I am ashamed to say that, despite having spent the last three months hanging out with midwives, speaking to pregnant women and new Mums about their pregnancy and birth experiences, and becoming generally a little bit obsessed with all things antenatal, I have not yet got round to watching Call the Midwife. 9 million others have though. The programme has even knocked Sherlock Holmes off its spot at the top of the ratings, leaving BBC producers (I imagine) blinking rather bemusedly at its enormous popularity. Who would ever have thought that the process of having a baby – that thing which we have historically been so squeamish and hush hush about - could make for such compelling viewing?
Midwives will tell you, however, that this recent phenomenon is long overdue; as former midwife Terri Coates puts it, ‘women talk to their midwives; stories of love, loss and family life abound(…) it was always a mystery to me why midwives – and birth itself – were so invisible from literature and art.’ Indeed, In light of the success of Call the Midwife and its more raw documentary predecessor One Born Every Minute, it is unsurprising that other TV channels have jumped on the maternity bandwagon – very soon, tellingly titled programmes such as A Dad is Born and Don’t Mind Him, He’s My Midwife will be appearing on our screens to remind us that Dads have a part to play in pregnancy and birth too (albeit one that is sometimes more difficult to define).
TV's new obsession with maternity: A cultural revolution?
What these programmes seem to represent is something of a cultural ‘moment’ – one might even go so far as to describe it as a revolution - that means that the process of bearing and giving birth to children is no longer seen by TV as merely a convenient catalyst for another tragic or momentous turn of events, or consigned to a world of Hollywood make-believe which projects a wholly unrealistic vision of what it’s like to give birth (see here for some frankly hilarious/ appalling filmic representations). Finally, pregnancy and birth – in their unique blend of the mundane and the miraculous, pain and happiness, tears and joy - are taking centre stage of the drama in their own right, slipping out from beneath the cloaks of cultural taboo that have thus far kept them enshrouded in mystery to emerge as the perfectly normal, messy and enormously moving events that they are. And along with this, the trials and tribulations of those who are most involved in the pregnancy journey – both the families who nervously await the big day, and the doctors and midwives whose job it is to ensure that the outcome is as good as it can be - have become a national focus of fascination.
After all, a midwife’s job is pretty special, isn’t it? As part of my research on the M(ums)power project, I recently spoke to a clinician, Jane, who is thinking about writing a memoir about her experiences as a midwife. She told me about the sadness she once felt after delivering a still birth (‘I held the baby in my own arms – we were all devastated’), and then – 3 years later –she received a call from the same mother , informing Jane that she was pregnant for a second time, and wanting to know if Jane would be her midwife again. Jane agreed, even though she was at this point working quite far away, in a different London borough, and six months later she helped to deliver a healthy baby boy. End of story? Well no, not quite - 15 years on, that mother is still the first person to send Jane a Christmas card every year, with an update on how ‘the little one is doing’. As someone whose current professional life is unlikely ever to have this kind of long-lasting impact on any other single human being, I expressed my envy upon hearing this story, but Jane was quick to point out that ‘things are different these days. There’s more of a focus on the system rather than the people. It’s less and less about relationships.’
More focussed on the system rather than the people
I have already blogged about a series of workshops that we ran with women and clinicians before Christmas, in which we sought to develop a deeper understanding of the strengths and weaknesses of current antenatal services. The workshops gave rise to a number of insights, one of which was a sense that both women and clinicians are concerned that, due to a range of pressures, antenatal care is increasingly becoming defined by a series of hurried and impersonal interactions . This leaves women feeling as though they are on a ‘conveyor belt’, while time-pressed midwives regret that they have little choice other than to treat women as a ‘tick box exercise.’ It goes without saying that this makes for an unsatisfying experience for all involved, and we heard the same point reiterated time and again: that the medical professions should be more geared towards treating pregnancy as a celebration, a social opportunity which is not simply about ensuring good clinical outcomes (though these, of course, are of the utmost important) but about cultivating good relationships: relationships between mothers and fathers, parents and babies, mothers and clinicians, mothers and other mothers, families and communities.
The NHS, however, is not set up for celebration. Its function is largely to treat people who are not well and who need to be made better, and the women who find themselves for the first time announcing to their doctor or midwife that they are pregnant are often disappointed by the response that they get. As one woman commented: ‘I felt let down by my GP for not sharing my excitement about my pregnancy.’ Other women remembered feeling overwhelmed by a clutter of ‘dull’ information leaflets, long waits in waiting rooms that smelt of disinfectant, physical examinations, tests, assessments – a seemingly endless round of perfunctory and clinical procedures that mostly involve just them and another professional, and often leave them feeling like a ‘nuisance’ or a ‘problem to be treated.’ At the same time, it was felt that these procedures do little to address the worries and anxieties that afflict women when they are not directly engaging with services – the mysterious aches and pains, the social isolation, fears about the future.
The next steps: Developing interventions that put relationships back at the heart of care
Last week we ran two workshops which represented the next step in our project, where we brought Mums and Mums-to-be together with clinicians at the two hospitals where we are working – UCLH and NUH – to discuss, embellish and challenge a shortlist of proposed interventions that we have developed in response to the kinds of issues I have outlined above. We asked participants to think through the various barriers and enablers that would make these interventions effective, and to use their knowledge and imaginations to flesh out the ideas.
Despite being very different hospitals faced with a very different set of challenges, a clear preference at both UCLH and NUH was the idea of a a group antenatal workshop in early pregnancy, which could facilitate the development of peer support networks of women. Enthusiasm for this idea largely centred around its social dimension, and during the sessions we developed the ambitious idea that this antenatal workshop would look and feel more like a social event than an ‘appointment’, whose features might include:
- a venue/ space that does not feel institutional
- the offer of drinks and snacks
- opportunity for women to speak to other women and clinicians – abolishes the sense of ‘waiting to be seen’
- women to be invited to the workshop via a stylish, possibly handheld invitation – to add to their sense that it is something exclusive and special, a formal ‘initiation’ into the pregnancy journey
- attendance by: a range of clinicians, including midwives and doctors; experienced Mums - ‘ordinary people’ who have been through the antenatal journey themselves and might be able to offer their advice and support; representatives from local Children’s centres or other community activities/ venues, who could encourage women to make full use of the resources available to them in their local area
- an option for women to share their contact details and be added to an online forum that enables them to continue and build relationships
Of course, some of this was rather ‘blue skies’ thinking, and the short term interventions that we will test over the coming months will be more moderate in scope, working as much as possible with the resources and systems that are already in place. But whether simple or more ambitious, an antenatal workshop in early pregnancy would be a way to bring information to life for women in a timely and appropriate way, as well as facilitating useful dialogues that would enable women to exchange advice and air common concerns. At the same time, it would also aim to be an enjoyable social occasion, in the same way that birthdays and weddings serve as enjoyable social occasions –connecting people and generating an energy and confidence amongst prospective parents that makes them feel positive and in control of their pregnancy, while also allowing health professionals to share in that sense of excitement and joy.
Would this be any different to what is already on offer? The Mums and clinicians who attended our workshops certainly seemed to think so. It is true that antenatal classes – whether delivered by the NHS or the NCT or other independent bodies – enjoy widespread popularity. Friends and family throw baby showers. But these are usually offered to women in the late stages of pregnancy – and there is little of this kind that is available to women when they are in the early stages of their antenatal journey, a time which is fraught with doubt, uncertainty and questions.
Social outcomes are inextricably intertwined with clinical ones (this is, incidentally, the case for a wide range of patients, and not just pregnant women). In the interests of reducing numbers of unnecessary antenatal appointments, cutting down DNAs, and encouraging vulnerable groups to engage with health services appropriately, women and clinicians agree that the NHS needs to find ways of putting those meaningful interactions back at the heart of care – to value and harness the social potential as well as the clinical aspects of pregnancy, the ‘amazing relationships’ that form the basis of any good story, whether TV drama or real-life.