Becky Talbot is a doula – an independent birth worker – in Cambridge who was central to initiating the protests by midwives and birth workers across the country on 21 November. She spoke to Sacha Ismail.
I’m very much part of a doula community where we train and develop and collaborate together. In early October one of our Cambridgeshire doulas, Paula Cleary, decided to have a march in the town of March, where she lives, to protest about lack of homebirth services and poor conditions for staff at the local hospital. We talked about it, and of course these problems exist all over the UK. Over the last three or four years things have got worse and worse and reached a point which is simply unacceptable.
Midwives, our colleagues we work alongside, are burnt out. They regularly can’t leave work as there’ll be nobody to take over from them. Often they can’t go to the toilet, they can’t eat; and they feel unable to speak out about it because of the culture of silencing and bullying that exists. So they’re going off sick, they’re leaving in droves, and more generally they can’t provide the kind of service they want to. It has a massive impact on those who are going to give birth.
The whole structure is crumbling. Homebirth services are being shut down, and if you give birth in a hospital very likely you’ll have a midwife who’s strung out and exhausted.
For doulas, collective funding sources have dried up. We used to have a certain amount of funding but it’s much more difficult to come by now. I work on the basis of what people can afford.
A group of doulas saw Paula’s post and commented, yes, we need to do something radical, we need to demand real change. So we started a steering committee with those doulas and some midwives, from across the country; we had new people coming to us from all over. It’s people who are very interested in and concerned about maternity services, from the perspective of women’s rights. The steering committee decided to hold the vigils on the 21st.
We set up a Facebook page – which now has over 20,000 people on it – and asked people to tell us their stories. We had lots of stories from midwives and doulas and lots of stories from women and families who had had children. At first there was tension between midwives and families. There were midwives who didn’t want to hear the families’ stories and families who felt they had been treated terribly by midwives. I don’t know how we did it, but we were able to develop understanding between these groups, that yes the situation is terrible, yes people are having horrible experiences – but it’s not at all midwives’ fault.
Maternity care has been going down hill visibly and rapidly for many years, certainly in the ten years I’ve been a doula – but it is good to finally feel we have channels to try to do something about it.
The situation a decade ago was not brilliant but things have got much worse for midwives, in terms of their conditions and the way they are routinely silenced if they try to speak out, and for women giving birth in terms of lack of choice and degree of coercion that goes on. Speaking from my own experience it’s the same all over Cambridgeshire and nearby areas. There’s a partial exception with the homebirth team in Norwich. That’s probably the situation all over – there are little pockets that are better but the wider situation is dire.
We’ve developed a manifesto. We want the government to listen to workers and service-users and their advocates, and provide funding to retain midwives in the job, including a restorative pay rise, and to train new ones, including through support for students midwives. There are 250 experienced independent midwives who can no longer work due to issues around indemnity insurance – that needs sorting out urgently. Breast-feeding support should be properly funded so it can be accessed freely, taking some pressure off midwives. We’ve got a long list of demands. The key theme all through the demands is that midwives’ working conditions are women’s birthing conditions, and at the moment neither are ok.
How do you see the crisis in maternity services fitting into the wider crisis in the NHS?
This is one of many parts of the health service that are being run down and destroyed – an important one among many important ones. And I believe what we’re trying to do can’t but bring to light the wider crisis in the NHS.
The awful situation in maternity care highlights how ridiculous the government’s claims about what it’s doing are. Their figures simply don’t add up. Staffing numbers are way below safe levels and getting worse. They are talking about training more midwives, but for every 30 trained, 29 leave. On this basis to get to safe staffing levels – not the levels needed for decent care, just the levels to be relatively safe – will take 50 years!
When figures for the numbers of midwives are bandied about, be sceptical. It needs breaking down. Many midwives are working in non-clinical roles, many are working small numbers of bank shifts, many have a midwifery pin but aren’t actually working as a midwife. Plus if you are working in a more and more difficult situation, with more and more social problems and more demands, the numbers mean less and less. Whatever the headline national figures, you can see the actual situation on the board in hospitals every day - “planned number of midwives 5, actual number available 2”.
I don’t think this government is unaware; I think it’s steering towards the destruction of the NHS as we know it. But that makes it all the more important we take urgent action to push them into changing course.
Do you have a specific demand for increasing NHS funding?
No. I think it’s not entirely on us to come up with everything – that’s the government’s responsibility. I don’t know exactly how much it will cost to restore the NHS, but clearly a lot.
Do you have more vigils or protests planned?
We don’t have anything set yet, but straight away after the 21st everyone was saying let’s do it again, so absolutely we will be soon.
It sounds like your movement began with doulas, but it’s focused on midwives. Can you say some more about that?
Doulas and midwives have very different working situations. At the moment actually doulas mostly can’t go in to hospitals due to Covid restrictions. This is not one of our formal demands, but I personally think women should be able to have their doula with them in hospital, and not make a choice between their doula and their partner. This can be a heartbreaking choice and for some women and families in vulnerable situations a really dangerous one.
Doulas are still usually able to provide a very good supportive service to women and families over an extended perinatal period. This is very different from the relationships most midwives are now able to develop with families – but it shouldn’t be. The focus has to be on getting funding and support so that midwives can provide that kind of service. We need to get to the point where midwives have their own limited caseload of clients they can focus on. Even where this does exist it is constantly disrupted by midwives being bundled into delivery units to deal with emergencies or fill gaps.
The government talks about ensuring “continuity of care”, but this is a million miles away from the reality. A million miles away and getting more distant all the time.
Were the protests mainly organised by doulas or midwives?
Mostly doulas took the initial lead but as things developed it varied a lot. For my Cambridge protest the organising team was maybe ten midwives, ten people from local families, and just a few doulas. In terms of who took part in the protests, it was a real cross-section – midwives, student midwives, doulas, people who’ve had kids, families and also the families of birth workers.
In Cambridge we had maybe 200 people and about half were midwives and doulas. It was really inspiring and uplifting, and I think a lot of midwives felt properly listened to for the first time.
I should add that all of his is organised by volunteers – we haven’t had any funding of any sort, and have organised all this on a shoe-string, because we are really bothered about what’s going on. I’ve certainly never organised a protest in my life before, and I don’t think many of us have.
Midwives’ trade unions seemed very absent from the protests. What’s going on there?
Very early on we contacted the Royal College of Midwives, we sent them our manifesto and tried to have discussions with them. They released a very short statement, which said [Becky quoted directly]:
“Making your voice heard, staying safe… On the 21st of November, the group March With Midwives are organising vigils across the UK. If RCM members are planning to attend the vigils, please do attend in your own time. Do check on relevant social media and uniform policies which may be in place in your organisation. Do follow any active government Covid-19 guidance. Don’t attend during working hours; this may be classed as unlawful industrial action; the RCM does not have a trade dispute with any employers in the NHS; and RCM members have not been ballot to take industrial action. Be cautious about any events taking place outside hospitals; consider how this might impact on service users entering the premises. And remember that other protests may also be in place.”
I think the basic thrust is: this is not a very good idea, is it?
Are a lot of your activists in RCM?
I must admit I haven’t asked the people involved in our steering committee, for instance, which union they belong to. Midwives are in different unions, RCM, the Royal College of Nursing, Unison…
Did Unison say anything?
I’d love it if the unions midwives are in actually did something to improve midwives’ awful working conditions and the abuse and bullying they face. What’s clear from the many thousands on our Facebook group is that midwives mostly do not feel at all supported by the unions.
One thing that struck me in the RCM statement was the way they completely worship and seem to see it as their role to enforce all the laws brought in to prevent organising at work and prevent people from going on strike. They’re even saying that you can’t demonstrate in case it’s illegal industrial action.
Yes. In reality midwives can’t really go on strike. Midwives aren’t mainly bothered about the money, they’re bothered about their working conditions and the service they provide to women and families. If they went on strike it would have awful consequences.
But there are instances, historically a lot in fact, of health workers going on strike. Even the RCM went on strike, I think for the first time, in 2014. It’s possible to do that while finding ways to ensure people remain safe, and it’s also possible to take strike action over exactly the kind of wider issues of conditions and services that you’re raising.
Historically sure, but in the current desperate situation I think it would just make things worse. At the moment things are really on the edge, it really is a life or death situation. Striking isn’t really an option. But what we can do is get out on the streets and protest and march. What we can do is refuse to be silenced. The scapegoating and silencing of those who raise issues is a terrible problem. When employers warn midwives against taking part in protests that is yet another way of silencing them. The whole of maternity care is built on a patriarchal structure of oppression – they tell you and you tell them, right down to the bottom.
Our protests are about breaking the silence. Since this began I’ve had so many midwives, hundreds, getting in touch to express the fear they’ve felt about doing anything to speak out. But getting together and organising and holding these protests is already massively weakening that fear. That’s one thing I’m really proud of, that midwives now feel they have someone they can go to lose their fear and find a voice
Have you had support from other unions, outside health?
In Cambridge we had people from quite a few different unions at our protest. I went to speak to our local trades council about what we were doing, and they were incredibly supportive. That’s something which everyone should do, across the country.
What’s the Labour Party saying?
We’ve encouraged everyone to write to their MP. By and large Conservative MPs have sent back a cut-and-paste letter repeating the government’s nonsense rhetoric. A couple of Tory MPs sent better replies, and lots of Labour MPs. Some Labour MPs came to the marches. In Cambridge at least we also had lots of Labour members come along, partly because I’m a member.
Our [Labour] MP Daniel Zeichner didn’t even reply to the email. Neither kid Keir Starmer. Jeremy Corbyn on the other hand made us a very good video.
How can people support the campaign?
Join our Facebook group, find your local group by searching on there – or if you haven’t got a local group, start one. You’ll get a huge amount of support. Follow us on Twitter and Instagram. Come to the next round of protests. Talk about the issues and get others talking about them – raise up the voices of midwives and families that birth.