A day to celebrate the life and work of Tricia Anderson 1961-2007 with leading midwives from around the world.

Saturday 14 June, Bournemouth University

By Nadine Edwards

What a privilege to be at this truly inspiring, creative and knowledge sharing, emotional, intellectual and spiritual day. This report cannot possibly begin to do justice to all those who spoke eloquently, knowledgeably, creatively and passionately about Tricia, her life and work, and about so many aspects of midwifery art,  philosophy, relationships, knowledge and skills. Many of the speakers had known Tricia for many years and talked about her life and passions. Describing both incredibly funny and poignant moments.

Soo Downe started off the day talking eloquently and articulately (as ever) about Drinking tea intelligently: reflections on a phenomenal woman. Soo talked about the being-ness of being with women – drinking tea intelligently. She quoted a woman from a colleague’s study, following a positive birth, ‘I always knew I could change the future – but I never knew I could change the past. Talking about the role of the midwife in creating space for women, she quoted philosopher, Martin Heidegger: ‘The project of the authentic self is the creation of a resolute individual who chooses to become authentic’,. She showed a very inspiring and moving video which included women’s quotes about the importance of the midwife being with them during birth photos of women in labour, giving birth, and holding their babies, and read Maya Angelou’s inspirng poem, Phenomenal Woman.

Jane Evans spoke next about Trusting midwifery skills. She commented on the hugely problematic current trend to judge midwives and midwifery on the (necessarily flawed) NICE Guidelines, the need for all women to be supported by midwives, and the loss of midwifery skills. The skills she talked about included those skills a midwife develops in her hands by palpating women’s abdomens and babies, the skills she learns when she listens to women and observes physiological changes during pregnancy and birth. These skills reduce the need for more  invasive examinations. For example, observing a dark line that appears from the woman’s anus to the top of her coccyx, which suggests that her cervix is fully open, rather than carryong out repeated vaginal examinations. She urged us to trust in and contimnue to develop midwifery skills. What a joy and inspiration to hear from a midwife who has listened to and watched women so closely, and continues to develop her knowledge at each birth she attends. Her knowledge, skills and passion for birth is embodied in her mind, hands, heart and voice.

Billie Hunter was the third speaker before the tea break, and spoke about Relationships: the hidden threads in the tapestry of maternity care. Billie, calmly, thoughtfully, and beautifully described the weft of maternity care being those aspects of care that are visible – the policies, outcomes, etc, and the warp as the invisible relationships that underpin care, that are lost at policy level, in favour of reductionist solutions that fail to address the complexities of birth and care. Research shows that relationships matter a great deal to women and midwives and facilitate the job of birthing and midwifing in very positive ways, that increase autonomy and self esteem..Currently, relationships are hampered by staff shortages, the industrial model of birth, a focus on tasks, the “with institution” imperative, and burnout. Yet meaningful, positive relationships enhance care, increase midwifery knowledge, impact positively on communities, improve team working and  contribute to safe outcomes. Billie concluded that without a focus on relationships, maternity care is weakened, because relationships develop and foster nurturing, reciprocity and emotional intelligence. Importantly, she observed that small really is beautiful.

Sally Millar began the second morning session, with an inspiring talk about One midwife’s struggle for passionate midwifery in Ireland. When Sally began practice as an independent midwife in Ireland, she was one of 14. Directives in place urged that all women should birth in hospital, and there are now centralised obstetric units (4 have 8000 births each year), and a 0.5% home birth rate. She described life as an Independent Midwife as both fantastic and lonely. There were no regulations, supervision was from non practising midwives, and insurance came from the Irish College of Nursing (this is about to be withdrawn). The 1990s, saw challenges by women, midwives and researchers, and there are now midwifery services, but these are attached to hospitals. Sally discussed the problematic relationship between insurance and health care, and the emphasis by insurers on control and risk reduction, that reduces the scope of midwifery and both women’s and midwives’ autonomy (insurers will want to put rules in place that prevent midwives from booking certain women). Sally urged us to join togther to challenge the potential restrictions, become political without compromising our integrity in order to hold spaces for all women and midwives, not only Independent Midwives. Her and our political energy and commitment are much needed.

Verena Schmidt talked about Why the world needs midwices with a heart. She shared with us her phenomenal knowledge of physiology She began by telling us about her midwifery school in Florence, where about 800 midwives a year are (re)educated in normal birth. She described the familiar problems with the medical model of birth, how this fits with modern, technological life, and the trauma this causes to women and babies. It constrains women’s decision making, and leaves midwifery knowledge and skills devalued and invisible (in Italy midwive students are forbidden from using pinnards). She called for a female way of birth based on physiology and salutogenesis ( focusing on well-ness, resources and improving health). It is impossible to sum up the wealth of knowledge Verena has on physiology, but you can read this in her book, About Physiology in Pregnancy and Childbirth. The main points were that the release of cortisone in reponse to stress causes problems, thus care needs to be based on anti- stress measures during pregnancy and birth, that epidurals contribute to difficult births, that care during labour needs to help women relax enough to avoid creating pain beyond the normal physiological pain of labour, so that crucial birth hormones which enhance parents’ feelings of protectiveness towards their babies, and enhance the healthy development of babies at birth and in later life (birth sets down patterns for life) are released. Oxytocin is particularly crucial in promoting emotional intelligence and Prolactin in protective behaviours. Verena concluded by suggesting that the release of birth hormones are important for both individuals and society, that emotional, physical and technological interventions prevent their release – which disturbs birth and the parent/child bond, and our bonds to society and the earth, and that women need loving midwifery care to birth their babies physiologically, because relaxation, in industrialised countries, is the key component to safe birth and salutogenesis.

Jane Grant gave a moving and personal account of Tricia’s life after the diagnosis of her tumour, Rooted in the now; a passion for enquiry. She talked about Tricia’s phenomenal capacity around the fusion of arts and science, and the accessibility of her writing and teaching of these. She talked about how Tricia continued her creative work after her diagnosis, but tha she described it as ‘dark’. Jane encouraged her to continue and write up her work (some of it is available in her book, Still Here, and can be ordered by going to http://www.stillherepoetry.co.uk/. Jane also talked about Tricia’s meetings and conversations with two other inspiring and creative midwives, Meg (who has a motor neurone illness) and Jen (who has a rare form of lupus). Meg is writing up some of the email exchanges she and Tricia had. Jane very movingly, humerously and poignantly described some of the conversations she herself had with Tricis about others’ hurtful, inappropriate, clumsy and unthinking responses to disibility and illness, about the paradoxical gains and losses of facing disability, the huge loss of midwifery often involved, and the need to understand more about and respond better to people’s disabilities and journeys towards death. Jane interspersed her insights and observations with readings of a selection of Tricia’s poetry about life, disbility, birth and death. I thank you deeply Jane for your courage and generosity, and hope I and others can learn from your and Tricia’s feelings and insights.

Kirsten Baker started off the afternoon session with Midwifery and the magic ‘if‘. If anyone felt a postprandial sleepiness, it must have vanished quickly in the face of her engaging, lively, insightful humerous session. Kirsten’s focus was on the importance of midwife teachers and students developing a quality of “wondering why”. She drew on the work of Konstantin Stanislavski, (Stan to us!) founder of Method Acting, and explained its relevance to midwifery. Method acting attempted to portray real life characters, which demanded that actors draw on their own life experiences, and develop emotional awareness and intelligence. Enter the magic “if”. ‘If I walk into a room for the very first time and meet a person for the very first time … ‘. The magic “if” helps actors to translate their own experiences into those of the character they are portraying. Midwives and others need this magic “if”to be with women. Using creative imagination and drawing from life experience, we can make the leap from self to other. When reflection looks at difficult, perhaps painful past experiences to inform future experiences, it contributes to developing emotional awareness and empathy with others. Kirsten suggested that the creative arts invoke and nurture these qualities, by developing imagination, and that the simulators used in teaching (life like dolls, vagina boxes) reduce imagination and imprint an objectification of women. She urged us to trust students imaginations, help midwives create safe spaces for women to do the difficult jobs they do, and trust in wise counsel, skilled hands, women to birth, and learners to learn.

Holly Kennedy talked about Midwifery presence: philosophy, art and science. Drawing on her important, extensive work on midwifery skills and presence, Holly mentioned the chapter in Essential Midwifery Practice: Intrapartum Care, edited by Denis Walsh and Soo Downe, due out in, March 2009, and published by Blackwell. She and Tricia started the chapter and she and Nicky Leap finished it. Presence, Holly reminded us, is a verb and a noun, and a philosophy of presence facilitates the woman to be the central actor in childbearing. The art of midwifery is to bring together the supporting cast; knowing when to step in and when to step back. Presence is depicted in the creatibve arts ofn a myriad of ways: even the Beetles sung about it – Let it be, let it be …. While presence is the foundation of relationships, and while there are different ways of being present, presence requires engagement. Holly highlighted Nicky Leap’s suggestion that ‘least is most’, but suggested that this is problematic because the value of being invisible is a challenge for policy makers. Holly told the story of a midwife knitting through a young woman’s labour, and the young woman commenting afterwards that although her labour was difficult, each time she saw her midwife knitting, she couyld only assume that all was well. To the consternation of other faculty members, Holly’s students knit in class! But doing this kind of ‘nothing’ is a skill that needs to be learned and developed., so that women can feel emotionally and physically safe and trusting enough to release oxytocin, to promote normal birth. Stress reduces the flow of oxytocin, and invariably causes problems. Presencing is therefore crucial and includes connecting, calming, listening, acknowledging and respecting. Holly finished by inviting Kirsten Baker to read a poem by Martin Vincent, about her (Kirsten’s) presence as a midwife in difficult circumstances.

Pat Brodie brought the first afternoon session to a close, talking about Passionate leadership: let’s get it together. Pat mentioned a new book, co-authored by her and two colleagues, Continuity of Midwifery Care by Caroline Homer, Pat Brodie and Nicky Leap and published by Elsevier last month, and gave a bit of background to maternity services in Australia: medicalised and busy hospitals with too few resources. Pat suggested that change is now happening and midwifery initiatives are developing. She described a midwifery group practice initiative in a poor area on the outskirts of Sydney that has protected women in its care through good leadership. Leadership is crucial to midwifery development – leadership that displays consistency, competency, creativity emotional intelligence, energy, enthusiam, that draws people together, encourages others to speak of their visions, and that enhances new knowledge. Transformational leadership motivates and builds on relationships with everyone, including doctors, and employs a “politics of optimism”. Drawing on her many years of work and insight, Pat described a wealth of qualities, energies, practicalities, concepts and anecdotes that promote healthy leadership and change. Among them she mentioned the importance of vision, autonomy, using previous good examples, safe spaces, public funding, involving the community (not token women), non hierarchical ways of working, understanding social justice and community principles, building in relationships and FUN. Collaborative working that builds on relationships seems a key ingrdient for transformational change: ‘the frequency of contact is almost as important as the nature of the contact’ (from Michael Schrage 1990). She also mentioned work by Karen Lane in the Spring edition of the Canadian Journal of Midwifery, Barriers to Collaboration. And of course passionate leaders need support, friends, courage and strength to continue to swim against the tide, in their efforts to promote and protect normal birth.

Nicky Leap began the final session of the day talking authoritatively and movingly about Power, pain and passion: the legacy of Tricia Anderson. Nicky mentioned the chapter on pain that she and Tricia wrote for Soo Downe’s 2nd edition of Normal Childbirth published this month, which focuses on birth as a rite of passage, and the paradox of the unknown, uncertainty with the potential triumph of new motherhood.  She dicussed others’ work on pain: Kahil Gibran’s words that ‘Your pain is the breaking of the shell that encloses your understanding’, Enid Gbagnold’s, The Squire, where the teller talks about birthing her fifth child, ‘going with’, ‘swimming with’ the pain. She mentioned Adrienne Rich’s observations, and Vangie Kelpin, about birthing ourselves, through challenging our limits, and the connections between birth, death and pain talked about by Carol Poston. Nicky told us about the Normal Birth Matters research project based at Kings College, London, which has filmed midwives at the Albany Midwifery Practice describing how they help women positively meet the challenge of pain in labour. The film clips are stunning. Nicky talked about a ‘culture of pain relief’ and how this is part and parcel of fragmented care, staff shortages, fear of being blamed for not giving adequate pain relief to women, and yet, women looked after by the Albany Practice Midwives say again and again how relieved and delighted they were that their midwives supported them to avoid epidurals. Needless to say, the films have been controversial among practitioners, and a great deal of conviction, courage and continuity is needed by midwives to be able to support women in this way. Nicky stressed some of Tricia’s many messages that trust and oxytocin are key to birth going well, that we learn a great deal through the creative arts, that we need to nurture a culture of curiosity and concern and urged us to Google on ‘tend and befriend’ (fascinating work).

Lorna Davies concluded the afternoon sessions with her presentation, Finding your heartsong: bringing harmony back to birth. Lorna showed us a clip from the film Happy Feet, about Mumble, the ‘misfit’, who was facilitated to find his own strength and courage and eventually, his own heartsong. She drew parallels with midwifery. She described asking student midwives about what they understood by our ‘heartsong’, and received answers about our ability to listen to our inner voice, core truth, who we are,  values and beliefs, and our place in the world. She asked us how many of us have felt we didn’t fit in, marginalised, we were whistling a different tune, and had been belittled or bullied for standing by our beliefs and values. Lorna is currently looking at why midwives move from Britain to New Zealand and has found an element of ‘escaping’ in the repsinses she received. She asked how many of us have experienced the magical feeling of finding our heartsong, and how we think we can possibly help others to find theres if we have not found our own. While we can pretend, this lacks authenticity – if we ‘are not part of the solution, we are part of the problem’. Lorna’s gave us her very own recipe for heartsong and harmony:

cupful of trust (in the process of birth)

large pinch of self belief

generous measure of support (added gradually)

spoonful of common sense (stirred in)

good quantity of midwifery knowledge (mixed in)

sound communication skills (garnish – but not optional)

‘By being yourself, you can make all the differce in the world’

Rona McCandlish summed up the day’s proceedings, gave thanks to all, and read the following poem.

Only a Person Who Risks is Free
by Author Unknown

To laugh is to risk appearing the fool.
To weep is to risk appearing sentimental.
To reach for another is to risk involvement.
To expose your ideas, your dreams,
before a crowd is to risk their loss.
To love is to risk not being loved in return.
To live is to risk dying.
To believe is to risk despair.
To try is to risk failure.
But risks must be taken, because the
greatest hazard in life is to risk nothing.
The people who risk nothing, do nothing,
have nothing, are nothing.
They may avoid suffering and sorrow,
but they cannot learn, feel, change,
grow, love, live.
Chained by their attitudes they are slaves;
they have forfeited their freedom.
Only a person who risks is free.

During the day, Tricia was awarded her PhD posthumously, a selection of wonderful poetry was read out by Sarah Coates, Flo Logan and Rachel Wheeler, and the day was introduced and chaired, expertly, humourously, and friendly-ly by Paul Lewis, Jo Alexander and Rona mcCandlish. A special thank you was given to Mary Stewart for making the day happen, and to staff at Bournemouth University for their support, as well as the Iolanthe Trust for its financial support.

Paul Lewis and Billie Hunter gave details of a new award for midwives. ‘The Tricia Anderson Award will be made annually and will support individuals or groups wishing to undertake activities that reflect Tricia’s passion, innovative approach, scholarship and commitment to the wellbeing of mothers and midwives. Applications from qualified and student midwives will be considered. Trustees will be looking to support activities promoting Tricia’s key interests: normal birth, the use of the arts in midwifery, and breastfeeding, although these are not exclusive. Activities should be innovative and imaginative. For further details about this exciting award go to  http://www.iolanthe.org/

The overriding messages from Tricia and this superb conference were relationship, relationship, relationship, humility, respect, courage, trust in birth, openness, being in the moment, self awareness and development through a variety of knowledges, including the creative arts, relationship, relationship, relationship.