups'. She would like to see all schools giving home birth information and films in their sex education classes. And of course, make sure that medical students spend more time with women in labour with their midwives.

I was then asked to review Wendy's book Birth and Power - A Savage Enquiry revisited. The book's tag line is 'An examination of who controls childbirth and who controls doctors'. In the book, Wendy Savage describes her return to work which was by no means plain sailing. She worked unfailingly over the following years to pursue her commitment to women, but continued to come up against the 'establishment' and the 'club culture' of male doctors. It made me ask the question that if some male doctors could treat their female colleagues so badly, is it any wonder that some treat their patients without respect too?

In the chapter entitled 'Birth and Power' Wendy looks back over the history of birthing, midwifery and obstetrics and concludes that the only way to change the system is for women to work together... 'grandmothers, mothers and midwives - to change the way that services are provided in the way that women want.'

Marsden Wagner follows the theme with an insightful account of his views on Bir th and Power - 'sociologists have known for some time that whoever defines the problem controls the solutions'. So by moving birth into hospitals, taking control of birth education, of drug dispensing, medical research, government guidelines, selfevaluation, the medical profession has done a pretty good job of controlling child birth. He also gives interesting facts about what happens overseas. Joan Donley gives views about the situation in New Zealand.

I found the next three chapters on Accountability, a fascinating debate on the subject. Are there only three elements - disclosure, explanation and justification, as Wendy suggests? John Eversley describes public body accountability in some detail and comes to a scathing conclusion about shifting the balance of accountability - well worth a read, especially in light of the furore over MPs expenses. From a lay point of view I want to hear more about responsibility. Where does the buck stop? James Drife's chapter paints the picture in his words of 'a command and control' structure in UK medicine, and of the future of innovation and unorthodox methods. I think in common parlance his message might be referred to as 'don't throw the baby out with the bathwater'!

Both Wendy and Ron Taylor have chapters on incompetence and competence of doctors - will doctors ever truly grasp this thorny issue?

The next subject to be tackled is Disciplining Doctors with chapters from Wendy Savage, John Hendry QC, Michael Goodyear, and an anonymous surgeon. I have to say I parted company with some of the views held in these chapters. Here I should admit that in my past life I was one of the dreaded senior health service managers (Personnel now called HR) and have been involved in organisational development in hospitals, and a few high profile disciplinary cases. Having said that it is very interesting and enlightening to understand where the writers are coming from. (One thing I would add is the experience of the anonymous surgeon is not confined to doctors - a good friend of mine in the health service who is not a doctor was subjected to the same horrific process.)

Academic freedom - these two short chapters by Wendy Savage and Anne Maclean throw light on the loftier arguments raging about universities. The recent history of managerial and financial considerations overriding intellectual debate, are well described. As a nation we should be protecting academic freedom - to research, publish, teach and speak - with all our might. The last three chapters written by Wendy, Beverley Beech (AIMS chair) and Jane Sandall are on what women want. They all speak from the hear t and we know, have dedicated their time to make women's need for a good birth to be a reality.

Wendy Savage concludes with her views about the future - ring fencing money for maternity services, more independence for midwives and natural birth in the national curriculum.

In conclusion, this book is not necessarily for the newly pregnant woman looking for reading to improve her birthing experience, but it is perfect for students - doctors and midwives, to give them a strong sense of history about what has been happening over the last 20 years. I enjoyed the book as it reminded me of the many varied views and debates in the Health Service. I'm not convinced about the arguments for professionalism in this book - I still think it is a barrier to common sense. It reminds me why AIMS has a lay committee!

Finally, a big thank you to Wendy Savage for her continued support to women in their wish for good births, and for her support of AIMS, especially in the shape of her dining room for committee meetings! We pledge to keep on campaigning.

  1. A Savage Enquiry - Who Controls Childbirth?
    Wendy Savage
    Published by Virago 1986
    ISBN 0-86068-859-3

Note: Birth and Power incorporates A Savage Enquiry Find this book on Amazon

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email or ring 0300 365 0663.

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