Saturday, December 14, 2013

Cultutal heritage in need of urgent safeguarding

Recently my attention was drawn to the UNESCO cultural project to develop a list of Intangible Cultural Heritage in Need of Urgent Safeguarding.

Intangible cultural heritage is knowledge and skill that, unlike monuments or collections of clay pots, cannot be touched.  The UNESCO list includes a fascinating range of human activities, from Mongolian calligraphy, to Watertight-bulkhead technology of Chinese junks, to many examples of traditional music and singing.

Readers of this blog may already have joined the dots, and wondered if some aspect of 'midwifery', or 'spontaneous, unmedicated *normal* birth' (or both) could be considered an under intangible cultural heritage in need of urgent safeguarding?

Is the reality of normal (natural unmedicated physiological) birth something that can be called a cultural heritage, and something worth protecting? I say "YES".

Is the skillful presence of an authentic midwife, who is 'with woman' in normal (natural unmedicated physiological) birth something that can be called cultural heritage, and something worth protecting? Again, I say "YES".

Is the knowledge and skill of this ancient yet contemporary 'midwife-with-woman' relationship under threat, and in urgent need of safeguarding?

That's the question.  And, if we think 'it' is under threat, and the true midwife is likely to follow the dinosaur into extinction, how can 'it' be protected?

Birth activists struggle to promote the concept that it is a woman's right to determine what is done to her body from a human rights point of view. That's fine in theory, but in fact it's very easy to get most women to agree to the first major intervention - such as induction of labour - and the rest is a cascade.  We so easily give away our birthright.

Surely there is something intangible about ALL human spontaneous natural (normal) processes that makes them worth safeguarding.

[I have just been away from my office for a few hours - being 'with woman'.  The birth of a baby boy, in the birth pool set up in the living room, proceeded without incident.  Now, as I return to this writing, my heart is full of that special satisfaction and joy that comes after a normal (spontaneous, unmedicated, physiological) birth.]

I ask myself, is there anything about this birth that is of value as an aspect of cultural heritage in urgent need of safeguarding?  

I will write from the midwife's point of view, because that's my story to tell.  I can't pretend that I am working in the same way as Jenny or Chummy or one of the others, in Call the Midwife, or some other cultural icon/ wise woman of the far distant past.

I drive a modern car, with blue tooth reception.  I am able to accept bookings 20 or 30 kilometers away from my home, while the midwives in London in the 1950s rode bikes.
I have a mobile phone, and the internet, and access to professional libraries that previous generations of midwives could not have dreamt of.
I use a doppler fetoscope, and carry emergency resuscitation equipment, and drugs to control bleeding.
I live in a big city with three major tertiary level maternity hospitals, and a handful of smaller public hospitals that are fully equipped and staffed to manage obstetric emergencies.  Attending home births in Melbourne is very safe for the midwife, as well as the mother and baby, because we can always access medical services in a timely manner, when they are needed.  

So, how can I claim that midwifery as I practice it is in some way to be considered as substantial cultural heritage?

Here's my story:

When the mother called me I drove to her house.  She thought she had possibly called too soon.  The contractions were not lasting very long.

"That's OK", I said, and left my equipment bag unopened nearby.  I waited a few minutes to assess the labour - intangible aspects such as how she responds, and moves, and comes out of the contraction.

I listened to the fetal heart sounds after a contraction.  This is tangible, and modern.  But the mother had already told me that a little foot had kicked under her rib - a sure sign of a strong baby.

We waited for the hot water system to re-heat, so that more warm water could be added to the birth pool.

I got my crochet out of the cloth bag.  I showed the mother and her sister the little beret I have made for one grand daughter, and another that is part made.   Is the act of crochet or knitting by the midwife an intervention?  Yes - it reduces adrenaline.  The next contraction came - a good one.  A few more stitches, and I put the crochet down.  The gloves, and towels, and other birthing equipment needed to be made ready.

The mother was keen to get into the birth pool.  She was beautifully buoyant in the deep, warm water.  The labour continued, and it wasn't long before she grasped the sides of the birth pool and went into a deep squat.  Another contraction, and the waters popped.  A few more, and a large, healthy baby was born into my hands.  He made the transition from placental to pulmonary circulation over the next couple of minutes, in his mother's arms, or floating on his back in the water in front of her.

With baby at the breast, and the cord uncut, the mother stood, and the birthing of the placenta was similarly uneventful. 

In attending this birth, I did not use a syringe and needle, or a bag and mask, or oxygen.  These things were available to me, but only if needed.  The mother had thought she had called me too early, yet she gave birth a little more than an hour after I arrived.  She did it all herself.

This birth, and many others like it, are surely an aspect of cultural heritage that is worth safeguarding. Perhaps normal birth is not under immediate threat in the same way as a primitive language or throat singing, where modern society sucks everything of value into its stomach, and spews out a franchised product that has no personality.  Yet with increasing rates of caesarean births over 30% nation wide, and the rate of homebirth being less than 0.5%, and the phenomenon of spontaneous unmedicated physiological birth being a rare event in mainstream maternity care, we do need to protect and safeguard the skill of the midwife in being 'with woman' for this awesome event.

But, even if the medicalisation of life events continues, I see the essential wonder of normal birth and all that it entails (including authentic midwifery) as a deep intuitive function of body and mind that women will need to keep on discovering for ourselves, and teaching to the next generations.

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