Dangerous Liaisons?

“Why should women have to prepare themselves and psyche themselves up for encounters with health professionals? It’s ridiculous.” Not my words, but those of a Nicky Grace, a midwife. The maternity system seems unable to organise itself so that women meet a familiar, friendly face rather than a stranger in the labour room. And I’m not even talking about continuity of care given by just one midwife, my research showed that having met a midwife just once before was nearly as good as knowing her well. (None of the mothers in my Mothers’ Experience of Birth study were cared for by a male midwife.) There have been seven months to prepare for this crucial meeting, half a dozen antenatal appointments, lots of chances to meet the team. It is indeed ridiculous to have to encounter an unknown midwife when in labour.

We are primed by evolution to be wary of strangers. We have to psyche ourselves up to prepare to meet unknown people. Think of the difference between a GP appointment and a hospital appointment. Seeing a GP you’ve met before is vastly different from the first hospital appointment with a strange consultant. Psyching oneself up involves secreting stress hormones which antagonise oxytocin, the primary contraction associated protein. On the other hand, encountering someone who has become a friend lifts oxytocin. Knowing your midwife (or midwives) is a win-win situation, not only do you not secrete hormones resisting oxytocin but you get an oxytocin boost from meeting a friend.

I wouldn’t say I was a conspiracy theorist, but I do wonder whether some hospitals prefer you not to know your midwife. Some say that it is inequitable to offer continuity of carer to some women but not others, thereby tacitly acknowledging that there is an advantage to continuity.  Some midwives say that it doesn’t matter that they don’t already know the woman, they can easily establish rapport with mothers, but others value the mother-midwife relationship so highly that they find themselves unable to practise in the NHS. The NMC certainly seems to be taking the view that it is dangerous for friends and relations to provide care for a labouring mother. Apparently, the danger is that known midwives will be less rigid in following guidelines and give special treatment to women they know. They will bend the rules to accommodate women’s wishes. I’m just wondering what dangers there are in granting women’s wishes. As to special treatment, if anyone deserves special treatment, it is the woman who is doing the work of labour. One of the mums in my study said she chose home birth so she could be the Queen Bee.

Guidelines are there for a reason, they say, but it is a thin line between protective steering and coercive control. Which is better, natural oxytocin or syntocinon augmentation, individualised care or birth by numbers?

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