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.”
This article appears in the 08 Mar 2017 issue of the New Statesman, The return of al-Qaeda