By Caroline Flint

Skimpy national uniforms and 'pretty' caps can be a positive barrier between the midwife and the family, argues Caroline Flint

Half of Tooting has seen my knickers. This dubious privilege is not earned, sought after, or even desired by most of its recipients. Even when wearing my Christmas pairs (one pair with sprigs of holly, one with snow flakes, one with Father Christmases and one with a Happy Christmas motif), it is a view that few, even my nearest and dearest would cross oceans for. Who are these less than lucky people who have been subjected to this sight? What common denominator unites them? They are the people whose babies I have delivered.

Probably in the heat of the moment, many of these parents have thought that this vision was a momentary lapse, or a refined type of distraction technique for strong labour. But, I am sorry to relate, this vision occurs every time I sit down on a low stool, whenever I squat to deliver a woman in a similar position, and frequently when I bend.

I am a proud member of the greatest and perhaps the most influential of all historical professions - I am a midwife. As a professional woman why am I not dressed in clothes that befit my calling? As a woman who wants to retain credibility, why am I exposing myself to ridicule and embarrassment? The sad reason is that I am employed by the National Health Service which, in its wisdom, has seen fit to rig me out in the uniform of another (and different) profession - the uniform of a nurse. Nurses' uniforms look fine on nurses; to my jaundiced eye most nurses are young and fairly slim. Most midwives are women of mature years and even maturer figures. As a midwife with a decidedly comfortable figure, wearing the

As long ago as 1978, in a letter to Nursing Mirror, it was stated that proper lifting techniques are impossible because of the narrow width of the nurses' uniform skirt.` In the report of an RCN working party entitled Avoiding Low Back Injury Among Nurses, recommendation 14 suggests that a trouser suit should be incorporated into the uniform to avoid low back injury in nurses lifting patients.'

If nurses' uniforms are not even very useful for nurses, how much less useful are they to midwives? Midwives who are forever helping labouring women up the bed, demonstrating different delivery positions, delivering babies in different positions, sitting on low stools in the delivery room. A skimpy skirt is probably the least useful article of clothing we could ever wear. If there is some strange reason for dressing midwives in the clothes of another profession, we would probably fare better if we wore the green boiler suits that the engineers and plumbers wear in the health service.

A consultant paediatrician once answered my grumbling about being dressed in the clothes of another profession by telling me that everyone in his hospital knew who he was without a uniform, and he went on to add that he never wore a white coat. He looks like a professional without either uniform or white coat - of course he does - he wears good clothes and he walks with confidence in the

There are times when I look like a professional. These are the times when I wear my own clothes. My clothes are designed for me; they are my taste and I buy them in colours that suit me. In my clothes I look like me. As Ann Rider said at this year's annual meeting of the Royal College of Midwives, the role of the midwife in the postnatal period has changed from that of a physical carer to that of educator, counsellor and supporter of the family in the changing relationships within the new family. The new family is not helped by the barrier that my national uniform creates between us: they need to see me and we need to relate to each other as people.

If some of my midwifery colleagues want something to cover their own clothes, what about taking on the garment that so many doctors are abandoning, the white coat? These are useful overalls that many professions use - dentists, greengrocers, vets, hospital receptionists, medical students, pharmacists and the specimen porter; how about midwives too?

If we decide to take on the green boiler suits or white coats to enable us to practise more effectively and to prevent us displaying our underwear, what will we be doing with our caps? These fluffy bits of lace are neither more nor less than symbols of servility.

Why do I call these caps, beloved of so many of my colleagues, symbols of servility? If you open out many of the caps of the great teaching hospitals you will discover that the frills and ruffles are embellishments to what is, in essence, a Victorian maid's cap, which started life as a cover for her hair and is now merely an ornament serving no practical purpose. When I write these

My cap takes an hour to make up. It has to be starched, ironed, stitched with running stitch, moulded around a saucer and the requisite number of ruffles put in it. It is a chore to be put off, done once a year or delegated to a friend. As a professional woman dealing with the public, I need to be careful about cleanliness. Consequently I wear a clean dress every day, clean bra, clean tights and the aforementioned articles to be viewed by the world, clean every day. I also shower and wash my hair every morning. So I set off for my work spanking clean and fresh, except that on my clean head I wear a very dirty cap, because of the time and toil involved in making it up.

My cap becomes dirtier throughout the day. In the delivery ward I brush it against the big light; when delivering a baby to a woman in a semi-squatting position I brush it against the labouring woman; when bending down to get something out of a cupboard I brush it against the top of the door. My symbol of servility is not very hygienic.

My symbol of servility is not very practical, either. It does not cover the hair or show evidence of training or of special midwifery skills. How can it, when it is worn by waitresses in motorway cafeterias, assistants in supermarkets and untrained care personnel? If my symbol of servility was anything other than what I describe it, why don't other professionals rush to take it on to enhance their status? Imagine your professor of obstetrics in my frilly cap. Does she/he want to look `pretty'? Or your solicitor? Or your accountant? Who will rush to take on my cap when I am allowed to discard it, together with my national uniform and when I am allowed to dress as my profession needs me to? Midwife means `with woman'; I suggest that means wearing my own clothes.

1. Letters. Nursing Mirror. 1978; 146:12. 2. The Royal College of Nursing (1979). Avoiding low back injury among nurses. Royal College of Nursing, April.