Birth Rites collection launch at King’s

Next Thursday evening (25/1/18), King’s College London will host an opening night gathering to celebrate the launch of the Birth Rites collection installation throughout the the Guy’s campus. The event is free and open to the public, but you have to book.

“And I assure you that it was a very startling thing for me to hear a woman describing her feelings as she gave birth in the same words used by Bucke to describe cosmic consciousness or by Huxley to describe the mystic experience in all cultures and eras or by Ghiselin to describe the creative process or by Suzuki to describe the Zen satori experience.” – Abraham Maslow, describing ‘peak experiences’

“Terese crowning in ecstatic childbirth” from Ina May Gaskin’s book ‘Ina May’s guide to childbirth’ Hermione Wiltshire, 2008,  black and white photograph. Birth Rites Collection.

Birth Rites is the first and only collection of contemporary art dedicated to the subject of childbirth. Works in the collection explore the intersection of emotional and technological experience of birth in 21st century culture.

Artist book ‘Cock’s Comb’ screen printed by Helen Knowles, bound by Helen Johnson and made in collaboration with teenage parents at Salford Women’s Centre. The book explored the teenage mothers language they used for the body and their experiences of childbirth by incorporating their drawings and writings, it also made reference to ‘The midwives Book’ written by Jane Sharpe in 1734, the first English midwifery text written by a woman. Detail of artist book ‘Cock’s Comb’ screen printed by Helen Knowles, bound by Helen Johnson and made in collaboration with teenage parents at Salford Women’s Centre.

The images are powerful and challenging, especially for those who are not used to seeing women’s faces and bodies transformed by the work of labour and birth. They provoke, and some are uncomfortable, controversial.

‘Yoga positions for Birth’ 2008 by Hermione Wiltshire. Photographic installation. Birth Rites Collection.

But this is the purpose of art. Private, hidden moments are public for a flash. And we’d love to hear your thoughts about it. If you are near London next Thursday, please do join us.

— Shawn

Can “mothering” be gender-neutral?

My work requires me to be able to speak to many audiences: midwives, obstetricians, paramedics, policy makers, birthing families. Increasingly working across cultural boundaries constantly challenges me to check my assumptions, to learn new ways of communicating. I don’t always get things right. I was recently asked by an education leader in an organisation I had worked with if I would consider eliminating gendered pronouns in my teaching videos. The request was warm, genuine and respectful. And it reflects the policy emerging within some maternity care professional organisations, particularly throughout North America.

I struggled with what I perceived to be a request to eliminate woman and mother in favour of gender-neutral language, and this blog is my attempt to be open and honest about this struggle. Some of my reactions are personal. I am a white cis-female who has given birth and raised my children as their mother. I have been privileged to have a good education and financial security. But my name is Shawn, and about once a week someone asks me how I ended up with a guy’s name, or addresses me via e-mail as Mr Walker, or expresses surprise that I appear to be a woman. It’s annoying, but I get it.

I’ve been using Ms, even when I have to write it in as an option, since I was a teenager. I had to do this yesterday, and the 1970’s have been over for at least 30 years. I have never changed my surname, even after marriage. And now that I know it’s a thing, would probably prefer that e-mailers use Mx rather than assume Mr. Although I have mothered four children (ages 6-16) who are growing up in Norwich, I live mostly 2 hours away in London and travel a lot for work. I am frequently asked who looks after my children when I am gone. No one ever asks their fathers, who are their main carers, when they travel for work. I am also American, but my accent has drifted across the Atlantic enough to be not quite English to English ears and quite English to non-English people. When I visit my parents in the US, people who don’t know me well refer to me as The English Lady. Thankfully, no one has ever referred to me as The English Pregnant Patient. I am enormously privileged and secure by chance and circumstance, but I also find myself in-between at times.

So why does gender neutral language in maternity care not feel obviously right to me? Certainly, referring to a group attending antenatal classes as parents rather than mums and dads feels right, because many combinations of parents make up families these days. But I feel a sense of loss as I contemplate dropping women and/or mothers completely from the way I teach and talk about my work.

Certainly, some of it is cultural. I am aware of advocacy for recognition of non-binary sex, gender and sexuality in the UK, and many things have changed for the better. But in general the midwifery profession still sees itself collectively as aspiring to woman-centred care, certainly in the UK and internationally if the collaborative Lancet Series in Midwifery is anything to go by. The etymology of “midwife” is “with woman.” Midwifery has a natural affinity with feminism in its aspirations to reduce inequalities, and this inherently involves recognising women as a class of people who are exposed to unequal and sometimes actively oppressive cultural and health care dynamics. In 2015, Glosswitch suggested, “Gender-neutral language around reproduction creates the illusion of dismantling a hierarchy – when what you really end up doing is ignoring it.” Elephant Circle, responding to MANA’s decision to shift to gender-inclusive language, made it clear that they are “committed to promoting the additive use of gender-neutral language in traditionally woman-centric movements.” I agree that use of exclusively gender-neutral language has at least potential to harm through erasure, but its additive use has clear potential to promote compassion and inclusion.

But I do question why it is so uncomfortable to have traditionally female-associated language transition into catch-all terms. When I was training, during a placement on the Intensive Care Unit, the senior nurse on the ward was a man. Senior nurses and midwives in the UK are often called Sister. Once, about to call him Sister, I caught myself and asked, “What should I call you?” Without hesitation, he said, “Call me Sister.” Then he told me off for wearing my jumper on the ward. My hesitation bothered me. But his professionalism and completely unthreatened acceptance of Sister as the gender-neutral term in the profession he had chosen impressed me. Male midwives have always done this. They are midwives.

What doesn’t impress me is when someone refers to a group containing both women and men as guys. This came up in a social media group for mothers who work in academia. Despite feedback from students voicing that it makes them uncomfortable, many people answered that guys is gender-neutral and, essentially, there are more important problems that require addressing so they were not going to go to the bother of changing their language. Guys will be gender neutral when it feels equally comfortable to refer to the same group or a group of men as gals. When taxi drivers no longer ask me if Shawn isn’t usually a guy’s nameMen was definitely neither gender- nor colour-neutral when the words “all men are created equal” sparked a revolution, and it still isn’t.

But it is very common, especially among male doctors, to refer to a group of midwives as girls, as in, “The girls will look after you …” It is incredibly tricky to challenge this language without being dismissed as an over-sensitive ranty feminist, the one with the problem, the one whose political correctness gets in the way of co-operating on more important problems. Yet if I do not change my own language in referring to birthing people primarily (but not exclusively) as mothers and women, I fear I will simultaneously be regarded as insensitive and possibly transphobic.

Some of my frustration also comes from years of being an ally in a different minority struggle. I would like every health care professional using predominantly gender neutral language in their practice to also normalise breech presentation. Every time you demonstrate the mechanisms of labour, do it with the baby coming out both ways. Always say, “Babies are born head-first or bottom-, knee- or foot-first.” Because they are, or they could be. I can’t tell you the number of times that people have said they would like to support breech birth, but it requires too much time and effort (see the “more important problems” excuse above).

Many professionals who hold the power to change things have even suggested that spending the extra time and/or resources it would require to ensure women who want to birth breech babies vaginally are attended by skilled, experienced professionals would be an unequal and thus unfair application of resources for such a small number of people (1:25-30 mothers at term carry a breech baby). Other rarer conditions, especially those which require expensive fancy-pants technology rather than more people-time, don’t seem to be affected by such arguments. In our over-stretched and over-aware maternity services, giving more to one seems to come at the cost of another.

I am genuinely grappling with the implications of the language I use, involving my family and colleagues in conversations, changing bits which feel right and remaining open to how my language may continue to change. I don’t feel there are “more important problems.” But I am not yet convinced that using exclusively gender-neutral language to ensure that a (non-woman) minority will not feel uncomfortable, will not mask another invisible injustice towards women. Inclusivity has to be both gender-acknowledging AND gender-neutral, rather than exclusively gender-neutral, until we know that losing gender specificity will do no harm to women. I am convinced by the research suggesting health professionals need to use more inclusive language and communicate with LGBTQIA+ families more sensitively and competently. I’ve seen no research assuring me that removing all gendered pronouns from the language around maternity care will do no harm to women. Until I am assured, I will continue to take an additive approach rather than an exclusively gender-neutral one.

For me, for now: More inclusive language is welcome, and in my work I will strive to include gender-neutral language alongside the gendered language that is embraced by the majority. I recognise that not everyone who gives birth is a woman, and I’m going to consciously use alternatives more often, just like I am consciously using people and folks where others are still using guys. When I do use women, especially in a group of parents, I am going to try to include other descriptors to acknowledge both women who want or need me to see the way their gender influences their experience, and people who need to know that I welcome them, and want to include and care for them, whatever their gender or lack of it.

And I hope that when inclusive birth professionals describe normal birth, they refer to the physiological birth of a baby who emerges spontaneously at term, head, bottom, feet or knees first, so that people who are pregnant with breech babies no longer feel they are abnormal or a freak for wanting to birth their breech babies. Just imagine what will happen when the families you teach attend their appointments expecting that they will give birth normally like everyone else, unless a genuine problem emerges! When I describe a person’s birth video, I am going to continue to describe them using the pronouns they use to describe themselves.

But I have a practical problem: I spend a lot of time talking about the way two pelvises interact with each other during a breech birth. I need to distinguish between the fetal/baby’s pelvis and the birthing person’s pelvis, and how they operate together as what the professionals in my research called the Mother-Baby Unit. Birther-Baby unit doesn’t feel right; it feels like I’ve separated the birthing body from the loving carer and sustenance-giver. Birthing is the ultimate reproductive act; but it is also a major bit of parenting. A time of being and becoming. Merriam-Webster‘s on-line dictionary tells me that the verb mother means “to give birth,” “to give rise to,” or “to care for or protect like a mother.” It feels right (to me) that mother itself has the potential to transition to gender-neutral. Not all of those who mother a child are women, nor do all women mother a child. (And not all people who father a child are men, nor do all men father a child.) I am asking those who wish for a more inclusive language to consider whether mother could be the mother of all inclusive terms. Such a concept may be just as radical as shifting gendered pronouns out of maternity services.

Folks, I am asking you to consider my use of mothering as a gender-neutral verb for giving birth, and to see such acceptance of maternal descriptors for the birth act as a radical act of solidarity with the women around you who remain a second sex. Women who have had to live with male descriptors being used as gender-neutral, but almost never vice versa, their entire lives. Women in every country of the world whose genders and embodied existences are immutably determined by others’ sexual (ab)use of them, women who are made to birth children against their will. Because no one should have to mother against their will. Mothering should always be a role one chooses, during pregnancy, birth and sometimes after. I’m remaining open to new possibilities as our language and culture shift. But for the moment, I ask you to be with me in considering the radicalism in mother-centred care, the importance of understanding women as a class of people despite infinite diversity within that group, and the need to explore and challenge the discomfort arising when descriptors historically associated with the female sex are used as gender-neutral terms in our brave new world. I in turn will recognise your radical acceptance and compromise, while I continue to check my inclusion of gender-neutral language.

I have shared my thoughts in good faith, wanting to do well by all I work with. I welcome you to comment here in order to help me and others continue learning and growing, but please as always, practice compassionate understanding in your response.

Shawn

P.S. I am a Unitarian. But I love unisex-named medieval mystics, especially when they are mother enough to be challengingly gender-fluid the 14th century without a position statement, awesome enough to be the first woman to have her book published in the English language, and their own self enough to depict Jesus as the bad-ass Mother that he was, inclusive of caesarean section imagery (how did she know how important this would be?) Go Jules!

Accountant Needed!

Now that my PhD is submitted, I am in the process of registering Breech Birth Network as a Community Interest Company. This business structure will enable 1) the accounts to be separate from mine; 2) all of the profits to be channelled back into the breech training, research and advocacy work we do; and 3) accountability, as the annual financial report is publicly available.

I really need an accountant who is either experienced with all of the following or able and keen to become experienced:

  1. Filing individual UK tax returns
  2. Filing individual USA tax returns (I am required to do this)
  3. Filing Community Interest Company Tax returns in the UK
  4. Understanding the company’s obligations when earning revenue by providing training outside of the UK and helping us to meet them

Prayer hands – breech births make more sense to me than tax returns!

I need this to be one person; continuity of relationship is important to me. I would like to work with a person who feels great supporting what we are doing with Breech Birth Network. Maybe you/they feel passionately about the physiological breech cause for your/their own personal reasons, or have a general commitment to the advancement of human rights in childbirth and respectful maternity care.

Obviously, I am expecting to compensate such a person appropriately.

Do you know someone? Are you possibly this someone? PM if you are using the form below. Please help me find my tax angel so I can spend more time recording voiceover for training videos!

Love,

Shawn

Breech in Belfast

Consultant Obstetricians Niamh McCabe and Janitha Costa, and Breech Specialist Midwife Jacqui Simpson

The Breech Birth Network visited Belfast this weekend. Dr Anke Reitter FRCOG of the Krankenhaus Sachsenhausen and I taught a day-long physiological breech study day at the Royal Victoria Hospital for over 40 obstetricians and midwives.

The day was organised by Consultant Obstetricians Janitha Costa and Niamh McCabe, enthusiastic upright physiological breech practitioners, and Senior Registrar Shaun McGowan. The team have recently published outcomes associated with their breech clinic (Hickland et al 2017 and Costa 2014).

 

Our study day increasingly emphasises pattern recognition and decision-making through the use of real breech birth videos, especially videos of complicated births. We watch, deliberate and critique – with compassionate understanding, respect and humble appreciation. These brave health professionals and women have allowed themselves to be vulnerable and exposed in order that others may learn, and we are very grateful.

We have also moved away from using heavy and expensive simulation models and rely instead on doll and pelvis models. These enable us to see what is happening from all angles and embed the theory of the manoeuvres we are teaching. We operate on a see one (the theoretical presentation), do one (hands-on with one of the instructors), teach one (of your colleagues) model. This helps build confidence to carry on teaching the techniques in the local setting.

Our preferred models (it’s a great idea to have some on hand if you are organising a study day or implementing this training in your local setting) are:

Fetal Doll Model; and

Cloth Pelvic Model; or

Female Pelvis Model

Final announcement: Blogging has resumed because … I submitted my PhD a couple weeks ago! Hurrah!

Shawn

Krankenhaus Sachsenhausen is also on Facebook!

Consultation: Rapid resolution and redress scheme for severe birth injury

The government are currently consulting on a potential shift to a rapid resolution and redress scheme for severe avoidable birth injury. Such an initiative was recommended by the recent National Maternity Review (Better Births, 2016), based on feedback from families and health care professionals.

Here’s why I think it’s a good idea:

  • The current system often requires lengthy and adversarial court proceedings in order for families to receive compensation. Litigation is the last thing parents need when their child has been injured.
  • Families have to prove negligence in order to get the financial support they need to care for their child. This is often directed at an individual, when we know that most problems are systemic in nature.
  • Local investigations mean learning is only disseminated at Trust-level. The nation-wide scheme would include a national database to identify learning which can be disseminated.

Globally, we need systems based upon relationship and response, care and mutual responsibility — and not just in maternity. A shift from adversarial litigation to collective responsibility in a rapid resolution and redress scheme is a step in the right direction.

Consultation is open until May 26, 2017.

Shawn

Breech holiday, Frankfurt – from Olvindablog

Justifying to a seven-year-old Anubis why I’m going to Germany for my week off – and missing mothers’ day, helped crystallise objectives and motivation for this busman’s holiday* (*a form of recreation that involves doing the same thing that one does at work). “I’m going to see some babies be born bottom-first.” “Don’t you see that […]

via Breech holiday, Frankfurt — Olvindablog

Visca les natges! Barcelona breech training

(See the Catalan version of this article below …)

This week (21-22 March 2017), the Breech Birth Network was in the beautiful city of Barcelona, at the invitation of the obstetricians and midwives of Hospital Sant Pau. Our team expanded for the occasion! Midwife Maria Segura translated all of our teaching slides into Catalan. And Cardiff-based midwife Carmen Rubio ensured everyone had an opportunity to receive hands-on help when practising manoeuvres to assist women birthing in upright positions.

I love studying and teaching physiological breech birth most because when a health professional learns how breech works, they learn how all birth works. Despite its apparent applicability for only a small proportion of the total population, skill in the art of facilitating breech birth resonates throughout a professional’s entire birth practice, their collaborative work with colleagues and within institutions.

Our experience in Barcelona made this clear. Hospital Sant Pau is in a period of transition, trying to increase the rates of normal birth. Breech birth is a part of that, but midwives are also working to establish the first midwifery-led birth centre in Catalunya. The hospital has recently established a new guideline enabling obstetricians to support physiological breech birth, including women who choose to birth without an epidural. To enable women to have a choice of pain relief for physiological birth without epidural, the hospital team are considering offering nitrous oxide (Entonox) for the first time. And for some of those attending this week’s training, our videos were their first exposure to women birthing in a kneeling position. One obstetrician suggested they could prepare for the change in breech practice by facilitating kneeling positions for cephalic births!

Dr Arianna Bonato, one of the external OB-GYNs attending the training, told me she feels that a breech birth is the most beautiful birth to see, because the physiology is so visible. I agree! This visibility makes possible learning about physiological birth in general within the microcosm of breech.

The way that a neurologically intact baby assists his own birth, the intuitive movements of a mother who feels safe and uninhibited, and the consequences of interventions in the mother-baby dance, to facilitate or disrupt, are all much more exposed. As Carmen Rubio reminded me, breech births demand calm wisdom in the birthing space like no other.

“Give it a wiggle” / “Donar una sacsejada” !

I have no doubt Hospital Sant Pau’s open-minded and forward-thinking approach will attract many more women to birth in this hospital, and that their midwifery unit will also thrive when it is opened. A blessing for the women of Barcelona. I look forward to staying in touch and learning from their experience of implementing these new practices!

Thank you to Consultant Obstetrician Ma Carmen Medina Mallen, and Maria Segura, for their work in organising the Breech Birth Network training this week. Hospital Sant Pau will be auditing their outcomes for term breech presentation over the next year, as part of our international evaluation of Physiological Breech Birth training.

— Shawn

Elevate & Rotate from Shawn Walker on Vimeo.


Many thanks to midwives Carmen Rubio and Maria Segura for the translation of this blog into Catalan!

Aquesta setmana (21-22 de Març 2017), la Xarxa pel Part de Natges va estar a la bonica Ciutat de Barcelona, com a invitació dels ginecòlegs i llevadores de l’Hospital de Sant Pau. El nostre equip va créixer per l’ocasió! La llevadora Maria Segura va traduir totes les diapositives de la sessió al català i la llevadora Carmen Rubio, amb seu a Cardiff, va garantir que tothom pogués tenir l’oportunitat de rebre ajuda en la pràctica de les maniobres per assistir les dones que vulguin donar a llum en posicions verticals.

Hospital Sant Pau

M’agrada estudiar i ensenyar el part de natges de manera fisiològica, sobretot, perquè quan els professionals aprenen el funcionament d’aquest, també ho fan sobre els fonaments de donar a llum. Encara que la seva aparent aplicació sigui per una petita proporció de la població, l’habilitat en l’art de facilitar els naixements de natges ressona a través de tota la pràctica professional, així com a la feina de col·laboració entre companys i al conjunt de les seves institucions.

La nostra experiència a Barcelona ho va deixar ben clar. L’Hospital està a un període de transició, intentant incrementar les xifres del part natural. El part de natges forma part d’això, però les llevadores, a més, estan treballant en la línia de crear la primera casa de naixements pública a Catalunya. L’Hospital ha establert recentment un nou protocol que permet als obstetres reconsiderar el part de natges de forma fisiològica, incloent-hi la voluntat de les dones que vulguin donar a llum sense epidural. A més, l’equip de l’Hospital està en vies d’introduir l’Òxid Nitrós (Entonox) per primera vegada, com un altre recurs d’analgèsia per les usuàries de part. Per alguns dels participants a la formació, va ser la seva primera vegada en veure, a través dels vídeos, a dones donant a llum en posició vertical. Una de les ginecòlogues va suggerir que es podrien preparar pel canvi en la pràctica de l’atenció al part facilitant més activament la posició vertical als naixements dels nadons que es troben en presentació cefàlica.

La Dr. Arianna B. una de les obstetres/ginecòlogues que va atendre la formació, em va dir que sentia que el naixement de natges és molt bonic d’observar, perquè en ell es pot veure clarament la fisiologia del part. I estic d’acord! Aquesta claredat és la que ha permès aprendre del part fisiològic en general des del microcosmos de les natges.

La forma en què un nadó neurològicament sa assisteix el seu propi naixement, els moviments que intuïtivament fa la mare quan se sent segura i desinhibida, i quines són les conseqüències de facilitar o interrompre la dansa entre mare i fill són molt clarament exposades. Com la Carmen Rubio em va recordar, el part de natges demana com cap altre, la saviesa calmada de l’espai en el qual es dóna a llum.

No tinc cap dubte que la ment oberta i de pensament avançat de l’Hospital de Sant Pau atraurà moltes més dones a aquest Hospital i que la seva Casa de Naixements serà també popular quan l’obrin. Una benedicció per les dones de Barcelona. Estic desitjant estar en contacte i aprendre de l’experiència en la implementació d’aquestes noves pràctiques.

Moltes gràcies als membres de l’equip obstètric, la Ma Carmen Medina Mallen i a Maria Segura, pel seu esforç organitzant la formació de la Xarxa pel Part de Natges. L’Hospital de Sant Pau auditarà durant l’any vinent els resultats dels parts en presentació de natges com a part de la nostra avaluació internacional respecte la formació del Naixement Fisiològic de Natges.

— Shawn, Carmen & Maria