Respectful Care Changes the World for the Better, One Birth at a Time

This posting from Soo Downe at the University of Central Lancashire describes her experiences as a witness to respectful maternity care in South Africa, her experience as a practicing midwife and what systems and steps are necessary to provide a respectful maternity care experience.

My first experience of maternity care was as a visitor to a maternity mission station in the homeland of Boputhswana in apartheid South Africa in the late 1970’s. This was a road to Damascus experience for me. I had never considered midwifery as a career, but there I witnessed Black South African women labouring calmly and confidently, supported with great care, skill and tenderness by White South African nuns.  I was suddenly and unshakably convinced that if we get childbirth right, we get the world right.

My experience since then, as a student midwife, then a practicing midwife, then a midwife researcher has led me to understand that part of what made this experience so powerful was the unconditionally positive, mutually trusting relationships that I perceived between the laboring women and the midwives.  Sadly, witnessing a lack of such relationships in some circumstances has led me to this realization. Sometimes the issues that get in the way of positive relationships between childbearing women and their caregivers are to do with personality, sometimes to do with the environment in which labour takes place, and sometimes around how valued staff in particular, or women in general, feel. In my experience, though, the common factor is that individuals are not ‘seen’ by each other; that is, they are in the same physical space, but they are not relating as fellow human beings.  This does seem to be much more prevalent in settings where rules, regulations, and procedures become the guiding force for behavior. In those kind of environments, interpersonal relationships seem to be much more liable to collapse. The human concern with which many caregivers enter maternity care (and, indeed, health care in general) seems to be completely swamped by institutional concerns. This is stripping the soul from maternity care, and this is traumatic for childbearing women, for their families, and for staff themselves, ultimately.

So what might the solution be? It does seem to me that positive respectful relationships need to be reciprocal. And this means they have to operate across the whole system in which people are living and working. Staff need to feel supported, respected, and trusted before they can support, respect and trust colleagues and the women and families they care for. But this is cyclical – peers and childbearing women need to feel the same way before they can reciprocate. To start this positive (virtuous) cycle going, to escape from the vicious circle of disrespect and abuse, someone has to have the courage to say I will not behave in this way any more. Once one person makes a stand, this becomes catalytic. Once one person is seen to treat women well, and colleagues see how good it makes them feel, and how well women respond, they start to think, actually, that is how I want to be, too. This has a ripple effect, on other peers, on managers, on support workers, on childbearing women, and on their families. In my experience, once we start working like this, once we have the courage to take the first step away from the vicious circle of toxic relationships and towards the virtuous cycle of positive regard for each other, we start to realise how much emotional energy we have put into sustaining these toxic systems. This emotional energy is then released as a feeling of wellbeing, and of capacity for innovation, and for new, exiting and fulfilling directions: it is a kind of food for the soul. In an almost magical way, positive relationships in positive environments generate more positive relationships in positive environments.

It's very simple really. Having the courage to make each relationship we have with women and colleagues a positive one changes the world, for ourselves and our society, as well as for our workplace and for the women and families we care for. Based on all my experiences since then, I still believe now what I learned in South Africa more than 30 years ago: if we get birth (relationships) right – we get the world right. So, all it takes is for each of us, at each encounter with clinical colleagues (junior and senior), support staff, administrative and domestic staff,  and childbearing women and their  families, to decide to treat each other well: so that we can change the world for the better, one birth at a time.