Why I left midwifery
And how I have found another way to be ‘with woman’
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This week, I am sharing this beautiful, if alarming, text by Rebecca Mack – who writes the newsletter ‘This Woman’s Work’.
The impetus behind the Fifth Wave Institute came partly as a result of my reading ‘Of Woman Born: Motherhood as Experience and Institution’, by Adrienne Rich, sitting on the steps of the Bodleian Library during my last few days in Oxford.
Reading that book, and diving into the world of thought that subsequently revealed itself to me, was probably one of the single richest intellectual experiences I’d had up until that point. In it, drawing on extensive research as well as her personal experience in her first heterosexual marriage and then as a lesbian mother, Rich picks apart how the figure of the mother – imagined, fantasised, imposed, enforced, all but defined by its actual embodied experience – has for millennia been a central tool of the subjugation of women.
In the below, Rebecca writes of her experience as a midwife in the UK’s NHS, and the systemic failures that ultimately led her to seek a different way to care for women. I’m sharing it here (it has been slightly edited) because it deeply resonates with the Institute’s vision for a different, care-centered world. It also feels appropriate as C-section rates have recently surpassed those of vaginal births in England.
Both this essay and ‘Of Woman Born’ exemplify two of our deeply held beliefs: our systems are broken, and they can be rebuilt. “The fields need to be radically dug up and new ones sown”, as Rebecca puts it – in midwifery as in all other spheres of human activity that involve people taking care of each other.
As Rich writes in her 1977 essay of the same name,
“We need to imagine a world in which every woman is the presiding genius of her own body. In such a world, women will truly create life, bring forth not only children (if we choose) but the visions, and the thinking necessary to sustain, console, and alter human existence—a new relationship to the universe. Sexuality, politics, intelligence, power, motherhood, work, community, intimacy, will develop new meanings; thinking itself will be transformed.
This is where we have to begin.”
I came late to midwifery. I was twenty-seven, earning 25K a year as Personal Assistant to a group of corporate directors. Free gym, nice offices, lovely boss. It wasn’t enough. I had a calling. Possibly a catholic or middle daughter thing, I don’t know – I just knew I wanted to help people.
Midwifery looked like the perfect job: women-centred, empowering work and oodles of babies to cuddle. Whilst training, I did a two-week placement on a special care baby unit where my main job was to sit, skin-to-skin-cuddling preemie babies in my cleavage. After the two weeks ended, they practically had to escort me off the ward. It was joyous.
I knew instantly at my university interview that this was the career – or rather, the place for me. Not long after, I was called back to the office of the midwifery lecturer who had just interviewed me. She sat at her desk, swinging on her chair, shoes off, chatting animatedly to her colleague who was curled up on the sofa. ‘I’m home’, I thought. ‘I want to stay in this world forever.’
The training lasted 3 years and was hard going from the start. We spent half the week working on the wards and the other half studying in classrooms. There were no long holidays like other students and if you missed a shift, even due to illness, you were required to make up the hours in your own time – meaning most ‘holidays’ were spent back on the wards. We were paid a small bursary (not meant for anyone to live on) which has since been terminated for new cohorts. The real payment came in the satisfaction of learning and experiencing the craft you loved.
Lovestruck I was. Many a time, I walked on air as I bounced home, remembering the beautiful newborn that had just been miraculously pushed into my hands. But as time progressed, I missed – or ignored – the emerging red flags.
The wards were permanently short staffed. By the second year, I found myself being used as ‘staff’ instead of ‘student’ in low-risk areas. ‘Breaks’ on an eight- or twelve-hour shift were a luxury, not an essential. A quick dash to the loo whilst running in between patients and finding sustenance from the ‘thank you’ chocolates left in reception became the norm.
Shifts never ended on time – typically due to a lack of staff to hand over to. The fear of litigation loomed large, and practice often felt more ‘defensive’ than ‘responsive’. The constant requirement for documentation interrupted the flow of organic relationship building and care providing.
As students, we were shielded to an extent from the negative sides of midwifery. Kind mentors would insist we take a break or encourage us to go home before our legs gave way. Unqualified, we were free from the threat of losing our registration, and we could spend time building relationships with our women and their families instead of documenting our every breath. Alas, we would not remain students forever.
With the thrill of qualification came the terrifying removal of the protective mentor’s shield. Caring for women and their families was still the ultimate high for me; but unfortunately, the anxiety around their safety – and my sanity – became the ultimate low. The system wore me down, not the people I cared for. The lack of staff, the overcrowded wards, the constant life-threatening juggling act. I was permanently anxious. I would frequently leave a shift exhausted, back literally breaking, bladder bursting and spirit just a tiny bit more broken.
The unpredictability of each shift terrified me. I can remember starting a night shift on the postnatal ward, being moved to the antenatal ward – while still caring for my postnatal charges – and then delivering one of my antenatal women on labour ward. After 14 long hours with no break, I emerged from the delivery room with a fresh newborn wrapped around my neck, begging to go home to my own children.
Yet barely through the door home, I was back on the phone. ‘Has that baby in bed 3 fed yet?’, ‘Can someone check the CTG on the woman in bed 6?’. My husband removed my shoes, I drank a longed-for cup of tea, then another, and then another.
This was not the exception but the accepted rule. I would have loved to spend that night providing life-changing care to all those women and babies. Instead, I was gasping for air just trying to keep everyone safe. Too many women, too many babies, not enough staff.
The professional cost of giving the ‘bare bones’ of care was a constant source of frustration and anger to me. Job dissatisfaction corrodes morale. I have a friend who is a decorator. He painted my living room last year. He is a perfectionist, prides himself on his smooth finishes and straight lines. He offers sage advice when I get carried away with clashing colours and he leaves every house he paints a better place to live. Each job he completes fires him up for the next. He is proud to show his customers his work.
Imagine if he was a midwife. ‘I’ve slapped some colour on the walls – if you squint a bit, you can’t see the dodgy lines; sorry I didn’t get a chance to do the skirting boards, you can hide them with the furniture; didn’t do the ceiling but it’s not so bad, just try not to look up. Anyway, got to go, didn’t want to say but I’ve been decorating two other houses at the same time, and I’ve not finished them either.’ Demoralising, embarrassing, sad. Not what I trained for.
During my last shift, I attended to a distraught mum as she delivered a 20-week-old, much-wanted baby in the maternity reception bathroom. The desperate mum was waiting for a bed. There were no beds. And not enough midwives to staff one even if one was available. It was 3 a.m. in the morning. Ten years from that inspiring interview and seven years on since qualification, I was done.
Sadly, I was not alone. Approximately one-third of my cohort of 30 had left the profession by the time I hung up my stethoscope. Some stayed within the NHS (I did). Some could not get far enough away and went into other roles, as diverse as overseas property management and cake making.
The solution appears simple – hire more midwives. But like me, so many just would not go back, and so many newly qualified just will not stay. Changing the landscape of midwifery goes far deeper than throwing more hands into the fields. The fields need to be radically dug up and a new fresh and women-centred field sown.
Answer me this… would midwifery be in this dire a state if men gave birth? I can’t see that men would be expected to tolerate a maternity system that struggles to provide safe, never mind (don’t make me laugh), holistic care if they were the pregnant ones.
The way we treat our pregnant, labouring and postpartum women is a tragic indictment of the way society too often treats women, and mothers in particular. Second-class, disposable, put up and shut up, vessels for male folly, unworthy of care. That women and their bodies don’t matter is no more evident than in maternity wards worldwide.
My love affair with midwifery will never end. I can’t go back to the trauma of the wards, but I can’t completely walk away either. My passion for the care of women is still as unshakable and necessary as it ever was, if not more so. Grassroots change is needed, and my pen is mightier than my stethoscope at this point.
So, I sit here, shoeless, swinging on my chair, animatedly chatting to Substack, writing about midwifery, misogyny, mental health, and more. Advocating for women, for mothers, for families. I never wanted to leave midwifery; midwifery is my home. I cannot deliver babies anymore, but I am working on delivering the truth about the treatment of women and mothers. I would love for you to join me.
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