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Time to call the midwife: how did pregnancy become big business?


Call the Midwife

Call the Midwife

BBC/Neal Street Productions/Laur

Dil Wickremasinghe and her partner Ann Marie

Dil Wickremasinghe and her partner Ann Marie


Call the Midwife

If you've ever wondered what it's like to return to childhood, when everybody and their wife feels free to give you advice "for your own good", you can do no worse than become pregnant.

You thought you were a functioning adult with opinions and views that mattered? Not any more.

Once you start showing that bump in public, it's immediately assumed that you have reverted to the age of 12 with corresponding mood swings and the irrational behaviour of a pre-teen to match.

You now need to be "minded". You may have been nominated for a Nobel Prize in economics, head the World Bank, be a famous mathematician, or even just be a regular independent adult woman.

But once you don those maternity clothes, everybody - and I mean everybody, including your postman, butcher and celibate parish priest - will know better than you about what you should be doing during your pregnancy.

As well as the obvious cautions, such as don't smoke, do crack cocaine or drink a bottle of Jack Daniels daily, pregnant women are increasingly inundated with warnings of what will happen to their unborn child if they engage in all manner of ordinary day-to-day activities.

Don't eat soft cheese, don't even think about having that glass of wine with dinner, give up those aerobics, don't go on long flights, don't wear tight clothes, high-heel shoes, dye your hair… the list of what you're not supposed to do during pregnancy seems to increase daily.

In the US, a barman can refuse to serve you a gin and tonic if he sees you have a bump.

There have been efforts to criminalise women who drink or take drugs during pregnancy. This is despite the fact that the vast majority of pregnant women are super-cautious about what they put into their bodies when pregnant (we're not completely thick you know?) - and women who do abuse their bodies during pregnancy obviously need professional psychiatric help.

If you're over the age of 25 (like the vast majority of new mothers in Ireland today), you are also given dire warnings about complications during pregnancy, premature births and all manner of horror stories about what may befall you and your unborn child during the following nine months.


Dil Wickremasinghe and her partner Ann Marie

Dil Wickremasinghe and her partner Ann Marie

Dil Wickremasinghe and her partner Ann Marie

Dil Wickremasinghe and her partner, Anne Marie

Many women I know become dangerously stressed and anxious when confronted with all the health problems they are told they may experience during pregnancy.

When I became pregnant with my first child, I was astonished to be told by a well-meaning (male) tutor (I was a mature student at the time) that I should immediately quit my studies and not return until my child was safely born.

"If I was your husband, I'd have you at home, wrapped in cotton wool, doing nothing more strenuous than making the odd dinner," he told me.

I was told that, because of my advanced age, I would need constant monitoring and doctor's visits.

Who knew getting pregnant was some sort of illness that needed constant monitoring?

When did the whole business become so incredibly monetised?

I ignored that advice, obviously, but I still worried that I was being "selfish" by continuing to live like a functioning, healthy human being during my pregnancy.

It wasn't always like this. For centuries, pregnancy and childbirth were seen as normal events best left to the female arena - after all, it was women who became pregnant, women who gave birth; they were obviously the people with the knowledge and the experience in this area.

And so, midwives cared for pregnant women and looked after the whole experience of childbirth.

But then, during the 18th century, we had what was called the "obstetric revolution", where forceps and fashion combined to change how women would experience pregnancy and childbirth forever.

In the same way that breastfeeding was considered to be increasingly confined to the lower, poorer classes, employing a "mere midwife" to care for you during pregnancy and deliver your baby was thought to be a sign of lower social status.

If you wanted to look as if you were a member of the ambitious "middling class", you made damn sure that you employed an expensive male doctor to deliver your (or your wife's) baby.

Lying-in hospitals were then built as the care of pregnant women was colonised by the new male profession of gynaecology and obstetrics.

As with most things in life, it wasn't about what was best for the pregnant women, but more about wealth, power and prestige. Wealth for the male doctors - some of whom became celebrities who treated royalty - power for those now in charge of a woman's reproductive system and prestige for those who used them.

But surely we know better now? In the 21st century, women are healthier and more informed about their bodies than their sisters of earlier times, and yet, instead of allowing women more responsibility for their pregnancies, we seem to be going in the opposite direction and increasingly infantilising them.

The bottom line seems to be that women just cannot be trusted during pregnancy or childbirth. They need experts (mainly men) to tell them what to do and what is best for them.

In Ireland, in 1954, the obstetrician-led Maternity and Infant Care Scheme was introduced, supposedly in an attempt to reduce the number of maternal and infant mortality rates.

What the scheme actually achieved, though, was to significantly change the way we view pregnancy and childbirth, according to Dr Jacky Jones, a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.

"In practice, the consultant-led model instantly led to the medicalisation of childbirth, downgraded the midwife's role, and maximised the power of health professionals over women's health," she explained.


She argues that this "ensured that obstetricians working in Catholic maternity hospitals/units could rigidly control contraception, sterilisation, abortion, fertility rates and, therefore, women's lives generally."

Jones says: "In the 1960s, the consultant-controlled maternity units introduced a policy of 'active management of labour (AML)', which ensured pregnant women lost all power over childbirth."

Intervention became the norm and women lost all power over their own pregnant bodies.

But again, that was back in the bad old days, before the feminist revolution of the 1970s; before contraception was legalised; before organisations like the Irish Family Planning Association had the health and welfare of women at the forefront of their ethos. Or was it?

Last month, Aims Ireland (Association for the Improvement of Maternity Services) published the results of a survey conducted among more than 3,000 women in 2014, about choices in pregnancy and childbirth.

Of those that did not currently have midwifery-led care available, 55.5pc said they would choose a midwifery-led service if it was available to them.

That's over half of Irish women (who do not have access to a midwife).

And how many currently do have access? A measly 5.5pc.

The rest are treated by an expensive ob/gyn-led system. Why is this? (The hint may be in the word "expensive").

Recently, broadcaster Dil Wickremasinghe wrote about how frustrated she was at how power is taken away from Irish women during pregnancy.

In a piece, entitled Ireland over-medicalises birth - and it is terrifying mothers-to-be, she describes how "Irish maternity services follow a medical model that at times does more harm than good as they tend to over-complicate, over-medicate and even over-think the process of childbirth".

Dil asks: "Did someone ever have to teach you to sneeze or cough? Childbirth is a natural part of life and a woman's body, if trusted to do its job, would naturally give birth to their baby.

"Of course things can go wrong in childbirth and that's when the midwife or the obstetrician can step in, but why not include the woman in the decision-making process right from the beginning?


"Shouldn't she be regarded as an expert on her own body and trust her natural instincts and judgment?"

And that's the nub of the question right there. Women are not allowed to be in charge of their own bodies. We are not allowed trust our own judgement. We are increasingly infantilised during pregnancy and childbirth. This is the reason why we have one of the highest rates of caesarean birth in the EU.

And the question has to be cui bono? Who benefits from this? Because it's certainly not the women.

When the Catholic Church opposed the infamous Mother and Child Scheme during the 1950s, they wrote that: "To educate women in regard to health, and to provide them with gynaecological services, is directly and entirely contrary to Catholic social teaching, the rights of the family, the rights of the Church, and the rights of the medical profession."

Everyone has rights, it would seem, where pregnant women are concerned, except the pregnant woman herself. Everyone knows what is best for a pregnant woman, except of course, the woman involved, whose brain is obviously addled by all those baby hormones floating about.

We have always been told that our expensive, male-led, obstetric, interventionist approach is the safest and best for both pregnant woman and unborn child. But that won't wash any longer.

A new series of studies from both Europe and the US shows that an increase in female involvement, midwife-led births, rather than "over-medicalised" hospital deliveries, would lead to a range of "physical and mental benefits for women and babies".

Bottom line?

In the vast majority of pregnancies, mother knows best.

Women need to take back their power from the vested interest groups and regain the confidence to know what is best for them during pregnancy and childbirth.

We did it for centuries. Time to do it again.