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Call The Midwife: It’s More Than ‘Just’ Clinical Care

December 25, 2012

OThe service provided by a midwife is uniquely significant, intimate and daunting: to attend to women and babies at their most dependent and vulnerable. The choice of another episode of Call The Midwife for BBC One prime time viewing on Christmas Night this year (2012) perhaps therefore reveals a new seriousness underlying perennial requirements to entertain. Is there a fear that current UK health service changes mean something we have come to value, but  is unnamed and unacknowledged, will be lost?

I spent a few years quite recently as a consultant to various Sure Start programmes, helping practitioners from a range of professional backgrounds to establish strategic, needs-focused services.

This was no easy task, either for my practitioner colleagues or indeed for me.  Sure Start drew together skilled people from many services (health, education, early years, social services etc).  Often in their previous work they had spoken different professional languages and held, unchallenged and as given, widely different priorities.

Contested priorities
Unsurprisingly the route to most effective Sure Start service provision was not always obvious.  My job was often therefore to rewind to the basics and find out what people in various sectors across the service believed they should focus on, and only then to attempt a broad consensus between these often diverse priorities.

Everyone wanted the best for their clients and patients, but what they thought that best might be often depended on their particular professional lens (which is, as an aside, why newly merged services need to be bedded in before judgements are made – as in this case they were, precipitately –  about their ultimate effectiveness).

Midwifery services
Midwives were in many ways central to the operation of Sure Start.  They know about the pending arrival of almost all babies born in the UK; and they also have unrivalled access to women in the run-up to, and immediately after, the birth.

It is rare  indeed for an expectant mother (and / or her family) to refuse entry to a visiting midwife at their time of need.   Just occasionally a client will be wary because she has a mental health, immigration status or other issue which makes her particularly afraid or anxious, but nearly all births in the UK are attended by midwives, whether at home or in hospital.

Midwives are therefore critically placed in the care of people at their most vulnerable.  Several times midwives told me in our private discussions that they saw their role not only as clinical care, but also as advocacy.

Who else, these midwives asked, had come to know newly delivered women as well as they did?  The sheer intimacy of the required service made it likely that clients’ private concerns and fears would be shared with the midwife, especially by those patients, the most vulnerable of all, who did not normally welcome ‘state’ intervention in their lives.

Advice and advocacy
Yet most midwives are not trained in advocacy, nor are they expected officially to take this role. They are understaffed, pressed for time and often unused to liaising professionally with colleagues from non-clinical disciplines.  Sure Start, taken forward properly, could have helped enormously to fill these gaps, where midwives currently working beyond the call of training and duty feel they must go.

Advice to clients on family matters, housing, benefits and much else is not often in the job specification of a midwife, whether based in the hospital context or even in the ‘community’.  Yet often, despite the many other calls on time and duty, she (he) values the opportunity to serve where others still fail to provide a service.

Care in transition
The stories of Call The Midwife – both as the BBC series and in the late Jennifer Worth’s original books – remind us graphically of the massive changes which have occurred in Britain since the early 1950s, when the NHS and its midwifery service were still merging and new and the challenges were often more basic and less well identified or understood than they are now.

Sure Start could, and till should, take us further along that road.  We know much more now than we previously did about how to protect and nurture babies, mothers and their families.  Technologies have been developed beyond the wildest dreams of the midwives in the 1950s, and the welfare state, at least until recently, offered a safety net for most who needed it.

Budgetary angst
But both early years services (Sure Start especially) and midwifery services in the UK are now under strain, facing serious threats of yet more hazardous ‘cuts’.

The nostalgia evoked by Call The Midwife is not simply for a rosy age that never was.  The stories in the books and on the screen embrace a grittiness which, once perceived, puts paid to that.

Rather, there is a sense that current political changes and severe budgetary constraints on public services have sparked a shared anxiety for all our futures.  Our commonly shared zeitgeist is shifting towards something which many ordinary citizens fear: a nation in which care for our most vulnerable diminishes even as we actually know more about how it should be properly delivered.

Basic human priorities
An episode of Call The Midwife broadcast on Christmas Day prime time television will surely sharpen this debates around this fear, even if the original intent was devoid of politics.

The tales Jennifer Worth told remind us, if that should be required, that nothing can be more important than the well-being of mothers and  babies; and at Christmas that message has an added poignancy.

If we put aside this self-evident truth, we put aside also our futures.

~ ~ ~ ~ ~

See also: Call The Midwife… Then, Now And In The Future

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