Jan Cornfoot was the great communicator in Australia. This was before Amazon, Google and the World Wide Web. She edited a popular parenting magazine, had her own successful mail order book company, and ran speaking tours and conferences. She and other bold spirits opened up a vast continent. She organised speaking for me in Perth, Adelaide, Hobart, Melbourne, Brisbane and Sydney. There were public lectures and workshops and seminars in hospitals on The Rebirth of Midwifery, Birth and the Transition to Motherhood, Massage and Touch, The Second Stage, Postnatal Counselling, and Traditional Rites and Symbols – just some of the subjects on which I lectured and demonstrated.
I met people like Georgina Walker, who worked with rural families in New South Wales. There women often had to travel up to 600 kilometres to give birth in large hospitals. The dirt roads were often impassable during the ‘wet’, and because of kangaroos and other wild animals, and so they were compelled to leave their homes and journey into the city to wait for the start of labour in huge hospitals. They were utterly isolated, and nobody visited them. These were the conditions in which Parents Centres were striving to promote distant education active childbirth classes with birth videos and phone discussions.
I visited Australia again in 1992. By that time midwives and mothers had joined together in activism. When the Facility of Health Sciences at Newcastle University with Hunter Valley Homebirth organised a conference to explore issues around birth. Nicky Leap, a midwife from England, and who was very experienced in setting up support groups for women, spoke directly midwife to midwife. The conference included input from the Aboriginal Medical Services on Women’s Business: Dream Babies; Belly Dancing, a discussion of feelings after birth and workshops for fathers.
Japan
Invited to lecture several times in Japan in the 80s, I was also able to do research on Japanese birth traditions and observe practices in large modern hospitals, and midwives’ birth houses.
Arrangements for my lectures ranged from addressing midwives in one hospital to facing the Mayor and corporation and their wives in another. In that one the Mayoress broke down in tears when confronted with the memory of her terrible births, and in another my interpreter had to stop because she was overwhelmed by hers. It seemed that the open expression of birth trauma and criticism of routine hospital methods was very suppressed, and when women were at last free to talk it was like an explosion.
Traditionally there is a link between having a good harvest and giving birth, and Suitengu is both God of the harvest and God of easy birth. His shrine is a place of pilgrimage for women seeking a good birth. A bell on a rope hangs in front of it, and if a woman places the end of the rope on her pregnancy belt, or ‘obi’ – the ‘fukutai’ – birth will be easy.
Dogs are said to give birth easily. On the Day of the Dog women and their families seek blessing at the shrine. The priest blesses the woman’s obi and offers a charm for easy birth – ‘itsumoji’. This rite is still accepted as a normal event in pregnancy, at the same time that Japanese hospitals work to a model of medicalised birth, like other hospitals all over the world.
At Ai-iku hospital in Tokyo I learned that 20–30 per cent of pregnant women were assessed as high risk. If pregnancy, birth and postpartum were normal health insurance did not cover the cost, and a woman had to book and pay a deposit for a hospital room at 34–35 weeks.
Waiting times in the antenatal clinic were usually anything up to 4 hours, largely because midwives had little function in the clinic. 95 per cent of women attended childbirth classes, but only 5 per cent of couples went together.
On admission, all women received a partial shave and an enema, and were only allowed fluids when in active labour. Yet, in contrast to hospitals in the rest of the world, drugs for pain relief were rarely used, and the epidural rate was only about 5% at that time. External electronic monitoring took place routinely. In the first stage catheterisation was mandatory and women had to be in the supine position. They were moved from the first stage to the delivery room when fully dilated. Pelvic examinations took place frequently in the second stage, along with routine electronic monitoring.
In spite of protocols dictating intervention, up to 90 per cent of women were delivered by midwives, though a doctor always had to be present. The episiotomy rate was as high as 80–90 per cent for first time mothers, 30–40 per cent for multigravidae. Only about 15 per cent of fathers attended the birth. Another woman companion was never allowed. After birth women were required to lie flat on the hard, narrow delivery table for two hours.
This juxtaposition of traditional practices in pregnancy, when women felt they had control, with a rigid hospital system and technological intervention in childbirth, in a virtually industrialised setting, where women had little say about what happened to them or their babies, was typical of Japan.
Some independent midwives were establishing their own consulting rooms and birth houses, resisting the medicalisation of birth and incorporating the best of traditional midwifery practice. I visited some of these birth centres, too, and saw how, for instance, the midwife laid tatami mats on the floor so that the labouring woman could move freely in her own space, and provided a doubled-over futon to support her in a semi-upright position to give birth.
There were a handful of traditional midwives – ‘sanbas’ – in their 60s and older – practising too, from whom some younger midwives were learning.
Midwives were joining together with mothers to challenge the medical system and create a culture of woman-centred birth.
Israel
I visited Israel twice, first in 1979 and then in 1986, when I was keynote speaker at the Fifth Birthday Conference of the Israeli Childbirth Education Centre to which I was already an advisor.
A four hour workshop on relaxation and massage in pregnancy was attended by 100 nurses and midwives together with pregnant women and their partners.
It turned out to be confrontational because I hadn’t understood how Israeli midwives were thinking and how dogmatic and authoritarian some of them were. The Jerusalem Post reported that there was strong opposition from many midwives and that I was ‘known for provoking the ire of health-care workers and doctors who, I said, “sell hospital birth without helping women to see the pros and cons of the different alternatives facing them or to be able to plan ahead, knowing that things may not turn out as they hope”.’ My suggestion that a pregnant woman might make a birth plan was described as ‘one of the more revolutionary recommendations’. The article continued, ‘Furthermore, Kitzinger noted in all seriousness, hospital staff should be “guests” in the delivery room, entering only after knocking on the door, and after receiving the consent of the woman in labour.’ A ‘veteran midwife’ who was ‘insulted by Kitzinger’s comments on the technological take-over in delivery rooms and the lack of flexibility among doctors and midwives’ said that staff ‘never force a woman to accept care that she doesn’t want.’
Midwives at this conference argued that fetal monitoring, intravenous drips, and even enemas had reduced fetal mortality. I said that well-controlled randomised studies on obstetric interventions had rarely been conducted, and that wherever research had been done the case for routine intervention had not been supported. I proposed regular meetings of the members of the medical establishment and the Israeli Childbirth Trust to exchange ideas and discuss the outcomes of evidence-based research. One midwife was reported in the press as protesting, ‘Hospitals cannot allow someone off the street to start giving advice to pregnant women.’
I discovered that the Israeli Childbirth Centre was in much the same position as the National Childbirth Trust had been 10 years before – trying to legitimise itself in the eyes of the medical establishment and the Ministry of Health.
The Tel Aviv conference happened to take place just as a court case had started against Wendy Savage, an obstetrician who was accused of malpractice in seven births, in which two babies died. Wendy Savage’s colleagues, consultants who belonged to the same lodge of the F
reemasons, suspended her from practice and fed loaded and heavily biased information to the media. Mothers and midwives who supported Wendy, together with some other obstetricians, organised a march which hit the headlines. Wendy believed that women had the right to make an informed choice and have the kind of birth they wanted in the place they wanted. If they did not agree to a Caesarean section she did not force them to have one and tried to deliver the baby safely vaginally. So I returned from Israel to help organise a massive march, together with the National Childbirth Trust, and the Association for Improvements in the Maternity Services. Choice in childbirth had become an issue of human rights.
Wendy Savage
Wendy Savage is a strongly committed feminist, an obstetrician, and a close friend. She was working as a doctor in Africa when the Abortion Act was passed and returned to England in 1969 to take up a post as Consultant in Obstetrics and Gynaecology at the Royal Free Hospital, the first woman ever to be appointed in London. She had seen the disastrous effects of illegal abortion and believed that women, not doctors, should make the decision about abortion.
Wendy became President of the Medical Women’s Federation. She had a hard struggle in her career. Much later, writing in the British Medical Journal, her advice to women was: ‘Make up your mind what you want to do and know what you are capable of doing and don’t allow people to tell you that you can’t do it because you are a woman. I have never forgotten being told by the senior obstetric consultant at the London in his Harley Street rooms when I sought his advice about progressing my career in O&G (obstetrics and gynaecology) having had four children in eight years, lived in four countries and three continents and worked throughout that “there was no place for married women in O&G”. It gave me great pleasure when seven years later, having been to another country in a fourth continent, I was appointed as the first woman consultant at the London and met him at the Xmas party.’
Some obstetricians treat each pregnant woman as an ambulant pelvis and every woman in labour as if she were a contracting uterus. Many assume that they know what is best for her better than she can know herself. The Medical Defence Union booklet Consent to Treatment41 stated, ‘the Union does not consider that a maternity patient need give her written consent to any operative or manipulative procedures that are normally associated with childbirth. When she enters hospital for her confinement it can be assumed that she assents to any necessary procedure, including the administration of a local, general or other anaesthetic.’ In a book for pregnant women, Gordon Bourne, an obstetrician, wrote, ‘You will learn to adapt to the difficulties and to accept the changes that occur. You will learn to co-operate with your professional advisers.’42
In Tower Hamlets, where there were many Asian women who wanted to be cared for only by a woman doctor, Wendy was in the vanguard of doctors determined to improve the quality of maternity services and to listen to women. She went to GPs’ offices so that women did not have to make the long trip to the hospital for prenatal care, something no other obstetrician in the area did. She supported the Domino Scheme, a system in which the midwife went to the hospital with the mother-to-be, delivered her baby, and then went home with the family afterwards. She helped many women deliver at home.
We first met when she was accused by colleagues at the London Hospital in 1985 of having failed to perform caesareans on five women who asked not to have surgery unless absolutely necessary, and agreed to a trial of labour. She was considered dangerously non-interventionist and suspended from practice following an enquiry in the blaze of publicity. She said it was part of a ‘struggle about who controls childbirth’. Her suspension was a direct attack on the concept of community obstetric care, and I wrote about this in professional journals. The committee that campaigned for Wendy’s reinstatement included mothers, representatives of various birth organisations, some GPs, health visitors, medical students, Asian women, and midwives. Never before had such groups worked together for a cause in which they all believed so strongly. To support her, we had a splendid march – her patients and a crowd of birth activists – wearing badges that announced ‘Wendy’s Best. Investigate the Rest’ that achieved good media cover. The enquiry resulted in her being re-instated.
But when she returned to work relations with obstetric colleagues continued to be difficult – so strained that she could not continue working there. It didn’t finish. Ten stressful years after this she learned of an anonymous complaint about her actions in a further five cases. At that point she became Honorary Professor at Middlesex University and updated her book A Savage Enquiry as Birth and Power, with additional chapters from contributing authors, including another extraordinary friend of mine, Dr Marsden Wagner, former Director of Women’s and Children’s Health in Europe for the World Health Organisation.
Wendy also spear-headed a campaign for keeping the Elizabeth Garrett Anderson Hospital, the first run by and staffed by women obstetricians, in London exclusive to the care of women and staffed entirely by women. She and I met with Frank Dobson, the Labour Secretary of State for Health, to plead for re-establishing a ‘woman-for-woman service’. We were unsuccessful, though Wendy set up a pressure group, Women for EGA, on which I served together with other pioneers, including midwife Caroline Flint, who ran an independent birth centre, and the feminist barrister, Helena Kennedy. Wendy doesn’t give up easily!
Visual Aids
Every time I attended a large birth conference in the 80s drug firms were exhibiting teaching aids and other equipment. There was invariably a bizarre, often floppy, fetus – either that or a semi-rigid medical specimen sold by other medical equipment firms, paired with a plastic pelvis and drawings that represented birth as a dangerous passage necessitating a narrow scrape between bones and cartilage – a rigid, immobilised structure. When the fetus was a rag doll it could be twisted into various positions but was nothing like a baby. It looked as if it had been whacked to death.
How to breathe a baby out
I decided to construct a pelvis out of a box into which I could place a flexible baby doll that was attractive, and mocked up a foam-rubber vagina through which it could gradually emerge. I sat on a table, legs wide apart in an upright position, as I acted breathing the baby out, stroking the head, and pressing it passionately, little by little, into the world.
Instead of displaying an instrumental technique and delivery by a gynaecologist, I was being the mother and breathing my baby out with intense excitement. I acted this with audiences around the world.
This teaching aid came into its own in Canada when we were demonstrating outside the College of Obstetrics and Gynecology in Toronto and marching for midwifery. The police told us that we must keep moving. It was fine by me! I danced ahead of the main procession, birthing my baby through the foam pelvis, making the sounds of pushing, and acted the baby out in waves of excitement. We were doing as the police had instructed us, and I hope they enjoyed it too!
Turkey And Birth Symbols
Carpet-sellers and silversmiths lingered outside their honeycombed shops and bazaars waiting to entice, plead, even order us in to view their wares: ‘Come only to see! It is free’. ‘Touch this carpet. Feel it! I can give you a better price than any other in the town.’ ‘My grandfather is selling all. For you I can give a special price because you are the first in the morning.’ ‘I am a sad man, for my two sisters died in a bus crash as it returned from Caesarea and now my family has no-one to weave. These kilims only remain from my sisters.’
Once persuaded inside, each shop was a temple of carpets, as ablaze with colour and intricate design as stained glass windows. The patterns were mixed, contrasted and mingled, with enchanting names like the Gate of Paradise, One Thousand and One Nights, The Tree of Life, and The Coming of Spring. Tea or coffee, sweet, black, rich – a devil’s brew – was brought and we were given a magnificent display of combined sales patter, poetry and cultural history. It took a good deal of determination to harden our hearts and announce that we were not going to buy t
oday. Perhaps later, perhaps we’d come again. Even then there was protracted discussion in which the price of each rug was progressively lowered if only we would buy.
Turkey was one of the few countries where I went not to lecture, but on holiday. We retreated to the oasis of our hotel which sat on a projection of white rock with iridescent lapis lazuli water nearly all round it. On one side beneath us was a crisp modern marina with swanky yachts. Opposite, two hours boat ride away, the soaring mountains of the island of Samos seemed to float in the distance. We basked in sun-dappled water, woke to the chatter of birds and a violet shaded dawn sprinkled with feathery clouds, and at night the sun dipped like a huge glazed apricot beneath a rim of sea which ran molten gold and the sky became a glowing, fiery furnace.
This was Kusadasi in the 1980s, then still a small harbour town on the Aegean coast of Turkey, 90 minutes drive south of Izmir, the Smyrna of classical Greece, which was the greatest port of Asia Minor. Though Kusadasi was a perfect place in which to swim and sun and laze, I had come on a treasure hunt. I wanted to search out fertility symbols. The ones I was looking for were not phallic. They were symbols of birth, representing the energy and creative power of women.
Freud introduced us to phallic symbols and since then they have been readily noticed; the solid, soaring, pushing shapes in art and architecture – all those towers, steeples and minarets. The symbol of women’s life-giving energy, however, remained mostly hidden and mysterious. Yet they were all around us in textiles made by women in countries stretching from the Middle East to the Pacific.
The code is a diamond with four hooked projections. Often there is a cross-shaped figure or a smaller diamond inside it, representing the fetus. The shape may be stretched out, turned on its side, have extra hooks, or a whole lot of them may be strung together like beads to form a border. But the design is still basically the same.
A Passion for Birth Page 28