Like much of the world, Kensington Palace just doesn’t get it. Every women needs a midwife and some need a doctor, too!

Kate, The Duchess of Cambridge, has been having care from a midwife for months, like every other pregnant woman in the UK, yet there is a white-out obscuring this important reality. This royal birth could do so much to share important messages about quality maternal and newborn care.

At 6.37 this morning LBC announced:

‘Kate will be looked after by a similar team of doctors and nurses to the one that helped her through Prince George’s birth in July 2013.

Guy Thorpe-Beeston, who holds the role of Surgeon Gynaecologist to the Royal Household, will be leading the medical team.

Alan Farthing, a consultant gynaecological surgeon, will also be present, as he was for the birth of her first son. He is also Surgeon Gynaecologist to the Queen.’

Guy Thorpe-Beeston ‘leading the medical team’, perhaps!

Alan Farthing ‘present’, quite possibly!

A ‘team of …nurses’, Oh please!

Who will provide the care throughout the labour? Who will encourage and support? Who will stage Kate through the undramatic hours?

A midwife, that’s who. A real person, a skilled and experienced professional. A person with a holistic approach, who thinks about the mind as well as the body, who knows that labour is demanding but that a women can do it.

A midwife with a name who should be celebrated for her part and for the sake of her profession. For the sake of other women in the UK and the world-over.

This roll-call  of the key personnel with the big hole at its centre must come directly from a Kensington Palace news release. Shame on their advisors.

Don’t they know that ‘Every woman needs a midwife and some need a doctor, too’? A midwife who is well educated, kind and reliable.

Of course it’s only one birth, but the coverage will be vast. What the royals do and value can influence a generation. We know that Kate is receiving midwifery-led care (no doubt with consultations with an obstetrician from time to time). When Lesley Page received her CBE William made it clear that he knew about the role and the value of a midwife.

The Lancet Midwifery series provides a framework for quality maternal and newborn care that firmly places the needs of women and their newborn infants at its centre. The framework is for midwifery care that includes ‘preventive and supportive care that works to strengthen women’s capabilities’.

In the UK we have some of the best maternity and midwifery services in the world, yet they still need to be developed and extended.

• More women need to be advised that a midwifery-led birthing unit or a planned home birth is a really positive option.
• Each and every NHS trust should be providing women with can care from the same midwife in pregnancy, for the birth and for care afterwards, as those who get this kind of relationship value it highly and we know that there are health benefits when continuity of midwifery is provided.
• More midwifery and community support is needed in the days and weeks after birth to help women and their partners adjust to new parenthood and to help them establish feeding their baby.

In countries where a medical model of care prevails, women are subject to far more invasive interventions and are frequently not respected, as Milli Hill reported yesterday.

The royals will have all the options, all the clinical care and all the support they need. What a good opportunity to promote midwifery care for all.

We have progressive maternity policy in England; hard fought for over many years. Making it happen in practice is the continuing challenge. Come on, Kate. Join us in sharing what you know matters.

And congratulations on the birth of your daughter!

Important further reading

All that matters: Women’s rights in childbirth

The roar behind the silence

NICE guideline on Intrapartum Care – All women should be supported in their choice of setting wherever they choose to give birth. Women who are healthy with a straightforward pregnancy (low-risk) should be advised that ‘planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit’. For multiparous women the same positive message applies to home birth.

Sheila Kitzinger described surfing the waves of labour contractions as a sport she could do. Plenty of other women get the bug and find it hard to give up the high of another labour and birth.

Yet, once your family is big enough, you have to stop getting pregnant. Whatever the pleasures of labour there comes a time when you know you will experience it no more. It is a draw for many women who love the cocktail of surging hormones, the excitement of the unknown, the anticipation that the baby is about to arrive, the fascination of each parturition being different, the powerful, demanding, sharp sensation of your own body, your uterus, working effectively. Then there’s the puzzle of finding the best accommodation, do you need a companion or solitude, does movement help or is stillness better? Is it eased by being upright or do you want to rest? Can you do both? Do you want to be immersed in water or on dry land? Keep silent or moan, curse… The time comes in a woman’s life when all of that is past.

Some of us have found another sport that we can do. I have become a runner, after a fashion. Running is a low-tech sport, requiring no equipment except for a decent pair of running shoes. You can wear any old soft stretchy clothes, such as leggings and a T shirt.

It involves no special pitch, facilities or expensive membership. If you are a woman who can go the course of labour, you can become a runner. Running requires the discipline of putting one foot in front of the other, over and over again, and keeping the momentum up when you want to stop. There are parallels with labour. The need to keep going. The sense, sometimes, of being more tired than in pain. The need to find a way of adjusting mentally; to relax as much as possible the muscles that are not essential to the act. To think when it demands an effort that it will not go on for ever. To know that you can do it.

I run more now at 56 than I have ever run before. But don’t get me wrong, I don’t run much. I don’t run with other people nor am I part of a club. I’ve never entered an organised event. I don’t know how far I run. I’ve been out running on and off since my twenties, very much more off than on. About five years ago, I started to run throughout the year, but very occasionally. It was hard work, though also liberating to be jogging up the road. As we get older our physical movements become so much less carefree and expressive. It can set you free to be floating, bobbing along. Feeling the air around you, aware of the weather on your face. Important to be warm enough, yet not too hot. Great to feel cool but not cold.

For me getting started meant finding a flat route, and an interesting place with a variety of sections to the route to help me count off the achievement of each phase. I’m really fortunate that I can run from the front door. Just down the road, the level crossing is the first point of interest. Over the green next, passing the children’s playground. I cross the road weaving through the traffic or skipping on the spot till the lights change, then follow the parked cars down to the river. I turn left by the pub and take the road along the river, noting how recently the tide reached up, leaving detritus on the tarmac. Cross between the bollards onto the path by the grassy bank and pass the bench dedicated to a husband, father and friend and his ‘round the river walk’. Go under the road bridge, always gracious and now with balustrades renewed. Here there are trees on either side of the path and then the steps to the river for rowers’ access. Soon the boathouse and welly-booted, lycra-clad oarsmen to avoid. Loads of women, too, enjoying being out and active. It’s definitely a quarter of the distance now, perhaps two fifths. That’s a game I play. How far run, how far still to go.

On along the tow-path. Years since a horse walked this way but blackbirds, a robin, and a heron sometimes over the water. The way is shared with dog-walkers, pram-pushers and families on bikes, as well as other runners, always going faster than me. The municipal dump sometimes smells a bit, then the posh flats with balconies. I used to stop at the turn-off for the shops. Now I go on further. To my special tree at the end of the wall. I press my palm on the rough patch and feel its imprint on my skin. Half way! I can turn back now.

Oh the joy of knowing that I’m on the count down, the return stretch. I often blow my nose, switch the iplayer into my left hand, circle my shoulders to shake out the tension, always running on. Slowing if I feel tired. Any pace is good enough, just keep going. In summer the flies hover over the path in clouds; annoying but a distraction. I’m running towards people I passed earlier. I smile, although I’m not sure what the etiquette is with lone men. If in doubt, eyes straight ahead. Luckily the dogs are uniformly well behaved. No harassment there. Soon I’m back at the boats. Is that three quarters done? Well, maybe once I reach the bridge? Definitely then. A bit of downhill before the crematorium. Then the last stretch of trees before its back onto the road. Past the house with the cow in the garden. A full size model! Past the pub and people drinking, smoking outside. Back between the brewery buildings, a whoosh of wind channelled between high walls. Then the sun lights up the green ahead of me. Negotiate the road, back across the park and see the picnickers, the ball-players and the families with little tots. Reach the level crossing and nip across or take the slightly longer route via the footbridge up the road. Sometimes the last bit can be a faster push, sometimes not a bit of it.

Back home, to stretch and puff and feel the warmth in-doors. I did it! That’s done for another month, week, three days, whatever. Waves of happy feelings, body rolling out, resting. The job done.

Last year, I set myself the target to run my personal route 12 times in as many months. This year, I have upped the target to a weekly run and now I’ve switched to an aim of twice a week. This is a sport I can do.

I’ve noticed that several research midwives are runners, too. I wonder whether others see the parallel with labour. I wonder whether they use the same psychological approaches that they used themselves when giving birth, or that they encourage the women in their care to use. Women can prepare for, and become accustomed to, extended periods of demanding physical activity and feel really good about doing it. Even if it is quite an effort.

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:

http://www.theguardian.com/lifeandstyle/2015/apr/12/sheila-kitzinger

http://www.telegraph.co.uk/news/obituaries/medicine-obituaries/11530874/Sheila-Kitzinger-childbirth-expert-obituary.html

http://www.dailymail.co.uk/news/article-3036293/As-childbirth-expert-Sheila-Kitzinger-dies-86-JENNI-MURRAY-pays-tribute.html