The Politics of Maternity by Mander Rosemary;Murphy-Lawless Jo;

Author:Mander, Rosemary;Murphy-Lawless, Jo;
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2013-08-15T00:00:00+00:00

Understanding midwifery's problems within the contemporary NHS

In his exploration of the current dilemmas within the NHS, Richard Sennett (2008) does not discuss midwifery specifically. However, he describes the frustrations for all clinicians as their scope to ‘do good work’ (Sennett 2008: 48) was radically reduced under the weight of all the reforms. Sennett speaks of low morale as nurses were forced to abandon older modes of relating to patients which had been central to good practice. The quantification project as it was applied to the NHS imposed targets which were meant to raise standards of care, but detracted from them, not least in the way care became more fragmented. Good clinical care required the space to listen in depth to individuals, to have a genuine dialogue and to reject ‘quick fixes’, undertakings which for all the emphasis on ‘patient choice’ had less value as the waves of reform rolled on: ‘People have no experience to judge, just a set of abstract propositions about good-quality work’ (Sennett 2008: 50).

Fragmentation of care severely affected midwives and their practice. They had already experienced an attack on ‘good-quality work’ during the 1970s as hospital birth was extended to include almost all women. Increasing numbers of women were subjected to routine interventions like induction of labour, with no clear evidence as to their value in reducing perinatal deaths (Chalmers et al 1976; Robinson 1990). There were new perspectives about birth and the value of skilled midwifery coming from midwives like Ina May Gaskin (1977), and the establishment of the Association of Radical Midwives in 1976 gave fresh energy to many midwives to confront medicalisation. The entire undertaking by Jo Garcia and her colleagues (Garcia et al 1990) was to document many of the negative changes as well as the potential for genuine change towards what women and midwives wanted.

Nonetheless, midwifery remained in a complex position during the 1990s and into the following decade. In that period, the work to strengthen understandings about what good birth comprises and how to support it effectively in clinical settings expanded enormously, while groups like AIMS and the National Childbirth Trust continued to raise public awareness about the consequences of indifferent or bad care. The parliamentary committee system was used successfully in this, and the notion of an established relationship with a midwife articulated by women was a centrepiece of theWinterton Committee Report in 1992 (HOC 1992). Continuity of care, however poorly understood (Murphy-Black 1992), occupied a core position in articulating what many perceived to be good midwifery practice.

The longstanding matter of midwifery's subordination to obstetric thinking remained an obstacle. Midwifery committed itself to a project of professionalisation in the hope that increased status and increased possibilities of developing vigorous research would help overcome older entrenched hierarchies that prevented autonomous practice (Robinson 1990). There was a growing sophistication in the analyses of what could go right fairly rapidly if there were a commitment to reorganising aspects of NHS maternity services (see eg Kirkham 2003, 2004; Shallow 2003; Downe 2004; Walsh and Downe 2004; Deery et al 2010).

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