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By Alex Smith
How better to start an issue of the AIMS journal entitled ‘Informed Decision-making and Consent’ than with an Arthurian legend? Are you sitting comfortably? Then I’ll begin.
King Arthur is out hunting with his friends when he decides to separate himself from the others. While he is alone, he comes face to face with Sir Gromer, who has been wronged by Arthur’s nephew, Sir Gawain. Arthur, who had left his sword Excalibur at home, fends off Sir Gromer’s threat to kill him there and then by pleading his defencelessness and saying that there would be no honour in such an execution. Sir Gromer responds by giving Arthur one year and a day to solve the riddle: What is it that women desire most, above all else? “Easy,” thought Arthur, as he returned to his friends, but as the year went by every woman he met gave him a different answer. Then, with the time nearly up, he rides into the forest again and comes across a loathly lady, the Lady Ragnell, sitting by the path. Despite her repulsive appearance, Arthur greets her courteously and takes this last chance to save his life by asking her the riddle. She replies that she knows the answer and will tell him on the condition that Arthur will arrange for her to be married to Sir Gawain. Arthur hurries back to court looking very troubled. How can he burden any man with marriage to such an ugly woman? Gawain can see that Arthur is troubled and invites him to confide. Arthur explains and Gawain, true and noble as he is, immediately agrees to the wedding. With this promise secured, Arthur rides to meet Sir Gromer stopping by the lady Ragnell who gives him the answer he needs (and here lies the relevance to this journal), What we desire above all else is to have sovereignty, to rule our lives as we see fit, to not be beholden to another.
This is indeed the right answer and Arthur’s life is spared. On the night of the wedding, alone together with Gawain in their bedchamber, the Lady Ragnell suddenly appears as a beautiful young woman. She explains to Gawain that she is under a spell that means she can have her normal appearance by day or by night, but not both. If she is beautiful at night, it might please her husband, but she will spend every day being taunted and ridiculed. If she is beautiful by day, then he must sleep beside her in her loathly shape. The choice is his. Gawain, true and noble as he is, says that this must be her decision, and in doing so, breaks the spell.
This 15th-century tale ‘The Wedding of Sir Gawain and the Lady Ragnell’ is preceded by the very similar story told by the Wife of Bath in Chaucer’s ‘Canterbury Tales’, 24 tales that were written between 1387 and 1400. In her tale, the answer to the riddle goes a bit further to say that women want sovereignty not only over their own lives, but over those of their men as well.
Wommen desiren to have sovereynetee
As wel over hir housbond as hir love,
And for to been in maistrie hym above.
This could be seen as a very masculine bid for power on the part of women, but I like to think that it refers only to having a higher power over those actions of a man (or a woman for that matter) inasmuch as they affect her (which, when you think about it, would be in almost everything). Others may disagree. In fact there is a lot of debate about whether or not the Wife of Bath’s Tale expounds feminist principles. The Wife of Bath herself is a strong and authoritative figure. She values the legitimate wisdom born of her own experience (she has been married several times) and values her own interpretation of the literature of the time. Today, she would most definitely be an AIMS reader. However, the tale she tells is complex and in it, the loathly lady, having been given free will, willingly uses it to please her husband, and in both versions of this tale, the happy ending sees the lady beautiful by day, and by night.
The freedom to decide at this turn of the story may be part of a ploy to gain her compliance and docility (lulling her with the illusion of choice), or it may be the means of her sexual emancipation (leaving her radiant and unashamed as her authentic self), but either way, the story seems to reinforce the stereotypical ideal of a woman and to disregard her anger, dissent and flabbiness. The interpretations are yours. However, the tale is complicated further when we know that her new husband had previously been arrested for the sexual assault of a young woman. The opportunity to solve the riddle was offered to him through the compassion of the queen as a commutation of a death sentence. This part of the story adds such deep scope for reflection that you may want to sit down occasionally or you will get dizzy. How can women best use their power when they have been violated?
Many thousands of women in the UK alone enter motherhood with the feeling that they have been robbed of something, seized against their will, traumatised by how they were treated. To me, the queen in the story represents the potential of a woman to claim her sovereignty, to realise her own power and authority. Once secure in this, should she show compassion for misguided male thinking and offer a chance for reform – you have a year and a day to find out what women really want and to respect this – or should she call for punishment? Which is the stronger stance? This is where I need to sit down, but suffice to say, the tale of the loathly lady, and her answer to the riddle, is evidence that the importance of women’s autonomy has been understood at least since medieval times, and probably since time immemorial. It is explored again in this September issue of the journal through the wonderful range of articles we have for you this month.
Emma Ashworth opens this issue by explaining how the Montgomery ruling has strengthened people’s rights when giving consent to medical treatment. She states in no uncertain terms that, “Medical patriarchy no longer has any place in maternity care”. To illustrate this, three short scenarios follow that show how gaining consent should, and should not, sound in practice. I take the character Muriel, from the scenarios, and place her in the centre of an examination of the forces at play when people attempt to exercise autonomy, while perinatal education practitioner, Caroline Smith, explores her role in supporting parents to assess all their options, before making decisions that feel right for them. Both these articles show that making and acting on informed decisions is far more complex than simply being informed. Full time mum of two, Maria Lyons writes about being pregnant and non-compliant. She calls on us to reject fear-based healthcare and to take back the reins, ensuring that when we give our consent, it is always consent in the truest sense of the word. Unfortunately, even when women are strong and confident in the knowledge that they legally hold sovereignty over their own person and that of their baby, the deeply entrenched assumptions within the hospital setting as to where power lies, can mean that an individual’s autonomy is wrongly denied. This is what happened to Heather Spain when she and her newborn baby were held in hospital against her will. Heather writes an open letter to the midwives involved. Personally, I would like to see this letter used as a mandatory part of the training of anyone involved in maternity care. Coming up for a wonderful breath of fresh air, hospital team Georgia Smith, Charlotte Harford, and Maggie Arlidge tell us how, in their practice, an elective caesarean is tailored, in numerous ways, in accordance with decisions made by the parents. Their approach honours the sanctity of every birth and makes for inspiring reading, as does Laura Jansson’s article in which she reflects on the complex interplay between spirituality and perinatal decision-making, and on how caregivers can support clients' autonomy along their spiritual journey to parenthood. And echoing Laura’s piece (quite coincidentally), we finish the themed section of the journal with Danielle Gilmour’s wonderful poem, ‘I’ve Just Had a Baby’.
As ever, the AIMS Campaigns team has been very busy this quarter. Jo Dagastun explains why the concept of ‘shared decision making’ contradicts the concept of ‘patient autonomy’ and consent. Georgia Clancy comments on the recent guidance of the Better Births recommendation. Nadia Higson introduces Scott Mair who writes about his personal experience of birth-related trauma and about the webpage he has started to promote parental mental health. Megan Disley updates us about the latest MBRRACE report, and the team share their commentary on the OASI care bundle debate. Last but not least, we have a Birth Activist Briefing about the importance of involvement in the Maternity Voices Partnership, and news about the AIMS Campaign team’s current activities.
We also have two book reviews in this issue; Verina Henchy and Jo Dagastun review the second edition of Margaret Jowitt’s ‘Dynamic Positions in Birth’, and Georgia Clancy reviews ‘Making informed decisions on childbirth’, by Sofie Vantiers. And we have an obituary for the late Murray Enkin written for us by Tania Staras.
We are very grateful to all our authors, to our peer reviewers – Anne Glover, Caroline Mayers, Georgia Clancy, Natalie Palmer, Megan Disley, Danielle Gilmour, Ami Groves, Carolyn Warrington, Beth Frances, Rachel Boldero, Julie Milan and Winsa Dai – and proofreaders – Josey Smith and Zoe Walsh – to the ever helpful Danielle Gilmour and Alison Melvin who upload all of the material to the website and to ISSUU – and of course, to all our readers and supporters.
Stories to Grow by website, ‘King Arthur and the riddle: The wedding of Sir Gawain and Lady Ragnell’: storiestogrowby.org/story/sir-gawain-the-lady-ragnell.
Satkunananthan A H (2018), ‘Sovereignty, agency and perceptions of the grotesque in two medieval interpretations of the Loathly Lady,’ Scheherezade’s bequest 1 (1): 9–25. www.researchgate.net/publication/329235456_Sovereignty_Agency_and_Perceptions_of_the_Grotesque_in_Two_Medieval_Interpretations_of_the_Loathly_Lady.
Melville A (2019), ‘Female ‘soveraynetee’ in Chaucer’s ‘The Wife of Bath’s Prologue and Tale,’ British Library website: www.bl.uk/medieval-literature/articles/female-soveraynetee-in-chaucers-the-wife-of-baths-prologue-and-tale.
 MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK - www.npeu.ox.ac.uk/mbrrace-uk
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.
The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: email@example.com
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