AIMS chair Beverley Lawrence Beech shares her thoughts on the changes that have and have not happened over the years
The women's movement has fought long and hard for emancipation in the work place but, apart from a few notable exceptions it has had little to say about emancipation in childbirth.
In employment, women have gained a considerable amount of ground and, more often than not, work on an equal basis with men. The pendulum of women's employments rights has advanced so much that women now feel under pressure to work right up to the beginning of labour and then to return to work as soon as possible after the birth of their baby. The right of the baby to have the constant attention of its mother in its early years is ignored or trivialised.
Charlotte Williamson, in her article, points out that radical patient groups (like AIMS) have fought long and hard to bring policies and practices into line with wider social values and aspirations. Caroline Hollins Martin in her article describes how difficult it is for a midwife to respond to women's choices in the face of 'guidelines' that are often cast in stone or directives from above; and Julie Trottier discusses the difficulties women face asserting themselves in pregnancy and labour. The current system of centralised maternity care is patriachial in that it empowers men, male systems, technology and drug companies and trivialises women' views and opinions. The research evidence showing better outcomes when a woman is cared for in a small midwifery unit, accompanied throughout her labour by a midwife she knows is ignored and instead the propaganda focuses on the illusion of 'choice'.
As AIMS is approaching 50 years of campaigning for better maternity care we asked our President, Sally Willington, to describe the beginnings of AIMS and give her view of what has changed over 50 years.
Fifty years ago my daughter was born in Baghdad where my husband was working for a mapping firm. By 1958 we were back in England and expecting our second child. I booked a home birth but unfortunately ended up in hospital for six weeks with recurring haemorrhage. I lay there miserably waiting and observing what went on.
Once released home with a new baby and a toddler who barely recognised me I wondered if other mothers had similar experiences. So I wrote a letter to the press. For nine months none of the newspapers published it. Birth was not a subject for polite conversation in the 1950s. So, when The Observer asked for letters on new subjects I wrote them a new one under my grandmother's name asking their readers about uses for Rosemary and other Herbs and the whereabouts of walnut trees. I knew these trees were rare and protected. So I sat back and waited.
Sure enough, an organisation called Men of the Little Trees was very cross indeed. The Observer's editor phoned me to say he'd worked out that I must be the same person who kept writing about the maternity services and that if I would dictate another letter to placate the Men of the Trees and assuring them I was not a timber thief he would in return print my original letter on maternity care. A few days later on April 1st the Guardian newspaper printed the same letter as follows: - '...In hospital, as a matter of course presumably, mothers put up with loneliness, lack of sympathy, lack of privacy, lack of consideration, poor food, unlikely visiting hours, callousness, regimentation, lack of instruction, lack of rest, deprivation of the new baby, stupidly rigid routines, rudeness, a complete disregard of mental care or the personality of the mother. Our maternity hospitals are often unhappy places with memories of unhappy experiences. They are overcrowded, understaffed and inhuman. Improvements will involve some rebuilding (more money) and an entirely new attitude to be taught to trainee-midwives. If anyone else agrees with me and thinks that something should be done, I hope they will write to me and join the SPCPW . (The Society for the Prevention of Cruelty to Pregnant Women).' Many Guardian readers thought it was an April Fool's joke.
Sad, isn't it? Nothing much has changed. Not only do we still have dirty hospitals but also deadly infections - which means that hospital is the last place for mothers and babies to be.
Much later, my innovation of 'Fathers-in-at-the-Birth' was not only to combat loneliness in labour but also I hoped they would lobby for more staff and new clean maternity wards. I hoped they would be outraged as taxpayers about the state of our NHS with its old plumbing, dirty lavatories, poor food and staff shortages. The nursing press said I was perverted to want men in maternity hospitals 'but doctors were different'! 'Fathers-In' has been nominated as 'the social revolution of the twentieth century'. Fathers have testified to bonding with their children. All good. I needed them 'in' because of complaints by mothers that they had been assaulted by midwives when alone. If complaints were made to management the conclusion was that the mother was drugged and could not remember what happened. I needed a witness.
Birth then, as now, was not regarded as important. Recent reports about maternity care and care of the elderly and disabled make me despair of my fellow citizens. Getting born right is a good start for good health.
The latest Reports (2007) on the state of our maternity services make me feel as if I have drowned and see my former life passing before my eyes - nearly 50 years of struggle by and on behalf of mothers. Why don't we learn? Why do we have such short memories? Why, given the opportunity, are humans cruel to other humans? I named AIMS originally as The Society for the Prevention of Cruelty to Pregnant Women. I sometimes wonder if we should have changed it? New members ask why the AIMS logo is a candle. Because, 'it is better to light one small candle than to curse the darkness.' Because actively trying to change things for the sake of other mothers, if not for ourselves, is better than sitting on our hands and doing nothing; because many candles make a bright light; because candles are put on birthday cakes.
AIMS spread rapidly and Groups sprang up all over Britain. We visited Holland (good, sensible maternity services). We ran a competition for midwives (How to Recruit and Retain More Midwives). We did surveys and we lobbied. In 1985 the AIMS Journal reviewed our First 25 Years and quoted on the front page some words by Harold H. Francis, Consultant Obstetrician at Liverpool Maternity Hospital: -
'The natural childbirth groups fail to understand that the practice of medicine consists of the recognition and correction of the shortcomings of nature and nature is a bad midwife. ... Some of the 1% of women who still have domiciliary deliveries do so as a protest against authority.'
Men like this had seized power over midwives' skills. Obstetricians were a lowly, less well-paid profession than other physicians and they wanted their own kingdoms and respect. They laid down the rules and they trained new doctors. Midwives who are practitioners in their own right were reduced to consultants' handmaidens. Only a short step more to declaring birth as an illness, caesareans as 'normal' and anyone who wants home births is as out of date as having your tonsils out on the kitchen table. Reasons for birth in hospital included the unhygienic state of British households. What a change! Now it is hospitals that are unhygienic and unsafe for birth.
The recently published Recorded Delivery (2006) Survey is worrying. Changing Childbirth we lobbied for and won in 1993. Yet now nearly another 15 years on, nine years of a Labour Government and its promised reforms and cries of 'Education! Education! Education!' The quality of maternity care has always varied according to where you live. No sooner had AIMS identified a 'good place to give birth' than reports varied again. So we hoped all AIMS suggestions, petitions, writings and lobbying would mean that when it was time for our grandchildren to be born maternity services would have improved. There would be choice, listening to what women say, being treated with kindness and respect. Now turn back to my original letter - so long ago. Have I lived in vain? No. I still think getting born right is important.
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