Three things to know: the maternity system and how to navigate it…
This is NOT an NHS-bashing blog post. As a doula & antenatal teacher, I wholeheartedly support our incredible midwives and obstetricians. But knowing what I know now, there are so many things I wish I could go back to tell my first-time pregnant self…
But apparently that’s impossible, so I’m sharing them with YOU instead…
Before doula-life, I was a teacher for 14 years.
I know the education system inside out and the more I work in birth, the more I see the parallels between the two worlds.
Truthfully, while I loved teaching English & have some fabulous memories, I am not always proud of what I did as a teacher. And here’s why…
Before having my children, I was a ‘lifer’ teacher. I loved my job and as hard as it was, I fully subscribed to the ethos. As a head of Key Stage, I was responsible for the progress of around 750 students, creating curriculum frameworks, learning policies, homework tasks, lesson plans, all with the mindset of supporting students to ‘succeed’.
And success looked like this: ‘passable’ marks, percentages and grades handed down by the government and educational bods from above (hello, Michael Gove. I’m looking at you.)
But naturally, there were students for whom this was not a goal, was a struggle or not even a possibility for a whole host of reasons. So they pushed back, misbehaving, avoiding work, coursework, exams.
So what did I, as the one responsible for their success do?
I coached them.
I organised additional tuition.
I monitored their progress closely to keep them on track.
On the not-so-infrequent occasion, I gave them a right bollocking to get them ‘back in line’.
Now, for some kids this worked and they ‘succeeded’ (aka passed). For some it did not. Regardless of the outcome, it was stressful all.
But raising those universal standards was part of my job. And I was good at it. My bosses said so & I felt good about it.
So why is this relevant? Well, because then I had my baby… and my perspective changed immediately.
The faces in front of me, the names on spreadsheets, were no longer a mass, but were individuals: someone’s son or daughter. That seems so stupid to write, but it was groundbreaking.
All of a sudden, I could see my girl’s name on that list. This little human who I thought the world of, and who I knew had her own strengths and limitations, and goals and aspirations and fears…
… and who I knew would flag up someone’s ‘intervene’ list one day, putting her on a path to be ‘successful’ in a way defined by a body or organisation that had never met, or considered her as a unique individual…
… that would be innately stressful for everyone, especially her.
And THAT’S when I realised I couldn’t be a teacher anymore.
Not because I didn’t value the role of teachers.
Education is a system that serves the masses and when you work in that system, and are accountable to it, working to the masses is the most effective way of working and one you are held accountable to.
Can you see the parallels yet?
If I am going to do something, I have to feel I am doing it to the best of my ability and that I am doing a ‘good job’. My pre-baby self believed in what I was doing. But now as a parent, I found it so hard to balance that against the individuals I saw before me.
Put simply: I couldn’t do a good job of both. I just could not find a way to balance the need to support the masses (which is what I was contractually obliged to do) with the intrinsic desire to support the individual.
So I left.
In becoming a doula & independent antenatal teacher, I have learnt a lot about how maternity care works. I’ve seen it first hand, observed it at professional meetings and training, and heard it from clients at postnatal doula sessions, antenatal classes and in discussions at ‘The Nest’.
And I’ve realised that all of this systemic knowledge I bring with me from education applies here, within maternity. Now, alongside my professional doula and antenatal training and experiences, I am now very well placed to guide people to create a more personalised approach to their birth and baby journeys.
Three things to know about UK maternity care…
The principles that guide the NHS are really clear: the vision for this incredible service is to create a ‘comprehensive service, available to all’ which is high-quality, clinical, accountable, cost-effective but which keeps the patient at the heart of all that they do.
These intentions are all incredibly important. However, for the individual on the ground, it’s beneficial to think about what that means in practice…
NHS maternity care is a system that supports health: in order to create this clinical and cost-effective space which supports as many people as possible, pathways and policies feature heavily to make dealing with masses of people realistically possible.
NHS staff are required to follow the policies and pathways that make up the system: to keep services universally high-quality and accountable, midwives and obstetricians are obliged to recommend (or not) according to policy. Whether or not they agree with it, or whether or not it’s supported by the most up-to-date evidence rarely comes into it.
Routine practices become unquestioned norms within a working day: this seems quite obvious, but comprehensive and accessible services are BUSY; and this volume of people, when channelled into different pathways, create trends. Midwives who do a lot of low-risk home births routinely see a different type of birth to midwives who spend their time caring for medically high-risk births. Just as we bring our own experiences to the birth room, so do they.
Now, while the mission of the NHS is to keep the patient at the heart of everything they do, these three things create certain challenges to that: the fact of the matter is that universal policies, accountability & routine based norms serve the majority.
Not the minority. Or even an individual.
An individual like you.
Three ways to make the maternity system work for you…
Your pregnancy, labour and birth is unique: previous experiences, mindset, emotions, hormones, physical composition, DNA, support systems are all influencing factors.
But within a busy, routine-dominated, universal-policy based system like the NHS, our individuality isn’t necessarily at the top of the list.
Systems can’t predict or prioritise every single possible individual variation: there are other priorities. Therefore, if we want our individuality to be accounted for or catered to, WE need to make it priority. But how do we do that?
Like this…
Start seeing yourself as THE most important person in the room: I know you don’t want it to be awkward, and you don’t want to be a hassle or inconvenience anyone. But trust me when I say you won’t. Anyone who works in birth WANTS to put your needs first. The chances of us being able to see them and act on them is greatly increased if you see those things as important too.
Write a birth plan focused on feelings not facts: use your planning to help your birth team personalise your care based on your hopes, fears & goals rather than ‘I want a waterbirth’.
Prepare your birth partner(s) to advocate for these feelings: including your birth partner in your ‘thinking’ behind the plan, as well as doing preparation that gives them real advocacy and birth support skills may well be a game-changer.
Will these guarantee a totally personalised, positive birth experience? No.
But doing them will absolutely increase the chances of it happening ten-fold.
Birth happens every single day, but this one is yours. How it happens matters: your experiences and memories will stay with you for the rest of your life and you deserve nothing less than being seen, heard and treated as the incredible individual that you are.
This mission is what gets me out of bed every day & is the reason I create the birth options workshops, antenatal courses and doula packages that I do.
Curious? Why not take a look, or book a totally free curiosity call to find out more about the ways I can help you carve your own path through the maternity system.
