As I reflect on my midwifery experience over the past 30 years, I am reminded of the privileged role of the midwife and my personal experiences of providing continuity of carer, supporting vulnerable women during pregnancy, birth and postnatally.
As we enter the third year of implementing the recommendations of Better Births (National Maternity Review, 2016), and focus on transforming services to support the provision of continuity of carer, I am reminded of women's experiences of continuity of carer at different stages of my career as a caseload midwife, lead midwife for education, consultant midwife, and Director of Midwifery. Evidence shows that health outcomes are improved where midwifery continuity of carer is provided antenatally, during labour and postnatally (Sandall et al, 2016), yet my reflections remain focused on the significance of relational continuity. Described as a therapeutic relationship of the service user with one or more health professionals over time (Saultz and Lochner, 2005), I ponder on the uniqueness of the midwife's role at such a time as this, and share this poem, entitled A Woman's Cry for her Midwife. This is the combined maternity experiences of three women, whose feedback remains with me today.
A woman's cry for her midwife
I conceived and grew my baby, a new life a reflection of me, but birth, the birth by me? How can that be, when I myself am not free?
Surely I, even I, can birth my baby too?
This one thing even I can do
Yet the waves of doubt, will they pull me under? Oh, I do wonder
And then the midwife, my midwife nurtures me, I start to share and feel believed
Each visit, and not to mention each precious call, bit by bit I feel reborn
My fear released, anxiety beneath, hidden memories I reveal
The waves of doubt, won't pull me under, oh but I do wonder
My baby grows, not long to go, his head I think is nice and low, but the waves of doubt will they pull me under? Oh, how I still do wonder
And then my midwife, just in time our plans for birth now combined,
My fear released my strength renewed, my path is straight no more reviews
The waves of doubt won't pull me under, and no, no, no I now don't wonder
My next appointment, diary in hand, so keen to share my heartfelt plans, empowered, believed, and no real fright, my birthing plans at last no fight
And then the doubt comes creeping in as my midwife no longer is!
My disappointed I can't hide as the waves of doubt firmly reside
Without my midwife by my side, the waves of doubt now occupy my every thought both night and day, my hopes for birth now far away
How can I lose one and gain another, my trust I gave to that significant other,
I shared my story one to another, and now alone, I can't recover. The waves of doubt have pulled me under and I no longer wonder
Where do I start? How do I begin? My story now remains within
You, new midwife, friendly enough, you can never know my stuff, I want my midwife and not you
I can't say this, if only you knew.
I see a midwife and then another, I see a doctor and then another
I close down, I won't recover, they can't see, are they bothered?
I don't connect, I cannot see, the waves of doubt they've altered me
The labour happened, the birth took place,
I remained in that dark place
They never saw, they never knew the waves of doubt, my trauma grew
A birth not mine, pain untold, where's my midwife do you know?
The one I had, no alliance grew, who that was I never knew, did you?
Today I think what could have been, had my midwife remained with me
But now I keep my hidden pain, deep inside it still remains
Yes my story is untold, the enemy, depression takes strong hold.
The depth of the relationship between a woman and a midwife should not be underestimated. This poem is a reflection of the experiences of women who started with continuity of carer, but ended with experiences of fragmentation, desolation and mistrust. Hopefully this will inspire all who work in maternity services to advocate more for the women in their care.