What does it feel like being born?

AIMS Journal, 2022, Vol 34, No 4

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What does it feel like being born? - A Memoir of Pregnancy, Birth, and Bureaucracy By Jodie Miller Independently published (28 Aug. 2022) ISBN: 979-8848738261 295 pages At time of writing, this book is £11.21 from Amazon

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Reviewed for AIMS by Charlotte Tonkin Edun

Jodie Miller’s comprehensive account of a decade campaigning for humanised maternity care in Queensland, Australia, is a lovely read, but it’s also a book with a subtle sting in its tail. On the surface, it’s a fast-paced, enthusiastic rollick, testimony to what women can achieve when they set their minds to it. However, it is also a tragedy, underlining how conditional and short-lived the victories described in this caper really can be.

This book brought to mind a colleague's assertion that if we could harness the energy of all the mothers across the country between the hours of 6.30–8.30am, we would power the nation. Miller captures this energy beautifully. She describes scenes many of us are familiar with; meetings at kitchen tables with children in tow, informal and last-minute childcare arrangements, grasping uninterrupted moments to think and write. There’s joy here, and the satisfaction that comes from community and shared endeavour. The whole book is played out against this backdrop, without fanfare or celebration. The mental acuity, emotional gymnastics, commitment and patience required to get bodies up and out of bed, breakfasts consumed, lunches prepared, bags packed, shoes on, bickering averted, teeth brushed, clothes on, hair straightened and the thousand other tasks that make up the daily domestic duties, is neither judged nor lauded. It just is. This is a memoir of women getting on with it. The coming together of the private and public; mothers making change while simultaneously holding the world together. This is grassroots activism, the trope of the ‘Indefatigable Mothers’, seeing what needs to be done to determine better maternity care provision, organising themselves, and getting the job done. To have it recorded for posterity is a wonderful thing.

Miller does not, though, write through rose-tinted glasses. She is clear that these domestic pragmatics are only part of the work carried out by women.^[1] Miller pulls no punches in her authentic depiction of the essential ‘and/also’ nature of motherhood, and the intense reality of the mental load. She straightforwardly and unashamedly tells how her own maternal joy and pride could be quickly superseded by frustration and irritation; that gratitude for health and well-being was juxtaposed against resentment at the limitations children impose; her ambiguous feelings roused by a possible pregnancy, bringing with it the potential of both a precious child, and also more grinding drudgery that limits and restrains. This is a secret truth for many women, that we rarely find honestly and confidently expressed.

While this is a memoir evidently germinated from Miller’s transformationally positive birth experiences, and her inclination towards physiological birth is clear, she is not blind to the possibilities outside her own experience. Miller acknowledges the personal situations and structural conditions that influence the choices she and other women make in their own births, and their ability to engage with, and be heard in, maternity activism. Miller offers the slightest acknowledgement that her position as a white, middle-class mother affords her the time and voice to push for change, but her focus is on telling her own story. Those interested in issues of equity, power and hegemony in maternity services may observe how even this relative privilege is patronised and frustrated, and reflect on how much steeper the mountain may be to climb for women in more marginalised communities.

It might be possible for this book to be critiqued as falling for the ‘naturalistic fallacy’ that everything natural is better (thereby fanning the flames of the Birth Wars, and further diverting from the real issues at play); however, I don’t think that this is the change that Millers activism demands. What Miller is really driving towards is that not all women, not all births, are the same. This truism should be the basis for maternity services that offer women appropriate, attainable, and realistic choice. Not the wholesale replacement of one service with another, but a woman’s right to choose.

And this is the depressing bit. Miller gives a good account of 10 years of maternity activism in Australia and the US. So, what Miller perhaps unwittingly gifts us, is an insight over both time and geography that reveals that the same structural and systemic issues are being played out over and over again. Miller's campaigning achieved some successes. However, regardless of the successes of local and regional campaigning, the cycle repeats. Women explain, request, agitate, and demand. Their quite reasonable efforts to effect change are dismissed as stubborn and wilful or nice-to-haves in the shadow of medicalised, paternalistic attitudes to birth and women’s bodies, which ultimately hold the power and determine the outcome. All of which - in contrast to those working within the organisations we give birth in - is unpaid labour. In the end it comes to naught. Still we face the same challenges in accessing humanised, physiology-informed maternity care. Still all women’s bodies, all births, are forced through the same narrow funnels of care protocols. Still we have to face down those in power (and holding the purse strings), firm in their belief that they know better than the women who inhabit the bodies that are subject to their services. Still women must gussy up, brace, and push on, regardless of the evidence demonstrating our demands are, more often than not, unequal to the inexorable momentum of the behemoth institution.

Miller's account of coming to and through motherhood is honest and considered, and will resonate with many women who will find their own experiences of motherhood, pregnancy and birth reflected in this book. Miller writes well, and so this is both a thought-provoking and a rewarding read. For campaigners and those working in UK maternity services, this book offers both inspiration and caution. Of the former, there’s brio, camaraderie and ideas aplenty. The latter might prompt a step-back to consider why it is that ‘what women want’ in maternity is so hard for us to access, despite the clarity of feedback from Changing Childbirth to Better Births, and all the activism through the years and across the globe.

Reviewer Bio: Charlotte Tonkin Edun is an AIMS volunteer, an academic researcher with a special interest in decision-making and continuity of care, and the Chair of the Maidstone and Tunbridge Wells NHS Trust Maternity Voices Partnership. She is also a birth doula and hypnobirthing practitioner in Kent.