Becoming a parent is one of those occasions when one gets to see a lot of ‘the state’ – engaging with doctors, nurses, hospital administration; becoming a welfare recipient, through signing up for child benefit, or the now defunct child trust fund; visits from health visitors; registering a birth. Of all the professional people we have engaged with in this process, twice now, my heroes are the midwives. ‘We’ have had very different experiences of maternity care, first in Bristol, now in Swindon. In Bristol, with our first child in 2006, we were part of a progressive so-called ‘domino’ system of midwifery care, attached to a midwife-led maternity unit – this system is distinctive because the same midwives provide continuity of care through antenatal, intrapartum and postnatal stages. We were enrolled into this practice through one of our neighbours, at a summer street party actually, when she and one of her colleagues convinced us of the benefits of this approach, compared to the model in which community midwives provide antenatal and postnatal care, while different midwives are responsible for care while in hospital. The Bishopston midwife practice was, in fact, full of properly feminist midwives – Mary Stewart, our neighbour, was both a practicing midwife and a part-time PhD student at UWE at this time, and she is now an academic at Kings College London. I didn’t know this back then, but she is the editor of an important primer on feminist approaches to midwife care. I remember having a conversation with her, after the birth of our first child (she wasn’t actually the attending midwife at the birth), about her use of Judith Butler and qualitative methodologies in her PhD to understand midwives discourses about performing vaginal examinations during labour. The speed-reading I have done in this area, just by tracking Mary’s publications and where they lead, reveals an interesting and unexpectedly close relationship between high-falutin social theory – lots of Foucault in particular – and very practical concerns of how to enact, as they say, feminist principles of empowerment in contexts where midwives are mediating all sorts of imperatives, from surveillance of women, doing things to them, and sharing their experience and expertise with them.
One surprising thing about being part of this midwife practice was that we were quickly converted to the idea of having a home birth, which would previously have seemed like a bizarre thing to do. In the end, our first daughter wasn’t born at home, but the decision to start from a home birth as a first preference was an important aspect in ‘empowering’ and building confidence for my partner around the process of labour and giving birth. This second time round, in Swindon, things have been a little bit different. No domino system, and the Great Western Hospital in Swindon does not yet have a birth centre either (it opens later this year, and my partner couldn’t hold on). While not impossible to have a home birth, it was not in any way encouraged. Before Christmas, just as my partner started maternity leave, there was a rush of national news stories about funding cuts to midwife care and heightened risk to mothers in labour, and about ongoing controversies about the safety of home births. So we found ourselves in a context of renewed debates about medicalization of child-birth, and campaigns to protect maternity services in an age of ideologically-led austerity. But in the end, the birth of our second daughter involved two great midwives at the hospital, in and out in one day, and no sight of a doctor at all. And whereas we had planned to use a birth pool at home first time (I never even got to inflate it in the end), this second time ‘we’ did a have a water birth.
Two children in two different towns, both born in hospital but under different organizational arrangements. There is a large aspect of comparison to the practice of parenting – comparing one’s own conduct to peers and cohort groups, or to parents or sisters; and now, it turns out, comparing the second time to the first time. And then you remember there is something irreducibly singular about each birth, each child, each nappy. So I’m not going to generalize on the basis of our experience, not least because while in Bristol we got the ‘theory’ right, in Swindon we have had as nice, and in some respects even nicer, and as ‘empowering’ an experience despite being in a more classically ‘medicalized’ system. There is, of course, lots of serious social science about the geography of labour (though not really much in Geography), in at least two respects: the different arrangements available in different parts of the country; and at a different scale, but closely related to this, the differences between births planned at home, in midwifery units, or obstetric units. Our former neighbour Mary, since completing her PhD, has been working on a major Department of Health research programme, the Birthplace programme, looking at whether there are significant differences in outcomes for mothers depending on where births are planned. The results of the programme are due to be published later this year.