The Invisibility of Midwives

Throughout last year, Grumpy Midwife facilitated a (frankly, brilliant) interactive training session on obstetric haemorrhage based on the tragic story of Princess Charlotte.

Princess Charlotte of Wales was the only child of the future King George IV. Had she lived, she would have displaced Victoria as Queen of England etc and so changed the course of European history. Tragically, Charlotte died in childbirth in 1817, at the age of 21.

Contemporaneous record keeping leaves a bit to be desired but we know that this was Charlotte’s first baby and the pregnancy was probably post-term. Her labour was long and inefficient and she birthed a large still-born baby boy after several hours of second stage. Shortly after, she started to bleed so her attendant performed a manual removal of placenta; the bleeding stopped but Charlotte collapsed and died three hours later. Cue, 200 years later, an excellent opportunity for inter-professional professional discussion on the possible causes of her death – and small group work on we would do today to manage the situation. (It is not known exactly why Princess Charlotte died, although Grumpy Midwife’s money is on a ruptured uterus. Or sepsis.)

Poor Charlotte was cared for in labour by Sir Richard Crofts. He not an obstetrician but a “man-midwife”; a male specialist in childbirth and the choice of wealthy women of the day (the alternative being a village midwife). By all accounts, Sir Richard was a skilled and compassionate practitioner but, at in a time before oxytocics and antibiotics, he could only watch and wait as tragedy unfolded. (Ironically, village midwives had probably been using raw ergo(metrine) for a couple of centuries but doctors did not approve.)

The country reacted to Charlotte’s death with (according to accounts) emotional bordering on hysteria, prolonged mass mourning, and profound anger – directed principally at Sir Richard. Three months after Charlotte’s death, whilst attending another woman in labour, Sir Richard apparently lost his nerve, left the room, and shot himself. (Grumpy Midwife recently visited Croft Castle in Herefordshire, the family home of Sir Richard. It was a poignant experience.)

Given the pressures of caring for royalty in labour, Grumpy Midwife can understand why four eminent doctors of various specialities felt it necessary to hover anxiously during the labour of the Duchess of Cambridge yesterday. She has a fond image of the men huddled together in a pocky staff room – drinking espresso, checking their phones, adjusting their ties – jumping every time the door opened. Meanwhile, two experienced midwives got on with the job, just as other midwives were doing at that moment  in hospitals and health posts and homes all over the world.

Waking up to gushing headlines this morning, Grumpy Midwife was initially irritated by the absence of midwives from this modern-day nativity. Surely a missed opportunity to spread the word about midwives as lead professionals in low-risk childbirth? A vehicle to celebrate natural childbirth and skilled midwifery care? A chance to redress the negativity of Morecambe Bay and Guernsey?

Then, after a while, GM calmed down and realised that – no – this is how it should be: midwives with women, quietly, reflective, nudging, guiding, supporting, protecting – but ultimately just there as the woman herself, princess or pauper, births her baby. Because it’s her show, not ours.

Proud to be a Midwife

Grumpy Midwife is proud to be a midwife. She’s proud of the whole second-oldest-profession-in-the-world thing. She loves the idea of being the latest in a long line stretching back to Biblical times; presiding over the primordial mess and raw emotion of an event that levels princesses and paupers, prisoners and pop stars.

Grumpy Midwife is even secretly rather proud of Call the Midwife; lynchpin of the community, respected by men, revered by women, keeper of secrets, defender of the weak, wise woman, witch. She likes the fact that when people ask what she does, she can simply say “midwife” with no need for explanation or elaboration. What other profession is thus so nicely defined?

If she had more time, there is a risk that Grumpy Midwife would find herself quite overcome by the sheer pathos of birth: her hands the first to touch this brand-new, blood-streaked little body; her words at this time remembered forever by the mother; her protection of this infant during the most dangerous moments of his life the first of step of his journey to nobility, Nobel prize, or notoriety. She still sheds a few discrete tears at every birth she witnesses, secure in the knowledge that these will be unnoticed in her general bustle and bossiness.

There have been times when this pride has been dented; by Grumpy Midwife’s own cynicism and discontent or by events or the opinions of others. But not for long – and never so much so that she has managed to walk away. And certainly not since she was recently reminded – by healthcare workers listening intently to her every word in a dusty, dilapidated classroom in a remote corner of Kenya – of the importance of midwifery skills, stripped of all romance and pretension, to millions of women across the world.