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The six articles comprising `Childbirth Attitudes' were written between 1982 and 1986 and encapsulate what people love and hate about Caroline's writing, namely her effusiveness, her ability to ground her arguments in the realities of her clinical practice, her eclectic use of research, her willingness to embrace controversy and her tendency to sacrifice subtle complexities for what she sees as the fundamental truth. The title of the earliest piece `The Obstetrics of Fear' is polemic and the opening sentence is couched in language counter to the traditions of 300 years of empiricism. Neither is likely to convert her antagonists to the arguments in the article. So to whom is the article addressed? Caroline has mainly written for one audience: those who are unhappy with the `status quo' in maternity care and aware that there are many areas in it that are substandard or could be vastly improved. Caroline has the ability to articulate, and make public, issues which have concerned, irritated, excited, frustrated and saddened midwives and others throughout the United Kingdom. When she says in `The Obstetrics of Fear' that midwives have `been intimidated into thinking that (their) feelings are irrelevant and unscientific' she is inviting us to create a new discourse about maternity care with her, appealing through her illustrative use of her own practice to what we have felt or thought but too often have been unable to say. Caroline's very public refusal to be intimidated, together with her ability to persuade editors to let her have column inches, has played an important part in reformulating the agenda for maternity care over the last 10 to 15 years. The theme of this section is attitudes: attitudes to childbirth, attitudes to women, to women's bodies and implicitly attitudes to life itself. Caroline's own approach to midwifery and her beliefs about the direction it should take are constantly framed against the backdrop of her personal life. Midwifery should facilitate not only the birth of babies but also the birth of mothers with the emotional imperative to mother with confidence and pleasure. Her own experience of being mothered (`The Obstetrics of Fear') and of being a mother acts as a catalyst for her vision for maternity care.`Mother and Midwife - on the same side' is also interwoven with autobiography. In 1970, long before she qualified as a midwife, Caroline became an antenatal teacher for the National Childbirth Trust and has continued to run NCT classes ever since. The title `Mother and Midwife' and the partnership between midwives and women argued for in the article reflect the unity of experience and purpose in Caroline's personal and professional life. The myriad of ways in which our personal histories and professional lives interconnect has yet to he studied seriously but Caroline has never subscribed to the ideal of the `detached professional' the detached midwife being a contradiction in terms is indeed her theme. Some people do not like Caroline (nothing personal you understand - they just don't like what she stands for or how she stands for it). It is hard for midwives to be assertive and seeing, hearing or reading of others assertiveness can be an uncomfortable experience. It is perhaps Caroline's misfortune that influencing people and winning friends are not always as closely connected in reality as in popular literature. The hapless houseman in `Nowhere Else to Go' understandably may have come to regret opening his mouth in front of her but I doubt his attitudes escaped unscathed. The professional members of the Maternity Services Liaison Committee in `We Always Do That Here' may have deleted her from their Christmas card list but probably introduced a smidgen of self-criticism to their subsequent agendae. There are sufficient midwives for whom being liked (by the consultant, the registrar etc.) ultimately takes precedence over standing up for clients to make Caroline and others like her even more necessary and refreshing. Caroline's assertiveness is not just a paper exercise. In the early 1980s
a new wing was built at St George's Hospital and a vast new canteen was
opened for all staff. After some months of these egalitarian dining arrangements,
it was announced that an adjacent room would be opened as a smaller dining
facility with waitress service. (Meals would cost ten pence extra therein.)
The consultants flocked towards the waitresses with everyone else keeping
a respectful distance. It may not have been called a Consultants' Dining
Room but everyone understood the intention. They reckoned without the
antenatal clinic sister. Caroline was having none of this nonsense and,
rounding up any hungry midwife she could find, would persuade them that
ten pence was a price worth paying for a classless society and lead them
cheerfully into this bastion of medical privilege. There she would plonk
herself at tables already occupied by various consultants (just to make
sure that there wouldn't be `consultant tables') and engage them in prandial
chit-chat. Being an occasional visitor to St George's (I worked in its
sister unit) I was rounded up for lunch on two or three occasions. Even
this little stab of assertion took some nerve. Attitudes and the behaviour
they engender are very deeply engrained; which is why most of these articles,
written a decade or more ago, could have been written yesterday. Most
... but not all: attitudes are slowly changed. |
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