In response to Tom Whipple’s article in ‘The Times’:

Tom Whipple is a writer who concluded his article on the question whether sex is healthy (well, the case was more specific) on the conclusion that we don’t know — but that we can conclude that if we have sex, we should make sure to get pregnant in order to avoid cancer. (Argument spelled out here.) Which I found almost as funny as Philomena Cunk. You have to consider his tongue-in-cheek approach. Of course, I would never advise to speak to expectant mothers about Heidegger or Sartre during labour.

But it seemed helpful to consider some communication issues outside of the situation, by giving midwives an opportunity to watch mini lectures (around 3 min.). The lectures consider some reasons as to why communication is so important. In a situation where the perspective come far apart, successful communication depends on taking the perspective of the other.

This requires the kind of moves that philosophers undertake more regularly: reflection, a close description of the moods involved, and an examination of the different communicative relations involved. These latter are particularly volatile since birth usually involves the presence of a person very close and one or more people who are normally strangers: healthcare professionals, especially midwives. In fact, in this situation, midwives come close to taking the role of angels, making the impossible possible, as you can see me explain here. I wanted midwives to be aware of their enormous significance, and of how much it matters what they say and do.

It seems helpful for ‘Better Births’ – to cite a title which the Royal College of Midwives currently uses for its initiative – to improve communication between midwives and parents. For improving such communication, it is helpful to understand the perspective of the other better. I have therefore utilised phenomenological descriptions of emotions around birth to tease out how the experience is strange, even uncanny. In terms of emotions, this means that it causes anxiety not only because it involves pain (that’s one of many relevant dimensions) but also because it involves unknowns on so many levels. Since the ‘when’ is a major unknown, the questions of ‘where’, how’, ‘with whom’, etc. all fall in place with the ‘when’ which can undermine all previous planning. And at any point of the process, things can and often do change. It is an overall uncanny situation also because it is inconceivable. We know it’s possible (just as we know that we are all going to die eventually), but we cannot actually imagine that it is possible, based on our experience of our body.

Communication in labour is an enormous challenge for the midwife because she encounters a person radically disorientated by the uncanny situation, and also physically disorientated because their body has turned into a whale-like substance that does not want to respond to the order to move in the previously familiar ways. In fact, the body is such that you don’t really know how you would be able to bring it into a bathtub, for example, except with help.

So, the woman is in dire need of help from those around her, yet seriously incapacitated in terms of communication. Speaking during strong labour is very difficult and can be disruptive to the process. It is thus even more crucial for the midwife to communicate also for the woman, asking her to nod, etc.

Various different modes of communication are discussed in the module, such as persuasive communication: what could be the best ways of persuading a woman to change position if her situation is such that she simply doesn’t want to be a body? What information during and on the process seems crucial to convey, and how to ask whether the mother needs information?

And whether she wants to talk. Because birth defies the basic rules of politeness. The midwives who were attending my homebirth were perfectly competent, friendly, and polite; yet their repeated question, every five minutes, ‘how are you doing?’ was annoying under the circumstances. Because I didn’t want to have to come back to the realm of words, and I especially didn’t want to think about how to not give the same answer each time.

It is an extraordinary situation, and it doesn’t hurt to emphasise this over and over again. It is also a situation which psychological research has shown to be crucial for at least certain dimensions of the later relationship between mother/parents and child.

It is a situation that creates tremendous challenges to communication and yet depends so heavily on it. Which is why communication without words is crucial. See my ’10 points of advice for becoming parents’ on how crucial massage is, for example. If midwives encourage and teach partners to give massage as a matter of cause, I think lots of the relational conflict between partners that is so apparent and disturbing in many episodes of ‘One Born Every Minute’ could also be reduced.

For midwives, the crucial concept that carries through the module is responsivity[i]. Responsivity means to ask and observe. It means to be aware of the enormous differences between personalities, circumstances, and cultures, and therefore observe the patient closely. And ask – but also be aware that continuous or repeated asking might be bothersome.

 

[i] Bernhard Waldenfels investigates this concept in various of his writings, leaning in on Maurice Merleau-Ponty and Emmanuel Levinas.

1.) Prepare for waiting

Waiting is often quite annoying and irritating. Waiting with somebody else, like your partner, is not necessarily easier. Although one can have a conversation, the increased irritation that waiting causes will easily lead to conflict and argument.

Imagine you would wait with your partner in a GP’s waiting room for ten hours or so. A horrible prospect, isn’t it? Now imagine you are in increasing pain, and your partner is not, but is still undergoing the same kind of ten hours wait that I asked you to imagine to begin with. Is it likely that you will start arguing? Probably.[i]

Is there any solution to the problem of waiting? Yes, there is. What would you do if for some reason you know that you are likely to have to wait in a room for ten hours or so? You would perhaps bring your ipod, smartphone, tablet, etc. Or you might bring a book, a magazine, a newspaper. Perhaps a game to play with your partner.[ii] Items of food and drink are certainly also desirable – and permitted, nowadays.

True, if you are in labour, you might not want to do any of those things. But you also might. In the initial stages of labour, it is quite possible that you would enjoy listening to music, watching a film, reading a book.[iii] What do you do at home when you are in some kind of pain, especially cramps or menstruation pain? Is there anything you do to entertain yourself? Try to have available whatever that is. And your partner should be encouraged as well to bring suitable items.

2.) Massage is more than just massage

Massage is an opportunity for your partner to become a part of the experience in such a way as to truly help you. Massage during labour makes a tremendous difference.

Nature has designated the right points for this massage through the dimples of Venus on the back. Don’t start the massage too early as the points will start hurting at some point. But in strong labour, it is a crucial remedy.

The birthgiver should bend forwards and lean on something, a couch, their arms, etc. The massager should really put themselves into it and give a strong, balanced massage. Rhythm is key, as in other intercorporeal (this means, between bodies) activities — sexuality is another crucial examples. Being in rhythm means for the woman in labour to give signs through hand, sound, or breathing for the massage to start and to stop. If the partner listens closely, they will be able to tell, of course. Massage makes use of the kind of communication that is most appropriate in birth: non-verbal, or body language.

Make sure to pause the massage between contractions as the area will start getting sore anyway. Staying in the rhythm together makes it a much more joint experience, and the partner will not feel — and will not be! — helpless or useless.

 

—- 8 further points, still to be spelled out —-

 

3.) Positions really do matter

4.) Communication before birth matters

5.) Communication during birth matters

6.) Beware you will most likely need to speak to strangers: healthcare professionals (and that’s why a birth plan matters).

7.) Beware that there will most likely be some divergences from whatever the original plan.

8.) Make sure to get the most basic relevant information and commit it to memory.

9.) Beware that it is scary in any case — already because it is so strange and primordial, and social at the same time. 

10.) Beware that whatever happens, seeing and holding the baby for the first time will almost inevitably be a moment of wonder.

That’s the point you are working towards. Keeping it in mind, somewhere at the back of your mind to take it now and then to the front, is extremely helpful. Remind yourself. The creature is not going to be aesthetically pleasing or beautiful, but it is going to be a person. A character, a creature with a personality. You don’t yet see which; but you see that it will be. It is likely going to be one of the most important and intense relationships in your life. The baby will look back at you, and you will have made it — for all practical purposes. And carried it out into the world. Wondrous. Amazing.

[i] If you want to see how annoying and conflictual this can become, watch the first episode of ‘One Born Every Minute’.

[ii] One episode of ‘One Born Every Minute’ shows a couple playing chess.

[iii] When I was preparing for my first birth, I took this task very seriously and chose a particular book, Bernhard Schlink & Walter Popp, Selbs Justiz (Self’s Justice). Detective story, short chapters, succinct sentences, good sense of humour and a cat; what more do you want? I had also purchased a season of Seinfeld that I hadn’t previously seen. Unfortunately, I didn’t get a chance to watch Seinfeld because the other couple in the room was watching a horrible Saturday evening show on the regular TV, and I stupidly did not bring earphones for my laptop. But I read the book, though mostly outside in the corridor on a bench because the Saturday evening show was just unbearably annoying. – As a society, we owe it to ourselves to give each other a bit more privacy in these situations. Furthermore, clearly more midwives are needed. Jacque Gerrard from the Royal College of Midwives says, 3,500 are missing. One of my interviewees had three homebirths to which the midwives arrived late. If it means raising some special tax for the NHS, who could seriously argue against that?