On a  cold Saturday morning in February, a group of midwives, midwife teachers and a student midwife, (eleven in all) congregated at Terminal 3 at Heathrow. Our group was privileged enough to be heading for The Farm, Summertown, Tennessee, birthplace of the classic midwifery textbook “Spiritual Midwifery” and home of the Farm Midwifery Center.

We were visiting The Farm as part of the ENB A31 Enhanced Midwifery Practice Programme programme run at Anglia Polytechnic University in Chelmsford. The programme aims to encourage midwives to question their own beliefs and value systems and to use an evidence informed approach to practice. The A31 offers students undertaking the course, the opportunity for a five day alternative practice placement of their choice.  As a result of the enthusiasm and motivation of the 1999/2000 cohort, their dream of such a visit had become a reality.

After a somewhat unsettled first night in Nashville, a group of us took a taxi into the city. At  short notice, I had managed to arrange for a visit to the Vanderbilt Medical Center, a large teaching Hospital in the city. I had been in contact with a woman called Liz Howard by email, and she had made arrangements for us to be escorted around the labor and delivery suite by one of the staff. She had also asked if we would be interested in visiting their freestanding birth center, which we eagerly accepted, without knowing anything about what lay in store for us. 

On arrival at the hospital, we were immediately struck by the plush, ornate hospital lobby area, which bore little resemblance to our own NHS areas of practice. We were particularly impressed by  the colourful, intricate quilted artworks.  A wonderfully enthusiastic woman who introduced herself as Rosemary Janofski, greeted us.  She explained that she worked within the hospital as a nurse-midwife, carrying a case-load  in partnership with another nurse-midwife.  We were quite taken aback, not really expecting to encounter Nashville’s equivalent of a 'one-to-one scheme'.  Rosemary escorted us on an informative and entertaining tour of the obstetric unit, questioning us about our practices as much as we questioned her about theirs. We left the Vanderbilt and headed out for the East End Birthing Center having again little idea of what the center was or what it represented.

In fact the Birthing Center heralded our first introduction to  The Farm, because it transpired that our guide, Margaret, had been born there, and had spent most of her formative years there.  Margaret had made the decision after much soul searching to take the formal route into midwifery and had qualified a couple of years ago as a certified nurse-midwife, as opposed to the apprenticeship route favoured by the Farm midwives. She felt that this decision had opened doors, which may have remained shut, had she not held qualifications which were recognised by the state.  Margaret and her colleague Carlotta had been involved with the Birth Center from its conception.  The project was funded by the Kellogg Foundation and  the management committee had actively engaged in consultation with the local community, a large poor Afro-American population, in order to provide a local service which specifically  met their requirements.

Margaret was extremely proud of the achievements of the Center to date, and rightly so.  It had only recently opened and  was yet to host the first birth but there was a sense of hope and commitment that radiated from Margaret which made it hard to imagine that it could do anything other than succeed.

After a rapid dose of retail therapy and lunch, we were picked up from the hotel by a member of the Farm Community and began our two hour journey through the pretty Tennessee countryside.  As we arrived at the gates of the Farm, I experienced a sense of incredulity.  I had first read Spiritual Midwifery as a student midwife and the book had had a profound effect on me.  The realisation that I was here, standing next to the sign announcing our destination, literally sent shivers down my spine.

We were greeted warmly by Pamela Hunt, the director of the Center, and I was immediately struck by her gentle and welcoming manner which was reminiscent of the reception we had received at the East End Birth Center earlier that morning.  At this point it struck me that Margaret was indeed a product of the Farm.

The five days that followed our arrival, were amazing.  We ate, slept and breathed midwifery in the company of the wonderful Farm women, exchanging  stories, songs, laughter and tears.  We spent time learning the skills shared by the midwives and the history of their experiential journey.  We were able to visit the Amish community neighbouring The Farm and to meet with the Amish midwives.

The Farm has an indefinable quality, which needs to experienced, and to attempt to describe it in words is futile and may actually serve to undermine the sense of wonderment that was discernable.  The Farm does facilitate ‘spiritual midwifery’ because the place and the people who live there have  a spiritual quality  which is almost palpable. It weaves a kind of magic on those present leaving one feeling quite exposed and vulnerable and yet  supported and loved simultaneously.  I appreciate that this sounds esoteric, but the visit has had, I feel, a transformative effect on me personally.

The  Farm midwives are probably the most together group of midwives I have ever had to chance to encounter. I really  thought that I understood the meaning of the words ‘empowerment’ and ‘autonomy’.  I felt that I was able to give women and their partners balanced information  which would enable them to make informed decisions.  I felt that I could instil in students the significance of birth in human terms. I have come to the conclusion that what I have been advocating is all too often half-baked rhetoric. On return, I have found myself asking questions like, “Where is the spirit of midwifery in practice?  Why don’t I feel here what I was able to feel on the Farm?  Why did I feel safe and supported at the Farm in a way that I seldom feel back here in the UK?  Why did I feel such a strong sense of sisterhood and experience the awesome collective power of women, when back here I feel all too frequently very alone?”

One evening, we were privileged to be invited to join with the Farm’s Women’s Singing group 'The Shamamas' , who taught us powerful songs of the fight for freedom and the power of true belief in a cause.  It suddenly struck me that these women are banded together by a common goal.  They have had to fight every step of the way and endure degradation, ridicule and persecution, to win the right for women to birth in a way which they feel is right for them.   They now have the right to practice in Tennessee, as Certified Professional Midwives, but one instinctively feels that such recognition and the inevitable regulation will not sully the integrity of their practice.

During the  visit and upon my return I have carried out some serious reflection.  I have come to the conclusion that it is unlikely that change will ever take place until midwives have the courage to do what the Farm midwives have done, that is to 'recreate' midwifery. It may be that the birth centre is the key to such change.  Interestingly, during our visit to the East End Birth Center in Nashville, Margaret described the birth center as the ‘midwife’s home’. By separating the midwife's domain from the sphere of  obstetrics, midwives would be  given more latitude for practice, and women a greater degree of choice.

 Interestingly, it may be heightened consciousness, but the birth centre here in the UK seems to be  on the political agenda. The current Birth Centre movement could offer wonderful opportunity for those who wish to practice as midwives.

Since returning from the visit, the programme has completed and the midwives have gone back to their respective Trust workplaces.  However, they are continuing to meet on a monthly basis as a supportive network.  I like to think that the Farm visit and the collective strength of women  had an influence on this decision.  During their gatherings, the group are working on a 'Farm Visit' quilt. As quilting is part of the cultural life of the women of Tennessee, from the Amish community down to the Therapeutic Quilt Garden exhibition in the Vanderbilt Center, it seems appropriate to try to retain some of that spirit in the form of a quilt.

In terms of practice, some major mind shifts have occurred, which the midwives would be the first to acknowledge. Some are directly attributable to the Farm visit. There is also a degree of dissonance, but as we know, true learning does not take place without stepping out of our comfort zones.

To return to the Farm, one morning early on our stay, I went for my daily therapeutic run and I came across a barn just off the road.  The roof of the barn  was brightly painted with words “Wake up and Live”  Maybe it was the magic of the place or I was just feeling high on the endorphin effect of the exercise, but I felt a sense of emotion, and vowed that when I returned the UK, I was going to take a little bit of the Farm back with me in spirit to share with other midwives. I hope that we are all able to do this.