ecological midwifery

Pregnancy and early parenthood are without doubt  times of great change in our lives.  They can alter  our whole perspective and change us fundamentally  in many ways.  They often cause us to look beyond  the sphere of our own needs, as for the first time  we find ourselves responsible for the needs of  another individual.  We may also become conscious  of how our lifestyle may have a direct impact on  our children.  This concern may extend to the  effects of environmental problems on our own  offspring and we may, for the first time,  question the use of pesticides on the food we  consume, the use of materials in our workplace  and the general quality of our local environment.

“Despite the claim that we are seeking to leave  a better world for our children, we know at  another level that we are doing no such thing.   We are we eating up their future, devouring their  resources, recklessly squandering their substance  in the pursuit of our here and now.”

Jeremy Seabrook. The Guardian 24.8.87

The above quotation from an article by Jeremy  Seabrook had a profound effect on my  own life when I read it many years ago as the  mother of two very young children.  It inspired  me to join the Women’s Environmental Network and become an environmental campaigner.   For several years prior to commencing  midwifery training, I campaigned vigorously on  issues such as the environmental detriment of  excessive packaging and one use paper products  (such as disposable nappies.)

When I entered midwifery, I found myself questioning  many practices and issues relating to midwifery,  pregnancy, childbirth and early parenthood, where  environmental concerns seemed to be largely ignored.   I was also struck by how oblivious many midwives  seemed to be to these glaring anomalies.  I was  horrified to discover that a talk on infant feeding  (including breastfeeding) was to be presented by  a nutritionist employed by a baby milk formula  company, as I was all too aware of the insidious  marketing ploys of such companies who create  untold environmental problems at a global level.

I recognise now, eleven years on that there is a  greater sense of awareness in some areas.  For example, the terries vs. disposables debate    is now clearly in evidence and reusable nappies are  enjoying a period of renaissance, and the ecological benefits of breastfeeding have been well documented,  notably by Andrew Radford.  However, although such  changes are laudable, superficial and minor changes  may lull us into a false state of security  undermining the need for greater awareness of the  magnitude of environmental destruction. 

Before exploring the  ecological issues at stake,  it may be useful to briefly examine some of  the basic principles of environmentalism which may  make it easier to understand the application of  environmental theory in midwifery practice. 

  Firstly, the linchpin of ecological economic theory  is sustainability.   This means minimising the use of  the worlds precious resources.  It is believed that  this could be achievable by reducing, reusing and  recycling the materials that we consume.  Jonathan  Porritt (1989) believes that although governments,  industry and commerce must take responsibility for the  problems that have been created, ultimately, individual  responsibility if central to the task of saving the planet.

   I recently attended a meeting where local residents  were opposing the construction of  a waste incinerator  close to a residential area. The representative from  Friends of the Earth who was there stated quite  firmly that unless people were prepared to take  individual responsibility for their waste, then  such facilities would be a necessary evil.  “The buck stops here - with you” she said.

  We must recognise the importance of understanding  the “cradle to grave” theory. This involves developing  an awareness of the life cycle  of a product and  of the environmental problems that are created  from the extraction the raw material, the  manufacture of the product, right through to its disposal.

The current generation of parents has been  brought up within a capitalist consumer society.   The present system embodies a masculine industrial  imperative which has controlled our lives by  controlling our economy.  It has taught us to value  the masculine elements in life and to shun the  feminine elements. 

Ancient Chinese culture embraces these elements as  Yin (masculine) and Yang (feminine) and it is  believed that both sets of elements are essential  to create harmony and health.   Many environmentalists  support this view and believe that to correct  global damage, we must reassert feminine values  so that they take equal place and restore harmony.

  The current organisation in most maternity  services can be seen to illustrate this disharmony.   The present dominant ideology is based upon a  patriarchal medical model, designed by men and  controlled by masculine values.  As a result  we have a high technology, drug dependent,  interventionist approach to pregnancy and childbirth.   This is justified by the belief that pregnancy  and birth are only normal in retrospect.   This approach leads to lack of autonomy  and disempowerment of women.

  The challenging midwifery approach on the other  hand can be seen to encompass the more  feminine values.  It encourages viewing pregnancy  and childbirth as normal physiological events  which are wholly normal unless a problem presents  itself. This approach encourages the woman and  her family to take the initiative in decision  making about her experience.  It is about cooperation  rather than control.  It is responsive and non  aggressive.  Unfortunately the medical model is currently  indisputably, the champion in the battle.

In her book Green Parenting (1990)  Juliet Solomon makes the following statement:-

  For nurture and care are not fashionable,  and these arts are no longer given priority… instant effortless drug aided solutions are  taught in response to demand.  Knowing which  of these pre-packaged solutions to use takes  priority over knowing something about humane  and human solutions, which are considered  too time consuming.  This approach to the provision  of solutions is increasingly common and yet it is  in direct conflict with one of the most  fundamental human needs, which is personal  attention

The midwife also meets a further ecological  criteria, in that she is less reliant on “high technology”.   Ecological guru, E.F Schumacher (1973) places  technology into three categories, high, intermediate  and low.  For example, a car could be considered  high technology, a bicycle intermediate and walking low.   Clearly in ecological terms, less is best, and often  an intermediate or even low technological approach  is equally as effective as the high tech alternative.   Schumacher’s principles are widely used in the  developing world where a simpler form of  technology is frequently sought.  In maternity services,  an example could be that a CTG (EF) monitor  is high tech, a hand held doppler is intermediate  and a Pinard stethoscope is low technological use.    It is interesting to note that recently the  National Institute for Clinical Excellence (NICE)   guidelines have recently advocated the  abandonment of CTG monitoring for normal  labouring women.

  The midwife’s approach should be one of holism.   We should look beyond the physical presentation  of the woman and incorporate her emotional,  psychological, social and spiritual needs wherever  possible.  This holistic style is also a gentler and  more ecological model which is apparent in  many forms of alternative complementary therapies.   We understand that if a woman is under great  stress for whatever reason, then the effects of  stress may manifest themselves  in physical symptoms.   Dealing with the physical symptom does not deal  with the root cause of the problem.

  By concentrating on the physical state of the  woman, we are far more likely to create problems  of intervention.  Ivan Illich (1976) condemns this  type of approach and stresses the iatrogenic consequences.   For example,  a woman comes into hospital in labour,  it is possible that she will be frightened.   If we  are unable to recognise that fear and discuss it  with her, she will remain afraid and her catecholamine  levels will alter.  This may have a significant effect  on oxytocin, endorphin and encephalin production,  and the delicate neuro-hormanal balance is  disrupted.  She subsequently feels greater pain  thus resulting in the need for drugs for pain relief.   If she has pethidine there is likely to be a  depressive effect on the smooth muscle of the   uterus resulting in uterine inertia and the increased  risk of augmentation and instrumental delivery.  

  Lastly, as midwives we have the responsibility  to provide women with information that they    may require in order to safeguard the interests  of their babies.  We need information about workplace  hazards in pregnancy, nutrition and breastfeeding   to enable us to provide women with the knowledge  they need in order to make informed choices, about  environmental issues that may affect them and their families.

  In conclusion, women are often the first to notice    that something has gone wrong in their environment.  Their intuition  plays a significant part in  their judgement. This has sadly proved to be precise  and accurate when confirmed years later by  officials and science.  But all too frequently, the voices  of women are silenced and  their instincts ignored.

  It would be easy to accept a fatalistic  perspective and develop a “what’s the point?” response.   But there are things which we can do, both as  individuals and as a body to address the importance  of environmental issues and to initiate change to  improve the environment in which we work  and in which we live.  To quote a much loved saying  often attributed to the Quaker movement:

  “It is better to light one small candle in the dark  than to curse the darkness.”

References.

Christenson K (1989) Home Ecology: Arlington Books. London

Illich I (1976)  Limits to Medicine: Marion Boyers. London

Porritt J (1989)  How to be Green, Century Hutchinson. London

Schumacher EF (1973) Small is Beautiful: Blond and Briggs. London

Solomon J (1990) Green Parenting: Optima. London