Charly holding newborn baby

How can we all be the midwives of change?

We are talking a lot about birth at the moment, and not just in our house where we have a seven week old keeping us on our toes…

… but in the world at large where we are asking what bundle of goodness could emerge from this cathartic year and what could we create that leaves us in a better state than we were in before.

Before we get any further, I want to apologise right away for shoehorning in here the kind of metaphor that’s laid on thick with a trowel, like lumpy cement. But as someone who has just had a baby, and who is currently writing this one-handed while breastfeeding with a Disney film on in the background, I figure I’ve got a free pass. So here goes…

I’ve often heard people speak of ‘being the midwife of change’ and so having recently spent time with actual midwives, I wanted to share their perspective on how we can reap good from the jaws of crisis. Bear with me, there really are some parallels.

In the middle of July I brought our second daughter into the world amid the plasticised madness of Covid-19, with my husband in a disposable NHS mask and my midwife apologising for having to throw away her single use PPE every time she popped out to check in with colleagues, only to put on fresh ones moments later as she re-entered our room. Prior to the birth, my final scan took place alone, without my husband, and my regular midwifery appointments were conducted through hot, impersonal masks (them and me) as quickly as possible. You might say, it wasn’t ideal.

While having a baby in the middle of a pandemic is not necessarily advised, I was nevertheless just as humbled by the antenatal and hospital staff as I was when our first child was born, four years ago.*  It was striking that while in the moment of multiple catharsis, in the wider world and in my body, the team around us stayed calm, kind and efficient. They didn’t just hold our hands, they got the job done. Equally, they didn’t get the job done at the cost of caring for us.

People who care about climate change often tell me that there isn’t enough time to be nice any more.

That the scale of the emergency is such that we have license to just get the job done at all costs. Riding roughshod over others is a price we might just have to pay when time is tight. As someone who’s personality preference is task-oriented, and who is terrified about the future, I have a lot of sympathy with this. But I learnt years ago that even in an emergency, getting the job done at the cost of getting along will only come back to bite you later, and indeed will slow you down. It is exactly in a crisis that well-tended relationships come into their own; not least because they save you doing everything yourself and making a mistake in your rush.

Medical teams know this. The step on and off of burning platforms every day. They know what it means to stay level-headed in life and death crisis, even when others become angry or frustrated, and how to set an even tone that others follow. They also know how to move between changing emotional contexts – happily discharging one well patient only to break bad news to the family of another – rapidly resetting themselves between each context. The obstetrician who chatted casually with me changed to serious and focused in an instant as he sped from our room to an emergency down the hall.

During both of my children’s births, I was met with medical teams who understood that even the risky endeavour of bringing a baby into the world can be done with compassion and grace. Lights were turned down low to create warmth and calm, and rather than experiencing teams who focused solely on the task at hand, I was cared for by clinicians who slowed down to my pace until it was necessary to speed up for the sake of our health. More than that, they recognised that how they were being mattered just as much as what they did.

Ultimately we all wanted a healthy baby and mother, but it is very easy to achieve that outcome and leave mother traumatised by their birth experience such that they need counselling to contemplate another pregnancy.

So even when our first child became tachycardic just before delivery, and the obstetrician was called in, he respectfully consulted our midwife (his junior) rather than unskillfully asserting his rank over all of us. He told me that we needed forceps as though it was a choice for me to make, and he calmly said ‘you push, I’ll pull, and we’ll do it together, ok?’ Only months later did I realise that this was a nice way of making me feel central to the experience, when really it was Rafael and the salad servers who really did the job. I remember these details so clearly because they made such a difference to my sense of agency and achievement in bringing our first daughter into the world. Even as her life was in danger and our best laid plans were being laid to waste, I felt respected and in control. And happy.

Our recent daughter’s birth was just as ‘off plan’ as the first, but no less empowering, safe or fulfilling. Despite the fact that the epidural I eventually begged for wasn’t possible, and I couldn’t use the pool I was so keen on trying, none of it mattered, because these were just ‘doings’. How the team were ‘being’ mattered far more. They were focussed and professional, but also fun and human. They treated us like people, not patients and they held us steady when we felt out of our depth and wanted to be coddled like children. Just like a good coach, our midwife knew that one of the most important skills you can use in times of fear and turmoil is acknowledgement. While I tried to convince her that I couldn’t do it without hard drugs, she reassured and coaxed me on. While I complained that it was taking longer than I expected and couldn’t we just forget the whole thing, she congratulated me on what I’d done so far to spur me on.

People judge us not by how we behave when the seas are calm but on how we treat them when the waves are 50 feet high.

People perceive that our true personalities come out in a crisis – often letting them down by proving that we’re not the nice guy they thought us to be – yet I don’t think that’s the whole story. We may naturally go to mush, scream the place down, or beg for our mothers when in the white heat of a disaster, but we can additionally learn how to be calm, considerate and well-paced.

Medical staff are not born this way. Just like airline crews, astronauts and countless other high-tension professions, they are trained to do it.

I’m writing about this not to share the gruesome details of my birth stories with you but more to underscore the idea that when we want to make change we need to do it collaboratively and with care and that it is just as much how we are being as what we are doing that makes the difference. The John Radcliffe hospital’s team made me feel supported and in control of the change happening to me, all the time holding the duality of the process of a good birth and the goal of a healthy family. We can employ the same dual focus when we agitate for change in the wider world.

When we are gripped by scarcity and feeling threatened by lack of progress, let’s not lose sight of why we do the work we do: because we care, for each other, the natural world, future generations and yes, even ourselves. If we really want to midwife change then let’s make the process of change as empowering and memorable as we can. That way, those we help through it will follow us through more change in the future.

Charly Cox, Sept 2020

*It’s not lost on me that just after we had our first child the UK voted to leave the EU, and then when we had our second the world experienced the worst pandemic in (just about) living memory. Is it something we did?! You can rest easy, we shan’t risk having a third, and not just for the carbon footprint.