By Lynn Walcott (Genevieve). Originally published in Midwifery Matters Issue 123 (Winter 2009). Still sadly relevant.
This was not my original plan; a grand announcement, but rather I’d envisaged a gentle fade out. However, I find myself wanting to explain, to friends, colleagues, my ARM sisters why I am leaving the profession of midwifery.
There were such sacrifices in the beginning to become a midwife. My story is a familiar one; married with children, I got the calling to become a midwife in my 20s. I spent years preparing to apply, waiting for the right time for me and my family. I was finally ready in 1994 once my youngest was off to school. Vocal from the beginning about my chosen profession, I recorded my training experiences for the NCT magazine, New Generation – ‘Diary of a student midwife aged 31 ½’ – the first diary of its kind, I believe? An early lesson was not learned (good!). One of my articles provoked the wrath of the local midwife hierarchy, as I dared to criticise the culture of midwifery I was witnessing as a student on labour ward. This was the first time I was ‘brought into the office’, a little bit of pressure, a hint of bullying, and I wasn’t conforming. I was wonderfully ignorant of the power they had over me – I was just a student, not actually one of them.
Strong memories – the training was about making me ‘one of them’ – I must fit in – it is the only way to survive. I recall vividly in the two-week break between qualification and starting my first job as a qualified midwife reading Andrea Robertson’s book, The Midwife Companion. I cried. I hadn’t been taught any of this. I felt woefully inadequate going into that first job, but I’d had a reputation as a confident, capable student, surely this would just transfer into qualification? I suppose it did, to a certain degree. My horror at feeling so ill prepared spurred me on to want experiences that were different from those in my training – to ‘teach myself’ what I had not been taught – what they had failed to pass on to me. After all, wasn’t I just made for this life?
I badgered the managers to put me on delivery suite as Me and Sarah (planned homebirth VBAC double breech twins soon as possible. But ‘the newly qualified need to rotate, for confidence, for experience’ – I had to wait nine months – I was so ‘full term’, so ready by then. I had already had the obligatory accidental births on the ward. Pitiful hurried catches as beds were pushed into side rooms. I proudly recorded them in my new birth register. So sorry Cathryn, Louise and Helen, I wasn’t really ‘your’ midwife; I was a bystander, with gloves on. The guilt was complete as you thanked me. This was not what I wanted as a midwife.
My chance came, at last. Delivery suite, 1998, post Changing Childbirth – hope in the air – I could be part of the revolution.
Seven months and 40 births later in my register (many others not recorded, ventouse, forceps and LSCS), how was I doing? Some satisfying experiences; women in alternative birth positions, ‘usual’ positions I say now. A tentative start to learning about physiological third stage, and a few successes. Once caught without gloves – the ‘trial of scar’ looking so relaxed bare foot hanging onto her partner’s shoulders, barely a groan as baby emerged. Waterbirth, finally achieved, so often thwarted as a student. And then there’s the four episiotomies that I would never do now. I have done one other since, which I would again repeat, but even that was in 2000.
I was already feeling the pressure of ‘being different’ as a midwife on labour ward. Every time I wheeled a bed into the corridor, having put the mattress on the floor in the room. Every time I heard the co-ordinator asking ‘where’s Lynn and her lady?’ as we hid in a bathroom with a pinard. I so needed to move to an environment that would welcome my apparent eccentricities. I was lucky; an opportunity for a secondment to a private birth centre arose. I was interviewed, but knew I’d get it – wasn’t I just made for this life? – ‘Independent clinical care but employed’ – a perfect compromise – I also knew that, one day, I must be truly ‘independent”.
Four months and five beautiful births later, I was hooked. I could not remain in the hospital. I had to get out. I had a mortgage, commitments, and debts, ‘independent midwifery’ was out of the question, but the fates were with me, a community job in another Trust nearby came just in time, only two months later. Of course I knew I’d get that job too – wasn’t I just made for this life? Fifty or more births in community later I was just feeling that I’d finally filled in some of the gaps from my training. There are so many memories – mostly positive, it has to be said. A group of colleagues who respected my ‘methods’, my differences, on the whole, and a brilliant manager who appreciated my need to be ‘on call for my women’ and did her best to accommodate this and pay me! During that year and a half, my statistics supported my approach – I still treasure that personal audit: 53% born at home or in the stand alone birthcentre – 83% SVD – 75% breastfed with 85% of those still breastfed at discharge. A personal caseload of over 100 women a year, breaking down to attending around 35 in labour per year with a transfer rate in single figures. But still I wasn’t satisfied. Yes, I knew some of these women well, but I was still sharing the care – my caseload was too big to give complete one-to-one care – the private birth centre had spoilt me.
Up stepped fate again – this same private birth centre advertised for a permanent midwife. I couldn’t get there quick enough – and, of course, I knew I’d get the job. Wasn’t I just made for this life? A heavenly five months and 11 personal client births later, disaster – the centre closed. But no. It was the best thing that ever happened to me. Thirty seconds after being told that it was to close, I’d made my decision to go independent, finally, in 2001 less than four Meg, James and Delphine (breech)years after qualification. At last, I really was made for ‘this life’ – that of ‘independent midwife’ – **** the mortgage and the debts – my wonderfully supportive family had watched when I drank heavily during my time as a hospital midwife, bewildered as to why I carried on doing something so destructive – they were elated that I found some peace by working outside of the NHS in the birth centre, so when I announced that I’d really had enough – that I could not go back to the pain of NHS midwifery once again, the support continued.
I was so lucky. Fate? Whatever, I know that I had the most dream start of any independent midwife in history (challenge anyone?). With the birth centre closing, all enquiries were diverted to me, as I was the only one of the six midwives there who was not going back to the NHS. I had an instant caseload. Forget worry about the mortgage, I could actually start paying off some debts too. In my first year in independence I had 18 clients – and eventually my busiest year (never to be repeated, I was obviously bonkers) with 29 clients! This was, finally, the life I was made for. I attend breech, twins, VBAC, actually VBACC and VBA3Cs, women, so called, ‘outside the box’ – I like being ‘inside that box’ with them.
So why am I leaving this perfect existence? Well, things are changing, and I don’t like the changes. I fear that ‘independent midwifery’ is in its death throes, at least, as I believe it to be, as I have experienced it. Let me explain:
In 2001, when I booked an independent client, I was happy to inform the local Supervisor of Midwives that I had a client in her area. We maintained a respectful distance between us, we only had contact again if there were ‘issues’, as I defined them. Now, I still do, as a rule, inform local Supervisors, but it is different. Close tabs are kept, ‘support’ is offered, discussion is encouraged – my ‘outside the box’ women require Supervision, apparently – after all, isn’t it all about ‘Safety of the Public’? Why does this feel so wrong? What am I worried about if my ‘care’ is competent? There’s only one real explanation – I feel ‘managed’. Dress it up all you like – but as a competent, experienced practitioner, I do not feel the need to discuss a post dates woman with my Supervisor, for her to recommend an obstetric referral – with a friendly consultant personally picked of course! Why do I feel so threatened? Where is the trust? Am I not able to professionally cover all bases for my client with regard to the difficult decisions they have to make? No, according to Supervision – rather, the Supervision that is on offer. But the problem is oh so much deeper.
In the end it is all about philosophy. My philosophy of birth has grown and developed to embrace all that nature offers, with the occasional, very occasional, need for medicine and technology. My philosophy does not believe that it is advantageous to women to have ‘all the research’, all the information available, from whatever source to enable their decision making. I do not believe that a woman about to bring a new life into the world should be trawling through academic tripe, for the most part, picking through facts and figures, absorbing all that negativity. There is obviously something wrong with my approach – isn’t ‘informed choice’ the new ‘Goddess’ of midwifery?
Well, what about the informed choice, to not go anywhere near a hospital – to choose a practitioner who trusts a woman’s body, and tries very hard not to intervene, knowing that her very presence is one of the first major interventions? What about the informed choice to accept it when nature doesn’t have all the answers and gets it wrong? What about the informed choice that accepts loss, accepts nature? No, I’m not saying never intervene, accept nature whatever the cost – I had a client have a much needed section this year, that needed some gentle persuasion on my part – the last emergency section had been in 2005 for me as an independent. I’m still proud of my stats.
But they count for nothing. So much for science and research. I no longer feel ‘independent’. I am checked, and measured, and followed, and questioned – I’m so fed up. It doesn’t stop there; my registration body, the NMC, feel the need to investigate the likes of me, independent midwives, on a regular basis. I’m just waiting my turn, now. And the quality of the investigations and decisions I see on some of the cases does not give me any confidence. My kind of midwifery is considered ‘misconduct’. I must admit, in print, to not doing vaginal examinations, or maternal observations such as blood pressure checks on normal labouring women. This is a heinous crime, despite not being research informed that is punished most severely – strike that midwife off who does not conform to the obstetric ideal!
I do not feel stressed though – I remember that feeling – this is different; I don’t need alcohol this time. I have a wonderful life (many of you are aware, I am blessed in many ways) – I have grandchildren, and yes I was midwife for them, I have a bizarre social life involving film and football people and the privilege of no longer needing to work full time. I feel I have it all, most of the time. But my freedom, my independence in my working life has eroded just too far – I no longer think it’s worth it. If I cannot practise truly independently then I’d just rather not practise at all. Midwifery, as a profession is just not what it used to be. I am so saddened watching some of the new breed of independent midwives coming out of the NHS. I must be truthful. The NHS has seeped into independence. It no longer leaches out for all, as it used to once, surrounded by the sisterhood of independence. It is not their fault, independent midwifery is changing to try and survive. This may be absolutely necessary, but I really mourn its passing. I’m just so glad that I was a part of it for a little of its golden age.
So I intend to just ‘fade out’. I now only book previous clients – and the ‘odd’ breech or twins – there are so few of us with any experience. It could still take a while. I have one client on number four, planning 10 children – but I suspect I’ll be long gone from the profession before then, maybe pushed out?
I always quoted ‘I could not not be a midwife’, something I’d heard from an American lay midwife as a student at a Midwifery Today conference, as my absolute mantra. I stand by that. In my heart I will always be a midwife – just not the registered kind, official, within the law, controlled, practising. I feel that I can actually retire, knowing this – it was the last fact for me to find peace in the decision.
The irony is that I thought it was going to be the lack of personal indemnity insurance that was going to be the death of independent midwifery for me. How wrong am I? The life I was made for has gone.