The drama of midwifery lies in the long quiet hours of focussed attention on the miracle unfolding before you, the satisfaction at hearing the change in a woman's voice from querulous exhaustion to triumph, awe and love as she welcomes her baby and the fulfilment in escorting families on their journey through childbirth. It's therefore not really surprising that most TV depictions of birth are profoundly annoying for midwives to watch, as the drama for TV has to be contained in short episodes with as much excitement, alarm and agitation as possible.
I try where possible not to watch most TV depictions of birth, as it's bad for my blood pressure - moaning ‘not again' where a pregnant character in a soap who five minutes ago was absolutely fine, clutches her abdomen, shrieks in sudden agony, a minute later yells ‘my waters have gone' and five minutes later is clutching a baby (who incidentally looks about two months old), or burying my head in the sofa cushions as a woman comes into the Accident and Emergency department in ‘Casualty' and all hell lets loose as either the mother, the baby or both suddenly develop a life-threatening emergency. It may be bad for my blood pressure but its more pernicious effect is the impact it has on women (and of course even more their partners) who then think they should rush to hospital as soon as the first contraction is felt or become convinced that birth is a major medical emergency. ‘One Born Every Minute' and many of the births shown on the Discovery Channel are frustrating for a different reason, as although obviously these are real people having real babies, both the amount of medical intervention and the focus on hospital as the place of birth create fear, trepidation and self-doubt for the viewers.
There have been some honourable exceptions to this rule, for instance the ITV series ‘William and Mary' which starred Martin Clunes as an undertaker and Julie Graham as a midwife. The births depicted there were realistic, dramatic in their impact on the families involved without introducing unnecessary medical dramas to the births themselves and took a reasonable length of time. There have also been a few ‘reality TV' births, such as ‘Homebirth Diaries' which have shown woman-centred births and empowering midwifery.
‘Call the Midwife' which has recently caught the public imagination, has been much more satisfying to watch as a midwife. Obviously, we have moved on from the 1950s (enemas given via glass tubes are thankfully a thing of the past!) but the technical details are much more accurately portrayed and the babies clearly are a clever mix of convincing models and genuine newborns. Like ‘William and Mary', the drama comes from the lives and stories of the characters, rather than from injecting unnecessary (and often spurious) medical emergencies into the story-line. While there have been some ‘unusual' births, such as premature birth, a breech and undiagnosed triplets, the midwives are shown just competently dealing with whatever is happening, without too much fuss and bother. The anecdotal evidence from colleagues who were working in the 50s concurs with these depictions, that many of those births which would now automatically be ‘risked out' of home birth were in fact managed successfully and safely at home. Even if there are genuine grounds for some of these births to take place in hospital nowadays, I feel it is a salutary reminder that it is possible and indeed desirable to maintain a sense of normality even in more complicated births.
One of the other key factors in ‘Call the Midwife' is the strong sense of community. Of course, the Docklands of the 1950s are a vanished world and some of the things that have gone with that vanished world are not to be regretted, the grinding poverty, the over-crowding and the unrelenting work. However, the presence of midwives in the community, well known to and trusted by all the families in the neighbourhood is something which we definitely need to return to. The Association of Radical Midwives has long advocated the idea of case-load midwifery, where a midwife, based in the local community, carries a caseload of women who she gets to know over the course of the pregnancy and for whom she will care in labour, whether that is in the home or in hospital. Even if we don't live in Poplar tenements or crowded back-to-backs, it is still perfectly possible to recreate the key elements of the model shown in ‘Call the Midwife' in today's different environment, by focussing on the woman, her needs and the needs of her family rather than on the needs of a system based in the acute sector and by seeing birth as part of life rather than a medical crisis.
Sarah Montagu, is the Admin Secretary of the Association of Radical Midwives (ARM) and a practising independent midwife
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