how do we instigate change?

I have been wanting to write something about this for a while. Before I start, I feel like it is important to remember that this is my opinion based on my own lived experiences and knowledge, there are no absolute truths. This is for you, but also for me. I feel a need to make sense of what is happening whilst I find sustainable strategies to encourage change and growth.

For better or for worst, there has been a lot of noise about “maternity services” in England in recent years. I would like to start by inviting people to think about what we mean by “maternity services”. By using this all-encompassing word, we conveniently do not directly address the people who work in maternity, we choose (mostly subconsciously) to dehumanize a service by making it an abstract entity. I think we do that because it is easier to cast judgement on something rather than someone. This can be useful at times, as it is important to be objective when we are sharing our opinion or experience of something. But is it really helpful when what we are trying to achieve is change, and this change can only be instigated by human beings? I, personally, do not think it is.

The overuse of interventions in pregnancy and childbirth in England is undeniable, there is a lot of talk about this being a consequence of “defensive medicine” (whereby healthcare professionals make decisions based on “if something goes wrong, how will I look in court?”), this is partially true, but not the whole story. In my experience, healthcare professionals who have seen the very worse unfold want to prevent that from happening to someone else, this is what they are most worried about, not if they are going to get the blame. We forget that pregnancy and birth are safe for most people, but not for everyone. Healthcare professionals who work in high-risk units have witnessed first-hand the trauma of what we consider a “bad outcome”. But maybe we should also stop and reflect on what witnessing these events means, doctors and midwives are humans who care about other people, and they have very human responses to trauma. I myself have experienced deep trauma and shock from emergencies at work, even when they had a happy ending or haven’t affected the people in my care as much. I am privileged enough to work part time and have a supportive home environment that has allowed me to recover from such trauma and shock, even though it has taken some time…

As much as we try to give unbiased advice at work, we are all conditioned by our experiences (for better or for worse). If our past traumas haunt us because we have not had the chance and/or time to recover from them, then our judgement of what is safe will be affected. We will want you to choose the option that we perceive is safest for you and your baby (and I guess here we could also discuss that the concept of safety is also very personal and different from individual to individual, but maybe that’s a can of worms that we’ll open another time).

So, what to do?

We also cannot ignore what women and birthing people are telling us about their trauma. But how do we instigate change when both sides are hurting? How do we make the world care about pregnancy and childbirth without creating rivalry between service users and service providers?

I do not have an answer to these questions, but I do know that since I started looking at the problem through the lens of compassion rather than anger, I have had some of the most deep, meaningful and insightful conversations with women, birthing people and colleagues. Anger can be a good catalyst for change, but it cannot be the answer going forward. I strongly believe that people are mostly good, and want to help each other, they also want to feel seen and be heard. Therefore, if we start looking at each other with compassion, asking for change whilst we also say “I hear you, I see you are hurting, I am sorry this is how you are feeling, but I need you to listen to me too” is harder as it requires more emotional labour, but might be more effective in the long run.

I don’t think that disengaging with maternity care is a solution to our problem, but I do understand that some are so tired to fight the fight that it’s the only thing they feel like they can do.

I still have some fight left in me, and I use it to try and bring change by compassionately challenging the status quo and by demanding more from our government. Because it’s always been political, womxn’s health is a political issue, let’s not forget about that.