The book will draw attention to the beginning of life; a poignant human journey that holds meaning and significance within and beyond current maternity care systems.
Hi all. I have received a variety of comments and feedback about caseload, continuity of carer midwifery practice. Would love to hear more. So vital to share our examples. There is a lot of misconceptions and fears about this way of providing midwifery. Also if you received care from a caseload midwife and want to contribute you are welcome! Let us have a conversation. My example was previous blog…..
Kind regards, go well
Focus on safety safety safety breeds fear,
fear then attunes us to more fear and then
the situations we find ourselves in, like childbirth,
become coloured by more fearful feelings ….
then it all feels even less safe!
Being constantly fearful is an unsafe place to dwell, function and be human,
we are simply not free when we are fearful!
Needing to feel safe is a human need yet it need not imprison us
let us not cover over what it means to be human in the pursuit of safety;
find ways of being and doing that awaken our potential to
flourish and feel safe and free
Susan Crowther 2016
There has been a lot of conversations across social media and various fora about caseload midwifery and working towards a continuity of carer model. There is a lot of anxiety and myth, misperceptions and unfounded concerns. I have had the pleasure to work across various systems in the UK and overseas. In the UK I worked in a group practice, standard maternity care and as an independent midwife. The standard fragmented care in which primary and secondary services are separately staffed simply did not resonate with me. The group practice arrangements I worked in at Chelsea and Westminster hospital in the 90s, although fun at the start, also were frustrating and exhausted me. Working independently in the UK was wonderful yet very stressful at times due to not being fully integrated into the system and the need to ask for payment. When I worked in New Zealand it was a fully integrated system in which women booked a midwife directly without having to pay when they were a resident or citizen. I have described the NZ system elsewhere.
I am not going to re-state the supporting research evidence for caseloading, you can find that elsewhere. What I want to do here is first describe what continuity of carer is for me. It is being the main point of contact for a women through pregnancy, labour and birth then postnatal. Care is only handed to others when I am on holiday, weekends off, sick, study days or have two women go into labour at the same time! The care I provide traverses risk and chosen location for birth. I follow the women where she intends to birth. The arrangement is flexible and agreed in partnership at each step of the journey.
For caseloading to work I needed:
- Excellent support structure with colleagues
- Like minded colleagues who were philosophically aligned
- Fair remuneration for the work I did that was equitable and matched the level of skill. Payment to be organised through ministry of health and be free at point of delivery to women.
- Regular time off arranged with practice partner.
- Self determine my ways of working, e.g. When to do clinics, postnatal visits, Case load numbers, organising annual leave and weekends off call in liaison with practice partner.
- One full month off for AL per year in one go, plus another week decided amongst group practice.
- Partnership working with women that was reciprocally sensitive to each other’s needs
- Time to be off call when needed urgently.
- Generosity of spirt and good communications amongst colleagues
- Excellent relationships at interface with hospital colleagues (midwives and medical)
- Regular support and guidance from the midwifery council and college of midwives
- Understanding family who supported my way of working
- Great rapport with everyone in my local community where I was working
- Reliable car and phone!
Caseload 4-6 per month. Reasonable living wage that was slightly more than colleagues working shift work in the hospital. The payment for caseload midwives in NZ is presently being challenged to meet inflation and degree of responsibility. At the time of this diary entry the 4-6/month booked women provided an adequate pay yet this had not increased with inflation hence current challenge.
I worked with 8 other caseload midwives split into partnerships for weekend off call, holidays, SDs, sick, 2nd midwife for primary births and when need support for long labours or when two women go into labour at the same time! Clinic times and postnatal visit times decided by myself and confirmed with women as needed. Key is flexibility. Some midwives prefer to do all clinics in one day, all bookings another day for example. Partnership is essential between the women and myself as well as with practice partner, group practice and associated support services such as GPs, primary birth unit staff and local hospital colleagues.
So what did a month look like? Was I over worked? Was being on call a constant intrusion in my life? Did women abuse the on call system and call me constantly?
Here is one month activity from my practice diary. All names and places have been removed. Each month was different but this gives you a snap shot.
So here it is…
Monday. On call, Antenatal clinic 8-12noon (8 women). Postnatal visits x3 X1 booking (2 hours). Home by 430pm. No calls
Tuesday on call x4 Post natal visits in morning. Office admin work afternoon. No calls.
Wednesday on call 3 post natal visits in morning. Afternoon free. No calls.
Thursday on call antenatal clinic (8 women). X2 PN visits. Practice meeting cancelled everyone busy. Home at 3pm. Called at 10pm to a birth. Home at 8am Friday morning.
Friday on call. Morning free to sleep. X4 postnatal visits in afternoon. Home by 5pm. Practice partner took my on call 6-11pm so I could go out of area to an event.
Saturday, on call, no calls. X1 PN visit.
Sunday, on call, no calls. X1 PN visit.
(Total hours actually away from home and working = approx 36 hours)
Called out outside of Monday to Friday working days – once
Monday on call. Antenatal clinic 8-12. PN visits x4. Home 4pm
Tuesday on call. X1 booking 9-11am. X3 postnatal visits. Home 2pm. No calls
Wednesday on call. No calls, no visits. Admin catch up (2 hours)
Thursday on call. Antenatal clinic 8-12. Practice meeting over lunch. X 4 PN visits. Home by 4pm. Took practice partners on call so she could have an evening off.
Friday called to birth at 7am. Home at 1pm. Booking 3-5pm. Called to be 2nd midwife at birth 7-11pm.
Saturday on call for my own case load and practice partner for her weekend off. X1 PN visit no calls
Sunday x2 PN visits. Free by lunchtime. Called at 5pm for BF problem.
(Total hours approx 35 hours away from home + 1-2 hours phone and admin work)
Called out or working outside working Monday to Friday working hours – twice
Monday on call. Antenatal clinic 8-12. PN visits x4. X1 booking. Home at 5pm.
Tuesday on call PN visits x2. Free from 11am. No calls
Wednesday. Called to induction of labour at 11am (post dates). Home at 11.30pm.
Thursday on call Antenatal clinic 8-11am. X 3 PN visits. Practice meeting over lunch. Home by 3pm. No calls.
Friday on call PN visits x4. Booking 1-3. Hand over on call to practice partner at 6pm.
Saturday and Sunday off call.
(Total hours approx away from home 38 + 1-2 hours phone and admin work)
Called out or working outside working Monday to Friday working hours – once
Monday on call from 8am. Antenatal clinic 8-12. PN visits x4. Called to birth at 4pm, home at 9pm.
Tuesday. Called to be birth support for practice partner at home birth 7-11am. X3 PN visits. Booking visit 3-5pm. No calls.
Wednesday. No calls all day. Did 2 hours of admin.
Thursday Antenatal clinic 8-12. Practice meeting over lunch 12-2pm. Then X2 PN visits.
Friday x3 PN. Visits. X1 booking. Perinatal mortality meeting at local hospital 1-3pm
On call from 6pm for practice partner also for weekend.
Saturday called to birth at 6am (practice partners caseload). Home by 4pm.
Sunday X1 PN visit. No other calls.
(Total hours approx working away from home 35 hours + 1-2 hours phone and admin work)
Called out outside working Monday to Friday working hours – twice
I for one flourished and loved this way of working. The rewards that I derived from the relational model of care continue to resonate throughout my perspectives on midwifery. The relationships energised and inspired me. Yes at times I was tired and wanted to ‘just turn off my phone’ yet these times were frequently ‘healed’ by the next encounter, the next birth, the next moment of awe; that as midwives we have the privilege to be invited to.
Don’t let caseloading and continuity of carer worry you or cause anxiety. It has been a wonderful part of my work as a midwife which I often miss now embedded in academia. The joys of working that way always outstripped the moments of vulnerability. Providing advice and care to women and seeing and hearing first hand how it worked or did not work so well for them shapes practice decision making. Meeting up with women again and again over the years whilst they make their families is a joy.
I would say it was being a caseloading midwife that really highlighted the art and magic of midwifery in ways that will always be dear to my heart. Don’t be afraid of caseloading, it’s sustainable, enjoyable and doable with the right support and flexibility. I know colleagues who are still flourishing after 20 years working this way, colleagues with young children, colleagues who just qualified and colleagues who had never worked in the community prior to caseloading. The barriers to this way of working can be overcome with the support, desire and inspiration to succeed.
What do others think? Would this work in the Uk? Would this work as a national approach for Scotland for example? Do you have your own experiences?
In this blog I want to share my transition to working as a practising midwife in a totally different system from the NHS and independent midwifery roles in the UK. I had worked extensively both in the NHS and independently as a midwife. My passion is and always will be family centred primary focussed continuity of care. I love it, thrive on it, inspired and energised by that model of care. Long before all the evidence started stacking up in favour of continuity and primary birthing I was hooked, convinced and intuitively just knew it is how I must work.
After working at Queen Charlottes Hospital in West London with its massive rates of epidurals, feeling downtrodden by a system that continually frustrated me, I moved to a group practice with the newly established Chelsea & Westminster maternity services under the management of Paul Lewis in the mid 90s. The seminal moment at QCH came when I chose to follow a mother from the antenatal induction of labour area to the labour ward. She was scared and had come to trust me throughout my shift. I went upstairs and provided continuity until after her birth. I was reprimanded for leaving the AN ward despite getting a colleague to take my place for the shift. Going into a group practice at Chelsea and Westminsiter was super exciting. Changing childbirth was a real possibility for change. Yet I still craved the continuity 1:1 relationship. So I went independent in and
around London and Surrey. Loved it but didn’t like having to ask for payment. I then worked as a midwife in France (long story for another blog!). Returning to the UK I continued in a community Group Practice in south London before going to Cambridge to be the first consultant midwife at Addenbrookes. That was a whole adventure (I’ll save that for another blog!)
Then to NZ. In midwifery terms I had died and gone to heaven! I spent a short time locuming in a Auckland hospital. Then swiftly moved rurally and within weeks was booking women for full childbirth care. No need to speak about money, no need to speak about insurance, (New Zealand has a no fault compensation system called ACC), no need to speak about who is in charge of my days on or days off! I was self-employed booking as many women as I wanted and being paid for the midwifery work I did.
In NZ women ask around, look in papers, yellow pages, look on notice boards and ring around to find the midwife they want to work with. They can even find a midwife online:
For my part I advertised and got known. I was in the local press, interviewed on a local rural radio station and attended several women’s support groups in the area. In one month I was busy. One month I was dashing to three births in one night! That was very unusual. Most months I had 4-6 births due. After the first year word of mouth is the most powerful way to gain more mothers for care.
Once a woman has decided to book with me we both sign a contract. This contracts me to provide full midwifery services. This then gets sent to the Ministry of health (DoH in the UK). The ministry then pays me. Such a great system. In New Zealand about 50% of midwives work as self employed caseload midwives 50% as employed working mainly in facilities. All midwives from qualifying and being certified to practice choose which area she practices. Some midwives spend time in both areas in the course of their careers.
I was living pretty rurally at the time so needed to ensure I had back up and good networks. This is vital in rural caseload midwifery. I got to know everyone as you can imagine. Sometimes I could be super busy others more calm. But what is always beautiful is the depth of connection forged with women and their families from 1st trimester booking to 6 week postnatal discharge. The collaboration, working together and guardianship of that precious time is warming and ackowledging of the human capacity to be together in health care. I felt the childbirth process unfolded more safely due to that relationship, knowing women over time allowed for red flags to become easily visible.
Knowing women allows for the felt experience to be magnified. The spirit of childbirth over the extended rapport with women and families comes alive. I have been at births when 4 generations are present…magic. I am so often moved to tears and feel the hairs on the back of my neck stand up on end in the sheer joy of those Kairos moments. Yes I am tired at times but knowing woman when they call me in labour is far less exhausting and stressful than shift work and fragmented care. Being woken up at 3am to attend a birth of someone you know well is so different to waking for an early shift at the hospital.
As a Lead Maternity Carer (LMC as named in NZ) midwife I am able to get full access agreements with local hospitals to ensure continuity is safeguarded. At these times I honour and respect my hospital based core midwifery colleagues. With them higher risk women get the midwifery expertise required in addition to the primary focus I provide as the LMC. The interface of primary and secondary service misunderstandings and differences fades. Women are in the centre of care.
NZ midwifery is a truly integrated service. I said to a group of student midwives in the UK before I came to NZ how working in 1:1 ways with women over the childbearing year brings the felt experience of being a midwife to a whole different level. I now work with student midwives who have this embedded as the infrastructure of NZ maternity models of midwifery. Partnership, collaboration, protection and continuity lie at the centre of the philosophy of midwifery in NZ.
Watching a women grow into her breastfeeding confidence over 6 weeks knowing you have provided consistent advice from AN, immediate postnatal when she first meets her baby and then ongoing support…pure magic. To work with a woman who is terrified of labour and birth and to watch her roar with delight as her baby emerges in water at home and see the power and rawness of a new being unfold infront of me, to have the elder children that I helped into the world watch on as I return to the family each year to see a new sibling come join the party, magic. Yes sometimes things do not go to plan. But with well formed relationships so many things are possible, even when outcomes are not positive. The relationship helps, heals and restores.
I was invited to the funeral of a neonatal death due to fetal abnormalities. It was a traditional ceremony in a Maori Marae (meeting house), I was invited to speak and sing for the baby. The whole ceremony was nourishing and healing. The eye to eye contact, the hugs the authentic being together in human pain was healing and freeing. Relationships and partnership are key to midwifery; birth is always significant whatever the outcomes requiring tact and sensitivity – connectedness.
Continuity of care is evidenced based, many midwives experience working this way, we are learning how continuity is sustainable, how continuity can be the very aspect of midwifery that maintains passion and joy of practice. It is not a gold standard, it is a minimum standard for all mothers, regardless of risk, place of birth. Yet we all all need to ensure that a philosophy of childbirth and midwifery is deeply grounded in trust and appreciation of physiology, a way of attuning that honours the invisible qualities of childbirth, the spirit, heart and hold what is most sacred. Only then does continuity truly rise above the technocracy and fear surrounding childbirth. Fear can be moved to joy allowing all possibilities to arise!
Do you want to work in New Zealand? Working in NZ requires adjustment and further study. NZ midwives on qualifying are able to prescribe for childbirth related things (UTIs, mastitis, thrush for example). NZ midwives on qualifying need to be proficient in neonatal examinations and be confident providing care from early 1st trimester including miscarriage care, intepret scans, blood results and make referrals. I remember being professionally challenged ordering serial blood tests to measure HCG levels for a mother with threatened miscarriage shortly after arriving in NZ. With help from practice partners I learnt what I needed to do and say to provide support to this mother. Post natal care extends to 6 weeks; after my UK postnatal 28 days experience there was much to learn here also! The learning curve at the start can be steep and also includes gaining appreciation of a bi-cultural society and the history of colonisation on indigenous Maori. Transitioning from UK midwifery to New Zealand midwifery can be challenging yet that challenge depends on what you have done previously, what you want to do and how adaptable and open you are.
That is a taster of my own felt experience. Hope it adds to your thinking about the myriad potentials in midwifery.
Here is some useful links to explore more….
This is another reminder about how brutish the moment of birth can be. How those there when a new person arrives can turn from the wonder of Kairos at birth. Thank you for this blog that I share again here
Picture this… A mother sits holding her newborn son on a postnatal ward during visiting time. One of her visitors reaches forward, grasps the baby by the head and pulls him out of his mothers arms leaving him dangling by his neck. Can you imagine the reaction of the mother and those around? Yet no one raises an eyebrow when this occurs during birth.
If we accept that human babies are people and have feelings (both physical and emotional) why do we accept how many babies are treated during birth? What is the experience of birth like from the perspective of the baby? I realise that the following are extreme examples, but this approach is common place worldwide.
A medical approach to welcoming a baby to the world
Once the baby has been ‘removed’ their first minutes are spent away from their mother being subjected…
View original post 223 more words
This is a short blog to garner a dialogue I hope. I am curious about how midwives feel the need to feel in someway “other” to colleagues in the maternity team. I have been guilty at times of feeling the need to safeguard the sanctity of midwifery from others that I perceive don’t understand. Or feel a need to protect and shelter what is precious in midwifery from those I believe will overpower my own professional position, stand, opinion and indeterminate knowing that directs my art of practice.
Yet is such positioning helpful, constructive and empowering? I am proud to stand as a midwife within my community. I live and work in a community of practice with lay as well as registered medical colleagues. I know my skill set, my scope of practice and have a knowing that stirs within me and bubbles up into action when needed. Such intuitive knowing is a wellspring of knowledge issuing forth just beyond my visual awareness; an historical and cultural embodied knowing. A knowing that brings deep awareness of how I stand on the shoulders of giants. Of a vast history. I need not be intimidated and lash out, avoid, do good by stealth, aggressively reject what I disagree with or even passionately accept what fits my present knowing – others may feel awkward in hearing my over zealous self righteousness. They perhaps have a different knowing. They may feel attacked, unacknowledged and grow uneasy around me. These encounters of difference, of divergent ideas are merely an opportunity to explore more of the complexity that is childbirth.
The knowledge and embodied knowing about birth does not belong to an individual group, time, place or person.
It is not feasible that anyone person or professional Group can hold all there is to know. Surely no one would claim this?
What matters most to us all is – being safe, feeling safe, being loved, being seen, being with-others respectfully. What matters is that we all engage in miracles daily. We, those privileged to be at birth, get to be at the time of an exquisite specialness. A time which is the greatest of equalises. A time when we can gather in awe at the mysteriousness of life! Surely that transcends any professional differences and conflict; surely within this living kairos time the silent voices of our collective inner selves are permitted to sing out in unison? We can transcend, just for a moment, the divergent discourses that serve us little when what matters most arrives as a message in a bottle from beyond the horizon. This is a celebration of our diversity and differing ways of coming to our knowing. Then we see there is nothing to protect. Then we become still and silenced.
What do you feel?
“Rachel was born at home, unplanned. In the lounge of course, right in the middle of winter. She came on hard and fast. I just woke up about 9.30 with feeling uncomfortable again nothing really, just niggles. Went back to bed I rang Sam [midwife] at about 10.30, said “I’ve had a couple of contractions, nothing regular”. She said “Do you want me to come around”. We’d just had a snowfall that weekend the roads were quite dodgy so needed to make the decision to travel or not. It can take a good hour and a half, two hours to the rural unit depending on conditions and up to 4 hours to the hospital. So it was a bit scarier especially at night time. The gorge passes can be quite treacherous with ice and snow on the roads. I cracked on – the road trip was not happening, they’d all decided for me but the decision had to be mine. I wasn’t frightening at all. It was horrible outside, cold and the roads were really bad. I had visions of getting stuck on top of the gorge and having the baby out side with my bare bum out in the middle of the snow. I was not leaving even if others wanted me to, not with that length of time travelling and the terrible weather conditions. I was comfortable here at home, it was really lovely. The fire was roaring, put the jug on, and had a cup of tea. Sam called her second midwife and popped home and got her home birth bag. We had a cup of tea and settled in basically, parked up, and let things progress – just did what I needed to do”
Things are certainly not as straight forward as we would often believe them to be as Lynn’s story narrates. I am now dwelling amongst pages upon pages of post doc gathered data. The data is brimming with stories of maternity care lived experienced descriptions from a wonderful host of participants as the one above. I am always bemused and delighted when I come to the part of qualitative research that involves ‘letting arrive what needs to arrive’ from the data. Amidst the seemingly overwhelming complexity of life rendered in these gifted stories are the shared meanings that gesture towards our together humanness! In this is the possibility of transformative understandings and how to go forward. At the end of day I’m a swirling energy of interpretive images and words punctuated by my exclamations of “yes”, “perhaps”, “oh I feel that”,” I see what that means”, “where is my note pad and pen” “oh wait there is more”. No-one warns one of the insomnia that can plague a qualitative researcher once immersed in stories about life.
To be fully engrossed in the process is to be witness to the Dionysian possibility of ceaseless convergence and divergence. It is to find oneself in Kairos time when fixed notions of the “final answers, solutions and conclusions” find no resting place. There never seems a ‘right’ time to stop for the day – nor is there a moment when interpretation is complete! I find it liberating and freeing not to have it wrapped up and formulaic. To be released from the need to have the final word on any phenomenon is absurd yet funded research demands the ‘output’.
Apollo directs into reason, systems and defined predictable processes
The often spoken secret between us Hermeneutic phenomenologists is knowing there never will be one definitive conclusion; there will always be ‘on-the-way’ findings ‘that satisfies’ the funding agency and those that accept your work for publication. I say secret because however many times I say that this type of ontological work bellies any finality I’m repeatedly asked “so what was your final conclusion?” – I smile, “There simply is no ending to the process of life”.
Maternity care provision in the remote regions of New Zealand is a tale of paradoxical tensions. This tension is between the need to let go into the uncharted yet inspiring territory of what may lay beyond the imagination of our own experiences while taking heed to the Apollonian structured world of the modern maternity systems when ‘things’ are made controllable, timed, charted, documented, where protocols and guidelines dominate and attempt to construct and hold that world together. There is the nearness of being home and feeling safe and fear when one is far from the highly structured world of medical help when needed.
Rural living tells a story of being on the edge and outside of that controlled environment of the 21st century maternity hospital. I see and ‘feel’ hard working down-to-earth pioneer types living frontier lives in these remote regions. People dealing with the challenges of isolation and close community; of scenic places that are often holiday destinations for many of us yet are the homes and birth places of many.
I will not speak in this blog entry further on the findings for that will come later, I promise! For now I am intrigued about the paradox as stated above.
This research, like maternity care in rural areas and birth itself requires an openness, receptivity and trust. These unfolding emergent processes epitomize the Dionysian approach. As researcher and midwife I find myself being reminded on this journey that responding to what emerges is about attuning with wonder to what surfaces in a kind of creative evolutionary flow. To be immersed in research that seeks to reveal meaning is to drink of the intoxicating Dionysian wine that releases me to go beyond constraints; it can make me dizzy! In my research on Joy at Birth I wrote:
The birth experience uncovers a drawing near of divinity that puts us face to face with Otto’s holy-other as Dionysus the ecstatic liberator from worldly concerns “… something that captivates and transports … with a strange ravishment, rising often enough to the pitch of dizzy intoxication…” (Otto, 1917/1923, p. 31). I am reminded of the lovely madness just after many births when everyone is intoxicated, fascinated and enchanted. Something enchanting is experienced that can be a moment of transformation; a moment in which we find ourselves able to go forward into new understandings.
I then wrote in my field notes at the time:
As soon as baby came the father held his son up to the night sky offering an Islamic prayer, all the hairs on the back of my neck stood up. This was a holy moment, I continued to attend to the mother yet there was such a presence that touched and thrilled me to tears. [Field notes 2011].
The mood of the Apollonian thinking that comprises systems, measures and to do lists would appear at odds with this intoxicating freedom. Yet that is not what I argue. Both the Apollonian and Dionysian ways of attuning speak to us as humans. Actions in the remote regions to secure safety and positive outcomes require planned actions, sharpened clinical decision making and critical thinking.
A recent heated discussion on social media concerning midwives and promotion of normal birth provoked condemnation from some quarters. Again the splitting of ways in the normal vs abnormal debate bears no useful long term fruit. What is important is acknowledging and appreciating that we are always somehow in the dance of the Dionysian and Apollonian paradox. Statistics at times can be used as weapons to prove “being right” and held up to be the sole voice of reason. Conversely an emotional charged flow of words can imply “rightness” – yet this ‘feeling’ contribution to the debate can be accused of being chaotic, unreasoned and therefore less valued. Both however can come at us like arrows of righteousness and strike us wherever we are situated.
As Rumi, a sufi mystic poet said in the 13th Century:
“Out beyond ideas of wrongdoing and rightdoing, there is a field. I’ll meet you there”
To dichotomise appears to be the domain of inflexible thinking that seeks rightness and disregard of the other. Likewise I am finding once again that the research project (whatever it may be) requires a Dionysian openness and flexibility. At the same time I need to pay attention to the more Apollonian disciplined processes such as the ethics procedures, funding applications, attention to literature (yes -quantitative and qualitative) and the academic restraint on styles of writing. It is in a sense a dance in Rumi’s field. It is neither this nor that, not a wrong way or a right way it is always dialectic, constantly both, one within the other…that is the tension.
Lynn had planned on a facility birth yet had her baby at home by the warmth of her own fire after a cup of tea with her husband and the local rural midwives. The snow storm and the worrisome distance from hospitals and secondary services lie beyond this tender scene. The story reveals qualities of relationships, trust, surrender and feeling safe. Life is always far more than we can predict and order.
For me it is about letting go of being right OR wrong and enjoying the fun of being finite in a universe of infinite possibilities that confound us! Befriend your Dionysian and Apollonian qualities.
Recently I did a workshop exploring 2014 and how I’m going forward into 2015. It was a beautiful thoughtful workshop with a group of like minded others cooperatively inquiring into what it means to be alive and together. I declared 2014 a year of “Relief, success, joyful connections and stuff that needs and beckons attention!” I love the contradictions in that yet feel how 2014 brought challenges that have informed my moving into 2015. I announced that 2015 is a year of “enriched relationships, deepening self-awareness and gratitude for my multitude of choices”.
I am now pondering relationships and what that means to me personally and professionally. What is enriched relationships? There are certainly my professional work based relationships, relationships via social media fora, social/fun connections and family. Yet there is something remaining invisible and ungraspable. The sense of what lies between us all, the mystery of relational connectedness. The moods we find ourselves in gesture to understanding the world. If I’m joyful the world I create around me is experienced vastly differently to a day attuned fearfully. For example arriving at a labour and birth attuning to fear directs my awareness to risk averse tasks, arriving with a feeling of joy draws me into something quite different, something wholly relational in quality. What is this mysteriousness going on between us, in our eye to eye contact, the mutual hug, the knowing smiles, eating together, sharing of stories, of being together…?
Yesterday I had the pleasure of sharing tea and cake with an old client and her 3 children. The mother gave me that extra-long hug and prolonged eye to eye contact infused with mutual positive regard when you just know you are connected on a deep level. The eldest child, Frida, as I was leaving run towards me jumped into my arms and gave a big whopper kiss on the lips. She starts school tomorrow at age 5, I was moved as I glimpsed a memory in her eyes of our first eye to eye glance when she was one minute old.
With this recent experience I wonder what is really going on – is something “always just there” despite my fluid moods which apparently alter my daily perceived realities! I feel something is surely going on between us in every moment. The moments between Frida and her mother were nourishing and extraordinary. There is something between us that beckons. A space of flourishing beyond right doings and wrong doings, notions of right and wrong. A felt sense of spiritual other when we attune consciously together in an intimate encounter, such as at a birth, tender moments with a friend or work colleague, when we sit in a circle (such as at a workshop), read a letter from a loved one. There is something tangible yet unseen in that space between I and You.
These precious and treasured moments I understand as a manifestation of relational spirituality. Although they are never complete they gesture infinite unravelling possibilities. Spirituality is thus not of faraway mystical places of the imagination (could be these realms also) but felt in our embodied experience of being alive together on this earth, in this time. Relational spirituality is felt when we see an old friend for the first time in years yet continue to just “know them”, their circumstances may have changed, their lives altered. However in those moments we are gifted the beauty of what lies quiescent and ineffable between us in our connections.
A beauty often over looked and given no significance in our busy professional and personal “doing” lives. The beauty is at the heart of who we are, our being; it is That which allows us to flourish. Yet this seems to require a certain authentic way of being in the world. The sweet possibility to be vulnerable with self and others in ways that are normally not expressed in everyday life. Someone recently reminded me of a Rumi teaching – “when you seek God, just turn to your friend and look into their eyes” – such a simple technique for dissolving conflict arising from difference or what seems contradictory. The challenge of integrating personal, professional and spiritual life encounters leaves me bewildered at times. The long staff meetings at the university where I work, teaching a class of student midwives, running a busy antenatal clinic, to name a few. Allowing myself to live through and within the presence(s) around and between us, gifts a certain permission to pause in my “doing” and to simply ‘be’ allowing access to this hidden treasure in life. This opens myself and others I encounter to celebrate and affirm our presence in the world. Such moments I find traverse the different aspects, roles and responsibilities of our lives.
I remember speaking with a student midwife recently who was concerned that she cried with joy at a birth. But why not feel and express joy in our lives? I asked her to share how the birth was special and how it made her feel. It was a beautiful dialogue. The potency of these feelings are embodied and embedded within relationships with others. In this context to be at a birth is profound, stirs us up and brings a depth of knowing not encountered much in our everyday life.
It is not surprising we are touched and moved – sometimes we experience embodied moments of tearful joy. It’s a celebration of our immanent experience of what is divinely sought in our lives. Immanent and transcendental presence in the world manifests in the form of our shared natality. Yet how is it that mortality over shadows natality? We focus copiously on mortality and morbidity avoidance in maternity yet natality sings out to us of newness, potential and endless creativity stretching far beyond our thoughts, protocols and daily activities. Tears of joy and sorrow are to be welcomed. They are embodied expressions of our relational spirituality. They are tears of yearning to feel connected and a symbol of our return from separateness and aloneness.
Spirituality is immanent, experienced in the ever unfolding creativity of creation in our lives with others. Immanent spirituality brings a sense of the sacred into our lives by connecting at once with the transcendent. For example when I am privileged to be at birth I am immersed in the magic of a creative act within creation. Simultaneously I and You are in relation with a vast unconfined unknown time that stretches back and forward meeting in a sacred Kairos moment.
The transcendent for me is beyond form, it is the non-material, otherworldly, unexplainable inspiring felt mystery of life. Participants in my own study and similar studies on spirituality at birth speak of unseen others, ancestors, spiritual otherness and the presence of those yet to come. This immanent-transcendent human experience co-exists, they are not dichotomous.
This living paradox in our lives frustrates our need to understand and have it all wrapped up in logic. This ineffable quality of our lives remains forever unexplainable. Do we need to remain open to further knowing and inquiry? My concern is that we simply avoid such inquiry. Relegating the spiritual explorations in life to a personal ‘hobby’ and dropping spirituality into the too hard basket at work avoids the risk of self-exposure in a revered and dominating “matter-of-fact” technocratic attuned world that would make us feel vulnerable. As Lammi (2008) asserts: “One might expect that if the question of the divine is undecidable, it is a particular kind of question unlike other questions. I would argue to the contrary that this ‘undecidability’ makes it the very paradigm for all questions beyond the merely matter-of-fact” (p. 51). To inquiry and be present to spiritual experiences in our relationships with others allows far more space in our personal and spiritual lives to live more authentically. It is a challenge for sure.
To draw into nearness enriching relationships is to embrace spirituality as relational to all that is seen and unseen. My own research into being at the moment of birth is one such occasion when there is a relational gathering when each there at that moment is touched by mystery. All who gather there willingly and unwillingly reach out and touch mystery. To be touched at birth is to touch seen and unseen realms, to be left vulnerable – physically and feelingly in the sweetest of ways.
So I embrace 2015 and wish you all the magnificence of flourishing enriched relationships and relational spirituality; be courageous, real and vulnerable and let the magic of what dwells between us fill your personal and professional lives.
Heron, J. 2006 Spiritual inquiry, Lulu Press, USA.
Abram, D, 1996 The spell of the sensuous, Vintage, NY
Buber, M. 1996/1923 (Trans) I and Thou, Touchstone books, NY
As Christmas arrives, a time of reflection for many on a holy birth, I ponder the way we as society attune at birth today. All human experiences are culturally and historically determined, including birth. Birth as with all other human experience and understanding is contextual. As Gadamer contends we are viewing and knowing the world from an inescapable effective historical consciousness. We are in a way continually walking into our past. I argue like others that birth is not purely physiological but enmeshed in its own unique context. Therefore to explore any phenomenon at birth is at once to address all of birth, past and present which at the same time is connected to future possibilities. There are constant hints from history that gesture towards birth as significant fusing with contemporary horizons of understanding and possible futures. That is to say that how we tune into, tune in or attune at birth reveals how birth is understood.
It is wonderful when someone emails you with a story that resonates with your work. In itself it is deeply nourishing, affirming and brings forth a sense of shared knowing. With permission I have pleasure in sharing the following story. I would love to encourage others to share and create a forum to explore the spiritual experiences in around childbirth that many of us turn towards and become inspired by.
Here is Peter’s story of a pre-birth spiritual phenomenon ( all names have been changed on his request).
My name is Peter and I am a PhD candidate at Saybrook University in San Francisco. My field of study is mind-body medicine. I am quite familiar with subtle energies and the problems the field presents for quantitative inquiry.
I am contacting you because of an experience I had in the birthing room of my step daughter who gave birth to a healthy girl today. Yes, I am still coming to terms of being a grandfather at 48. My birthday is December 7… I am just providing this information to give context to my experience (not sure if it means anything).
So, here is my experience.
When I arrived at the birthing unit at the hospital, my wife and her daughter as well as my wife’s mother were there already. Jane, my step daughter was in labor, dilated about 4cm.
Jane had contractions as well. Here is the part that sent me on a database search, were I ultimately found papers authored by you. One on Kairos, another one about the joy of childbirth…
I swear, and no I am not crazy, I felt a very strong “presence” in the room. This “presence” or “subtle energy” seemed to become more pronounced when contractions occurred. Somehow I was able to pick up and feel this “subtle energy” that permeated the room and its human contents (myself, I can’t speak of the other people present).
It felt a bit eerie, at times quite overwhelming. When I looked at the “cozy cot” (the medical crib) that had been prepped for “Mary’s” arrival, the energy seemed to become even stronger. So much so, I took a picture of it. Not sure why… perhaps to capture the mood of “anticipation?” The mood of a “spiritual” event? Perhaps to capture this moment for the rest of my life as not to forget the impact the “subtle energy state” of room 201 had on me?
I stayed for about 5 more minutes during which the “subtle energy state” of the room did not seem to change much. I left, saying to my wife, “there is very strong, good energy in this room.”
I went to my office, only 10 minutes away from the hospital, to do some work, only to return an hour and a half later, after my wife called informing me that “Mary” had arrived. When I returned to room 201 the energy of the entire room was “gone,” “evaporated.” Compared to when I left, the “subtle energy state” of room 201 seemed to have been replaced with what I only can describe under the circumstances as a “vacuum.” Upon my arrival, room 201 felt just like any other of dozens rooms one might enter without great fanfare during the course of the day.
I have not read enough about this phenomenon to have the proper language to clearly document what transpired, but I am starting to investigate this “pre-birth spiritual phenomenon” (for lack of a better term) that I experienced.
You are my first contact, and I am wondering if you could point me to literature that perhaps deals with “spiritual” or “subtle energy” states associated with birth in shamanism or other indigenous healing rituals that might describe this phenomenon that I experienced in a bit more detail.
In closing, again to reiterate that I think that I am not crazy, my training in mind-body medicine provided me with extensive training and practice in mindfulness… observing non-judgmentally what arises, moment to moment, without reacting to it… whereas my training as research scientist has prepared me hopefully to ask the right questions in order to ultimately find ways to investigate and quantify such phenomena.
I would like to thank Peter for this sharing. The power and potency of what addresses us in and around birth is both visible and invisible. The world of our lived experiences around childbirth invoke and provoke such tenderness and awe. Something deeply personal yet shared and significant inheres within childbirth. Our responsibility whoever we are at birth is to safeguard such experiences so they continue to be and shelter them so they are protected from harm. Speaking our experiences can provide opportunity for us all to know we are not alone in what at times can seem such sterile medicalised environments. The spirit (whatever that be) continues to be however much we turn away from it’s calling, however much we attempt to cover it up and hide it in a world mesmerised by technological thinking.
Have others had such experiences they would like to share? Would love to hear.
Birth is a special event in all our lives, whether we have our own birth experiences, been at births, or not been at births, other than our own. In my own work I find that there is certainly an experience of deepening insight of a holy timeless moment involving numinous encounters and connections across generations at births. My own research work supports the sacredness of birth. I interpret sacred in this context as meaning a sense of holy specialness beyond mundane yet, at the same time, experienced as imminent and tangible.
Early and traditional creation stories tell of wonder and joyousness at the advent of new life and belief in holy other at birth is found through early history and remains throughout many religious cultures (Callister et al 1999). To this day myth and magic, ritual, sacred acts and holy rites around birth continue to be found universally throughout human cultures (Campanelli & Campanelli, 1998; Selin & Stone, 2009). The idea of birth being under the auspices of Earth Goddess and other female deities was strong (Crowley, 2001; K. Hill, 2011; Kitzinger, 2011). Women birthing may have called upon a feminine divine presence dwelling in the universe providing order and purpose. For example, the Gnostic gospels speak of God as Mother or Sophia (wisdom) who exists before all else. There is evidence that birth was interpreted as sacramental with spirits invited or/and sent away (Kitzinger, 2011; Selin & Stone, 2009).
Callister & Khalaf’s (2010) review of anthropological studies reported birth as a sacred and spiritually transforming experience rich in meaning. Some women connected deeply with their religious beliefs. A mother recalls: “…right as she [baby] was born… It felt honestly like a moment frozen…it was one of those moments when the spirit is there” (p.18). Another woman recalls the mood: “…there was something holy around me, something beyond the ordinary, a feeling, a spirit about being part of God’s creation of a child” (p.18).
Birth invokes a felt sense of holy, something of beauty inheres within birth. In my own 2013 study I say:
“There is also the feeling that holy-others draw near; others that are so near as to be unnoticed, others that bring comfort, new insights and deepening sense of connection. This mystery is difficult to ‘say’ but is at the same time something so simple and so near within the experience”
I contend that birth is a sacred and holy moment that acts as catalyst for change. Birth as holy is something greater than us as individuals. To name the holy can inspire but can also frustrate because it is invisible, immeasurable and dependent on belief and/or faith. However to be absent or invisible and unmeasurable does not prove that it does not exist or not! Love is arguably equally ungraspable. The holy numinous qualities at birth are timeless, they remind me of a Dionysius ecstatic experience “… something that captivates and transports … with a strange ravishment, rising often enough to the pitch of dizzy intoxication…” (Otto, 1917/1923, p. 31).
I will end this blog and share my interpretation of holy I wrote several years ago:
Holy for me is something private, tender and special. It is a blend of western Christian theism and Asian mysticism. It is the profoundest relationship in my life. It is an interconnecting knowing and loving, the source of all things; a creative force that provides and liberates. The Holy is invisible but whose actions are visible. It is the something ineffable, unexplainable that peeps through a poem, a painting, a child’s smile, the fragrance of an unfurling flower, the unseen artist painting the crimson dawn over the ocean. It is benevolent and seeks my happiness.
The holy calls me to serve others as in that serving I feel closer to what is holy. It shows itself from its invisibility through my experiences. When I catch myself moved to tears by another I know I have been touched by the holy. It is the glint in the eyes of all I meet every day and everywhere. It shows itself in the simpleness of being still and silent and in the raw of thunder and exploding volcanoes! When I stop and take notice the holy gazes back in the mirror. It is the wonder of body and senses. The holy holds all together and makes up the material of the physical earth; both imminent and transcendental.
The holy has a personality that attracts and inspires constantly sending messengers from beyond into my everyday life. It is all relationships in one. When I find myself in despair I feel furthest yet the holy is nearer than my ‘I’. The holy desires that I remember the deepest belonging and connection; the feeling that ‘I am in love and loved’. I come to know the holy in special moments when the invisible touches and reminds me of who and what I am.
To be at a birth is to be amazed, touched and connected. Being there is always a privileged and unique experience unlike no other.
Using poetry in research and professional life as an academic in health care practice could be construed as professional suicide. Yet it is a medium that keeps me sane and allows something more deeply felt to filter through. I am in the process of writing an academic journal article about poetry use in research and thought I would air some of my early musings.
When I completed my PhD thesis the final chapter evolved around a final poem that emerged from participants words (see below). It was risky – however it paid off. That same poem on request from faculty management is now enlarged and lives proudly framed in front of the midwifery school in the faculty buildings. When presenting poems in conferences the audience is often left in a quiet place where I have to confirm to the chair and audience – “I’m finished” so the session can end. Unspoken experiential processes play in that moment.
But why poetry? Empirically reported evidence using prose alone is important and certainly has a place in our midwifery and natal world. Yet there is always more.
well I made it to blogging! I love twitter but sometimes I just have more to say than a sentence can convey. So here I go – brave new world…
I’m not sure how this will evolve but I expect like all other things in life it will unfold and provide unexpected surprises. My first thoughts were “where will I find the time?” I dare say it will find its way into a space when I would have watched a silly TV show or spaced out in a novel. The ability of humans to be reflective and self-reflect is exciting. In reflective moments when we slow the world there is a possibility that things previously pre-reflective and thus hidden will arrive in a moment of insight from no where and everywhere. This blog is my avenue to explore, share and gesture towards pre-reflective taken for granted meanings in life.
My site is named ‘Kairos time – moments of insight‘, a timeless time in which something just beyond prior knowing springs forth and surprises. This is my space to share such times with you in the hope that a dialogue can bubble up!
Life can deliver a jolt to our sensibilities that reveal in an instant just how extraordinary life is! Being at the birth of another human being is one such moment. Yet everyday life has always held so much meaning.
“Earth cannot escape heaven
Flee it by going up,
or flee it by going down,
heaven still invades the earth,
it energizes it,
makes it sacred” (Meister Eckhart – lived: 1260-1329)
There is always something to discern in the invisible sacred layers of life, a richness of meaningful inspiring purpose not ordinarily expressed that dwells quiescent in the words, letters, doings and complexity of life. The challenge is always then to bring such moments of kairos to words for sharing with others.
I inhabit, as we all do, a sensuous world that lives, breathes, moves constantly with meaning. Meaning that continuously reaches out and touches as we reach out and touch life’s mystery. To write like this is to take a pause, to stop and trust whatever will arrive.
Life’s purpose and intelligence beckons me to be with others wherever they may be in meaningful and relational ways. Everything conjoins from the past and future into this present moment of writing – everything at this precious moment rests in an eternal now. As I gaze out of my Auckland home office onto the native bush, hear the Tuis (Native NZ birds) sing their exquisite melody, see the breeze playing with the leaves on the trees, the fragrance of orange blossoms flow into my experience, the dancing ripples of water as the tide re-enters the estuary beside my home and the warm tingling on my skin of the evening spring sun, there is also a growing awareness that my mouth is dry and my stomach desires food and I realize in this moment of pause that I am invited with others into a moment of conscious knowing. This is a felt-space of unseen depths that surrounds us, holds us and embraces all our senses.
Take a pause – it always seems to bring remembrance that life is so interesting and amazingly interconnected.
The day is complete watching the sunset