In advance of Birth Companions‘ launch of the Birth Charter for women in prisons next week, Maternal Matters is delighted to squeeze in an interview with busy lady Viv Gray, trustee of Birth Companions, independent midwife, mum-to-two and gran-to-one – huge thank you Viv!
Can you tell us about the work of Birth Companions?
Birth Companions is unlike any other charity. We provide support to vulnerable pregnant women and new mothers who are, have been or are at risk of being detained. We deliver our services in prison and in the community in the greater London area.
How did you first become involved, and how are you involved currently?
In 1996 there was a televised documentary, in which a prisoner gave birth handcuffed to a prison guard. There was a big campaign at the time about ending the shackling of prisoners during birth. But I was struck by the fact that the woman had no one to support her in labour apart from an advocate for women’s rights in childbirth (Beverley Beech of AIMS), who had been talking to her as part of the campaign.
The childbirth anthropologist Sheila Kitzinger, put a notice in some journals asking for people interested in supporting prisoners during birth to get in touch. As I live quite near to Holloway and was involved in childbirth education at the time, the old,
“if not me, who; if not now, when?”
thing got to me. So Sheila put me and a bunch of other women together, and within a few weeks we had accompanied our first prisoner during the birth of her baby.
We became the Holloway Doula Group, then when we registered as a charity, Birth Companions. We continue to work with incarcerated women, but also support other women with severe and multiple disadvantage in the community. Our overall aim is to improve the experience of pregnancy, birth and motherhood for women and ensure the best possible start in life for their new-born babies.
I am no longer an active birth companion, but support the work of the charity as a trustee.
What do you see as being some of the key issues for pregnant women and new mothers who are in prison?
“Prisoners are more likely than most of the population to experience mental health problems, history of abuse, having spent time in care as a child, have physical health problems or problems with addiction. All of these issues will impact on the experience of pregnancy, birth and motherhood.”
Lack of control and agency are big issues for any prisoner. For pregnant women, this means that they are unable to choose special foods to reduce nausea, or to eat ‘little and often’. They are likely to be sharing a cell, possibly with other women who smoke. They are unable to choose where to have their baby, when to attend for antenatal care. They are often unable to have significant others with them during appointments, as there is a risk that if these appointments are known about, escape attempts may be supported. They may be housed far from their families (this is particularly the case for foreign nationals) and may face labour alone. They are not allowed to have cameras, and so often have no photos of their babies. They have a relatively high likelihood of being separated from their babies. They are not allowed the maternity leave allocation of women in the community.
It is for this reason that Birth Companions has developed a Birth Charter, and are working with the Ministry of Justice to try an ensure that all prisoners receive equal treatment within the estate, and as far as possible equivalent to that received by women who are not in prison.
What inspired you to train as a midwife?
I was inspired to train as a midwife by attending births as a Birth Companion. It made me appreciate the exemplary midwifery care I had received during my own births, and realise that although I might never be as amazing as my midwife, Margaret Hill, I could certainly provide better care than some women received, and work my way up towards the standard of care Margaret provided for me.
What have been the highs and lows of your 15 years of working as a midwife?
I have been really fortunate in my midwifery practice. Apart from a year after qualification, I have been able to work in a caseloading model, providing continuity of carer to the families I work with, first in the NHS as part of Sure Start, and then as an independent midwife.
“There really isn’t any high to beat getting to know a woman through her pregnancy, helping her give birth to her baby, and watch her develop confidence in her ability to mother her baby during the weeks after birth.”
The lows of midwifery are supporting families through loss. And the paperwork.
You are currently working as an independent midwife – what led you to this choice?
I have always wanted to provide continuity of carer to women. I experienced it myself in both my maternities and really felt it made a difference to be cared for by a midwife I had a relationship with. When funding for the NHS Sure Start team was ended, I decided to see if independent practice was feasible for me, and I am pleased to say that Maya Midwives has been financially, professionally and emotionally rewarding.
Unfortunately, despite mountains of research evidence supporting the benefits of continuity of carer in terms of outcomes and cost effectiveness, NHS policy persists in providing piecemeal maternity care. All the midwives and doctors I know are lovely people who practice to high standards. But the lack of personalised care and not knowing who you are looking after means that sometimes women don’t get to be supported in the way they need.
How do you see the role of independent midwives shaping the future of maternity care?
I’m no expert in the political question about the future of maternity care, I just help people out. But independent midwives offer the only support for women wanting home births in some areas where the NHS fail to properly staff a community midwifery service. We are often the only option for women with a baby presenting by the breech who would like to labour and birth spontaneously or the only way a women with a complex needs can get continuity of carer through her birth. This is particularly the case for women with a history of abuse in childhood, who may have issues around trust and consent and are particularly vulnerable to flashbacks during birth.
“It is interesting to me that this issue of childhood abuse, which was so crucial to be aware of and sensitive to during support of birthing prisoners, is also a major factor in my independent practice, when at first thought it might seem that these are two very different groups of women.”
The recent government proposals for a portable fund of money which pregnant women may be able to spend where they want could enable a wider range of women to choose support from an independent midwife, and that would be great, as I know there are lots of women out there who can’t choose our care for financial reasons. We will have to see how whether it lives up to its promise…
Featured image credit: Ann 4, Flickr Creative Commons