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"There is so much fear at the moment": meet the midwife who wants to change how we give birth

Pregnancy and childbirth are unpredictable, so call the midwife – preferably one you’ve met before.

What’s the best way to calm a crying newborn? Place the baby on the mother’s chest, next to her heartbeat. It might seem obvious, but the importance of this simple action has only been fully recognised by the medical profession in the past five years, following a campaign by a British midwife called Jenny Clarke.

Professor Lesley Page, who is coming to the end of a five-year term as president of the Royal College of Midwives (RCM), has seen its near-miraculous effect in her own practice. If necessary, she says, she would rope in dads, too. “If the mother had had a Caesarean section or something and looked as if she couldn’t have the baby skin-to-skin, I would ask the father to lift up his scrubs and put the baby there,” she says.

I meet Page in her office at the RCM, just off Harley Street in London. It’s a sensible, no-nonsense space, reflecting both her taste and the fact she travels often for work. She tells me she has forthcoming trips to Orkney to discuss midwifery in remote parts of Britain, and Greece to help local midwives deal with caring for pregnant refugees.

Her career has spanned three decades and all types of care: home births, hospitals and midwife-led units. It also coincides with a profound change in how we think about childbirth. “Thirty-five years ago, in the hospital, it was very institutionalised,” she says. “You had to do ten normal deliveries before you could do an abnormal one. The sign would flash and you would have to run to get your delivery – and fight the medical students. We kept women in bed for ten days, and separated the babies from them.”

She much preferred to attend home births, even if it did mean packing a metal bedpan alongside the delivery kit. “It was lovely, ­because the children would come and see the baby immediately afterwards. I worked in a poor part of Scotland and there were cups of tea. In a more upper-crust house, you got champagne afterwards.”

Midwifery has a unique place among NHS services because pregnancy is, by its nature, unpredictable. The hormones controlling childbirth don’t respect office hours or planning rotas. This makes it difficult to cram maternity services into an NHS bureaucracy that prizes “efficiency” above all else.

And so Page, and the trade union she oversees, have become crusaders for a different approach altogether – one focused on personal relationships rather than a Fordist production line. “To me, midwifery means being with a woman . . . being able to help a woman understand the information available, her hopes, her fears,” she says. “It’s becoming more difficult because of high-pressure health services, which have become quite institutionalised.”

The models she advocates are “caseload midwifery” and “team midwifery”, where each pregnant woman has a single primary carer, who gets to know her during pregnancy – “so you don’t have to ask her all the key questions while she’s trying to manage her contractions” – while each midwife looks after 30 to 40 women a year. She says many NHS workers find the current system frustrating, because they often have to end their shift and walk away, never knowing the end of the story.

Page believes that the system she advocates could save money, both in the short term – continuity of carer reduces preterm births by 24 per cent – and in the long term. Midwives who have time to get to know women can help with public health goals, advising expectant mothers on how to manage obesity or give up smoking.

There are models for how it could work: Neighbourhood Midwives, a social enterprise in London, takes a caseload approach. Its cheapest package costs £4,950, whereas a private birth can costs upwards of £12,000 and a straightforward birth costs the NHS £2,000. “I used to say it’s a Rolls-Royce service for Mini prices – but Minis are probably quite expensive now,” Page laughs. “Midwives doing continuity of care look after more women than those in fragmented systems. It’s counterintuitive, isn’t it?”

That’s important because the RCM estimates there is a shortfall of 3,500 midwives. The profession is ageing, and one in three is aged 50 or over. Last year the government announced what Page calls a “short-sighted” cut to training bursaries: George Osborne claimed that a move to loans would free up money to create more places. (Unfortunately, creating opportunities is pointless if people cannot afford to take them up.)

Page has been involved with maternity policy since the 1990s, when she was involved in a landmark report called Changing Childbirth, published in 1993, which made the bold suggestion that “the power should be with a woman, and her family”. There was, she adds ruefully, “a lot of support – but no money”. Today, only half of women who want a home birth get one, according to a Women’s Institute report.

She believes firmly in “woman-centred care” and so refused a recent request, when lecturing in Canada, to change her slides to be gender-neutral. (The British Medical Association recently suggested the NHS should talk about “pregnant people” in deference to transgender patients.) “I’m strongly feminist and I think childbirth has been off the feminist agenda for too long,” she says. “I know there are transgender people and we need to be sensitive to their needs, but I don’t think we can change our language around woman-centred care.”

Page steps down from the Royal College of Midwives in June. What does she hope her legacy will be? “I would like to see every woman have the possibility of a midwife she can get to know over time,” she says. “And I have another agenda: I would like midwives to know the joy of birth, not just the fear – because there is so much fear around at the moment. To me, it’s the most meaningful work you can imagine doing.”

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 09 March 2017 issue of the New Statesman, The return of al-Qaeda

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Andy Burnham and Sadiq Khan are both slippery self-mythologisers – so why do we rate one more than the other?

Their obsessions with their childhoods have both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

Andy Burnham is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s widely seen as an unprincipled flip-flopper.

Sadiq Khan is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s the hugely popular mayor of London, the voice of those who’d be proud to think of themselves as the metropolitan liberal elite, and is even talked of as a possible future leader of the Labour party.

Oh, and also they were both born in 1970. So that’s a thing they have in common, too.

Why it is this approach to politics should have worked so much better for the mayor of London than the would-be mayor of Manchester is something I’ve been trying to work out for a while. There are definite parallels between Burnham’s attempts to present himself as a normal northern bloke who likes normal things like football, and Sadiq’s endless reminders that he’s a sarf London geezer whose dad drove a bus. They’ve both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

And yes, Burnham apparent tendency to switch sides, on everything from NHS privatisation to the 2015 welfare vote to the leadership of Jeremy Corbyn, has given him a reputation for slipperiness. But Sadiq’s core campaign pledge was to freeze London transport fares; everyone said it was nonsense, and true to form it was, and you’d be hard pressed to find an observer who thought this an atypical lapse on the mayor’s part. (Khan, too, has switched sides on the matter of Jeremy Corbyn.)

 And yet, he seems to get away with this, in a way that Burnham doesn’t. His low-level duplicity is factored in, and it’s hard to judge him for it because, well, it’s just what he’s like, isn’t it? For a long time, the Tory leadership’s line on London’s last mayor was “Boris is Boris”, meaning, look, we don’t trust him either, but what you gonna do? Well: Sadiq is Sadiq.

Even the names we refer to them by suggest that one of these two guys is viewed very differently from the other. I’ve instinctively slipped into referring to the mayor of London by his first name: he’s always Sadiq, not Khan, just as his predecessors were Boris and Ken. But, despite Eoin Clarke’s brief attempt to promote his 2015 leadership campaign with a twitter feed called “Labour Andy”, Burnham is still Burnham: formal, not familiar. 

I’ve a few theories to explain all this, though I’ve no idea which is correct. For a while I’ve assumed it’s about sincerity. When Sadiq Khan mentions his dad’s bus for the 257th time in a day, he does it with a wink to the audience, making a crack about the fact he won’t stop going on about it. That way, the message gets through to the punters at home who are only half listening, but the bored lobby hacks who’ve heard this routine two dozen times before feel they’re in the joke.

Burnham, it seems to me, lacks this lightness of touch: when he won’t stop banging on about the fact he grew up in the north, it feels uncomfortably like he means it. And to take yourself seriously in politics is sometimes to invite others to make jokes at your expense.

Then again, perhaps the problem is that Burnham isn’t quite sincere enough. Sadiq Khan genuinely is the son of a bus-driving immigrant: he may keep going on about it, but it is at least true. Burnham’s “just a northern lad” narrative is true, too, but excludes some crucial facts: that he went to Cambridge, and was working in Parliament aged 24. Perhaps that shouldn’t change how we interpret his story; but I fear, nonetheless, it does.

Maybe that’s not it, though: maybe I’m just another London media snob. Because Burnham did grow up at the disadvantaged end of the country, a region where, for too many people, chasing opportunities means leaving. The idea London is a city where the son of a bus driver can become mayor flatters our metropolitan self-image; the idea that a northerner who wants to build a career in politics has to head south at the earliest opportunity does the opposite. 

So if we roll our eyes when Burnham talks about the north, perhaps that reflects badly on us, not him: the opposite of northern chippiness is southern snobbery.

There’s one last possibility for why we may rate Sadiq Khan more highly than Andy Burnham: Sadiq Khan won. We can titter a little at the jokes and the fibs but he is, nonetheless, mayor of London. Andy Burnham is just the bloke who lost two Labour leadership campaigns.

At least – for now. In six weeks time, he’s highly likely to the first mayor of Greater Manchester. Slipperiness is not the worst quality in a mayor; and so much of the job will be about banging the drum for the city, and the region, that Burnham’s tendency to wear his northernness on his sleeve will be a positive boon.

Sadiq Khan’s stature has grown because the fact he became London’s mayor seems to say something, about the kind of city London is and the kind we want it to be. Perhaps, after May, Andy Burnham can do the same for the north – and the north can do the same for Andy Burnham.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.