My first blog is an appreciation of the life and work of Sheila Kitzinger (1929-2015), who died on Saturday.
I first read Sheila Kitzinger’s classic The experience of childbirth 40 years ago this summer when I was 16. I chose the book as one of my school leaving prizes, causing more than one raised eyebrow. The not-amused were right to think it would have implications, or that it reflected unfolding events in my life. Both were true. I was hooked. I have spent the years since researching and writing, teaching, networking and influencing. I was well placed in one key respect to do that, I had a grounding in giving birth – twice, once at 18 and then again 19 months later, ‘the experience of childbirth’. Sheila was a great mentor in listening to women’s stories and encouraging them to have a voice.
Now there are wonderful blogs and websites, images and films, international campaigns and local groups pushing for more humane birth. Sheila, sowed a movement; technology has taken it forward. Each generation of women and men plays their part, choosing where and how to give birth; keeping the aspiration for positive birth alive and growing. Midwives are becoming better informed, more political and more managerially savvy. All these skills are needed. But where are the next generations of vocal and informed British obstetricians (GPs or paediatricians) with the clout of Wendy Savage, who celebrated her 80 birthday last Sunday?
Perhaps the publicity this week will inspire more activism.
When I trained as an antenatal teacher over 30 years ago, Sheila’s feminist, woman-centred perspectives were inspirational. Her passion about families and partners and children, and the potential joy we can experience from true closeness – from intimacy fulfilled – were bold and exciting.
Sheila was criticised. Anyone who speaks out about the way things can be personally, and could be politically, gets it in the neck from someone. Some scoffed at birth plans, others took issue with orgasmic birth. Fewer knew about her support for the reproductive rights of women prisoners or the support she gave and organised for women following a traumatic birth. She championed continuity of midwifery care and support from a birth doula. These causes, services and aspirations were sound and sensible; they attracted few headlines.
Playing it safe was not Sheila’s style. Attempts to avoid causing any offence, or negative reaction, is what leads to big P politicians trotting out bland platitudes that they hope will upset no-one. One of Sheila’s special qualities was that she was willing to take risks in order to get her ideas across, so that they could be discussed and debated. And so that women could get a better deal. Have more power. More knowledge. More say. More control. More care when they need it.
Yet Sheila was nobody’s fool and not insensitive to nuance of expression. (God dammit, she was a fabulous, fearless wordsmith.) She gave me a few tips on enlivening my language.
As an individual writer she could be a maverick. She was highly influential in getting NCT established. She encouraged the charity to use evidence, to collect women’s experiences (of episiotomy, of care in hospital, of interventions generally) and to value and celebrate women. Once NCT grew and became a broader church, or more timid or more mainstream, depending on how you read the history, Sheila moved on. She was more the vanguard pioneer than organisation woman.
As an institution of one, with massive support from Tessa Kitzinger in running her office and website, and the work of her various publishers – most recently Pinter and Martin – and photographers, she had more influence than any single campaign or organisation.
Remarkably, Sheila influenced many policy makers and managers, whether or not they would attribute developments to her. She – with other courageous but less high-profile women and men – parents, activists, researchers, clinicians and educationalists made it possible for the principle of women-centred care to be the focus of the Winterton Report and then Changing Childbirth in the early 1990s.
We now have birth centres popping up all over the place. Women and their partners, grandmothers and school children need to visit them, get to know where they are and what they do. They need to talk to families with experience of home birth and find out what it’s really like. We all need to lobby for a better environment and more personalised care in hospitals – starting with firm comfy couches, stools, balls and the birth ‘CUB (for Comfortable Upright Birth), and shelves, for perching and leaning. We need more midwives, so that in every NHS trust there is an opportunity for women to get to know their own midwife who follows them through their pregnancy and into motherhood, there for them at the times it matters most, including during labour. We should start with improving the quality of care for the most vulnerable and those who want continuity of carer.
A birth pool is needed in every birth room as standard, not as the exception. This would be a massive step forward.
One of the things that confounded even Sheila in during her life-time was halting the steady tramp forward of the medicalisation of pregnancy, birth and postnatal ‘care’. Nor have any of us yet had lasting impact on holding it at bay. Women have more choice, but not in circumstances of their own choosing.
Wendy Savage put her career and reputation on the line over how much to resort to caesarean birth. A few NHS trusts have brought down caesarean rates of over one in four to less than one in five, but generally caesarean rates in the UK have edged above 25%. So, one in four women have no opportunity to experience the ‘gradual opening up, like a bud into full flower’ – the climax of labour, that Sheila spoke about.
There is much more to work for. Will there be more leaders like Sheila, willing to climb on the table and lie on their back with their perineum pointing skyward and their legs in the air to illustrate the madness of modernity? Let us hope so.
Other articles and obituaries:
5 thoughts on “Sheila Kitzinger – inspiration, activist and friend”
What a beautiful tribute Mary! And your first blog? Congratulations.
Sheila’s book ‘Episiotomy and the second stage of labour’ transformed my practice as a newly qualified midwife. During my training we were ‘encouraged’ to do episiotomies, especially on primigravidae. Wow betide a midwife who didn’t and the woman had a slightly torn perineum! So we lived in a state of fear – from senior midwives as well as old-school obstetricians (this was in the late 1980s). My episiotomy rate, at that time, was over 80%. Shameful to admit! After reading Sheila’s book, and loving such analogies as putting your arm through a lined jacket too fast, and allowing the vagina walls to be ‘taken up’ like the cevix, stretching gently, no ‘cheerleading pushing’, etc, my whole second stage management changed. And I’m thankful to say my episiotomy rate tumbled to almost nil (there are of course a few times when it’s needed).
I had the pleasure of meeting Sheila just once, and was in awe of her brightness, humour and friendliness.
Her legacy will live on for generations to come.
I, as you, truly hope there are many others who continue the good work for women, and maternity service providers.
Arohanui (big love)
It’s so good that you reference a particular aspect of Sheila’s work. There must be many, many gems for all of us to re-visit and share. She had a deep understanding of physiology and the social model of birth (mind, body, environment), used great imagery. How exciting to hear what an impact it had on your practice.
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And countless others of course, as I mentored and supervised and educated other student and qualified midwives! I recall a specific birth, of a woman who’d had a previous really nasty tear needing suturing in theatre, who refused a c/s for the next birth. She asked for my support to birth gently, and we worked so well together using Sheila’s analogy. She totally breathed the baby out, using entonox, on her left side, as I controlled the head – and she had an intact perineum (as well as a healthy baby of course)! The look on the Senior registrar’s face who’d been waiting outside to say “I told you so ..” was a picture. And the woman was so proud. And I was proud too, and very relieved, but I’d been confident it would be okay.
A legacy indeed. I shall never forget the lessons I learned from that book. I just wish I’d known of her work before i had my own children, years before becoming a midwife.
Are you at all tempted to work at a midwife again? Women NEED midwives like you. If not, why not? Have you heard about the newly announced maternity services review? ….led by Baroness Cumberlege!
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I last worked March 2013 in a small unit in Gisborne, NZ, where around 750 women birth a year. I let my NMC registration lapse that year too, having kept it up for the 8 years I lived in NZ! We travel the canals and rivers, it’s not possible to have a ‘proper’ job with such a lifestyle.
Wow! Lesley and Baroness Cumberledge are amazing women, 25 years after Changing Childbirth they’re both going strong. Full of admiration for their passion and tenacity. Maybe I’ll check it out …