For love nor money? Midwives in a material world

Duff E. MIDIRS Midwifery Digest, vol 18, no 2, June 2008, pp 199-200. Original article. © MIDIRS 2008.

Excerpt from Page 200:

Returning to the question of midwives' own remuneration, one of the ICM member associations in the UK, the Independent Midwives Association, is campaigning for an independent midwifery service to be enabled to continue, in spite of impending legislation affecting its existence (IMA 2008). Although midwives function independently in many comparable countries such as the Netherlands and New Zealand, this type of service has struggled for support in the UK in spite of high commendation from many women who have experienced this care. Among fund-raising events, the IMA organised a screening in April of a much publicised film called The business of being born - produced by TV presenter Ricki Lake and directed by Abby Epstein, whose pregnancies were both included in the film (www.businessofbeingborn.com).

Although the showing to the IMA supporters was certainly 'preaching to the converted', the vigorous question-and-answer session afterwards demonstrated the many points raised. The film is US-based and cultural differences between the US and UK inevitably become apparent, not least the very low profile of midwives and normal birth among American childbearing women. Mothers were interviewed with the question, 'Did you consider midwife-led care during your pregnancy and birth? and at least one simply smiled and said, 'No', rather gently, as if the questioner must be sadly misguided even to ask. A group of three young, smiling, white, female doctors were asked, 'How many normal births have you observed?'; as if synchronised, they all first looked blank, then looked at each other, then began to laugh, in a self-deprecating but not very critical way. It was perfectly clear, even before they spoke, the answer was 'none'.

French obstetrician Dr Michel Odent was interviewed and his thoughtful responses, in very fluent but accented English, were helpfully subtitled in English, perhaps particularly with a view to the US audience. 'Two nations divided by a common language' is often said (or attributed to Oscar Wilde or Bernard Shaw), but this film shows up even more divisions between the culture of the USA and the UK, and -while making striking points against this - it warns of the medicalised, commercialised, litigative culture moving ever eastwards.

Midwives and many others in the UK have been, in a sense, distanced from the commercial world by the protective bubble of the National Health Service (NHS), which despite years of gloomy news, well publicised local failings and blurring of the boundaries with both the voluntary and private sectors, nevertheless maintains its enviable ethos of a service free of charge at the point of care. This is of boundless benefit to consumers and has been particularly so to women who previously tended to be the lowest priority for spending of a family's limited health care budget. The principle of the NHS, and generally the practice, are highly commendable, but can also raise concerns where this has the effect on both providers and consumers thinking that any mention of money in relation to health is dubious. Talking about where the money comes from to provide high quality care is necessary, and promoting discussion to determine criteria about how to determine what are acceptable sources is to be encouraged. The ethics of financing cannot be described in black and white terms or even shades of grey: there is a multi-coloured and multi-dimensional framework that requires viewing from every perspective - neither 'through a glass darkly' nor with rose-tinted spectacles.

Elizabeth Duff is Communications Manager for the International Confederation of Midwives.

References

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