From Becoming a Mother (1979)
Later reprinted as From Here to Maternity
Chapter 12, ‘Mothers and medical people’
It's your first experience, and you feel as if you're the only one in the world having a baby. I think they should make you feel as if you're a little bit important. [A patient]
Who knows what is important? Well, if a doctor doesn't know what's important, what is so important about doctors? [A doctor]
It has become improper in the modern world to have a baby without consulting medical experts. Even women who want to go against the tide and have babies at home seek doctors or midwives to attend them. Throughout most of history and in most cultures childbirth has not had, does not have, this medical aspect: those who manage childbirth are experienced women in the community. But in many places today having a first baby brings a woman into a direct encounter with medicine, probably the first or the most thorough she has had in her life. Pregnancy involves a series of visits to hospital or general practitioners, birth is a hospital affair, and the advisers on postnatal health and baby care are also experts. Childrearing, like childbirth, has become a scientific field in the twentieth century. How people bring up their children has ceased to be simply one facet of social behaviour and has become instead a technical exercise...
Doctor knows best?
LOIS MANSON, research worker:
I haven't got a high regard for any doctor particularly. When I was at university I used to do film extra work in the holidays and I got into it through a medic friend because loads of medical students from the London hospitals do this film extra work. And I was amazed, because I used to think that doctors saw the body as a sort of diagram of veins and muscles and what have you, but they were the most pornographic bunch of people you'd ever come across. And they were incredibly immature as well. It's a real eye-opener, isn't it? I'm afraid I've had no respect for doctors; I know it's a vast generalisation - I shouldn't say that - but it really did lower them in my esteem...
I: So how do you feel about your medical care so far?
LOIS: I would say that it's difficult to expect a lot more. You know, I come home and I complain to David every time and he says really I can't expect very much more, because of the time factor and what have you. It annoys me intensely that I've not seen the same doctor twice. I mean, they're very efficient and what have you, but I really do feel as if I've travelled quite a long way to be dealt with in a matter of minutes and that they're very loath to sit and chat with you or answer any questions or give you an opportunity to ask questions. I know I'm a bit over-sensitive about this sort of thing, and I'm sure I'm a pain as far as that is concerned, but I do think they could be nicer. I'm sure that they think I'm a pain!...
LOUISE THOMPSON, law student:
I personally don't like to have that much attention from doctors. The less, the better. Being on a conveyor belt is just fine. The faster the better.
It's like a mystique. That's what I think is so funny. Like going to law school, which is a profession, you realise that you just learn the right language and then it becomes very mystical, and that's how I think the medical profession is as well: if you just use the right words, people believe you. I mean if they talked very simply, people wouldn't go to doctors. The less I have to do with medicine and doctors the better...
NINA BRADY, shop assistant:
I would be happy to have whatever the doctors say, because doctors, the hospital, you can't beat them; whatever they say I would do. I trust them that much. They're bound to know. I would leave it to the doctors, for surely they would do what is best for you, wouldn't they?
Doctor knows best: safe deliveries only happen in hospital. Ninety one per cent of the sample women did not even consider the alternative of a home birth (although 21 percent said afterwards that they would think about it for their next baby).
It didn't cross my mind. I was expecting to go into hospital. In hospital they've got everything. (Deirdre James)
I like to know that I'm in a place where I’m being looked after. They've got everything there. You couldn't have your first one at home, could you? I don't think I could. I just want to know there's a doctor there or a nurse there: they know what they're doing. (Veronica Pratt)
Being the first one and my advanced age  I thought the best thing would be to go into hospital. Because I'm not one who wants to know what's going on, anyway. If anything goes wrong, they've got all the equipment there. I like to think they're well equipped to cope with anything that might go wrong. (Hilary Jackson)
I thought okay, first baby, the best thing to do is to have it in hospital, because it's far more of an unknown quantity. It's the done thing these days to have your first baby in hospital, because you think oh God if anything did happen, perhaps it would be better. So I decided to fight down my initial dislike of hospitals for the sake of the baby. But now I keep saying to Luke I wish I'd decided to have it at home. It just turns me off. It's this concern with medicine that seems to override everything else - the natural process. (Alison Mountjoy)...
When I was in labour this fellow came along with this apparatus and although I was dopey, I said what are you doing? Oh he said, I'm just going to put up a drip in your arm. So I asked him what kind of drip it was and he sort of looked at me and said, oh it's a glucose drip, and I told him I didn't think I really needed one because I'd just eaten a meal before I'd come. And he asked why I thought I knew, why I thought I knew what was best for me in this situation? So I just told him that I'd done a lot of reading and everything. Anyway, he talked me into having this drip, because he said you don't know how long – it’s good that you've had enough nourishment to sustain you up until now, he said, but you don't know how much longer you're going to be in labour. And if it gets much later we can't put it in. That's certainly not true - but anyway, he said are you going to let me put it in now? And I said yes, you can. And then I saw that he wasn't going to give me a local anaesthetic. So I said I'd like one. And he said what makes you think you need one? Why should you know what's best for you? So I just said that I'd had a drip set up before and I thought it was quite painful. I was so fed up arguing that I just said firmly I'd like to have a local anaesthetic, please. So he went off and he came back and he waved this little bottle in front of my face and said you've got what you wanted! Actually it was a good thing that I did have one because it took him five times before he found the place where he could get it in...
How do you feel about your care from hospital doctors and midwives?
Time Satisfied with
doctor care Satisfied with
Early pregnancy 80% 82%
Late pregnancy 63% 63%
Birth 60% 80%
After the birth 59% 74%
Women who had all their antenatal care at the hospital saw an average of nine different doctors. The average length of these antenatal consultations is 3.9 minutes. Nearly half of all questions asked by mothers in one series of antenatal encounters were requests for information about the progress of the pregnancy, about the physiology of pregnancy and birth in general, or about related medical procedures. Twelve per cent of all statements made by mothers concerned pain and discomfort, which was discounted by the doctor as clinically unimportant.
A typical antenatal consultation (as observed by A. 0. in 1974-5) goes like this:
DOCTOR [entering cubicle]: Hello.
DOCTOR [reading notes]: Mrs Watkins?
DOCTOR: Well, how are you?
PATIENT: Fine, thank you.
DOCTOR: Can I feel your tummy? [He undoes the buttons on her dressing gown and does so] Any complaints?
DOCTOR [filling in notes]: Have you felt the baby move yet?
DOCTOR: How long have you felt it?
PATIENT: Two weeks.
DOCTOR [feeling patient's ankles]: All the tests we did last time were okay.
DOCTOR: Okay [leaves cubicle].
It's like a cattle market, a production line. You queue up and in you go and out you go. They just say are you alright? And most people say yes I'm alright unless they've had something drastically wrong. The doctor has a quick feel around and he says right we'll see you in four weeks' time. And that's it, in and out in a couple of minutes. Well, I suppose they must know what they're doing: if there was anything wrong they would have said so. I haven't had any bad treatment; they're all very kind. But I suppose they get so many people, when they say their bit at the end it's all automatic, like a parrot, no tone in the voice. They just say it off pat: they don't have time to get involved with people. There's no personal touch at all. You're just a body to them. A body with a name...
It's like a butcher's shop, you're laid out on slabs...
I wanted special treatment and I didn't get it. I think I was a bit upset about that. Maybe because the baby's so special to me. I thought it must be special to everyone else.
Questions unasked and unanswered
Any questions I've asked him is about the size of the baby, and this doctor, he kept asking how tall I was. I said why? He said: just answer that, you answer me. I said no: you answer me. So he said, well he said, all we want to know is how tall you are. So I said if I tell you how tall I am will you tell me why you want to know? And he said yes. And I said I'm five foot one. And he hummed and harred and hummed and harred and I said right: you tell me now why you want to know. And he said well we won't be able to tell you till your next visit, he said, we'll give you an internal examination. You won't be able to tell me what?...
I went in one day and the doctor said my blood pressure was up and I had some protein in my water. I'm still not sure what that is, protein in the water. Do you know what it is? They asked me to do another specimen then, midstream. They don't tell you anything. Then they asked me to do a twenty-four-hour urine collection. Anyway it cleared up: when I went back the next time, they said it was alright.
I don't know whether these doctors should say these things. Either they tell you nothing or they tell you some diabolical thing to frighten the life out of you. Because this doctor said it leads to some kind of disease or something, some Latin word ... it can lead to that which means that the baby will stop growing and could be susceptible to fits. It frightened the life out of me.
They don't realise you go down to these places and you're a little bit nervous, and it's all a bit above your head type of thing, and you can't really talk as freely as you would like, and all the questions seem to come an hour after you've left, you know, the questions you wanted to ask, and I don't think they really appreciate this...
If they give you your notes to take somewhere they give them to you in a big sealed brown envelope stapled up, and if you want to read them you have to get them down from the rack in the cubicle and you get caught...
He's a bloody whizz kid, he is, he came breezing in and he said: right, we'll see you next week. I said well I hope not, she's due before next week. And he said oh really? So I know he didn't even look at my notes enough to know when she was due, and then I said well what about the X-rays? And he said what X-rays? And I said look, I've had four X-rays and one ultrasound test supposedly to see whether I'm going to have a caesarean or not. Don't you worry about that, my dear, we'll worry about that. Like I'm a real idiot, and he couldn't possibly discuss me with me. And he breezed off.
Er, I don't know how to put this really. After sexual intercourse I had some bleeding, three times, only a few little drops, and I didn't tell the hospital because I didn't know how to put it to them. It worried me first off, as soon as I saw it I just cried. I don't know if I'd be able to tell them. You see I've also got a sore down there and a discharge and you know I wash there lots of times a day. You think I should tell the hospital? I could never speak to my own doctor about it. You see I feel like this, but I can talk to you about it and I can talk to my sister about it...
Three-quarters of the women had never seen the person who delivered their baby before. This is an innovation in the management of childbirth, for the traditional custom is for there to be some special relationship between the woman having the baby and her birth attendant. The baby is not helped into the world by a total stranger who walks in out of the blue, and then walks out never to be seen again. Of all the features of hospital birth today, this is perhaps one of the hardest to tolerate.
Isn't it funny that you do feel this sort of emotional tie with the person who delivers you? It's strange. That was one of the things that I do remember saying at the hospital, at the clinics: that it would be really nice to know who was going to deliver you because it would be one less thing to be scared about; if you knew who it was you'd get to know them. So it really was a bonus to find that the person I did feel at ease with was in fact going to deliver her...
If you've got a husband who isn't there - I mean I would have liked my mother to have been there if my husband wasn't there. Really you were the substitute for my mother being there [A.0. attended the birth]; that sounds funny, but I mean it was horrific that the midwife and the pupil midwife who were there I'd never seen in my life before and I've never seen them again since. And yet they were the people in about the most vital and powerful experience in my life so far...
YOU CAN'T ASK A BOOK A QUESTION
...Throughout the process of becoming a mother, the people who are valued are those whose expertise is of the personal and practical kind. The contradictions are not between the expert and the non-expert, but between one kind of expert and another. Theory should be grounded in practice, not practice in theory.
HEALTH VISITOR: Does she not settle if the wind's not brought up?
EMMA BUCKINGHAM with DINAH, aged five months, screaming: She can't eat till she's got her wind up.
HV: Oh, really? People don't seem to worry so much about wind these days. Hugh Jolly at Charing Cross is dead against winding. He doesn't think it's necessary at all.
EMMA: Well would you like to take this little thing? She's blue in the face!
HV: She's okay, is she?
EMMA: Yes. She's just got wind!
[Later] If health visitors had children they might be a good deal better!
The health visitor is a bit of a dilettante sort of person, isn't she? A bit of a buffer, really. You go with your problems to get reassurance. She hasn't been able to help this friend of mine over feeding. That's one thing I do think: you've got to have been through having children yourself to understand what it means and entails.
In hospitals the only real help I got with breastfeeding was from two nursing auxiliaries - women who both had a couple of children each and they'd talk about their children, and they were just ideally suited to the job. One of them sat down and really showed me what to do: she was terribly good. The best people are the least qualified people I think.
The nursing auxiliaries I thought were very very good. Most of them were very helpful and there was one nurse particularly, a state enrolled nurse, who was absolutely super, and had about eight children herself and would sort of say to you on the quiet, well don't tell so and so I've told you this, but I wouldn't do that, I'd do so and so. For instance, the baby milk. You didn't - the nursery nurse said you don't need to warm it up as long as you give it at room temperature that's all you need to do. And Mary, she was getting tummy ache, she'd started her colic by then, and this nurse with eight children said to me why don't you warm it up? She said your baby's got a new tummy and milk's going into it and everything's new to her; you know, give her a chance and have it a bit warm. So I did, which actually did the trick. And it was tips like that which she gave me and she was really super. Sort of a mother figure...
I think it makes a difference, I feel that about the health visitor. There's one there, she's very sweet, but she's not even married.. I know it sounds wrong to say it, but it must be different. I think that the health visitor who's had her own child she was so much more sympathetic. She could see that I was really worried about the baby's weight gain. And also practical experience of day to day things. You can read anything in a book but then I feel they're just trotting advice out of a book. They haven't actually had to deal with a baby themselves.
Practice may not make perfect, but at least it improves on theories. Motherhood means listening to the baby and not the experts; or, babies are interpreters and revisers of what the experts say. If any single phrase can sum up the message of becoming a mother it is this: the value of experience.