Making the case for independent midwifery: The Baby's Coming by Virginia Howes

Virginia Howes's book The Baby's Coming - A story of dedication by an independent midwife was published this week, just as the Department of Health announced that the government would not support independent midwives' proposed insurance solution, which means that when new EU legislation is implemented later this year independent midwives will become illegal. To anyone who has had any involvement, however remote, with independent midwifery - even if they've done no more than watch Virginia on TV in ITVs Home Delivery - this must seem like total madness: independent
midwives are highly skilled and offer choice and high-quality care to women with a wide variety of needs, relieve the pressure on an over-stretched NHS and save £13 million per year in costs to maternity services. You can read more about the situation facing independent midwives in this article in the Express, this blog by Angela Horler on the Huffington Post, or on the Independent Midwives UK website.

Reading The Baby's Coming this week, then, means that I have read it with an eye on the wider picture too. And, having read it, it couldn't be clearer to me that if independent midwifery is outlawed then we will have lost something of immense value, and outcomes for the women who would choose independent midwifery if they could will be less favourable as they are forced to birth in circumstances they wouldn't have chosen - either within the NHS or alone and unsupported.

Although the book is in many ways an entertaining read, packed with wonderful birth stories, moments of humour and everything that birth junkies like me love to read about - it's also profoundly political, stuffed full of clear demonstrations of where there is room for improvement in our maternity services. In a climate where choices in childbirth are becoming limited within the NHS, due to the suspension of home birth services, the closure of stand-alone midwife-led birth centres and fear of litigation - and all this despite a European law that enshrines a woman's right to choose the circumstances of her birth - it seems to me that we need independent midwifery more than ever.

I'm involved with the Positive Birth Movement, and at meetings we share positive experiences of birth and discuss how women can make their own choices and work with their caregivers to ensure their needs are met; in the process we often hear how difficult this can be and debrief previous experiences. Virginia's book, it seems to me, could be seen as almost a manual for mothers and their caregivers for how respectful, woman-centred maternity care should be delivered, whether in home or in hospital, within the NHS or outside it. There are 'scripts' in its pages that mothers (and midwives) could use to great effect and that's a real strength of these stories - they are an antidote to the 'am I allowed'/'will they let me' position that so many women find themselves in and they show how, even in difficult circumstances, you always have a choice about your care and your informed consent should always be sought.

I had all three of my children at home - with NHS midwives - and I love how the book, again through real-life birth stories, gives a truly realistic picture of what home birth can be, both when all goes well and when there are complications. (I absolutely loved the story of the parents who planned a home birth, went into hospital for monitoring, found all to be fine, then dashed back home again to have the baby in the pool as planned!) Parents considering home birth can read the book and get a sense of the 'back up' that's in place, whether the care is independent or NHS, and feel reassured. On the whole the book is immensely reassuring; it's a long way from the 'drama' of birth on television shows like One Born Every Minute. Even through the (admittedly very unusual!) story of a breech birth that took place in a moving ambulance in a snowstorm there is never a sense of panic, more a sense of wonder that birth can often unfold spontaneously even in the strangest of circumstances. I also relished the moments where traditional (yet evidence-based!) birth wisdom - so easily overlooked in more medicalised births - was in evidence: Virginia describes how something as simple as getting out of the pool could slow down labour enough to give her time to arrive to be with a nervous father worried about having to catch the baby, and how labours that are progressing well can be stalled by people coming in and out and talking to the mother, or turning on the lights. She often talks about the subtle signals women give about what is happening in their labours, without the need for vaginal examinations or calculations of 'rates of progress'. There's valuable knowledge here that we would all do well to take note of.

It's probably clear by now that I loved this book (I've ordered a few copies for my mobile book stall so I'll be spreading the word...) And I'm with Virginia in hoping that it doesn't become a historical document in the near future: if you can join in the campaign to save independent midwifery, please consider doing so. You can go to the IMUK website and take it from there - lobby your MP, donate to the fighting fund, sign the petition.

Finally, I wouldn't be an editor worth my salt if I didn't flag up the fact that there are a few proofreading errors in the book, and that some of the dialogue sounds a bit clunky (that's down to the fact that someone decided not to use any contractions - strange, given the subject matter! - so instead of 'I'll' 'I'm' or 'We're' these are spelled out in full). These are minor niggles, didn't spoil my enjoyment of the book and can no doubt be corrected in future editions (of which I hope there are several, revised and updated to include many future birth stories!)

I received a review copy of the book from Headline; my opinion of it is, of course, my own!

Breastfeeding in swimming pools - Virginia Howes takes up the cause

Earlier in the year this post about breastfeeding in swimming pools became one of my most read ever - and I'm disappointed, after all the debate about those cases, to be revisiting the subject again so soon.

Virginia and Sophie Howes

On 26 October, Sophie Howes, a midwife and mother of two, was feeding her baby at the edge of the pool, partially submerged in the water, at the Stour Centre in Ashford when she was approached by the manager and asked to move to somewhere where she couldn't be seen. Apparently one of the lifeguards, a woman, was so 'offended' by the sight of a baby breastfeeding that she was 'unable to do her job properly'. Sophie, who left the pool and continued to feed her baby during the conversation (apart from one moment when the baby let go to look up at the manager - a mental image that has really made me smile) refused to move and pointed out that the manager was breaking the law (you can read what the law says here). The manager, however, insisted she move, citing 'company policy' (which she said she would email to Sophie later). Upset by the incident Sophie and her party left the centre.

And that might have been the end of it - another day, another breastfeeding mother discriminated against and belittled for responding to the needs of her baby, while going about her normal daily business - but Sophie is the daughter of Virginia Howes, independent midwife and star of ITV's Home Delivery, campaigner and author, who, as an outspoken advocate of the rights of women and their babies has both encouraged Sophie to complain about her treatment and taken up the cause: as she sees it, not only was the way that this individual case was handled indefensible, but it is also evidence of a widespread lack of awareness of the law that applies to breastfeeding mothers in our society. The law, as I said in my previous post, is there to protect women and their babies from being harrassed or victimised. As I wrote then:

"Regardless of how other individuals might have acted, or chosen to feed, or cover, or not, the law protects us all, whatever we decide to do. A mum who fed out of the pool, or in the changing room, or in the lobby, or under a towel, or at home before bringing the baby in, has just the same right to be respected by staff as the mum who, for whatever reason, fed in the pool itself."

And in this case, respect was the last thing Sophie got. When Virginia Howes called the centre manager to discuss the incident, the manager claimed that if a lifeguard, or a member of the public, was offended by seeing a woman breastfeed, in the pool or in the cafe, then it was the manager's duty to speak to the mother and ask her to move, because it is a public place! This is totally backwards, since the breastfeeding mother is the party protected by the law. If nothing else it highlights a serious lack of training at the Stour Centre, and I suggest that it's unacceptable for the manager of a public leisure facility to have such a lack of understanding of her responsibilities in this area. (I refer her to my previous post about what should have happened!) And as for customer service...

You might expect, in the face of the high-profile coverage of the other swimming pool stories, and given the widespread response to this latest discrimination, that the pool, the council and everyone concerned might swiftly issue an apology and attempt to make amends. Unfortunately, that hasn't happened. You can read the correspondence on Virginia Howes' Facebook page here: the pool's representative has attempted to justify the position taken by the manager. Many of her 'health and safety' points were robustly debunked by the Analytical Armadillo, IBCLC here the last time the issue was debated; and indeed, many of those commenting on the campaign have pointed out that baby swimming instructors often recommend that babies are fed in the water to stop them getting cold! It also seems telling that the promised 'centre breastfeeding policy' has not materialised, despite repeated requests.

When I first heard Sophie's story I was saddened - as I always am when breastfeeding mothers and their babies are targeted - and I've been appalled at the response to the many complaints that have been lodged. But this time I think the issue will not be swept under the carpet - Sophie and Virginia have so many supporters that the campaign that ensues might succeed where others haven't. If they can raise awareness, and break down some of the barriers to breastfeeding that currently exist in our society, then that will be a great thing. And I can't help feeling just a little bit excited about that.