We’re like chameleons, we midwives, adapting our personalities to match the families we look after. Different people want different things, and sometimes there are cultural considerations to take on board.
The Traveller community is one group that often has a completely different set of norms and expectations when it comes to giving birth. To begin with, no matter how much Travellers travel or where they go, many will prefer to return to the same hospital every time to give birth. I noticed this early on, when I started to recognise the names as they came up on our ward over and over again. “Rosie Malley, is it? I recognise you. Didn’t you give birth here three years ago?” I asked one lady. “Oh yes,” Rosie replied proudly. “I have all my babies here.”
They like things a certain way. All the female relatives accompany the birthing mother into the delivery suite while the men remain outside, just popping in for updates. But they never stay long. It’s in and out, in and out, all day.
It gets very crowded and noisy in the delivery suite, what with all the grandmothers, aunties, sisters and daughters chatting, arguing and giving their opinions. It’s like a giant family outing. Normally our unit allows only two birthing partners, but we have to make an exception for the Traveller community, because they just won’t do things any other way. Occasionally, it does mean raising my voice: “Right, stop now. Stop talking, please! Everyone be quiet because she really needs to listen to me!”
Lovely families and pristine homes
One time we had a Traveller lady who went into labour earlier than expected. Even though she was registered at another hospital, she was in our area when her waters broke, so she rocked up at our unit, accompanied by the whole shebang. Eight caravans were parked on the grass verge outside our hospital. It was quite a sight and they were there for three days, causing a bit of an uproar with the management.
But they were a lovely, lovely family. And, as always, the men were so respectful. Traveller men treat us so well it’s like something from a former era. They call us “nurse” or “sister”, and every time they pop by, they shower us with flowers and chocolates. “Here you go, nurse. A little something for you. For doing such a grand job there.”
I did a few stints in the community in my early years and I had one area that included a static caravan site for Traveller families. There were about 12 caravans on this one enclosed site and despite everything I thought I knew – or the prejudices some people have – about Travellers, it was a real eye-opener to visit them in their homes.
Every single one was absolutely pristine. It was immaculate, like walking into a show home. Even the children looked perfect. And they were so nicely spoken and well-mannered.
Mothers must feel as at ease as possible
It is vital that all our mothers feel as at ease as possible during the birthing process, so, for example, when I’m dealing with a woman who is a strict Muslim, I’ll be careful to make sure she is fully covered throughout. Muslim women often give birth in a full burka, only lifting the hem when it’s time to push.
For some strictly observant Muslim families, bathing the baby as early as possible is important to conduct prayers, whispering words in the baby’s ear soon after it’s born. The advice from Nice is to not bathe a baby for the first five days, as the vernix – the white oily coating on their skin, which they are born with – is a natural moisturiser and should be absorbed into the skin. Nice argues that by washing the vernix away, we could be exposing the child to irritants or conditions like eczema. But to Muslim families, bathing the baby is part of their religious ritual.
One mother had an emergency C-section for her first child and the baby went to the neonatal unit for the first three weeks. There was no washing, which meant they couldn’t do the prayers until the baby was three weeks old. For her second child, she was coming in for an induction, and the father was by her side when they asked me if they would be allowed to wash their child straight away. “Of course you can,” I replied. “It’s your baby.” We have our Nice [National Institute for Health and Care Excellence] advice but, at the same time, we have to accommodate different wishes.
The challenges of FGM
I have only come across a handful of cases of FGM in my career. These cases are always difficult because the women are left with only a small vaginal opening, so quite often they will tear very badly. Even an intimate piercing is classed as FGM, but that doesn’t need to be reported to the police. All other cases of FGM, or female circumcision, as it was previously termed, are illegal in this country. It is classed as child abuse, because it is mostly conducted on girls before they are 15 years old.
We don’t tend to find out about it until a woman is due to give birth. Then the pregnant woman will most likely confide in the community midwife. But the physical experience is not always the same. In some cases the female genital parts are still present; they have just been stitched together. But at the more extreme end of the mutilation, everything has been taken away: her labia, clitoris, everything. All that’s left is a smooth area and a very small opening for the vagina.
In FGM cases, doctors prefer to take the lead because the birth will often need medical intervention. If the doctors are male, that can be a problem with the husbands. We try to facilitate requests but there is only so much that can be done if there are no female doctors on the day.
Sometimes I want to scream, but I stay respectful
It is quite maddening at times to see how people will put religious belief above medical necessity. Sometimes I just want to scream at them: “If you don’t let this doctor help, the next time you see him, it will be to pronounce your baby dead!” But I’m pretty sure such vocal persuasion wouldn’t fall within NHS or Nice guidelines.
If an FGM victim tears during labour, our doctors are forbidden from sewing her back up the way she came into the unit. She has to be repaired as any woman’s vagina would be repaired and allowed to heal normally. Even if we know she is then likely to go elsewhere and be sewn back up the way she was. It’s heartbreaking. But we don’t make any comment or judgement in the room. Whatever happens, we stay respectful and professional throughout.
‘The Secret Midwife: Life, Death and the Truth about Birth’ (Bonnier Books UK, £16.99) is out now
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