Why I’ve ditched the word doula and become a “modwife”?

“Modwife” is a term I coined recently in response to the theft of language - committed gradually, creepingly by the industrial birth model.

In the UK today, one is not permitted to identity oneself as a midwife without first paying £28,500 to one of the regulated educational institutions and spending 3 years studying a bachelor of Science in Midwifery with Registration as a Midwife, witnessing and, incrementally participating in the abuse, coercion & obstetric rape that contemporary maternity services perpetrate.

Did you know that health care is routinely withheld from women unless and until they submit to a vaginal examination? (that’s fingering to me and you)

The midwifery degree course is full time (40 hours a week) with students only permitted to work 20 hours of paid work per week alongside those commitments (that’s if you can find the time of course)

This high barrier to entry and the establishment and consolidation of various Midwives’ and Health Acts, from 1902 onwards, means that midwifery is now an elitist ‘profession”, with all the habitually attendant racism, classism, status claims, snobbery and careerism. Sadly, it is sans the respectable paypacket because as a female-dominated profession, like Nursing, it has been subject to a relative pay cut over the last 10 years.

Because of the all-consuming prevalence of current birth culture it is easy to imagine that this state of affairs is inevitable and right but it really only began in 1902 with the first “Midwives Act”. Before then, births, (natural, physiological events lest we forget) would be attended by laywomen. It was often an elder in the community who had herself successfully (and of course occasionally unsuccessfully: death is an inevitable part of life) borne children and who also shepherded and prepared (in both a practical & spiritual sense) people at the end of life too.

I engage with a lot of student midwives & midwives in my Association of Radical Midwives Steering Group member role. I do not give them any space to bemoan the role and the conditions as they have chosen it freely. I have sampled this mode of midwife preparation myself as a student midwife at King’s College London from 2019-2022. I found the training not only unable to adequately prepare me to support women in pregnancy, labour, birth and motherhood but also unpleasant, abusive and antithetical to confident, autonomous professional birth attendance.

I was bullied by senior staff at my placement hospital and the lecturers were unsupportive of anyone who engaged in critical thinking and challenged the status quo. King’s Midwifery Faculty and placement trusts hounded students to get the experimental mRNA Covid vaccine or lose their place on their degrees well before the government deadline and eventual u-turn. More than a few of my cohort reluctantly took the first dose in order to stay on the course. Student midwives are given nowhere near an appropriate level of supervision and support to safely complete the degree where they witness obstetric rape on a daily basis and are expected to begin upholding that system of female oppression. There was an attitude from registered midwives that their training had been hard and unpleasant so they must now ensure the same for those coming up below them. The fact is, the educational institutions that provide midwifery training in the UK are churning out obstetric handmaidens because that is what the midwifery system has become and therefore needs more of. Many student midwives are idealistic and begin their careers with the noble goal of transforming midwifery services from within. The more terrifying see the system as performing perfectly well as it is and are happy to just be filled up with the technocratic, paternalistic medical model of the status quo.

In talks with student midwives & registered midwives I question why they remain. Most midwives aren’t happy with their pay, conditions, governing body or the model of care they must provide within the current maternity system. You may remember the recent March with Midwives national demonstrations that were well-attended by thousands and had numerous demands, including better pay and staffing. If you have to spend decades demanding that somebody respect you, then the individual or organisation you are beseeching does not, and likely will never, treat you the way you deserve.

I agitate for more of them to quit and for them to stop complaining about their choice to uphold an abusive, patriarchal system. This is what many midwives fail to understand or refuse to acknowledge; it is their service that keeps the wheels on this flamin’ dumpster fire turning. They argue that without them women wouldn’t have a midwifery service at all and most mothers don’t want to freebirth. This shows an astounding lack of imagination. The current abusive system or nothing at all are not the only options.

Midwifery has taken a very clear and guided pathway of government legislation and statutory orders (see Appendix A for timeline) to become the permutation we see today. It is far from inevitable that the service’s hierarchy, buildings, structure, funding, pay banding and staffing are the way they are. Birth didn’t always traumatise, it doesn’t have to be a bleakly regimented, torturous event devoid of spirit or reverence.

If you don’t like the current version (and we can see, from the high staff turnover and short-lived midwifery careers, that thousands of student and registered midwives don’t) because it generates too much birth trauma or too many surgical and instrumental deliveries or because it erodes traditional midwifery skills and knowledge for technocratic machine-driven methods or surveils women, objectifying them and their bodily functions, it pathologises a natural, physiological event and so often robs the family of what should be a sacred, life-affirming event…. I totally get that. I understand and I concur. But to choose to enter that system, working within its parameters, serving its agenda while purporting to challenge it and “fight for better” I will never understand and do not encourage. It is poor strategy and has never worked. It is foolish at best and a betrayal at worst.

A student midwife I know who is currently being bullied off her course still believes herself to be a feminist fighting valiantly against a system of abuse. She is allowing herself to be abused by that very system, desperately clinging on to her bullies coat tails hoping that after enough “hazing” she’ll be let into the club. Do they think they’ll be protected from obstetric rape if they join the team perpetrating it? No, it’s not that, as data shows a much larger percentage of midwives have freebirths and homebirths than the general population. They know, from bitter experience, not to go to the epicentre of industrial birth, the labour ward (shudder) to have their own babies.

I encourage midwives and student midwives to consider how much better they could serve women, families and crucially, themselves if they applied their significant skill, experience, expertise, knowledge and energy inside a system that respected women, physiology and natural birth. Or within no system at all. What would birth and motherhood look like if there was a mass deregistration from the Nursing & Midwifery Council (NMC) and if newly qualified midwives refused to pay to be registrants and just went about providing exemplary care as “modwives”, birth witnesses and birth keepers, after graduation? We could swiftly take birth back into the home, into the hands of highly-experienced, highly-skilled, but non-medical, experts and reduce the outrageously high incidence of poor care, sabotaged births & death that we currently see in the system.

What if a band of clever midwives got together and created a midwifery degree training programme? One without registration as a midwife tagged on, one that’s not a pipeline to disenfranchised, disheartened, deskilled system operatives, one where birth is seen as a natural physiological event with greater aspirations than simply a “live baby” at the end, one where non-evidence-based, archaic practices are interrogated and cast away like the useless, patriarchal, risk-averse, infantilising crap that they are. Holistic midwifery that utilises both modern and traditional knowledge and skills and is fresh and alive, not predicated on towing the line, becoming a good little automaton for the system, one in which students actually study, think, pioneer, instead of just getting filled up with business-as-usual policy and procedure.

So many student midwives and midwives are disgruntled because very many entered the profession to fundamentally change it. This strikes me as a special kind of madness and delusion. You see a sick, inept, crumbling, atrophying system and rather than running from the putrid smell of rot & decay, you think…… I’ll join that, martyr myself, get sick and be bullied and disrespected trying to turn it around.

Is the problem perhaps that midwifery is encumbered by the wrong type of regulation? If Midwifery, as a profession, was regulated better or differently, could it be improved? Maybe we could extract Midwifery from the NMC and create a separate Midwifery Council. The NMC have a track record for homophobia, racism and unlawful protocols and the role of a nurse (pathology, illness) and a midwife (natural, physiological) make them unnatural bedfellows. Extricating midwifery from nursing has been tried before but perhaps it’s worth another shot. The professionalisation of midwifery at the turn of the twentieth century paved the way for the continued medicalisation and dehumanisation of birth. Anything we can do contemporaneously to bring birth out of the hospitals, away from the obstetricians and midwives who’ve been trained to see pregnancy and birth as fraught with compilation and error and who are paid to professionally “manage” it and back into the home, with women, is a good thing.