Power, Politics and Practice

The ARM Conference 2023

Hands Off Midwifery - Power, Politics and Practice

On a wet and grey Saturday morning in London, women came from across the country to gather in person and listen to women speak. The approach to Jeffery Hall, UCL, was unremarkable apart from the sight of women on their own or in pairs hurrying in out of the rain and towards the meeting of minds. Brollies and scarves were shaken off, and women joined the queue for registration, receiving goodie bags with Midwifery Matters and The Practising Midwife along with Weleda products, as they signed up for workshops. Friends recognised friends, and moved from the reception area to the conference hall. There was tea and coffee, miniature breakfast pastries and an excited buzz in the air, the first in-person conference since Covid - and the first in London - was about to begin.

Registration with members of the London ARM Group

Bine Brown (NHS Continuity Midwife) and the London ARM group have worked hard for many months to pull off an in-person conference in a year when many other organisations have had to cancel theirs. Covid has hit the in-person market hard, but on the Friday before, ARM announced Hands Off Midwifery! Power, Politics and Practice had sold out and we sadly had to turn people away. With a jam-packed schedule and four amazing workshops, the hall was filled with midwives, students and birth workers ready to share and learn and be together in a time when it feels harder than ever to be a midwife.

ARM Merchandise with Becky Miller, Amanda Burleigh and ARM Membership Secretary Irene Walton

First we heard from the National Co-ordinator Katherine Hales (NHS Continuity Midwife), before handing over to Chair Christine McCourt (Professor of Maternal and Child Health, School of Health Sciences, University College London). There was excitement in the room, in a year when more damning Maternity reports are being published (and more scheduled) and political discourse seems thin on the ground. ARM wanted to ask where midwifery was in all of this, and what can we do as midwives?

National Coordinator Katherine Hales speaking, with Chair Christine McCourt

Our first speaker was Claire Feeley (Midwifery researcher and lecturer at King’s College London) who focused on the silencing of midwives. She argued that women’s autonomy is being pitted against the baby’s safety, in a race to the bottom where physiology is seen as unsafe. She highlighted that the social contract which existed between the NHS and midwives, and midwives and birthing women, has been broken through years of austerity and covid. She argued that the midwife’s public health role is embedded in the promotion of health; promoting physiology, and yet our ability to fight for it is being eroded. So she encouraged us to take a seat at the table, to take a stand against this silencing on a local, regional and national level; highlighting many committees and groups where holistic midwifery voices could be useful. 

Claire Feeley presenting the Silencing of Midwives

We then heard from Margaret Jowitt (childbirth activist and author) on the subject of CTG monitoring, with her magnetic and animated style she engaged the room on the restrictive and damaging practice of continuous monitoring. Arguing from both a maternal and fetal perspective, Margaret challenged us to think more critically about the dynamic between movement and the entwining of the two birthing bodies - mother and baby.

Margaret Jowitt - Labouring in a Strait Jacket: The Impact of CTG on Maternal and Fetal Movement

Following this, Kirsten Small (retired obstetrician, researcher and educator) presented via video on the current evidence for intrapartum fetal monitoring. CTGs don’t work, and they harm some women and babies. So why are we still doing them? Kirsten gave us her answers, and all of the reasons are to do with politics and power and very little to do with physiological birth or improving outcomes. She also discussed her new course, and her hopes for further research into effective wellbeing monitoring which improves outcomes.

Kirsten Small - Why are we still doing CTGs? The Politics of Fetal Monitoring

After a short break, Benash Nazmeen (Assistant Professor in Midwifery, University of Bradford) delivered a presentation that was rooted in political change and oriented towards motivating and empowering midwives as political agents. She introduced us to movement ecology, and demonstrated that we all had a role in recognising the opportunity for change and understanding how to get our message across most effectively. She challenged us to think about where we were in the movement cycle, where we wanted to be and what tools we needed to get there.

Benash Nazmeen - Encouraging Midwives to Find Their Voice

During a brief Q&A Sheena Byrom (Midwife and Director of All4Maternity) was the first to ask a question, focusing on current online discourse. A topic that was echoed in many discussions throughout the day. Conversation flowed regarding ‘birth keepers’ and ‘medwives’, where midwives are criticised from both ends. For supporting physiology and ‘normal birth’ right through to being interventionist and contributing to the traumatisation of women. Many on the panel contributed to this debate, suggesting we humanise and ask ourselves if and how we ourselves are contributing to this discourse. Benash encouraged us to aim any engagement at the silent majority who scroll on by without commenting, and to acknowledge that we can’t change the debate, but that we can use it as an opening for change. She also made a very important point that marginalised groups will always have to access the mainstream, so the mainstream does need to remain a focus for midwives. Another great question from the floor, very sensitively asked, pointing out that death - even preventable death - is a part of everyday life, and how do we bring this perspective to the damaging discussion on fetal and neonatal mortality, without seeming indifferent, uncaring and dangerous? Kirsten added that less than 5% of fetal deaths happen in the presence of a healthcare professional, so we could never prevent all of them. Panel members highlighted the induction of labour crisis as a contributing factor, and midwifery led continuity of care as an evidence based solution.

Sheena Byrom addressing the panel

Midpoint panel; Margaret Jowitt, Christine McCourt, Claire Feeley, Benash Nazmeen and Kirsten Small.

For the afternoon we had four workshops planned; Shawn Walker (Senior Research Fellow, King’s College London) and Breech Birth, Selina Wallis (doula and Public Involvement Manager for NIHR) and Resolving Malposition, Closure (of the Albany Practice) / Freebirth Stories with Becky Reed (retired midwife and author), Nadine Edwards (childbirth activist and author) and Mavis Kirkham (Professor of Midwifery), and A New Birth for a New Earth in Maternity Care with Nickita Starck (doula, activist and founder of When Push Comes to Shove and Angela Chamberlin (holistic therapist and midwife turned birthkeeper).

 Shawn Walker - Breech birth: Facilitating Physiological Birth

Shawn presented alongside her little dog, discussing the OptiBreech study which has a 70-80% midwife facilitated breech birth rate (physiological breech presentations ‘managed’ by a midwife in an obstetric-led setting). Becky and Nadine presented their newly published book Freebirth Stories. Selina hosted a session on how birth workers can aid malpositioning and ease labour dystocia/pain. Nickita and Angela proposed a dual approach to confront the challenges facing today's maternity care system. They looked at external pressures as well as inviting introspection on midwifery emotional baggage.

Selina Wallis - Unlocking Birth: Techniques to Resolve Malposition

The Conference saw the book launches of Freebirth Stories edited by Mavis Kirkham & Nadine Edwards, and the Saynotobullyinginmidwifery Report edited by Angie Barrett, Amanda Burleigh, Dr Patricia Gillen and Deborah Hughes; with Jenny Wylam, Becky Millar, Jeannine Webster and Karen McEwen. Both have clearly been labours of love, the report in particular, which has already started to gain traction in the national media.

Closure, Freebirth Stories and Birth in Focus

‘SaynotobullyinginMidwifery’ Report launch with Amanda Burleigh and Jenny Wylam

Following lunch there were two further presentations; Antonella Gambotto-Burke (feminist author and journalist) reading an excerpt from her book Apple: Sex, Drugs, Motherhood and the Recovery of the Feminine (reviewed in MM176), which was very hard hitting. The passage she chose looked at the newborn experiences of convicted multiple murderer Ian Brady. It was a compassionate and emotional retelling of a tiny and perfect newborn infant, which really tugged at the midwifery heartstrings, and brought home just how crucial birth and early infanthood are.

Antonella Gambotto-Burke - A Troubled Birth: The Matrix of Dysfunction

Our penultimate speaker for the day was Erin Fung (childbirth activist, podcaster and hypnobirth teacher at Better Birth). Erin sits as the Chair of her local MVP (Maternity Voices Partnership). She showed us how easy it can be to make little changes, and that taking matters into your own hands (a cake sale to raise money to buy mood lights for birthing rooms for example) can be more successful than wrangling with bureaucracy constantly. She left us with a positive note, that engaging with the mainstream and making it your own, can be possible.

Finally, Mavis Kirkham closed the day by reiterating how much worse ‘things’ had become since she trained and practiced. Following on from discussions earlier about birth keepers vs midwives, Mavis observed that the relationship-based midwifery care model is now being performed (informally and non-clinically) by doulas - with woman now not possible as a midwife. However, she encouraged us to tell our stories of birth and of supporting women, along with positive experiences of working relationships with obstetricians and other midwives. Focusing on what unites us rather than what divides us, and suggesting midwives and women need to work together to demonstrate how birth can be better.

We thank all our speakers, workshop hosts and chair Christine McCourt, as well as Bine and the ARM London group for making this sold out conference happen and allowing us as midwives and women to come together and raise our voices in solidarity. There was a palpable desire for action following the closing of the day, with many expressing a desire for more local groups and political action. We are now working to facilitate this, so please get in touch with our Membership Secretary membership@midwifery.org.uk if you would like to join (or start!) a local group.