Waiting for Agnes

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After the horse September 27, 2010

Filed under: Breastfeeding — titchandboofer @ 2:00 am
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Breastfeeding has been getting a lot of exposure in the past couple of weeks. Dr Jennifer James sparked a a slew of newspaper articles, television news stories and current affairs program stories with her proposal that infant formula should be available on prescription only. At the same time there have been a few articles and television stories popping up here and there, debating whether or not women should or shouldn’t have to, or want to, cover their babies and their boobs while breastfeeding in public. Usually I’d be thrilled that a topic so dear to me is getting this much airtime, but at the moment I’m in an ambivalent kind of fug. In fact, it’s not so much ambivalence as a quiet sense of hopelessness. If only the media was buzzing about the value of breastfeeding, the value of mothers, about increasing support for women to initiate and sustain breastfeeding, and about helping women mould their lives around their need to breastfeed instead of the other way round. Then I would be delighted. But it’s not. To me the focus seems so negatively skewed. There’s a prevailing defeatist attitude that while women might want to breastfeed, most of them will be failed by their inadequate bodies or their sick babies, so they might as well opt out from the beginning.

This is absolute crap. Yes, there is a tiny percentage of women (<10%) who physically cannot breastfeed because they just don’t have sufficient breast tissue, or they don’t have their breasts anymore, or they’re being treated with the very rare medications that are not safe during breastfeeding (note to all: commonly used antibiotics do not fall into this category). The rest of them are not failed by their bodies or their babies. They’re failed by our peculiar society, with its distrust of the unpredictable rhythms of the human body and its voracious, conspicuous need to consume and control. Articles like Breast is best, but don’t ditch the back-up are just a literary and, in this case, actual advertisement for artificial feeding – the original article had an active Google advertisement for Nutricia smack bang in the centre. I could go on and on about the enormous infant formula companies and their ability to profit from fear-mongering. But really it is as simple as this – there is no money to be made from breastfeeding women. Except possibly for the people who make these (Oh Hathor, thank you. On days when I really feel the whole world is mad, I visit your blog and am instantly cheered up.). So, it doesn’t matter that breastfeeding is the biological default – I would say it’s the normal thing to do, but statistically that is a doubtful statement these days – it will still be advertised as too difficult, inconvenient and easily and safely replaced with powdered, modified cow’s milk. Is there another mammalian species on earth that fails so comprehensively at feeding its young that it chooses the milk of another species instead? Somewhere in me is a lengthy opinion about shared breastfeeding and community and donor milk, but that’s for another day.

Sometimes it’s just exhausting to care what choices we make as a society. So what if breastfeeding is the default setting? So is spontaneous, unmedicated vaginal birth. So is boys having a foreskin on their penis. Who cares if it’s the best choice, with long term health consequences for mothers, babies and society? So what if women are encouraged to opt out of doing something because they might not succeed, or it might hurt, or their partner won’t be able to bond with the baby, or they won’t be able to have a drink, or they might want to go to a wedding, or they won’t be able to buy enough stuff to sustain the local baby emporium? Why even bother trying to stop the juggernaut? Let people opt out. We can opt out of every other potentially uncomfortable thing in life. Why should this be any different? Even goddamn Pass the Parcel at children’s birthday parties has a prize in every layer these days, so kids don’t have to feel the discomfort of not winning. If that’s life when you’re four, why should adulthood be any different? And isn’t that the beauty of choice? So that people can make choices for themselves and their children even if the consequences are negative and irreversible.

That’s how I feel when I read the news these days. If people don’t value breastfeeding, if they’re not taught and supported to do it, if they’re misinformed, if they’re hindered, if they’re shamed for doing it in public, if they’re harassed for doing it for more than six months, if they suffer through difficulties over and again with no help, or if they just don’t want to do it, making infant formula more difficult to access won’t change that. But if we can fix everything else? Then absolutely…I’m on board!





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OMG NVB! September 22, 2010

Filed under: Midwifery — titchandboofer @ 9:17 am
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Some days being a midwife is hard. It’s tiring and emotionally draining, frustrating and noisy, complicated and messy and sad. Days like this pass slowly. A visitor tells you that you’ve got the best job in the world and you feel like snarling ‘Sure, underpaid servant to an overwhelmed public health system. Super’. There are hours of never really finishing an endless string of overlapping tasks, being snappy and snapped at, stomping down the hallways, trying to ignore the constantly ringing phones, running out of everything useful and going home exhausted to slump on the couch and whine. And other days it’s totally fantastic – still noisy and messy, but joyful and energising. A visitor tells you that you’ve got the best job in the world and you smile smugly and give them chapter and verse on which university course to apply for. The work flows, nothing seems like a chore, there is enough of everything – time, rooms, heatpacks, thermometers – midwives joke with the doctors, births are uncomplicated, breasts work, and you go home buzzing on a high that can last for days. These are the days that bind us to the job, that mean we keep turning up despite the crappy pay, the dreadful cafeteria coffee and the rotating roster. Yesterday was one of these days for me.

Yesterday I was truly able to be with a woman as she laboured, breathing with her as she stood and rocked through contractions, kneeling by her side as she knelt, eyes closed, under the heat of the shower, squatting by the bath as she swayed and roared and pushed. I didn’t have to be in three other places. No one interrupted, bursting into the room to yell Have you got The Keys? Her family didn’t ask her irritating, irrelevant questions mid-contraction. There were no complications, no continuous monitoring, no drugs, no doctors, no phone calls, no-one hassling for the room, no machines that go ping. There was simply a woman, encircled by her mother, her aunt, her boyfriend and her midwife.

She arrived just two hours after her labour began, teary, scared and wanting a way out. Already working hard, her labour racing ahead like an express train, destination babyville. She laboured, breathing hard, yelling, swearing she couldn’t do it, really really couldn’t do it, wanting something, she didn’t know what, just something. She knelt in the shower, looking so peaceful in the soft spaces between the rocking contractions. After a while it wasn’t enough. She needed something more, something to hold her tired body up, something to lie her head on, dark, heat. Sinking into the bath, she had a few moments of relief before labour surged on. She pushed mightily, roaring with effort and yelling with frustration, just pull it out, pull it out, pull it out. So soon, her baby’s head is out, waters unbroken, membranes shimmering over the baby’s face under the water. A pause. Then all of her baby, slipping out, gathered up, held to her chest. She holds her daughter, whispering to her, shielding her eyes from the flash of cameras, already a mother, protective and fierce.

She is a mother and yet still she is an eighteen year old girl. Labour over, the roaring labouring woman retreats and the teenager I have never met returns. She is sweet and naive and funny. And she has a posse of bubbly, glossy eighteen year-old friends. About three and a half minutes after she has climbed out of bath and into bed, her naked baby warm against her chest, they spill into the room. They’re all hair and eyeliner and heels and iPhones. Uncertain for all of a minute as to where to look, sit, stand, the excitement takes over fast and they’re fine again. Then it’s all ohmygod!!, look at it I mean her it is a her right? was it like hard? what are you gunna call it I mean her? ohmygodwhat’sthat? is that meant to come out? did you have like heaps of drugs? it’s so cool you’re breastfeeding your boobs are so totally awesome right now! yeah, I put it on facebook already, it I mean she is so cute! you need some pink things, I’m totally buying her a pink dress tomorrow! I can’t believe you have a baby! I am a hundred years old. And I am so proud of her, this teenager I have never met before, as unfazed she lies naked in front of her friends, breastfeeding her new baby girl, telling them how hard it was but how she did it all herself.

 

Hands September 16, 2010

Filed under: Midwifery — titchandboofer @ 12:11 pm
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Some days I can get quite mushy about my job. I’ve had sentimental moments of gazing at my hands in wonder at the things they have done, the brand new beings they have held, the hands they have squeezed, their capacity to soothe and to damage. I remember how they shook the first time I took blood, the first time I had to sign a drug chart, the first time I got to sign my name to someone’s birth registration papers. They have held and massaged, injected and cut, caught and pulled, flushed IV lines and drawn up drugs, pressed and lifted, carried and hugged, and pushed countless pens through countless hours of paperwork.

Today I wished they could be magic. Today there was no easing into work, no relaxed banter as women juggle breastfeeding and breakfast, no time to linger, no setting off with a woman at the beginning of her labour. Today I was flung into the middle of the storm. I arrived on the scene of a woman who had been labouring for almost twenty-four hours, who has been trying to push her baby out for more than two hours and who is bone weary. Most women having a baby get tired – physically, emotionally, hormonally, it’s pretty wearing. Sometimes, not too often, women are utterly exhausted. This woman can barely hold herself up, open her eyes, take a sip of juice. Her body keeps labouring but she is far far away, eyes distant, arms and legs heavy but pliable. She neither speaks nor understands english. Her anxious partner has a few words – no power, get the doctor, too long, danger? Two hours later, her baby is born under the fluorescent glare of the theatre lights, a chubby baby girl, heavy in my gloved hands. Another hour later, she and her baby lie skin to skin in recovery, recovering. Her hands on the blanket are pale, too much blood lost in surgery. Another hour later, she and her baby daughter are back on the ward, still tucked up close, muddling their way through their first breastfeed. Three hours after this she sleeps, one hand resting on her sleeping baby in the cot beside her bed. And all this time the only words we have shared were yes? thank you, baby stay or go away?

So, today I wished my hands could be magic. I wished they could say ‘your baby is okay’, ‘you are strong and brave’, ‘I know it’s hard but it will end’, ‘we won’t take your baby away from you’, ‘I won’t leave you on your own’. I wished they could explain that I knew she needed help, that she hadn’t been forgotten, that I knew she had done everything she could. I wished they could help her feel safe and heard and not alone.

 

Passing through? August 31, 2010

Filed under: Midwifery,Parenting — titchandboofer @ 9:39 am
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Some months ago I was asked to co-author an article with one of my lovely-midwife-friends, on the topic of birth as a rite of passage, for Barefoot magazine. As can be the way with writing, the words went off in their own direction and what resulted instead was a story of the small one’s birth from both of our perspectives (my LMF was also my private midwife). ‘Birth as a rite of passage’ is an enormous, unwieldy theme. For any person, it is all too easy to get bogged down in the nitty gritty of either facet. For me, the co-existing perspectives of midwife and mother lead to deep entanglement of thought in the realms of both. As my LMF and I tried to exert a coherent and shared grip on the entire concept and put pen to paper, or hands to keyboard, we got more intimate with our own ideas but further and further from either consensus or an article shorter than a thesis. The confines of small’s birth at least gave us a helpful boundary around a shared experience.

What it didn’t allow for was any meandering into the social paradigm, any talk of the meanings placed on birth by the modern woman (well, to be more specific, the white, middle-class, english-speaking woman of Australia, who is all I can really speak of with a speck of authority) and the society in which she lives. So what is this paradigm What are these meanings? What order can I create out of my tangled thoughts? How much can I assert my viewpoint without being critical and alienating?

To be flat out negative, I think the importance of birth as a rite of passage has been diminished to the point of non-existence. My cynical self believes that the modern, capitalist world has turned becoming a parent into yet another consumer experience. It’s no longer about being transformed, stepping away from one self toward a new self, irreversibly. It is all about acquiring a baby. Sometimes this is couched in ‘becoming a family’, but let’s not kid ourselves, this is just one more way of saying ‘as a couple, we are getting a new thing’. A new thing, in a natural progression of new things: holiday, engagement, wedding, house, coffee machine, car, a fancier phone, a pregnancy, a baby, mountain of largely unnecessary stuff for baby, newer bigger car, newer bigger house, newer baby, holiday (and yes, I’m  aware that I am generalising wildly, but that doesn’t make me wrong)….. Becoming a parent is just one more opportunity for us to be aggressively marketed to and it starts before you’ve even conceived. ‘Take this supplement! Scientifically proven to make a better baby!’ ‘Buy this pill for your man! Give him the gift of higher quality sperm!’ ‘Eat this cereal! Your ovaries will thank you!’ I know that taking prenatal supplements isn’t an inherently bad practice (unless you’re the woman who unwittingly took ten times the recommended dose of folate) but it’s certainly not bad for business either. There’s not nearly as much money to be made from telling people how to maximise their ability to conceive without drugs. In pregnancy the pressure builds a little more. ‘Book into our private hospital! We have a big sparkly nursery!’ ‘Use this cream! You’ll never get a stretch mark!’ ‘Buy this special seat-belt!’  ‘Buy bottles now! Every mother needs them just in case!’ Then comes labour and birth. ‘Wear this labour dress! You don’t want to be stuck looking bad in hubby’s old t-shirt!’ ‘Take the drugs! Don’t be uncomfortable!’ ‘Listen to this music! Your unborn child will already be smarter!’ And once your child is out in the world the marketing pressure that parents are exposed to intensifies further, cunningly devised to play into every fear and anxiety they are vulnerable to. ‘Worried if your baby is sick? Buy this drug! Use this dummy that doubles as a thermometer!’ ‘Afraid your baby will stop breathing? Use this motion-detecting cot alarm! Buy these multi-point baby monitors!’ ‘Want your baby to sleep? Buy our disembodied, plush model-hands so you can trick your baby into thinking you are holding him! Bathe her in this bubble-bath! Slather him in this cream! Use this dummy!’ ‘Want your baby to be smart? Buy this toy/music/book/dvd/mobile/walker/bouncer/class! It’s never to soon to be over-stimulated!’ ‘Want your baby to be healthy? Buy this fortified formula! We’ll pretend it’s for toddlers but you know it’s really for babies!’ On and on and on and on. And that’s just the stuff you’re meant to be buying, never mind the image of modern motherhood you’re meant to be buying into.

Which takes me back to the notion of transformation – and this is where things are even more depressing. For an event to truly be a rite of passage it must involve change, irreversible, life-altering, monumental change. The transitions through menarche and menopause, from boy to man, from parent to grandparent, the events of starting school, finishing school, leaving home for the first time, retiring, all times of change. Change that, for the most part, is celebrated. Yet we have an image of motherhood held up for us that glorifies an absence of change. How many articles exhort you to get your old body back? How many articles indirectly encourage this, documenting celebrity mothers and their miraculous bodies, manicured nails and glossy hair? How many methods are being peddled, promising to produce a baby so controlled it couldn’t possibly inconvenience you? How pervasive is the notion that babies should be cutely silent and sedated, predictable and compliant? How negative the adjective ‘mumsy’? Because whatever you do, you shouldn’t actually look like a mother. Dammit, you should look sexy – boobs up, tummy flat, stretch-marks erased (if you were so irresponsible as to come by them in the first place), back-in-your-skinny-jeans-slim and absolutely no leaking. You should be out there, working, shopping, socialising, having coffee, having it all. The message is strong: have a baby – you needn’t let it change your life.

And whatever you do, don’t be dwelling on your birth experience. If it was awful it doesn’t matter, because (chant with me now) all that matters is a healthy mum and a healthy baby. If it was great just shut up, or you’ll make the other whiny mothers feel guilty and inadequate. Anyway, why are you even thinking the birth was about you? Clearly your pregnancy was a temporary and potentially life-threatening condition, treated heroically by our state of the art medical system. All you had to do was show up and get handed a baby at the end. There’s nothing special about having a baby. Women all over the world do it every day, squatting in rice paddies and fields and whatnot, and you don’t hear them banging on about it ad nauseum.

But it is special. And when the cynical ranter in me takes a break and the dewy-eyed midwife steps in, I’d even say it is magical. No matter how many times I see it happen, it is magical to watch a whole new person come into the world, a person that has been there, out of sight, curled up behind a wall of skin and muscle for fortyish weeks. It’s magical to see women birth their babies and cross over the threshold to parenthood, sometimes sweetly, sometimes with a lurch and a crash. I love bearing witness to those first few hours of naked emotion, naked bodies, tears and blood, shock and awe. Before the cleaning up, tidying up, washing, dressing, wrapping, texting, calling and anxiety begin. But if the message I’m reading, socially and culturally, is that birth is no biggie then should I care? Maybe women don’t care. Maybe I’m wrong. Maybe it’s the idealistic hippy in me, yearning for a scene from Spiritual Midwifery, where all the sweetly smiling, long-haired, vegetarian folks are kissing and singing as the newest arrival slithers into Ina May Gaskin’s hands. You could almost have convinced me of the error of my convictions, before I crossed the threshold myself. Yes, as a student midwife and even as a newly minted midwife, my only image of the transformational power of birth was a scene like that. I would have argued that birth has to be felt, that a woman needed to immerse herself in the raw physicality of it to truly appreciate her female power, to be truly transformed. I don’t believe that anymore. Yes, I believe in the importance of natural, physiological labour and birth, but not for the same reasons. I don’t think a normal labour should be messed with, but that’s because I’ve seen the damage that can be done to a woman and her baby, not because I feel we’d be interrupting her passage to powerful, enlightened motherhood. Now I believe that whether a woman births her baby through the tumult of labour, or has her baby lifted out under the glare of surgical lights, or even if she adopts her baby, she still walks the wild and vulnerable path to motherhood. She is changed and can never be the same again. She could bear the pain of her baby dying or of giving her baby up for adoption but she cannot undo becoming a mother.

This passage should be honoured, tended carefully, rejoiced in. Whichever way they do it, women need to be held up by their friends, family and carers when they become mothers. They are vulnerable and need to be able to find and wield their own power, they need safety but not rescuing, they need love but not infantilising. They need open minds and hearts surrounding them, allowing them to change and enabling them to know the changes within intimately. That knowledge, that is power.

 

Oh baby August 21, 2010

Filed under: Midwifery — titchandboofer @ 3:38 am
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It isn’t often that the newspaper makes me cry anything other than tears of frustration. In fact, I haven’t gone out and bought a paper version of the papers for a while, usually flicking through the online version suffices. But it’s election day and here it is a crisp and sunny morning, perfect for walking our hilly streets and smiling at people conspiratorially – did you vote? I voted! We are all voting! The power! The responsibility! The democratic process at work, right here in our local primary school! Isn’t it a bonding thing, all of us here at the school hall, all for the same reason? It makes me want to do crazy things like talk to our neighbours and eat sausages in bread at ten in the morning.

Now we are home, the small one and I. He is snoozing in his bed, face buried in his sheepskin, arms flung wide. And I have the newspaper to spread out on our table, to mark with rings of tea from an overflowing mug, to ponder, to sneer at, to exclaim over, to sob into. Tucked just under the front cover, with its ubiquitous bloody photos of JG and TA, is this story of Grace Wang, her husband Jason and their baby Alexander. To summarise, baby Alexander is two months old. His brief time in the world has been spent by his mother’s bed in the high-dependency unit of a Sydney hospital. During her labour with Alexander, Grace elected to have an epidural. Instead of anaesthetic, an antiseptic was injected into her spinal canal. Grace is now a very sick woman, whose condition has thus far only worsened. Her prognosis is uncertain due to the uncommon nature of this complication. This is a woman who may not get to go home, who may not ever care for her son, who, simply put, may not survive.

When people contemplate the risks of childbirth I can guarantee this is not one of the factors they are considering. Midwives’ and obstetricians’ minds turn to events such as pre-eclampsia, shoulder dystocia and haemorrhage which can complicate a woman’s pregnancy, labour and birth. Parents try not to imagine a prolonged labour or a distressed baby leading to a forceps, vacuum or caesarean birth. They try and wrap their minds around what labour pain might be like, pitting their everyday ‘pain threshold’ against their predicted pain of contractions, bargaining with themselves about what they will withstand before they ask for intervention. They (and I know I am generalising wildly here) tell themselves that they will do their best, but in the end ‘all that matters is a healthy mum and a healthy baby’. They trust that when push comes to pull out that they will get accurate and complete advice. Mostly, statistically, they trust that they will be safe in hospital. And mostly no-one really believes that today, in ‘the safety of hospital’, in Australia, that women can be injured or die during childbirth. Obviously, in far far away, foreign-type places, where women get about squatting in fields to have their babies, this might happen. Because they don’t have hospitals. And people can imagine how babies might die during birth. Because they’re not in hospital, or they are in hospital but they were in the private system, or the public system, or born in water, or born on a weekend, or or or….

I get it, I get why no-one wants to believe that things can spin out of their control, leaving a mother or a baby without the other. It’s just too awful to contemplate. But the risks are real. And whether or not it’s warranted, all intervention adds risk. That’s right – even if a baby needs to be born by caesarean, the risks are not discounted by this necessity. I realise that the natural progression of this argument skirts dangerously close to blaming the victim. That is not my intention. I cannot blame Grace for a catastrophic drug error. Drug error. Sound quite banal put like that, doesn’t it? I can, however, blame a system that has seen epidural administration turn into a procedure that many people assume to be no more risky than popping a couple of paracetamol. I cannot count the number of couples that have been astonished by the reality of an epidural. ‘What do you mean in my spine?’ ‘What do you mean I’ll need a catheter?’  ‘What do you mean risk of nerve damage, paralysis, instrumental birth, incontinence?’

I know that there are times when epidurals are necessary. I’m also very aware that what happened to Grace is so rare as to have only happened once before that anyone is aware of. Yet it could mean her son Alexander grows up without his mother. And for that I cry.

 

Disappointingly real August 11, 2010

Filed under: Midwifery — titchandboofer @ 6:33 am
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All of you television-watchers out there will know that there is a lot of air-time dedicated to examining the medical world. Comedies, dramas, documentaries, reality shows, shows about hospitals, celebrating ‘hero’ doctors, following ‘brave’ patients along their ‘journey’ (eye-roll hard here at reality tv having so comprehensively ruined one word), behind-the-scenes looks at complex medical procedures, fly-on-the-wall surgical delights, ambos, surgeons, GPs, oncologists, possibly even the cleaners will have their own show soon. I remember one year back in the nineties when there were about eight on in any week: Chicago Hope, ER, even A Country Practice was still running.

Once I became a midwifery student I started to long for the day that someone would make a show about birth centres, or maternity wards, or midwives. Now I’d rather they didn’t. Now I dread seeing how birth will be depicted on the small screen. I stopped watching Packed to the Rafters to avoid seeing the birth of the tiniest Rafter. Knowing that Asher Keddie’s character in Offspring is an obstetrician puts me off ever starting to watch it. Seeing bad, dramatic, gory and laughable births on everything from All Saints to Triple Zero Heroes, to reruns of Nine Months used to make me furious, indignant. Now I just find it depressing. I’d rather stick pins in my eye than see one more actor peer under a sheet in the general direction of a labouring woman’s inner thigh and shout “she’s fully dilated!” in the same tone that someone would shout “shark!” in the surf. Occasionally this phenomenon is excused by the claim that it is only worth showing dramatic emergencies, as who wants to watch things go to plan? I understand this query in relation to, say, home renovation. Woman successfully tiles laundry splashback in time and under budget. Man’s plastering effort remains adhered to wall. Compelling stuff. But even normal birth is spectacular. The main difference being that the birthing woman is the hero of the story. Maybe that’s the problem.

One Born Every Minute, screening on SBS on a Tuesday night, has not reignited my love affair with the idea of televised midwifery.

“Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras. Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff”.

Frankly, I found watching OBEM brought up the same feelings as being at work on a crappy shift. No thrill of watching people stumble over the threshold of parenthood, no spark of empathy for the midwives, no secret wish to go and work in the stark Southampton hospital. The women seem scared, the families are about as supportive as a bad strapless bra, the midwives are bossy and threatening and even the ward clerk is stroppy.

Carolyn Hastie at Thinkbirth has also written about her disappointment with OBEM. I absolutely agree with her contention that this show serves to reinforce every negative stereotype surrounding labour and birth. However, she is bothered by the documentary proposing that the maternity care shown is normal. This is where I disagree. As much as it pains me to say, this is pretty damn normal. As I write this I have no doubt that in a birth suite not far from here a woman will be being bullied, ignored, threatened, starved, unnecessarily connected to a machine, separated from her baby without her consent, infantilised, and she’ll be apologising for it. As midwives (and obstetricians) we might know better but it doesn’t mean we always do better. There are exceptions of course. There are some fantastic people caring for birthing women, but they’re outnumbered by the bored, disaffected, burnt out, fearful and underskilled.

What you see on One Born Every Minute shouldn’t be the norm, but all too often it is. In our maternity care system the quality of care you receive is a game of chance. That is, unless you are in the know and have the guts to speak up, loudly and repeatedly, to ask for the care you deserve. If you are pregnant or considering having a baby get in the know. Read, ask questions, seek multiple opinions and never assume that the professionals will always act in your best interest.