There is no alternative? Don't you believe it...
I am - finally - properly back to work this week. I have written a review of a book about maternity activism for AIMS (look out for it in the December journal) - simultaneously a joy and a kick in the head. I have supported two births, and continue to support another family as 'Pocket Doula', so I'm right back in the ring, witnessing the hard, painful realities of the midwifery crisis in action. I'm also listening, with gritted teeth, to the news, and I have to tell you, I have had an absolute gutful of it.
In the not-to-missed podcast The Rest is Politics (Thursday 29th September 2022 - and really, don't miss it, it's a particularly searing one), Alistair Campbell uses the phrase 'the Sovereign Individual' several times. This relates to the neo-liberal idea that we - ourselves as individuals - are not neither connected to, influenced by or dependent on the structures, attitudes and behaviours of those around us. The popularisation of this idea is the mechanism through which we are unwittingly coerced into valorising the successful and condemning the poor, sick and vulnerable. It's why Kamikwaze Kwarteng was able - in all conscience - to write a mini-budget in September that cut taxes for the rich but still isn't able to commit to an inflation-matching increase in Universal Credit. The only way it's possible to do these things is to believe that the successful are successful purely on their own merit and capabilities. Absolutely nothing to do with those private tutors, or being spoon-fed how capitalism is done from the cradle, or not having to do a tonne of zero-hours job on top of your study and your student loans, oh no, and absolutely, definitely nothing to do with the wonky pivot from which we determine what 'success' means. From this wonky pivot, the converse belief can be rationalised; that those who don't attain financial stability, or can't work, or get stuck in poorly-paid jobs, with little chance of promotion (you know, those who we learnt to call 'essential workers' during the pandemic, but who now aren't even able to afford 'essential purchases', like food and heating) are simply a bit feckless.
Neo-liberalism' is not a new idea, and has infected much of the last century in one way or another. It really picked up the pace and showed its perniciousness during the 1980s (when us plebs were treated to 'trickle-down economics' first outing). The fundamentally erroneous idea that we are separate and sovereign units was memorably summarised by Margaret Thatcher in her infamous 1987 Woman's Own interview, when she opined that '...there is no such thing as society, only individuals and their families...' (I was reminded of this in Neil Vallelly's interview with Laurie Taylor on Thinking Allowed this week - another brilliant listen, and at only 30mins a manageable one).
Neo-liberalism isn't just economics. It's an idea, a way of understanding the world. It is fundamentally flawed for me, because it resolutely separates the mind from the body, reason from feeling, the socialised from the natural. The complex, messy, inconsistent, wonderously effective reality of our animal bodies is forced to fit a supposed 'logic of the market'. This logic is not actually logical at all, though, and in order for it to work effectively we have to do a goodly amount of heavy lifting. We have to reconstruct how and where all sorts of things fit together, from the psychology of decision-making, to the economic value of women, to our place in the environment. It's how we can have had 40 heat in Kent this summer, with wild-fires raging around the M25, but not a hint of a whisper about climate change from the bunch of chancers who now form our Government (oh, wait, yesterday Truss described climate change activists as part of some form of 'anti-growth coalition'. My eyes rolled the full 360). We're caught in it because those that benefit from it, those at the top, reiterate and repeat that there are no alternative options or ways of managing ourselves in the world. No 'magic money tree'. Neo-liberalism - the bureacratisation of everything, money before people, pure, joyless utilitarianism for 'those who have not', while 'those who have' feather their nests - has come to be understood as just the way things are. An example this week is nurses being admonished because they are even thinking about striking for the first time in their 140 year history. '...won't they think of the patients...' we're asked, while the Government refuses to apply windfall taxes to the energy companies. I mean, why won't the Government think of the patients? It's their bloody job after all. Why should nurses, who have suffered real-terms pay-cuts for years, who have to pay to park at their place of work, who do the shitty, bloody, hard graft so many of us rely on but couldn't countenance, why should they shoulder the entire burden of responsibility?
This all reminds me of the status quo that Silvia Federici described in 2010, and that hit me hard when I read it;
'...the neo-liberal attempt to subordinate every form of life and knowledge to the logic of the market has heightened our awareness of the danger of living in a world in which we no longer have access to the seas, trees, animals and our fellow beings except through the cash-nexus.'
Silvia Federici
Feminism and the Politics of the Common in an Era of Primitive Accumulation (2010)
in Revolution at Point Zero, (2020, second edition)
In my line of work, this is abundantly clear. Your best chance of having the uninterrupted birth that most women prefer is to pay for private antenatal care and a private midwife. The NHS is not able to provide continuity of care or appropriate ante-natal education. This means that pregnant women cannot have the conversations they need to understand the physiology of their own bodies, or to embark on the iterative, situational, absolutely unique and personal decision-making that happens throughout pregnancy. So women doubt themselves and their bodies. Because the ancient art of midwifery is unvalued, and has been bureaucratised under a succession of British neo-liberal Governments, midwives are underpaid and understaffed. They are unable to offer the tacit, compassionate care so many went into midwifery to provide. They are physically and emotionally burnt out from trying, every day, to do their best for the women in their care. The result is a maternity care system on its absolute knees, and the majority of British women having to take their chances in it (and that's before considering the intersectional equity issues that load the dice yet further against different cohorts of women).
What's my point? Perhaps I'm just ranting here. Or maybe I'm hopeful that there's some form of belated fin de siecle change in the air. With change comes risk, and the risk now is that uncertainty and instability drive the rise in populism, which is always patriarchal (even when its fronted by a woman). There are changes afoot in maternity services, bought by both Ockenden and the impending financial crisis, which do not look very much like moves towards the woman-centred, humanised care that has been recommended by review after review since Changing Childbirth in 1993. I am realistic, and recognise that maternity services will inevitably have to yield to the reality of too-few midwives and too-little money - so perhaps I'm asking that amidst the pragmatism of doing the best we can with what little we've got, we don't lose sight of the fundamentals. Mothers do matter. One size does not fit all. Birth is a fundamentally relational process, that starts way before cervices dilate and carries meaning well after breastfeeding has finished. It does not have to be this way.
Charlotte Edun is a doula, hypnobirthing teacher and academic researcher based in Kent.
For more information about continuous support through your pregnancy, birth and early motherhood contact charlie@thegoodbirthpractice.co.uk
