Border Mail Column Wednesday 26 September 2012
A woman who speaks barely a word of English is fighting to keep her premature baby with her at home, while the doctor is insisting that to live, the baby needs to be taken to the neo natal unit at the hospital.
It is not her first child, but her 25th and despite language differences it is clear that she is highly distressed at any suggestion she will be parted from her baby.
This scene is from the heart-warming Call the Midwife, currently on ABC television.
The series, based on midwife Jennifer Worth’s account of her experience in the East End of London in the 1950’s, gives us not just a glimpse, but the chance to step into this neighbourhood where community, and mothers and babies are at its heart.
The nuns of Nonnatus House (in reality the Sisters of the Anglican Community of St John the Divine) and the young midwives including Worth (then Jenny Lee) were trusted to provide ante and post natal care to mothers-to-be and mothers, but there are the signs of the increasing intervention of doctors – then mostly men – in this women’s business.
Women generally had their babies in their own homes where they felt safe and it also meant that their female children learnt that labour and childbirth were a natural part of life, rather than a process to be managed at every step.
Mother and baby were checked on by the midwife or as we see in the program attended a public health clinic, but strict routines of baby care including four hourly feeding schedules, were still to come.
Like the midwives, mothers were trusted to know what was best for their baby – even when their living circumstances were not ideal.
In better off neighbourhoods in England and in Australia from the late 1950’s, women were booking into hospitals and having a more controlled birth and post delivery experience.
The medical practitioners intervention extended to giving advice on how women should feed their babies, with the mantra being ‘doctor knows best’, rather than ‘breast is best’, when what the doctor knew could be highly influenced by the formula companies with evidence of collusion at that time between them.
In the 1960’s the women’s liberation movement in countries including Britain, the United States and Australia saw a questioning by women of the interventions that had been happening and a push for a more natural birth experience – not necessarily at home, but at least in an environment that was not clinical and where a mother, if her delivery was ‘uneventful’, would not be separated from her baby after birth.
The morning after I watched this episode of Call the Midwife, I read a report in the Sydney Morning Herald of a study that had found that between 2000 and 2008 only 15 per cent of women in private hospitals in New South Wales had no intervention in their delivery, and according to lead researcher, Dr Hannah Dahlen, much of the intervention was driven by a need for obstetricians to make their ‘workflow and patient flow easier to manage’.
There is anecdotal evidence over a longer period of time that doctors are concerned about increased risk of litigation if something goes wrong during a delivery.
My aim here is not to demonise the medical profession: if it were not for medical intervention by my obstetrician (male) my first child may not have been delivered safely, but to observe that there is much intellectualisation and subsequent interference in natural processes that deserve closer scrutiny.
Yes, we have the technology, but it doesn’t mean we always have to use it.
DR Hannah Dahlen was lead researcher for this study. BMJ open: Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study Click here
Research regarding influence by the manufacturers of baby formula on doctors is included in my masters thesis: The Critical Factors in a Woman’s Decision to Breastfeed or Not Breastfeed in Terms of the Messages She Receives – Their Content, Source and Timing