This Is Going To Hurt...
Updated: Feb 7
So, the birth world has definitely responded to the BBCs announcement that the book 'This Is Going To Hurt' by Adam Kay, is going to be made into a mini series... it's been met with shock, I think would be the best term to describe it!
Spoiler alert - if you've not read the book then the premise, in a nutshell, is following Adam from his role as a Junior Doctor in Obstetrics and Gynaecology, in the progression of his career. Starting off fresh-faced, putting in too many hours but doing it for the love of the job, with an optimistic patient-centred focus. As time marches on, and Adam is massively overworked and underpaid (you'll see the parallels between this and all areas of the NHS), he becomes hardened: even joking at the expense of those patients and people who he was so focused on caring for initially. By the end of the book, Adam has left the NHS.
Part of the objection in the birth world, is his treatment and attitude towards service users towards the end of the book. Mocking those who had birth plans, or who wanted their birth to pan out a certain way. This is nothing short of mean, and absolutely not the person centred approach he had initially. Those of us who work in the birth world, know that obstetric and birth trauma is VERY real and runs deep: mocking or minimising that is cruel, unprofessional and contributes to the momentum of normalising birth and obstetric violence and trauma.
There always was a part of me that could look at Adam and his journey and feel sympathy, though. The mocking is unforgivable, absolutely, but I'm thinking about how the system breaks not only those using it, but those working in it, too. We know that in midwifery, for every 30 people who train, the NHS loses 29 of these midwives. Adam's story tells us of similar patterns - starting your career full of optimism, wanting to do good and to help people, and before too long becoming that senior person in charge who you've always hated for their hardness in the role.
Why does this happen? Well, not enough money, not enough resources, not enough staff... I am forever grateful for the NHS and the people who work in it, but that gratitude doesn't pay bills. Working long long shifts and days without a break, is not sustainable. People who once were full of fire and passion are now burnt out, and they have no fight left for anyone. Now more than ever after two years of working during a pandemic, and it's heartbreaking.
But whilst the system is broken, I do genuinely believe that there is still good in that system and I am (wildly) optimistic that it can and should be fixed. I see people removing themselves entirely from the medical model and I can understand why, particularly when we look at trauma. But just as medical professionals can become hardened to their craft, so can we all: the idea of under-medicalisation can be as damaging as over-medicalisation. As an integrated medical practitioner, I am very firmly in the camp of being patient/client led: my own opinions and ego are left at the front door. I'm not here to push herbs over meds, or vaginal birth over a caesarean. I'm here to support you and work for your benefit. We always talk about risk, chance and balance in our meetings, but these are your decisions and not mine.
You don't have to be at one polar end or the other: that's the beauty of working with an open minded and person centred practitioner. I very much see the benefit of being integrated: marrying together the magic and science of herbal medicine along with modern, and often very much life saving, medicine.
Ultimately I feel like this programme is perhaps poorly timed, given the #ButNotMaternity campaign which highlighted the disparities in perinatal care during the pandemic; more so now as we hear stories of people alone, dealing with trauma in hospitals whilst our government partied. But I also think we need to stop for a moment: maybe not laugh at the birth plan jokes in the show and think about the people behind it: the people with trauma from a system which doesn't support them, either those working in it or those using it. Maybe instead of making it a big joke, we need to really think about how we are going to change things.
Perhaps I'm still in the fresh faced and optimistic stages of my own career to think that change is possible...