The Roar Behind the Silence: book review

Soo Downe and Sheena Byrom are midwives from the UK with long and illustrious clinical careers in midwifery and also many midwifery research projects and publications to their names.

This year they published an edited collection of brief, sharply edited chapters written by 50 (count ’em) different authors.

The topic that the book deals with is the need for maternity services to be based on a philosophy of kindness and compassion: [back cover blurb]

For many years there has been growing concern about the culture of fear that is penetrating maternity services throughout the world, and that the fear felt by maternity care workers is directly and indirectly being transferred to the women and families they serve.

The consequences of fear include increased risk of defensive practice, where the childbearing woman and her family become potential enemies to those providing her care. In addition, the prevailing risk management and ‘tick box’ culture in maternity services encourages maternity workers to give priority to the records instead of the woman. These factors contribute to the dissatisfaction felt by those using and providing maternity services. There is however increasing evidence that kindness, compassion and mutual respect improve efficiency, effectiveness, experience and staff morale within healthcare settings.

The book is divided into three sections:

1. Stories and perspectives from maternity care.

2. Principles and theories.

3. Making it happen: solutions from around the world.

This is an action manual for creating change.

These are issues that are not only for the UK to be concerned with –  in Australia we have important problems to address with regard to how maternity care is provided, how women are respected within particular models of care and, of course, with regard to rising caesarean section rates and the consequences of this.

The chapters in the book are written by people as diverse as…

Kirsten Uvnäs Moberg:  a medical doctor and author of two books on the physiology of oxytocin. Her take on the impact of intervention on the action of oxytocin should make us reconsider the “safety” of many interventions which effectively block the action of the hormone.

Alison Barrett: an obstetrician who practises in New Zealand, and talks about how motherhood is not valued in western culture, “which is a nice way of saying that our culture (still) hates women” (page 63). She describes how every woman in the maternity system deserves the Best of Care. Every woman. She invites us to examine the barriers in our own minds that prevent us from providing this.

Milli Hill:  is a writer and campaigner and author of a book on water birth. She is the founder of the Positive Birth Movement – a grassroots organisation designed to promote discussion amongst women about positive birth. It emerged as an antidote to the widespread cultural fear of childbirth. As she says: “women in the PBM network consistently report that being treated and spoken to with kindness and respect is at the heart of a positive birth experience” (page 189).

Anna Byrom: is a midwifery lecturer who has used drama through Progress Theatre to explore issues through critical reflection and discussion and debate in maternity and general healthcare services. The chapter, co-written with Adele Stanley, Gemma Boyd and Kirsten Baker, outlines how their methods have enabled understanding of different participants’ experiences in healthcare settings as well as personal development – with a view to providing compassionate care.

Mavis Kirkham:  is a midwifery researcher who has written about and researched midwifery for 40 years. Her work has often focussed on the context of midwifery work and what kind of care this produces. Her chapter argues that  the NHS maternity care system is a powerful shaper of how midwifery care is delivered. We can’t ignore the impact that a system which oppresses midwives has on the way care is given.

Hannah Dahlen: is an Australian midwife researcher and practising midwife who is a professor of midwifery at Western Sydney University. Her research has covered topics such as episiotomy rates, perineal safety during birth and the impacts of place of birth and antenatal care on birth outcomes. Her chapter in the book (co-authored with Kathryn Gutteridge) looks at how the fear of midwives impacts on the experience of women during pregnancy and birth – how models of care based on risk alone take so much away from the the miracle of the
experience…and also the joy of doing midwives’ work.
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Maybe you don’t usually read books about midwifery?

That’s ok.

This is unlike any midwifery text I’ve read – the chapters are readable, understandable, distinctly lacking in researcher or academic jargon, and contain many stories.  They are also SHORT, concise and written in such a way that if you want to find out more about a particular person’s work or point of view, you can easily do so by looking at the reference list for each chapter or googling the organisations and publications referred to.

It is also a great way to find out the names of people who are doing interesting and stimulating work in our profession.

The other amazing thing is that at the end of each chapter there are summaries of key messages, and then a list of action points: what you can do – as a midwife.

I’m excited about this book because it has the potential to enliven and excite our profession towards change – a change that is centred on kindness and compassion for the women and families in our care.

The book is available for purchase online (for less than 20 bucks) via Amazon or Book Depository or locally through Capers: http://www.capersbookstore.com.au

Do yourself a favour.

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Breastfeeding in public. Build a bridge.

I’ve been a subscriber to google alerts for a couple of months now. The topics I am sent include “breastfeeding”, “bottle feeding”, “pregnancy” and “lactation consultants”. I get links to newspaper and magazine articles that the great google machine finds via its keyword searches.

Most days I skim them, some days I read a few and my midwife Facebook friends will know that I often post links that I think are discussion-worthy or particularly interesting.

The breastfeeding posts and links and articles have predominantly been focussed on two things: reported incidents of women breastfeeding who have been asked to cover up or leave the space they’re in. The other topic is how women are unfairly pressured to breastfeed by so-called breastfeeding nazis – a topic I have addressed in another post (More women doing it for longer).

I am coming to think that breastfeeding in public is a key issue for ongoing breastfeeding rates in Western countries. And it’s an issue of human rights…no,dammit, women’s rights.

If a woman is going to have the freedom to leave her home and surrounds with her breastfeeding infant she needs to know that she can feed her baby whenever and wherever she wants to, and more importantly, whenever, wherever and for however long it takes for her baby to feed. With no judgement whatsoever, and even with some encouragement – not a cheer squad, but maybe a nice place to sit and a drink of water.

Women who breastfeed in public are expected to look after the feelings of everyone else who enters that public space. It’s less of an issue that anyone can actually see anything (for example, areola or nipple) and more about the idea that this woman could be breastfeeding.

Breastfeeding women are often being asked to be discreet by the members of the public who see themselves as Reasonable People: “I don’t mind if women breastfeed, but they should be discreet about it”.  These people seem uninformed as to the realities of feeding a live, wriggling child.  And also to how rare sexual exhibitionism is amongst breastfeeding women.

Being a mother of a small baby and toddler can be an isolating experience. A lot of a mother’s time is spent in her own home with her children, attending to her childrens’ needs and running the household. Being able to get out, even if it’s to the shops, is what you need to do every day and sometimes it’s a downright lifeline (please take note shop keepers).

We all expect that when we enter the public sphere we can act as we please, within certain boundaries.

For a breastfeeding mother that means that she will very likely need to breastfeed her child at some point in public.She needs to do that so that she can leave her house, buy food, feel part of a community, stimulate her child, maybe even have a latte…in short, live her life.

Frankly, anyone else’s sensibilities will need to take a back seat if we can agree that, as a member of our society, she has the right to do those things. And breastfeed.

In Australia she has the inalienable legal right to do so.

I know that women’s bodies being displayed in public is a complicated issue in Western society. And breastfeeding is seen as a private activity that shouldn’t (?) be brought into the public sphere. What better way to cut through the hypocrisy around the objectification of women’s bodies than for a mother to carry out a beautiful, physiological activity of love and food with her child?you-can-do-it-breastfeeding