Author Archives: Luna

About Luna

Training to be a midwife in the North of England.

Pleased to meet you.

Last week, for the first time so far in my training, a woman named her baby after me. What an honour! That is memorable enough on it’s own, but there’s more.

I’d been looking after the woman on a night shift on the antenatal ward whilst she was having an induction (where we artificially try and start the labour, because there is a medical reason it is felt the baby would be better off out than in – or sometimes just because the due date has passed). Once we start this intervention, we monitor more closely to ensure the baby is coping ok. One of the ways we monitor the baby is using a CTG – a cardiotocograph – to monitor both the baby’s heart beat, their movements, and the pregnant person’s contractions. And the CTG reading was telling us this baby was very distressed, so the decision was made to have an emergency delivery by caesarean section.

As students, we are taught in an academic setting, and we complete training sessions, but (cliche alert) the real learning happens when we are in practice. I had learned what to look out for on CTG readings to indicate the baby might be in distress, but it’s not until I someone in my care was being monitored, and the CTG started throwing up distinctly un-reassuring features that I really learned what I was looking for, and how quickly you need to act. That’s not something you forget.

Especially when the baby is named after you.

Fatphobia in midwifery care.

I went to a midwifery study morning on obesity recently, (ie how to improve care for obese people receiving midwifery care) and I got a lot of good stuff out of it. I also (unsurprisingly, despite desperately hoping I wouldn’t) had to listen to a load of fatphobia.

So, obesity is the term applied when a person has a BMI of over 30. Personally, I think BMI is such a blunt tool as to be almost useless, I think the word “obesity” has a load of stigma attached to it and I think the move to classify obesity as a disease pathologies those of us with fat bodies. As a fat woman active in fat positive and body acceptance circles, I prefer to talk about “fatness” but unfortunately in clinical midwifery settings the preferred term practitioners use to describe our bodies is obese, so there you go.

The day was generally informative and not too problematic. There was really interesting stuff like how to support obese women with breastfeeding, and a round up of the latest research and evidence into care of obese women in pregnancy. But there was one speaker who, whilst she was undoubtedly incredibly knowledgeable in her field (how to reduce risks in pregnancy for women with elevated BMIs) – had filled her presentation with so much casual fatphobia that it undermined my confidence in her ability to give good care to people of size.

So what was it she did? Whilst setting the scene for her topic, she included a headless fatty slide in her presentation. There was no text, just a full screen picture of the torso of a fat person, to provide a thematic backdrop to her talking about obesity. It was on screen for minute or so for us to look at whilst she talked. These type of photos anger me because they completely dehumanise fat bodies, and are used without the consent or knowledge of the subject to illustrate presentations and articles that further dehumanise fat people. They are crass and add nothing, other than making me look out for further fatphobia.

She then went on to outline a case study of giving care for a woman who weighed around 20 stone, which would have been an excellent format to convey her information, as we were able to follow the woman from the case study through the antenatal, intrapartum and postnatal period and learn about ways we might need to change our standard care to meet her needs and reduce the risks she faced. (Different doses of certain medications! Earlier testing for gestational diabetes! Discussion of scanning vs palpating to determine the baby’s growth!) But the way she spoke about this woman was neither kind nor judgment free. Her commentary on the case study was relentlessly peppered with fatphobia. Like telling us that she discussed healthy diet with the woman in the case study, who told her what she ate on a usual day but ha! she didn’t believe her, come on! I got the feeling – obviously I cannot be sure – that the little digs she added in, the fatphobia, the undermining of what the woman told her, that these were the same sorts of things she would share with colleagues about fat patients.

She talked about the challenge of weighing a pregnant woman whose weight is above the maximum weight on standard scales, and in her case study this had to be handled by weighing the woman on the larger scales normally used for weight patients in their beds. To be honest, my understanding is that there are specialist scales available that can accommodate heavier people, and if health trusts are recognising an increase in the number of people in their care who are at these weights, it might be an idea to make some available. But if you need to use scales designed for a different purpose, ie for weighing patients in their hospital beds, do it with tact, kindness and humanity. The thing which made me question the speaker’s ability to do this? Whilst describing all this, she told us, whilst laughing, she couldn’t find a photo of the scales that she was talking about, so she included a photo of a huge set of industrial scales weighing a yellow pick up truck.

And I see these kind of comments in practice all the time too. Midwives question amongst themselves how a woman that weighs “that much” could have gotten pregnant. (Seriously, how do you think? And that question is relevant to her care in which way precisely?) When asked a woman’s BMI, a midwife saying “oh I don’t know, 100!” and then puffing out her cheeks and motioning a huge phantom body around her own, holding her arms out and waving them around. And this is what they say when there is a visibly fat colleague (me) in the room, which I imagine makes some people censor themselves slightly. I imagine the fatphobia is worse when there is no one fat in the room.

When confronted with fatphobia from midwifery colleagues like this, I have to remember I am seeing it through the eyes of a fellow health professional, and that even the most fatphobic practitioners might manage to mask their distaste for fat bodies when giving care to fat women. A friend of mine tells me that’s all we can hope for – that practitioners will go on thinking whatever bigotry they think but we can hope they will manage to hide it from the women they care for. But I want more than that. I want fat people to receive kind, compassionate, respectful healthcare not only because their practitioners have learned to hide their distaste for us. I want them to unpack and deal with their fatphobia to the point that they no longer have to hide it, because it’s no longer an issue. But as a fat woman who receives health care in other settings, I can say honestly even this isn’t happening a lot of the time.

LINKS:

Charlotte Cooper – Headless Fatties http://charlottecooper.net/publishing/digital/headless-fatties-01-07/
Health at Every Size – http://www.haescommunity.org/

Happy Birthday Emma Goldman!

So I decided to become a midwife… I wanted to deliver a thousand babies. And as each one arrives, especially the little girls, I’ll be there first to whisper into her tender little ear: REBEL! REBEL!” – Emma Goldman

Emma Goldman was born today in 1869, in Kovno in the Russian Empire (Now Kaunas, Lithuania), 146 years ago. She is heralded as the founder of anarchafeminism (my own fave political stance)  and she demanded “… the independence of woman, her right to support herself; to live for herself; to love whomever she pleases, or as many as she pleases… freedom for both sexes, freedom of action, freedom in love and freedom in motherhood.”  She was anti prison, anti marriage, and pro contraception. She was openly bisexual. And she was also a midwife!

She emigrated to America in her teens, and became involved in the anarchist movement in 1989. She was imprisoned several times for her political activism, and it was whilst in the prison infirmary that she learned to become a midwife – and once released she went on to practice midwifery to support herself alongside giving speeches and writing books and pamphlets on anarchism.

Emma Goldman was really excellent. You’ve probably seen the quote “If I can’t dance, it’s not my revolution” and many slight variations thereof on tshirts. Attributed to her, this is a tshirt-slogan-friendly reworking of her belief in “the right to self-expression, everybody’s right to beautiful, radiant things”, linking in the criticism she once received “that it did not behoove an agitator to dance”. (Pictured on the right is my favourite Emma Goldman tshirt design – click on the picture to get through to http://www.caebuttons.com/ to get hold of one!)

From one queer anarchafeminist midwife to another, Happy Birthday Emma!

Further Reading:

A Dangerous Woman – The Graphic Biography of Emma Goldman. By Sharon Rudahl (http://thenewpress.com/books/dangerous-woman)

https://en.wikipedia.org/wiki/Emma_Goldman

Catch! Who’s really delivering this baby, huh?

This weekend I caught my first baby!

I’d attended a number of births before this one, first as a doula and now as a student midwife, but this was the first one where I had my hands poised ready and caught the baby as they were born.

I “caught” the baby. I didn’t “deliver” it – if anyone delivered this baby, it was the mother. It’s a simple linguistic switch that I see other (often radical) midwives doing and it’s something I try and keep in my mind. The language we use shapes the world as we experience it. and I want my midwifery practice (and the wider world I practice in) to centre the people giving birth. They are the ones doing the work of birthing the baby. In my mind, to centre the midwife and say that they deliver the baby risks disempowering the person actually giving birth.

(I went to a talk last week by hypnobirth educator Katharine Graves, and she pointed out how the first time many of us hear the word “deliver” is in the Lord’s Prayer which asks that we be delivered from evil. And then after that it’s mostly a word we hear used for parcels! It’s a phrasing left over from a world where doctors were in charge of birth as a medical process, and they *did* deliver the babies. And that’s not something I want to replicate!)

Not everyone agrees with this talk of “catching” babies. I was discussing my choice of language with my mother, and saying how I talk about midwives catching babies rather than delivering them. And she told me, in no uncertain terms, that she felt the midwife delivered all three of her babies and she did not find that language to be disempowering at all. And I am *glad* – I wouldn’t want her to feel disempowered at the time of my birth, or at any time! I’m not about to start arguing with her that it was in fact her delivering the baby, because the whole point is to empower the people giving birth – something which seems to have happened here despite her narrative having the traditional language of midwives delivering babies.

But in future wouldn’t it be better not to take that risk with the words we use? Not to hope that the people giving birth will feel empowered and centred in the process despite us telling them that we are the ones delivering their babies, the ones doing the work?

New moon, new season, & new placement!

Today feels pretty special.

It’s a new moon in Pisces AND it’s the spring equinox. A new moon and a new season, and – even though I couldn’t see it because of the clouds – that moon totally passed in front of the sun a couple of hours ago giving us a total solar eclipse.

It is against this perfect backdrop of potential that I start my labour ward placement, with my first of three night shifts tonight.

I’m pretty excited.

The end of February marked the half way point of my training, but I didn’t feel able to take stock and celebrate at that point. I still had an exam looming, taking up all my energy, and there didn’t seem much to celebrate. It was hard. Then once the exam was done the last week of teaching rolled into the first week of placement with only a weekend to pause. But a happy accident with the rota meant my first shift on the week wouldn’t be until the Friday night – tonight – giving me the gift of this week to reflect.

I have spent the week getting ready. Spring cleaning the house, sorting through my record collection and my zine collection. Finding new homes for the things I don’t need. Getting the garden ready to grow vegetables, planting seeds indoors and crowding them on to the tiny sunny window sill in the living room. Clearing out our converted basement so my housemate and I can use the space to do yoga in there together because it is hard to survive & thrive as a midwife with the little core strength I have. Getting a new vacuum cleaner and being impressed and horrified and the amount of dust and cat hair it sucked up in its first trip around our little two bed terrace house. Creating physical space and in the process creating head space for what comes next. Which got me to a place where I could look back on how far I have come.

It can feel a bit like I have had to move heaven and earth to simply get to a point where I could start, and then continue, to train to be a midwife. Quitting my stable job with the local authority to go back to college. Moving to another city to be closer to campus and the hospital. Another house move and then another to finally put down roots in a house share with another student midwife that will see us through to the end of our training. The end of an unsupportive long term relationship which resulted in a loss of queer community for the best (worst) part of a year.

But I haven’t had to do it alone. Each time I moved house, I moved into a new home with friends. Countless friendships with both midwives and non-midwives have been there to help me when I needed to either talk more or think less about midwifery. One friend provided a one-woman pep squad to cheer every time I wrote a blog post, after months of talking about how I was gonna start writing about the way my politics and my practice inform each other. The end of the unsupportive relationship gave space for my other, more important romantic relationship to flourish as it became my only one. I’ve had family both in this city, and on the other end of a skype call when I have needed them. I’ve also been lucky enough to have several excellent hair cuts during this time. It has been hard. But it hasn’t been impossible.

But I needed this week, and the space it allowed me to make, to realise that.

How do we get midwifery research out of this heteronormative rut?

So whilst I am here writing posts about how we need to stop thinking that all the pregnant people we are caring/all people accessing reproductive healthcare around pregnancy are automatically women, on the other side of the looking glass I am training in a heteronormative world where we haven’t even got to that thought and are still referring to “fathers” rather than partners when we talk about the non-birthing partner.

I tend to use the word “partner”, with the phrase “partners of any or no gender” tripping off my tongue unless we are talking about something that *specifically* concerns non-birthing partners who are male. In which case I say “male partner”. Some other (student) midwives do this, but many just say father.

This week I went to a lunchtime event where researchers showcased their ongoing or current research around the theme of “involving partners and fathers”, and I had hoped from this wording that this would be a showcase that didn’t centre father’s experiences.

And the presentations were good! Important work is being done! But it is focussing on the experiences of fathers. After hearing the researchers speak, I realised that one of the problems we have – even *if* we talk in terms of partners so as not to centre the experiences of fathers and erase all others – is that so much of the research done into non-birthing partners/non-birthing parents is specifically research into “fathers”.

Researchers set out a hypothesis specifically about some aspect of fathers’ role in pregnancy/birth and then recruit fathers into the study and then publish this research and then there we have it, another piece contributing to the body of work that erases the experience of non-male partners, contributing to the heteronormativity of midwifery care. Another piece of research that because of its design can only be applied to fathers – despite the fact that the experiences of fathers detailed within the study may well also be the experiences of non-birthing partners of any or no genders.

I raised this point at the end of the presentations – my concern that research into partners was very heteronormative – stressing that I didn’t think it was any one researcher’s responsibility to fix, but that by continuing the centre research on “fathers” rather than partners of any or no gender, the problem perpetuates. There were a couple of points in response, the first being that it’s because male/female partnerships are traditional, and pointing to a growing minority of research into the experiences of same sex partners.

I am of course aware that heterosexual relationships are traditional. That’s not a justification for seeing them as the only relationships. Regarding the research being done into the experiences same sex partners;  it’s welcome, of course, but that is a separate point, and doesn’t get you off the hook limiting research into fathers when it could be framed as the experience of any partners. Because whilst I imagine same sex partners do have unique experiences (stemming largely from systematic homophobia?) which should totally be researched so practice can be improved, I bet they also share a lot of experiences as non-birthing partners with the fathers that we see so much (comparatively speaking) research about. And also, do you really think by covering fathers and same sex partners that we have covered everyone? Because I have some thoughts on the (falsehood of the) gender binary that you might find interesting…

Until those researching the experiences of fathers stop and ask themselves – is this really something that needs to be specifically limited to fathers, or can I ask the question more generally of partners of any or no gender – then this problem is not going to go away. If anything it’s going to get worse, as the existing body of work about “fathers” available each time someone embarks on a literature search at the start of a new project is gonna grow and grow.

I’m not a researcher (yet), so I imagine their are complexities to this I may be missing. Like what happens if we say we are studying the involvement partners of any or no gender but then only fathers come forwards to participate – can we still generalise our results? But surely it’s better make a commitment to moving away from heteronormativity, and to tackle these questions as them come up? To at least start ?

Can’t strike/won’t strike? What would enable you to make a different choice?

IMG_0438There was industrial action planned for Thursday of this week: an NHS staff walkout at 9am lasting until 9pm, to make the point (again) that NHS staff deserve the 1% increase recommended by an independent review. Plans then followed for another walkout on the 25th February lasting 24 hours, with almost a month of working to rule in between these two days of actions.

This planned industrial action was cancelled only days before it was due to take place, when a “breakthrough” was negotiated in terms of pay, causing the strikes to be called off to allow union members to decide if they can accept the offer on the table.

I feel a bit weird saying this but I was relieved when the action was called off. I was glad that there was finally discussion happening around pay, an acknowledgement of the need for change, but it was more than that.

The first day of action was planned for my last day on placement in what was deemed an “essential service” (therefore exempt from participating in the strike) but as a student not counted in the numbered staff making up minimum staffing levels, I felt my status was less certain. I couldn’t let myself off the hook. Not because anyone was pressuring me to participate – my suggestion that I would was met with surprise – but because of pressure I put on myself. I was tying myself up in knots to work out how I could support this action without jeopardising my placement, as it was crucial I worked the day of the strike both in terms of hours and in terms of an assessment taking place that day, but my deeply held desire not to cross the picket line made it a difficult choice. I was lucky to have supportive mentor who was accepting of whatever decision I made, but perhaps luckier still that the strike was called off before I had to choose between my principles and my academic progression. I didn’t have to decide, and I am still not sure what I would have decided.

All this gets me thinking to what stands between us and the things we want to do, or the versions of ourselves we want/need to be. Each time a strike is announced I find myself thinking “if only everyone went on strike this time, imagine how much more quickly this issue could be resolved!” but then I remember it’s not that simple. There are many reasons people can’t (or feel they can’t) strike, and no one individual should be made to feel responsible for the action’s success – or ‘failure’. They did not ask to be put in a position where they either accept the unacceptable working conditions on offer, or stick their neck out. We can’t know the individual decision-making process people undertake when deciding whether to participate in industrial action or not. And we also can’t know the factors they are taking into account – their work culture, their financial situation (because for those on the payroll, striking means losing pay), whether their relationship with their team and manager is supportive, whether they are out at work about their politics… not to mention the additional considerations to take into account before standing on a picket line (because I would argue it’s somewhat of a privilege to have health that enables you to stand outside for four hours in winter making a point).

What we can do is ask of the people not yet able to stand in solidarity (and I count myself as potentially one of those people this last week) – “what would enable you to make a different choice?”.

For me, there is also an element of needing to acknowledge the confines of being a student midwife within the NHS, and they way this limits our options. A good friend of mine recently compared being a student midwife to being a teenager, in that it is a time when we experience the combination of overwhelming, overblown emotions with the realisation that we have very little say in how things can turn out. This certainly feels true to me.

However It also means I will continue to grow beyond this point. It is a necessarily temporary stage. I will not be a student midwife forever.

LINKS:

http://www.theguardian.com/society/2015/jan/27/health-workers-strikes-supended-talks-breakthrough