Added comment - March 2019
During my career I have been inspired by, and aspired to be like, several midwives.
Professor Soo Downe is one of those, and I was incredibly fortunate to work closely with her during my role as a consultant midwife. Soo gave me confidence in my academic ability, and she fostered in me a sense of self worth. I remember hearing her giving a talk to several hundred midwives, and mentioning the work we did at East Lancashire Hospitals maternity service. I couldn't believe it. She really thought we were doing great things as a maternity unit, and it gave us a much needed confidence boost. Soo Downe is a transformational leader, and shares her knowledge and skills for the greater good, and not to receive accolade or to gain power. I was delighted that she 'agreed' to do this guest post, because I know that every nano second in her day (and night) is taken up with family and work. I hope you enjoy this small glimpse into Soo's amazing midwifery world.
Hi Soo, thanks for agreeing to chat to me here! Could you introduce yourself?
Hello my name is Soo Downe, I am a midwife and I qualified in 1985. At the moment I’m working as Professor of Midwifery studies at the University Central Lancashire in the Research in Childbirth and Health (ReaCH) team. Our main area of research is around the nature and consequences of normal childbirth.
When did you first become interested in becoming a midwife?
When I was at university in the late 1970’s, I had no intention of being a midwife at all. I was studying English literature and language, and beginning to wonder what to do with my life when all the years studying finally came to an end. In the middle of my degree studies, I found myself working at a maternity mission station in Bophuthatswana, which was a homeland in South Africa, at the time when the country was still suffering under apartheid. There was a long chain of events that led to me being there that is not worth going into, but the most important thing is I found myself watching women having babies quietly, peacefully with the loving support of the midwife nuns who were working there, with minimal resources, and, on reflection, no interventions that I can remember.
The labouring women were apparently completely unfazed by what was going on, and completely engaged in their labours. It came to me that, if we can get childbirth right, we can get the world right. It felt like a kind of road to Damascus experience, even though I’m not particularly religious. Having finished my 4 weeks in Africa, I came back and to finish my university studies, after which I worked for some months as a healthcare assistant at Guys Hospital in London. This was because I knew that midwifery was very unlikely to be the same in the UK as it was in the middle of a homeland in South Africa. Despite the differences, I still loved what I could see of the profession, so I applied to St Thomas’s Hospital in London to do nursing, because at that time I didn't realise that you don't have to be a nurse to the midwife. However, having been accepted on the nursing program, I found out that there were, at the time, two places in the country where you could become a midwife without having a nursing qualification. So I immediately applied to Derby City Hospital and that's where I undertook my midwifery training. It was not at the level of a degree or even a diploma, it was just 3 years of midwifery theory, practice, and skills development, and it was the most difficult thing I’ve done; far harder than my academic qualifications, because it mattered so much to get right.
Once I qualified I worked for about more years on the labour ward at Derby City Hospital. The labour ward had about 5000 births a year, so it was very busy, with a fairly high rate of interventions, including the early adoption of routine fetal monitoring for all women. This raised a whole series of questions for me that started to push me towards undertaking research, to find out what the implications were of what was happening. By the time I left Derby city Hospital in the year 2000 to move into academia, I had been working in a joint clinical and research midwifery post for several years.
What does a typical day in your working life look like?
Sadly, I am no longer working clinically, so my working day now is much less hands-on. I work in a team of about 12 people, and they are divided into 2 separate but related groups, one which I lead (the Research in Childbirth and Health group, ReaCH) and the other which is led by Prof Fiona Dykes (the Maternal and Infant Nurture and Nutrition group, MAINN). Much of our day is spent on the computer. This includes responding to hundreds of e-mails that come from all over the world from students and collaborators and colleagues, who are networking, writing papers, writing bids, and generally discussing questions of research and practice. More specific activities might involve writing a presentation for a national or international conference, meeting with one or two Ph.D. students to talk over the work they’re doing, talking to local midwives and doctors about the areas of research that might interest them, meeting with service users who are involved in some of our studies to discuss information leaflets, or how to disseminate research findings to a wide audience.
It might also involve the more frustrating bureaucracy that is growing all the time in higher education, just as it is in the health sector, including filling in large numbers of administration forms. I also attend a range of meetings, catch up with the work of team members, review papers that have been submitted to journals or bids that other researchers have submitted to funding committees, or teach and supervise undergraduate or postgraduate students. Occasionally we get a bit of space to write an academic paper, or a bid, and the day includes great excitement when were awarded finally one of our bids (on average, for most academics, only about 1:10 bids are successful), or when one of our papers is finally accepted for publication, or when one of our students is awarded their qualification after all their hard work, or when the media contact us to find out about the results of one of our studies which might be significant in practice or policy for the future.
Fairly often I visit colleagues overseas, to give keynote lectures or to talk about future research projects. Indeed one of the really rewarding and reinforcing factors in my work life is a number of countries I visit where women and midwives and doctors and other stakeholders are saying the same thing: we really need to get physiological birth right.
As you can see, it is extremely hard to sum up a typical day in this job!
The main focus of your work in promoting and supporting the normal birth agenda, can you tell us why this is so important to you?
What has always fascinated me is the sense that the process of childbirth is far more than just getting a baby out. It is something that links us back through all our ancestors, and into the future, and we are all (mother, father, baby) irrevocably marked by it. It is also one of the few experiences left in society which, when undertaken physiologically, is ultimately unpredictable and uncontrollable and, as a consequence, deeply emotional. It takes all those who experience it authentically to the very edge of their capacity to cope, and it says to them, you can do this – and if you can do this, you can do anything. Getting it right is therefore profoundly important for the wellbeing of families, and for future generations. While I have always believed this intuitively, recent exciting evidence from epigenetics seems to suggest that there is biological evidence for the impact of labour and birth on way genes might be expressed for the child, and for their adulthood, and then their own children in the future. So, for all these reasons, the normal birth agenda is really important to me.
There are some individuals and pressure groups in England that would like to abolish to the term ‘Normal Birth’. What are your thoughts on this?
I really dont understand why we can talk about 'normal child development' and 'normal adjustment to school' or whatever else, and not about normal childbirth. I am the mother of a profoundly disabled child, but I dont object when people talk about the normal development of their or any other child - I dont feel that that makes me or Jessica (my daughter) somehow less because she is (clearly!) not developing normally, and never will, and I certainly dont think I have the right to deny other parents the joy in the normal achievements of their own child. Why do we think we have the right to deny women who have normal births the right to delight in this?
I do tend to use the word physiological when Im writing about normal birth in the professional sense, but women routinely use the work 'normal' in terms of pregnancy and birth, around the world - and, indeed, in my experience very few other countries see any problems with it. It is part of the international definition of a midwife. I honestly think we should resist this populist pressure to redefine a fundamental female biological process as something 'other' that cannot be talked about. The problem is not with normal pregnancy and birth, but with the systems we have set up that render it almost extinct, so that women think that the traumatic things that happen to them in labour are 'normal' birth (indeed, I have seen a USA blog where a woman says her 'natural' birth was barbaric and horrific and then we find out half way down the blog that her labour was induced). Of course women who experience this feel they have failed, and are traumatised - but this is not normal birth, and it is not they who have failed, but us who have failed them - and we need to own up to this and change it.
The less we talk about what normal birth is, the more it will vanish. We need to say, loudly and clearly: unsupported, traumatic birth with unconsented proceedures and non-present staff (in all senses of the word) is NOT normal birth. Normal birth as we have always meant and defined it is the kind of birth that most women, with the right support and skilled, compassionate care can achieve - and for those women for whom this is not possible or desired, then the optimal birth experience is necessary for them as well. Once again, it isnt either-or but both-and.
Sometimes 'normal' or 'natural birth' advocates are criticised for 'encouraging unreal expectations' for childbearing women. What do you think about that?
I think the best parallel here is with the breastfeeding debate. The reason women found it so hard to succeed in breastfeeding in previous generations was because of the insistence of maternity organisations on profoundly non-physiological ways of managing breastfeeding. This meant that we had a whole generation of women who had ‘failed’ in breastfeeding, and so who could not help their daughters to do so; indeed, I suspect that some of them felt that, if their daughter did try to breastfeed, this was an implicit critique of their own ‘failure’. We are now in this situation with physiological labour and birth. We have a generation of grandmothers, and of friends of newly pregnant women, who cannot contemplate their daughter/friend having a baby without, for example an epidural. This has happened because we have created the circumstances in which it is very hard for women to have their babies without such technological help.
What makes the expectations for physiological labour and birth unreal is not women's innate capacity by large (although of course for some women and babies there will always be a need to intervene). Unreal expectations only exist because we have setup maternity services to make them unreal. Where we create circumstances in which women are able to trust those around them to give them space to labour spontaneously the vast majority will succeed in labouring spontaneously and positively and even joyfully.
What are your plans for the future Soo?
It would be great to finish all the projects that I’ve started and that I haven't yet had a chance to sort out or write-up!. However I think this is probably never going to happen – indeed, just getting to the bottom of my e-mail inbox would be a massive achievement, but again I don't expect to achieve this before I retire in about 10 years time!. More seriously, the major piece of work I want to start with colleagues including Holly Kennedy from the USA and Hannah Dahlen from Australia is to look at how what happens during labour and birth influences the well-being of mothers, babies, partners and families into the future, in terms of the epigenetic make-up of the neonate, long-term noncommunicable disease, and perhaps more importantly even, to find out what is about labour and birth that might help things to go right in the future for the baby and the family (see link). For example how, is it that some women with a difficult personal or family obstetric or medical history, or difficult social history, still manage to have very positive empowering life affirming birth and others do not. How many situations that are currently treated as pathological, such as long gestation or long labour, are actually physiological for some women and babies in certain family contexts?. Ultimately, can we use this information to make the allegedly unreal expectations that women have at the moment real expectations, by changing the maternity services globally, so that it maximises the potential for the best possible outcomes to mothers and babies in the future?
And lastly….what motivates you to continue to champion the cause?
All the factors above, I think!
Aaaaa Thank you Soo, for this incredibly insightful interview. So many childbirth workers (and childbearing women) are grateful for your hard work, passion and dedication.
You can contact Soo at: