Invoking vocation
A while ago my partner found this photo, the full shot is of a group of nurses who were working in a field hospital during the First World War. There is a division in the weird blended queer found family about how much she looks like me. Personally, I agree with my partner, it looks like I time travelled back to 1916 and got myself a starched hat. I’m allergic to ironing though so they probably would have spurned my crumpled uniform.
Over the last few years I’ve been thinking a lot about what being a midwife means. In leaving academia, running the Sheffield Maternity Co-operative and now being ‘self-unemployed’ as an Independent Midwife and an International Health Consultant. The Co-op was an experiment in what anarchist community centred co-production of maternity care might look like. We achieved so much, both locally with projects like free training (from the amazing Abuela Doulas) for Doula’s and Birthkeepers of Colour in Sheffield and nationally with our Cultural Safety training. I think we must have directly reached nearly two and a half thousand maternity staff. There were many midwives; professional leads; student midwives; junior and senior doctors; midwifery support workers; and one very sweet but confused anaesthetist.
Being on the ‘sidelines’ though, with the co-op and now as an IM and freelance researcher, is giving me a strange sense of perspective on the behemoth institutions which govern so much of how we mobilise health care at one end and ideologize humans and their bodies at the other.
This could be a blog about the patriarchal and deeply colonial origins of medicine in late capitalism. It could be specifically about how we as a society judge and actively shape the female body. It is not uncommon, after wines, for me to start listing all the eponymous names of female genitalia. Who the f**k is Douglas? Why is it his pouch? Who gave Bartholin the right to stick a metaphorical flag on both sides of my vagina? Pass me the bottle. The only manoeuvre I know that is named after a midwife or even a woman is the Gaskin roll, my preferred second line (immediately after MacRoberts - see, another dude!) to release the posterior shoulder in a dystocia. And in all the text books now, it’s named the ‘all fours’ manoeuvres. Just so it’s clear. We make medical students learn what the islets of Langerhans are, and apparently that’s fine. But hey, hey, let’s not confuse people with a name for someone turning around, guys.
This isn’t what this blog is about. Mainly because I’m not currently drunk. It’s about what it means to have a vocation, to be a professional, to take on a mantle that is something bigger than you. A mantle so that is heavy that sometimes it consumes who you actually are.
We are inculcated in our training with the need to not just act in a professional way but to become a professional. A whole quarter of our NMC Code is a section on ‘Promote Professionalism and Trust’. It is fascinating that these two, quite different, aspects of a moral being are conflated here. Why is a professional demeanour more trustworthy? Why is homogeny in act (The Code) and appearance (uniforms) so important to the nursing and midwifery professions? Why is scalability desirable and industrialised processes so integral to us and to the wider health services?
I have said, and heard others say, well, you need to make sure you’re getting the same service in Cardiff as in Cambridge. Why? What if the needs are different? What if the metrics by which we both track outcomes and assign funding to are not applicable to many communities? I’ve seen countless excellent homebirth and caseloading teams and services shut down with the reason ‘we can’t do this for everyone’. Yes, of course everyone should get the best, the safest, the most empowering care possible. But this is not going to look the same in different contexts. Whilst we continue to operate in a system that is manifestly under resourced then yes, we have to take hard decisions about where we allocate resources. But the insane logic of ‘we can’t give this to everyone, everywhere so we’ll give it to noone’ is not a response to scarcity. It is a response from a system that fears individuality.
We talk a lot now about authenticity, about ‘showing up’ about the Roar! I’m fully in favour of all these things. I’m also in favour of intellectual pursuits and the importance of criticality (which is not the same as criticism). It’s a shame the academic sector has monetised and functionalised intellectualism out of all real meaning. I’m still a recovering academic, just one sniff of that markerboard pen and dusty papers and I’ll be using the word ‘dialectic’ again without a valid license.
Why then, do we continue with this archaic, and at it’s heart capitalist, way of both providing and measuring health care? When we are not our own selves in the birth space, we are implicitly not allowing others to be either. When we form connections why do we feel that they have to be ended to move on? The co-op which didn’t fundamentally know what it was, was a glorious confusion of light and laughter. Now being an IM I feel that I have ‘permission’ to bring at least some of my own personality to the work. I’m working with an incredible birthkeeper who I trust because I know how awesome she is, not because she interchangeable with anyone else. I’ve also just sent a mum a seven paragraph text on vaccination schedules and epidemiology so maybe I also need to be a little more succinct, you’d have to ask her. I’m sure she’d tell you who I really am.
