'and what is your birth philosophy?'

I told the car mechanic story outlined in my last post to my new midwife, who laughed along with me, sharing my outrage, or at least I thought so. When we had finished laughing, she said, ‘if the obstetrician is the mechanic, what is the midwife?’ I was gobsmacked. Hello?! The point of this story is that I was being compared to a car! A car. An inanimate piece of machinery. That doesn’t give birth to little cars. To my face! (Can you tell that I’m still gobsmacked by this?)

A few months later, when she brought a trainee midwife with her on one of her visits, she got me to repeat the story, and the trainee’s response was the same, ‘what is the midwife in this scenario?’ At which point, I replied, half-jokingly, ‘I don’t know, perhaps the tea-lady?’ My midwife sardonically thanked me.

I know the two midwives were only picking up the ball of the metaphor and running with it to figure out what the analogue for their role was, but it still made me feel kind of like an object. I was not a chassis hovering up near the ceiling on a mechanical hoist, I was a pregnant woman. For that moment, it seemed that even the people who were most supportive - in the non-mechanical hoist sense - sometimes lost sight of that in the long-standing doctors versus midwives conflict.

I’m not sure how many stories I heard from my midwife about how great it was that the law had been changed - and no, I’m still not sure what law that was - so that midwives had more autonomy to practice how they wanted. It was like I was supposed to be vicariously thrilled that they’d won their battle. Not that I’m not, I just didn’t want to hear about it all the time. This was the first - and possibly only! - time I was pregnant, and I wanted the focus to be on me, me, me. Oh, and the baby, of course.

Let me be clear. My midwife was excellent. I have few complaints about the care that I received from her. And I was aware that, as childbirth became more medicalised in the nineteenth century, midwives, who had primarily looked after women in childbirth until then, were marginalised in the process. Women’s bodies became subject to the authority of male doctors, who presumably knew better because, well, they were men. If the original car incident with my former GP had taught me nothing else, it was that some male doctors a) still viewed women as objects (a car!) and b) still pathologised what is a natural process.

As I have mentioned before, I have some skepticism concerning the reification of the natural in childbirth and child-rearing. But pregnancy, as that feminist bastion Netball New Zealand confirmed when Adine Wilson played in the losing New Zealand side in the 2007 world championships final three months pregnant, is a state of health. (side-note: there was a storm in the teacup over this pregnancy when it was announced after New Zealand lost 42-38. Would it even have been an issue if they had won?) It is a natural process, but one that is not left solely to nature.

When I was trying to select a midwife, several asked me about my ‘birth philosophy’. ‘My what?’ I thought to myself. Am I supposed to have concluded whether or not my birth would be an affirmation of Platonic Idealism, Cartesian dualism, or even Derridean deconstruction? It turned out that a birth philosophy is more along the lines of whether you’re a ‘give me an epidural with everything’ type or ‘I want to feel every mind-blistering painful moment’ type. The midwife who I had personally gravitated to most told me that she practised natural childbirth i.e. the ‘pain and lots of it’ kind. I really wanted her to be my midwife, as I thought we had got on well when we spoke, but I was unsure if I would be able to cope with an unmedicated birth experience.

I thought about it a lot as I wondered whether to go with her or not. The number one consideration for me was to be with someone that I could trust, and I had felt this way straightaway with the midwife I liked. I also intellectually liked what she said about ‘woman being able to do it’ without help. I liked the idea that the pregnant woman should be in control of her own destiny as much as possible. It sounded like an empowered, even feminist, birth experience. On the other hand, I am a big chicken when it comes to pain - and that goes for big epidural needles too. In choosing a midwife, was it finally time to put my uterus where my mouth was?

In the end, I decided to take the leap of faith and commit to having a natural birth. I felt daunted by it, but hoped that I would be proud of what I had achieved when it was over. Before the labour started, I had even convinced myself that all the pain would be productive and, even though it would hurt, it would be better for the baby and mean a better recovery for me.

But as flies to wanton boys are we to the gods. Far from a natural childbirth, I ended up having an almost completely medicalised experience: induced labour, epidural, antibiotics, forceps, lots of surgery, general anaesthetic, blood transfusions, the works. My midwife stayed with me the whole time, encouraging and supporting me, even though the doctors took over in the end. The baby was fine. I was not, for a long time. It turns out that if we had really let nature take its course, it’s possible one or both of us wouldn’t be here.

I think I have a birth philosophy now, having gone through the experience, and having had eleven sleepless months to think about it, but it isn’t ‘give me lots of drugs’ or ‘I’ll die before I mainline anything’. It’s ....

Nope, sorry.

It's gone.

'an obstetrician is like a car mechanic'

Continuing my non-linear approach to blogging, I want to look back at when I first entered the health system after finding out I was pregnant. I had already taken an over-the-counter pregnancy test, which came back positive. Not really knowing what to do next, but feeling that health professionals should be involved, I made an appointment with my GP. When I say ‘my’ GP, he wasn’t really, just one of the doctors at the local practice, who I hadn’t actually seen before. My husband and I both went along for the appointment, feeling both nervous and excited. That didn’t last long.

My first clue should have been that he was a sports doctor. His wall was papered in images of him attending prone rugby players in a natty shell suit, which dwarfed his practicing certificates. I’m guessing too that his clients didn’t include netball players or other female athletes, as, when I mentioned that I thought I was pregnant, he looked like he didn’t know the meaning of the word. Instead of offering congratulations, he asked what we’d like to do about it. Feeling my good mood start to evaporate somewhat, I said, ‘um, that’s what we’ve come to you to find out about.’ He looked startled, as if he would much rather have had to deal with an injured hamstring or a misplaced metatarsal.

As we looked at him expectantly, he started mumbling about obstetricians, and trying to think of names of golfing buddies who weren’t holidaying in the Caribbean, I presume, that we could see. Feeling confused, we asked whether we had to see an obstetrician or whether we could go with a midwife. Being asked a direct question seemed to at last provoke a semi-coherent response.

‘Oh no,’ he said. ‘Seeing as this is your first pregnancy, and I’m not sure how it’s going to go, you’re really much better off being seen by an obstetrician.‘ Well, seeing as it was my first pregnancy, and I wasn’t really sure how it was going to go either, I wanted to know why he was so dismissive of midwives. Having done a short research project on midwives about fifteen years earlier, I suspected gross institutional sexism and a reversion to the Dickensian Sairey Gamp stereotype. I wasn’t too far off, as he then proceeded to tell me that there had been a few cases in the Wellington region where babies had died under a midwife’s care. He also noted that midwives didn’t even have to be nurses these days, and some had only trained for six months.

I wasn’t exactly sure what the situation was, but felt pretty strongly that this was a load of crap (side-note: it was, as we later found out). At this point, I should also add that maternity care for women in the New Zealand public health system is free. The primary care-givers, known as Lead Maternity Carers (LMCs) are either midwives or GPs who also deliver babies. If we had elected to go with an obstetrician, we would have to pay private fees, running to thousands of dollars.

I could tell my husband was not impressed by the doctor’s answers so far either. Rather than feeling stonewalled like I was, he attempted to get some more information. ‘So what exactly is the difference between an obstetrician and a midwife?’ he asked.

‘Well,’ replied the doctor, speaking slowly as if he were addressing someone who was a bit thick. ‘One is a doctor, who has trained for several years, the other one isn’t.’

Suppressing the urge to say, ‘no shit Sherlock,’ my husband persevered. ‘The course you’re recommending could cost us a lot of money. What’s the benefit of going with an obstetrician as opposed to a midwife?’

The doctor searched around for something to convey the difference. ‘Well, an obstetrician is like a car mechanic ...’ he began.

At this point, I can’t even remember what he said next, as I reeled from the shock of being compared to a car. That’s right, a car. An inanimate piece of machinery. That doesn’t give birth to little cars. To my face. I think we both decided then and there that we were 1) not going to take any advice from him and 2) going to change doctors asap.

Unfortunately, this visit left us floundering somewhat as to what to do next. We didn’t even have a list of midwives in the area that we could ring, much less any idea of whether they were any good or not. This then led to a merry dance over several weeks where we actually tried to get some information to help make this decision. I contacted the Ministry of Health and they supplied their list, which didn’t list every midwife in the area. The Midwifery Council’s list was voluntary and didn’t contain contact details, although it did list qualifications, where they had been provided. In the end, we asked around friends and colleagues who had given birth in the last couple of years, to see if they could recommend someone. In the end, we took a colleague’s recommendation and were cared for by an excellent midwife. While we had a good outcome in the end, it was an unnecessarily protracted and stressful process.

This incoherent state of affairs is dressed up in the language of choice. Women can choose what kind of care they want, where they want to give birth, and which midwife to use as their LMC. It sounds good, doesn’t it? As a middle-class, well-educated professional, however, I found all this choice overwhelming, confusing and scary as the weeks ticked by and I didn’t have a midwife. I wondered how people who didn’t have my advantages managed. I support some choice, especially concerning where and how to give birth, which I do believe should - as far as is possible with such an unpredictable event - be driven by women. But I question the value of such a piecemeal system, where no one place even has the full information about services available in the region. Is using the language of the free market really empowering, or is it, rather, importing its stratification and actually limiting choices for some? I guess it works for those whose GPs aren’t certified idiots, and can point them in the right direction in the first place.