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"Englishness" and maternity care

It’s my last day in the UK for this trip. In reflecting on this visit, as I try to do each time, it is interesting to see what the big issues have been and what I have learned from the many midwives I have met and the many hospitals I have visited.

While I have been travelling about, I have been enjoying a book “Watching the English - the hidden rules of English behaviour” by Kate Fox. This is a delightful book, written by a social anthropologist, in which she explains why the English behave as they do.

The core characteristic she describes is “social dis-ease”, the chronic inhibition that underlies all social interaction, leading to “embarrassment, insularity, awkwardness, emotional constipation, fear of intimacy and general inability to engage in a normal and straightforward fashion with other human beings.” This may sound rather harsh, but it in fact leads to a very polite society, an obsession with privacy and a multitude of coping strategies that are familiar, such as “don’t make a fuss”, “mind your own business”, “don’t draw attention to yourself” etc.

Kate Fox also explains many other cultural habits that define Englishness such as their wonderful use of humour, their addiction to moderation, class consciousness, courtesy and sense of fair play. I recommend this book to anyone who ever travels or works in England - it will enable you to understand and appreciate what makes this country so interesting and different.

The book also explained some of my frustration, at times, in working with the midwives here. They know so little about what goes on in other parts of the country, even towns or cities close as a few miles away, and seem reluctant to try new ideas or strategies. I can see now that this is in part the English “drawbridge” strategy of retreating into the familiar home or workplace to avoid social contact and potential embarrassment.

Moaning is a national pastime, and often forms the basis of conversation. It is not acecptable to boast or promote oneself and constant complaining is much referred. It is therapeutic and part of the bonding process and is usually humorous in tone and seen as an enjoyable pastime. The down side is that when people write about a new service, such as a Birth Centre, or a caseloading midwifery practice, other perhaps interpret this as “showing off” or being too earnest about their successes - a definite no-no in this country. Moaning about a lack of services etc is much more acceptable, and absolves the complainer from having to do anything about improving them.

There is also the “keeping up with the Jones” element, a manifestation of the class system that pervades British society. A NHS Trust may not want to know what is happening in the next Trust area in case it shows up some deficiency that would put them in a bad light. It almost as if they say “if we don’t know what others are doing, and everyone keeps to themselves, we won’t be embarrassed by scrutiny of our service provisions”. There is certainly little consistency in either services, standards or quality from one NHS Trust to another, even if they are just a few miles apart. It is called the “postcode lottery” here and affects all areas of health care. It can mean that a woman on one side of the street, in one Trust area, can have a home birth, whereas her neighbour over the road, in another Trust area, has no homebirth service available to her.

The “social dis-ease” that Fox describes is also apparent in my workshops. I regularly broach embarrassing topics (the sexuality of childbirth for example) or ask participants to engage in uncomfortable activities (such as introduction games) to show that these things can be done, usually with humour and fun, and that once we overcome their discomfort, much useful interaction can occur.

I understand where they are coming from, and have many of the same English characteristics myself (being an Australian of English descent). However if we are to move forward and get better maternity services for women, some of these natural inhibitions will need to be challenged. It will mean “making a fuss” and “drawing attention” to new and notable programs, lowering the drawbridge to let in new ideas and seeking valuable conversations and interaction with colleagues in other places.

It’s been an interesting month, and I have learned much, as usual. There are many good things happening here with maternity care, but they need trumpeting, celebrating and publicising, so they can be embraced by others and not ignored or sidelined. Perhaps that is my main role in criss-crossing the UK on seemingly endless train and plane journeys - to be the messenger, mediator and communicator that helps to link these groups and individuals up. My next attempt at this feat will not be until March 2006. Meanwhile, I have a huge workload awaiting me in Sydney, where I will land in 2 days time.

Posted by andrea at November 01, 2005 01:51 AM