Nicky and Billie have brought to The Midwife’s Tale the attributes of both midwives and scholars: rigour, patience, diligence, thoughtfulness, deep reflection and respect for those whose stories they are telling. The Midwife’s Tale reflects an essential component of good historical narrative, an absence of condescension when interpreting the time, and empathy for their interviewees.
The decision not to rewrite the book, but to republish in the original form was a good one. As Nicky and Billie tell us, the approach to writing the book today would have resulted in a very different kind of book more complex more cumbersome. The book as it stands is riveting but no less scholarly. A complex story is told apparently simply, a great art.
Each of us reading the book will hear many different stories. For me at the forefront is the tale linked with my own personal history. My grandmother, Dorothy, known as Dot, a tiny feisty woman married to a miner and living in Tyneside, in the early 1900s was attended by a handywoman for her seven births. I heard the stories from my Mother of the local handywoman, ‘the woman you called for’ when your baby was coming, who lived down the road known by everyone, who arrived invariably with a clean apron (no Sairey Gamps these women). I knew of my Grandmother’s spotlessly clean overcrowded house, of washing days and poverty and pride. I knew of the worry of paying for health care and the relief when the National Health Service was introduced. ‘The woman you called for’ would also sometimes come to lay out the dead. These were midwives who were part of the fabric of daily life, almost lost to us in modern day midwifery where birth is often in hospital separate and apart from the everyday.
On my first reading I read the book like a novel, entranced by the lives unfolding, the accounts of life in a world now unimaginable to many. On my second reading I could appreciate the structure that laces the story of handywoman to midwife, the professionalisation of midwifery. Life for working class women was usually constant pregnancy, birth and childcare. There was often absolute ignorance about the ‘facts of life’, the frequent death of babies and children. With no means of preventing pregnancy, abortion was sometimes resorted to, a dangerous treatment that was illegal. Bearing a child when unmarried brought disgrace and exclusion.
Life was poor and hard and presented few opportunities for women, even middle class women. Two world wars had a direct effect on women and their families but also brought liberation and social change. Through all of this, the local midwives or handywomen, were called out night and day. Often busy doctors relied on them. As midwifery was reformed, their role changed and they would often help the new professional midwives, but without money or education they had little access to qualifications.
The influence of the early reformers and midwives in professionalising midwifery was often undertaken with missionary zeal, and the stories and history revealed demonstrate the class divisions of the time. But the work of these early reformers was to establish the basis of midwifery in the UK, at a time that in other parts of the world, such as the US and Canada, it was lost. The reform of midwifery is the basis for a strong profession, but was to contain inherent restrictions that persist to this day.
A year ago I was elected as President of the Royal College of Midwives, one of the biggest midwifery associations in the world, with over 40,000 members. The RCM grew from the early Midwives Institute created to establish professional midwifery. The RCM combines the work of professional organisation and trades union, both supporting high quality midwifery and maternity services and representing and protecting midwives and midwifery. I am an ambassador for the RCM and on ceremonial occasions wear a chain of office engraved with the names of previous presidents there at the start, the period of this book. So to write a foreword to this book is particularly salient for me at this time.
Overall I was struck with the idea that the lives of so many women who would never have imagined they would be in a book, are now immortalised and celebrated. These were ordinary women who often managed difficult lives in a heroic way. They were truly extraordinary. For the feeling of knowing the individual women from the pages of this vivid book we can thank the open, patient listening skills, and the ability to tell a good tale, of the two authors, two extraordinary midwives.
I hope you will read this important, unique book. Read it to simply enjoy it, after all it tells the story of the most dramatic event of human life in an era of life-altering social change and courageous reform. Read it to understand better the origins of midwifery in the UK. Read it to understand better what life was like without the safety net of welfare, without equal access to health care, in a world of deep class divisions and extreme gender inequality. Read it to appreciate just how important reform of health care, of maternity and of the creation of a more just society was and how easily this could all be lost. If you are a midwife read it to understand just how important our achievements are, and how they might be built on.
Professor Lesley Page
President of The Royal College of Midwives
Oxford, (Mother’s Day, 10 March 2013)
New Introduction
Returning to ‘The Midwife’s Tale’ after two decades
We were delighted when Jen Newby, Commissioning Editor of the new Social History imprint of Pen and Sword Books, invited us to publish a new edition of The Midwife’s Tale in late 2012. Scarlet Press was no longer operating and with second-hand copies of the original edition soaring, we had been approached by many people asking where they could get hold of the book at a reasonable price.
Our first task was to go back to the original edition and re-read the whole book to ascertain whether we should re-write it. This was a surprisingly poignant process; the quotes from people we interviewed nearly 30 years ago conjured up their voices and vivid images of visiting them in their homes. It felt as if they were talking to us yesterday and yet we were acutely aware that the chances of any of them being alive were slim.
As we scrutinised each chapter in order to decide whether we should engage in re-writing the second edition, we both became increasingly aware of how our lives had changed and with those changes, our approaches to researching and writing. We are both now professors of midwifery and any oral history project we might engage in today would require a carefully planned funding proposal, ethics submission, methodology, structure, and publication plan, informed by extensive searches of Internet databases. We would report our findings in an academic style of writing: guiding the reader through quotations, in text punctuated with references to relevant literature.
The Midwife’s Tale relies largely on the voices of the people we interviewed, leaving them to speak for themselves. Minimal background information was obtained through visits to the Royal College of Midwives (RCM) Library, where we pored over government reports and Nursing Notes, the journal of the Midwife’s Institute (later the RCM). We quoted the work of experts in the history of midwifery and childbirth, many of whom met with us and gave generously of their expertise and encouragement. The book therefore has a very different ‘feel’ to it when comparisons are made with contemporary oral history reports. It is clear to both of us, however, that we will leave The Midwife’s Tale alone; we do not want to re-write the book in a more contemporary, academic style and we feel comfortable with it reflecting the enthusiasm and motivation of our younger selves. We have also decided to include the original Introduction, since it provides an adequate overview of what is in each chapter.
When we set out in the early 1980s to engage with retired midwives and women who gave birth in pre-NHS Britain, we were both practising midwives, juggling the demands of children, being on-call for home births, extensive social lives and political activism that encompassed a wide range of issues, not least threats to the NHS and the closure of small maternity units. We were motivated by feminist and social justice principles and the Women’s Liberation movement still had a strong influence on how we ran our lives. The idea of coming together to make change happen – in consciousness raising and support groups, demonstrations, and
campaign meetings – had not yet waned or evolved into activities that would replace them through the Internet. Within that context, we were passionate about improving the NHS maternity services within which we had done our training; we were disturbed by the increasing use of technology and fragmented care that characterised the way maternity services were heading. As student midwives we had both turned to the Association of Radical Midwives (ARM), an organisation with feminist ideals, committed to making change happen that would improve maternity services for women and their families; that is where we met. It may have been in an ARM meeting, or perhaps in conversations when we were each other’s midwives, that we hatched the idea of ‘capturing the stories’ of what we were sure would be a ‘golden age’ of midwifery.
We were passionate but very naïve. When we listen to the tapes of the first interviews we carried out, we are embarrassed by our enthusiastic ‘interrogations’. It took us a while to learn that you did not need a check list of topics to work though and that a few open questions, a lot of pauses and good listening skills were the most likely ways to elicit good stories. We fitted our interviews into our busy lives over a decade, starting in 1982. This involved a recruitment technique that would be called ‘snowballing’ in contemporary research parlance. We visited the RCM’s Annual Christmas Party for retired midwives where we found several volunteers but many of the people we interviewed came to us through our networks of friends, family and work colleagues and, in turn, their networks.
Early on we gained support for publishing our interviews in a book. Literary agent Philippa Brewster met with us regularly over the years and encouraged us to keep going with the interviews. In the early 1990s she referred us to Scarlet Press and the idea of publishing became a reality. We engaged in a painful process of resurrecting all the audiotapes and transcribing over 70 hours of interviews by hand.
The bizarre story of how we analysed all these hand-written transcripts has been told verbally many times to those who we trust. Now that Billie’s son has converted all the audiotapes into digital sound files, we feel able to tell the story for the amusement of all. Shortly after the birth of that son who would later develop technical digital sound skills, we met in Billie’s South London flat and proudly spread out all the hand-written transcripts on the floor. We identified ‘themes’ and enthusiastically cut up all the hand-written transcripts and put them into little themed piles across the carpet.
At some point we realised that we had just cut up the only copies of the full transcripts. In damage control mode we marked each strip of paper with the name of the person whose words were so carefully ‘themed’. It would not happen today and may seem hard to understand, but photocopiers, printers and computers had not entered our lives in a big way and we did not belong to any institution that might have given us advice and support.
We put rubber bands round our little piles of ‘themes’ and engaged in a concerted attempt to transfer the words on the slips of paper into chapters. Nicky was given a small Apple Mac computer in return for being a midwife at the birth of a baby whose parents had access to computers but no money. She took the computer and a small printer and went to stay with her sister Annie in rural Somerset. And that’s when Scarlet Press gave us Gilda O’Neill. Gilda was already a renowned oral historian and her role was to help us bring the book to fruition.
Fed and watered regularly by Annie, Nicky spent over 12 hours a day at the computer writing drafts of chapters. Each day she would print out two copies of recent drafts, walk down to the post office and send them ‘first class’ (next day delivery) through the post to Billie (now living in the Outer Hebrides) and Gilda, who in turn would mark up the drafts with suggestions and send them back through the post ‘first class’. And so it went on until everyone was happy with a draft to send (through the post, first class) to our Scarlet Press editor, Ann Treneman, who would edit our drafts and send them back (through the post, first class) … Eventually there were proofs.
We still have hard copies of the drafts that Gilda sent back. The margins are littered with expletives like ‘Blimey!’ ‘Bloody Hell!’ and ‘That is incredible!’ next to our quotes. Her enthusiasm and guidance made us believe that we could do it – she ‘midwifed’ us through the process of bringing together the ‘amazing’ quotes with minimal text around them; just enough to bring them together with a sense of cohesion that did not distract from the raw energy of people’s testimonies. Reflecting on all of this in 2012, it was easy to arrive at a decision not to meddle with this format through a major edit in the new edition.
When we knew that there was to be a new edition of The Midwife’s Tale we went online to find Gilda and let her know, anticipating her excitement. We were so sad to find a Guardian obituary. Gilda died in 2010, aged 59, from side effects triggered by medication prescribed for a minor injury. As the obituary stated, Gilda ‘had a nuanced understanding of ordinary lives … she figured out how to use story telling, lived experience and memory to draw political parallels’ (Lorraine Gamman, Guardian 6 October 2010). We learnt so much from Gilda and, for both of us, her delight and skill are embedded in the way we read and reread the voices of the people in this book. This new edition of The Midwife’s Tale is dedicated to Gilda O’Neil.
Growing interest in midwifery history
Since the publication of the first edition, both popular and academic interest in the history of midwifery, maternity care and childbirth has grown considerably. For many people this interest has been generated by the popular television series, Call the Midwife, based on the autobiographical books by Jennifer Worth.1
Oral histories, such as those by Tania McIntosh2 and Lindsay Reid3,4 have deepened our understanding of early twentieth century maternity care in the UK. These publications give us new insights into how the experiences of midwives, mothers and consumer activists have influenced the way that maternity care was provided. This picture has also been enriched by oral histories of sexual behaviour and contraception use5 and women’s stories of childbirth;6 and critical histories of midwifery.7
The Royal College of Midwives has seen growing interest in its Archives following their re-location and cataloguing as part of the larger RCOG collection (see their website www.rcog.org.uk/what-we-do/information-services/archives). A renaissance of interest in midwifery history has also led to the establishment of ‘De Partu’, a History of Childbirth group: (www.departu.org.uk).
What has happened in maternity care/midwifery since 1993?
Preparing the new edition of The Midwife’s Tale has given us an opportunity to reflect on the changes that have occurred in midwifery and maternity care in recent decades. The first edition coincided with the publication of the Changing Childbirth report.8 This English report, produced by an Expert Maternity Group chaired by Baroness Julia Cumberlege, led to major shifts in UK maternity policy. Importantly, it recommended that women and their families should be fully involved in any decision-making about their care, and that maternity services should be primarily community-based and responsive to local needs. Midwives were to play a full role in maternity care, and women with straightforward pregnancies could choose a midwife as their main care provider. Women could also choose where to give birth, including birthing at home.
The report was heralded as a radical shift in thinking, and a number of midwife-led, continuity of care initiatives resulted. Although many midwives were enthusiastic about Changing Childbirth – seeing it as an opportunity for a renaissance in midwifery – others were more cautious, citing a lack of funding to support initiatives as a major barrier to sustainable change. Ten years later, many of the projects had ceased to exist and now the Changing Childbirth Report itself has become the subject of historical research.9
A study of health professionals’ views about safety in maternity services identified many factors that may be obstacles to the implementation of reports such as Changing Childbirth.10 These include: the increasing medicalisation of birth; the social and medical complexity of the pre
gnant population; inadequate staffing, particularly of experienced midwives; poor management; a lack of resources; and low staff morale.
In 2013, UK maternity services differ widely from area to area, compounded by the fact that the four UK countries have differing policies. Whilst some areas offer (and encourage) home births and midwife-led birth centre care, in other areas these services are under-resourced and often in danger of being closed.11 As identified on numerous occasions in the press and Royal College of Midwives commentaries, maternity services in the UK are struggling to support a dramatically rising birth rate within the context of a changing demographic profile. Improved infertility treatments and better medical care for women with chronic health conditions mean that more women are becoming pregnant who would not previously have had this opportunity. Compared with the situation in 1993, midwives are now providing care for a broader range of women, some of whom may have complex health and social care needs.
Campaigns led by the Royal College of Midwives seek to address the national shortage of midwives, which, they argue, is in danger of compromising the quality of care. The media have provided plenty of examples of where women have not received one to one care when they are in labour, and where support for women following childbirth is lacking. To address the shortfall, most maternity units now employ Maternity Support Workers, who have recently been allowed to become members of the Royal College of Midwives.
Midwifery practice in the UK has therefore changed significantly over the past 20-years, as has midwifery education. All midwifery students are now educated at undergraduate degree level within universities. Their education is focused on producing practitioners who are both clinically and academically credible, and who can base their practice on up to date evidence. There are growing numbers of midwives, like us, with Masters degrees and PhDs. Interestingly, there has also been a resurgence in ‘direct entry’ midwifery education (three and four year programmes for people who do not have a nursing qualification), with the majority of universities in the UK now offering only this option of study.9
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