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Do midwives know about babies?


I was talking informally to a small group of third year student midwives recently. We were having coffee together in a break at a conference. I was – as I always am – impressed and heartened by the enthusiasm, liveliness, creativity and determination of this next generation of midwives. As it is these about-to-qualify midwives who are going to be the ones looking after my daughters when they have their babies, their knowledge and sensitivity are of importance to me!

We talked about how to promote normal labour and birth and how to persuade women that midwife-led care and home birth are safe and for many mothers, better options than birth under a consultant in hospital. We then moved onto the subject of babies (my favourite). I asked them, out of interest, how much of their training and education was devoted to babies. They were somewhat surprised by my question but one quickly responded that they were all confident and competent to administer the ‘newborn check’ and would quickly spot signs of jaundice, respiratory difficulties or infection.

Probing a little more, I asked how much they knew about the way in which babies find out who they are, what their world is like and what their place in the world is. What did they know about the ‘environment of relationships’ in which the under 3-months old baby grows his/her brain and begins to understand what it is to be human, as well as starting to decipher the musicality of speech which will soon enable him to develop language.

One student replied – with nods of agreement from her colleagues – that they knew little or nothing about these areas. I talked briefly about how much midwives can do to build a nurturing environment of relationships around the baby, and how their open-ended questions asking mothers and fathers ‘how they thought their babies were feeling’ could foster mentalizing capacity - the capacity to track the effect of their own mental states on their child and of their child’s on theirs.

The students wondered if all this was rather beyond the scope of practice of the midwife who generally ‘hands over’ the mother, baby and family to the health visitor less than two weeks after birth. I disagree. At the recent World Association of Infant Mental Health conference in Prague, one eminent speaker entitled his talk, ‘Birth: the moment of intervention par excellence?’ and went on to argue that birth was indeed the first and perhaps the best of the opportunities early care-givers have to foster in the mother and father that essential awareness of their role in helping their baby to develop neural pathways of trust and confidence that will form the basis of his empathy with others as he grows up.

Perhaps pre-registration training is also a moment ‘par excellence’ for building the understanding of maternity care staff of their role in helping new parents to understand how their mental states connect to their child’s, and their child’s to theirs.

Of the importance of mutual gaze.

Of the overwhelming need of the baby to engage with others.

Of letting the baby take the lead in ‘conversations’.

Of listening to their baby………

Two images come to mind:- I remember seeing a gardener picking up a flower head that had fallen to the ground and standing with it in her hand. She gazed at it intently before turning to me and saying ‘It’s just amazing, isn’t it?’ And I recall a midwife on a postnatal visit holding the baby about 20 cms in front of her face, with her hand gently supporting her head. She smiled at the baby and spoke softly to her. The baby smiled back and cooed. ‘Isn’t she amazing?’ she said.

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