The Day The Bubble BurstAug 19, 2023
Before the word 'bubble' took on a new meaning in early 2020, I felt that I understood the birth world pretty well.
I knew, for example, that the midwife is the ‘expert in normal birth’.
I knew that interventions came in cascades and that they were best avoided.
I knew that each woman had the right to ‘informed choice’.
I knew that there was midwife led care, consultant led care and shared care.
I knew that midwife-led care led to more ‘normal births’ and fewer interventions overall.
By now I had figured out - and it niggled at me - that the concept of ‘midwife led care’ and ‘normal’ pregnancy and birth were defined by the medical model of childbirth but I had decided to make the most of it.
By the time I handed in my notice back in 2019, Student Midwife Nicole's desire of trying to change the system from within and changing the narrative to 'physiology first' had waned. It was about the one woman right in front of me there and then, the one experience I could influence. I particularly loved advocating for women with risk factors who wanted out of guideline care. Making sure they had their voices heard and seeing some of their babies born at home or in the midwife led unit got me out of bed on those mornings I was doing my NHS shifts. The joy that this brought was enough to keep me going and my business was starting to get noticed. I loved the niche I had carved out for myself. I felt like I was being authentically me.
Then covid regulations came to our maternity hospitals.
First, birth partners were excluded from most of the happenings in the hospital, ushered in just for the birth itself. I met women who laboured without a loved one on induction wards or on the antenatal wards until they got to be transferred to labour ward, and sometimes their partners didn’t get to see their own babies be born. Doulas were out of the equation in hospital entirely. It was tough on staff as well, particularly those of us who were sceptical of the ‘Why’; and yet, we all took direction from the top and passed it onto the mothers in our care, no questions asked.
Then covid testing was introduced as a routine procedure. Women could not easily decline a covid test even though it is an invasive and uncomfortable nasal and throat swab; even though, in the heyday of restrictions, a positive test would have massive implications for you around the birth of your baby. Regardless of whether or not you had any symptoms, you had to let us swab your nasopharynx or we would implement the protocols otherwise reserved for covid positive people.
I understand that those times, for many, were scary and that people were trying to do their best. And I also understand that a public institution must at least try to prevent cross-infection and that this would be the way to do it. My suspicion had always been, though, that in the long run the covid response was at best an overreaction and at worst a fabrication and perpetuation of a particular narrative. So, regardless of whether I was right or wrong, my experience of working in the NHS at that time was tainted by this perception. I got hyper-aware of his approach in other areas of 'care' too. The concept of 'If you wont let us exclude it, it's there' is commonly imposed on women now. One of my clients recently was told that the fact that she had chosen to decline a glucose tolerance test meant that she was put on the gestational diabetes pathway anyways because pregnancy diabetes couldn't be excluded (but that's for another blog post).
The months and years that followed the first lockdown opened my eyes to the fact that the very concept of choice within the medical system is a sham. Your choices are contained within the medical industrial paradigm and you can only choose freely if you pick à la carte. Anything else involves an enormous amount of assertiveness and resilience. This is the case every single time you engage with the National Health Service and not just in relation to birth or, say, a pandemic. Still, I was invested; I felt that, overall, we were doing good. We were doing what we could with resources that had been dwindling way before any of this happened. I was up for giving it my best even though my own philosophy of birth, life, health and death is so very different to the medical industrial take on it all.
It took for my employer, the National Health Service, to do the unfathomable to shake me out of my delusional dream of believing I could continue to make myself fit in.
Enter: Le vaccin.
Covid vaccine rollout in the UK started on December 8th, 2020 and many were optimistic.
I went about evaluating the limited amount of information that was available about this supposedly prophylactic substance in the same analytical way that I go about supporting decision making around birth choices:
What outcome is this drug aiming to prevent?
How likely is it that this outcome would happen to me in actual figures?
How effective is the drug in preventing it?
Are there any risks associated with the drug?
I held off getting jabbed given the mRNA messenger technology was new to the world of vaccinations and I interpreted the actual risk of being hospitalised and dying for anyone my age as low. Meanwhile I was doing what I know to do to protect myself from getting sick. According to official information at the time, protecting oneself also meant protecting others - so I was happy that I was doing my bit my way, even if the people around me became increasingly judgemental of my choice. Fear had gotten the better of people and to say that things got very uncomfortable for a while is an understatement. No dinner at the restaurant, no travel and the looming threat of loosing permission to still do shifts as a midwife. That's where we allowed ourselves to go as a society!
In case you are curious: I had one single respiratory tract infection between 2020 and 2023 and I isolated myself during it. I did this because I was brought up to believe that it is good manners to stay at home when you think you might be contagious. I was never fed paracetamol suspensions and sent to school as a kid and neither was my daughter. In my family we operate on the wisdom that resting supports your body’s healing processes and that fever serves a purpose, another reason for staying in your bedroom or on your couch when sick. It really isn’t rocket science and in my view it shouldn’t have taken a government order and a monumental waste of public resources spent on silly mobile apps and stay at home orders to attempt to enforce this very common sense approach to basic health care.
On July 28th, 2021 Pfizer released their ‘Results from 6 Month Safety and Efficacy Data Analysis of Landmark COVID-19 Vaccine Study’ and at the time of publication it hadn’t been peer reviewed. Despite the obvious potential for positive bias inherent in non-peer-reviewed data, published by the people who are also distributing the product, in an industry with a track record of putting profit before people, I was not impressed. The highly publicised relative risk reduction of 95% that became the ‘95% effective’ marketing slogan translated into an absolute risk reduction of less than 1% for severe illness1. The risk of an adverse event was around the same ballpark. In their report Pfizer also stated that ‘The Pfizer-BioNTech COVID-19 Vaccine may not protect all vaccine recipients’ and in the six months it took for the data to be published I had observed that colleagues and friends who had chosen the jab were still getting sick with covid.
With the information I had at hand at the time, there was only one reasonable conclusion that was right for me. In my estimation and considering my overall world view, the potential risk of accepting the drug did not outweigh any potential benefit it might offer to me or anyone around me.
This is what ‘informed choice’ means, right?
The day the bubble finally burst was January 7th, 2022 when I realised who my employer ultimately was and that I didn’t like him even a little bit. Who am I talking about? The then Health Secretary Mr Sajid Javid! Eventually our own Mr Swan here in Northern Ireland would follow suit with what was unfolding in England.
To an extent this isn’t personal to Mr Javid or Mr Swan. I have always felt that a midwife should be answerable to the woman only and being employed by the National Health Service meant that, really, I was employed by the State. I went through a process of realising that the very essence of midwifery - being with woman - cannot be upheld in this dynamic. The State has no business between a woman and her midwife. I think that midwifery regulation has eventually led to a total disempowerment of women and midwives and it has facilitated the absorption of midwifery into the medical realm of birth. We are told that this is to protect us as midwives, to standardise practice and to eliminate 'malpractice' but I am increasingly sceptical of this. I appreciate that this is a radical train of thought but I promised you brutal honesty when I invited you to bear witness to my journey of conscious uncoupling from my regulator.
Back to the issue at hand; In January ‘22 I couldn't help but notice that Mr Javid was poised to extend the private sector vaccine mandates to NHS staff in England. The private sector mandates had led to tens of thousands of unvaccinated care staff being dismissed during a time of crisis and Mr Javid was ready to let tens of thousands of unvaccinated NHS staff go, too.
Hey, at least we clapped!
And then Dr Steve James and Mr Sajid Javid had a conversation that was aired on BBC news. Dr James had made the same choice that I had made and he got to tell the Health Secretary why…on television! Dr James became one of the founding members of the campaign group ‘NHS 100K’ and by November 2022 the government had taken a complete U-Turn on any vaccine mandates within the public and the private care sectors (for now).
Meanwhile, also in January 2022, a Freedom of Information Act Request in Texas led to a court order that obliged the Food and Drug Agency (FDA) to release the Pfizer trial data that led to the approval of the vaccine in the USA. As a result, the raw trial data that Pfizer intended to withhold from the public domain for 75 years (yes, that’s 75 years, not a typo!) was to be made available within the following 8 months. I haven't personally made the effort to look at the tens and hundreds of thousands of pages of data sheets that entered the public domain. For me it's enough to know that they were meant to stay buried for three quarters of a century, but other people have analysed the data. If those evaluations are to be believed, it looks like 'safe and effective' was never the best way of describing the product.
This was the first time that I felt truly compromised as an NMC registrant and an NHS employee. If my employer decided that they wanted to mandate any vaccine, however poorly it performs, they could. To be honest, it makes total sense, too. Any company is much more effective if their staff endorse their products, their ways of seeing things, their approach. I will be much better at recommending a product if I also use it (although, it would help if the product was performing as described). Either way, I was starting to see how I wasn’t a good fit for the NHS anymore. It’s not you, it’s me.
The materials that the Royal College of Midwives circulated to us to support us with discussing the covid injections with pregnant mamas didn't inspire confidence either. They were ultimately a reiteration of the ‘safe and effective’ pitch mixed with some messaging about how bad it can get for mamas and babies if they get sick with covid. There was NO data in them, none. The information leaflet for parents couldn’t have been more patronising if it tried. It had gotten to a point where it felt that there really was only one ‘informed choice’ to promote to pregnant women; the right choice. Nobody seemed to be interested in exploring potential disadvantages of this intervention. Officially there were none.
Let me just say at this stage that I am fully aware that covid or the flu can be devastating to a mum and her baby. I know how ill women can get from either of these viruses and how this can affect their babies. It is, however, worth noting that an ICU admission is still an overall unlikely thing to happen and my point is that I wasn’t up for implying that the injections would definitely prevent it. And what about the disadvantages? I wanted to be able to discuss any potential disadvantages in real terms. I didn’t feel that the whitewashed handouts that were made available at the time were cutting it.
To me, the coercion strategies that already existed in maternity care were taken to a whole new level then and I was struggling with some other discoveries I was making about the very foundations of midwifery...
1 - relative risk measures how much more likely one group of people is to experience an outcome than another. Without looking at the total amount of people in each group and knowing how many people in each group experienced the outcome (absolute risk), relative risk tells you nothing about what your risk actually is. For example 100/100 versus 5/100 is a 95% reduction in risk and 100/1000000 versus 5/1000000 is also a 95% reduction in risk but they represent a very different reduction of actual risk.
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