National Baby
a 1949 birth story, and the NHS maternity services crisis today
Yesterday, the Parliamentary and Health Service Ombudsmen released a report into maternity services across the U.K. Its findings will be no surprise to anyone who have given birth in the NHS in the last, say, 5 years. “Too many women and babies are being put at risk as expectant and new parents are repeatedly ‘failed’ by maternity services.” The report and its accompanying website contain stories of obvious clinical negligence and its tragic consequences. It contains many more that show the non-fatal but routine neglect that many birthing people in Britain have experienced or even come to expect. I’ve not spent too long reading it, partly because it’s too familiar. Not just from news stories about so many maternity scandals, but also from my generation of friends who birthed through covid. But as ever, I’m interested in how on earth we got here. At what point did we almost come to expect that care for birthing people in the NHS would, and could, be this bad?
I’m chipping away at this question slowly and lately went back to the very beginning: a book, published in 1950 called National Baby. The book is written by ‘Sarah Campion’ (an alias for author Mary Rose Coulton) who finds out that she is pregnant in the British Museum. She calls her doctor from a payphone outside the reading room at lunchtime. It is July 1948, one month since the ‘appointed day’ when the NHS had lumbered into being, and Sarah realises that hers will be one of the very first truly ‘national babies’, cared for not just from cradle to grave but in utero by the new health service. Over the coming months – too tired and nauseous to work on her novel – she keeps a diary of her journey through some of the first NHS antenatal clinics (buns and tea given out as standard!), the labour ward, theatre, and her first meeting with the national baby himself, Philip, (‘frankly, I don’t like him’).
I first read National Baby in the British Library in a single sitting. It was unlike anything I’d read about birth previously. During my pregnancy with my second baby during the second lockdown, I read lot of accounts of birth, trying to understand two parallel birthing universes seeming to exist at the same time. In one universe, women had relentlessly ‘positive birth stories’ in which they were the main characters. Their choices about birth determined the path that their labours took, and the wider context was reduced to flickering candles (electric, of course, so as not to burn the birthing suite down) and supportive birth partners. In the other universe, women were being engulfed by the machinery of the pandemic hospital, separated from their birth partners, stripped of their agency, and told, essentially, to do their bit for the diseased national body by not making a fuss. I was reading these competing accounts of 2021 births – on facebook, the news, via the CQC report on my local maternity unit - trying to work out which kind of experience mine would be.
After my baby was born, I realised that the two universes existed together, of course, and that women were simply making narrative choices. Were you telling a ‘birth story’ or ‘lockdown baby story’? Would you be an agent in your story, or talk about the context of the pandemic and its impact on birthing people? As much as I read, I had found no-one writing in a way that balanced the grim realities of the pandemic NHS with a sense of themselves as agents within it. I felt equally unable to reconstruct my own experience somewhere between these two poles.
Unlike me, Campion was making sense of her birth before the genre of the birth story (or, the birth trauma plot) were established. Her only piece of experience-based advice came from a friend who accompanied her to hospital in the taxi, ‘forget Grantly Dick Read, it’s going to hurt like hell’. When she gave birth in 1949, the rise of ‘birth story’ was still 20+ years away.
Sarah Stoller has written about how, in history of birth stories, we get a microcosm of the trajectory of second wave feminism. Birth stories were originally conceived of as a form of feminist consciousness raising: they recentred women, their bodies and their choices in birth, and wrestled it back from the control of patriarchal medicine. But this restoration of the agency of the birthing woman bled into an increasingly individualistic understanding of birth. Birth stories obliterated the wider context of birth, celebrating a woman’s achievements (you smashed it mama, you’re so strong, etc) and overlooking that birth outcomes were more closely connected to other forms of social inequality. Girlbossing birth was more likely to be achieved by heterosexual, white, privileged women. The agency-focused birth story obscured the context in which having agency was possible.
Campion’s proto-birth story, on the other hand, gives us lots of context. She shows us how her body and baby exist within the wider ecosystem of the NHS hospital, despite her attempts at singularity. In the antenatal clinic, she trades her identity for the generic ‘mum’ (‘the word, with its faintly facetious, faintly sentimental flavour, is universal currency in welfare clinics, ante-natal clinics and hospitals’); on the labour ward, she lies supine, surrounded by other women ‘working hard, grunting’, frustrated by her lack of ‘progress’ and the opaque instruction to ‘push from her tummy not her face’, (‘if ever there a child came into the world on a sheer tide of hot temper, that will be my child’). She is reluctantly taken to theatre for a forceps delivery under general anaesthetic (‘be careful with his head’).
antenatal clinics could be all day affairs, with live demonstrations of baby care basics (image from Dagenham, 1959)
Sarah doesn’t protest the obliteration of individuality up until this point. While pregnant, she muses, you ‘feel yourself as never before, singly and stoutly yourself; and yet need to belong, to be snug in the middle of the herd, safe, secure in the warmth of your fellow cattle’. It’s easy to read second wave critiques of birth in the NHS onto the immediate postwar period: the prioritisation of medical ease over ‘natural’ process, the quick recourse to anaesthetic and instruments, the conveyor belt or cattle market of maternity. But for Sarah, all these things hold an appeal. Socialist daughter of a Cambridge professor, she had spent her childhood at a girls’ boarding school, and the Blitz years managing London Underground air-raid shelter. She was, like many men and women of her generation, used to feeling ‘part of the herd’. She accepts that she must bend to the efficient will of the hospital.
It is only after birth that Sarah truly comes to resent the rigidity and routine of the hospital. She describes how women ‘came down from the labour ward triumphant, each one a queen’ only to find themselves being treated like ‘idiot children’ on the maternity ward. After giving birth she was kept on complete bedrest for 3 days, while her son was kept in the adjacent nursery.[1] Relieved of their babies, the women develop rivalries and solidarities. Those that are ‘allowed to walk’ sneak around after lights out to gather gossip and look out of windows. My favourite scene is when a handyman enters the female space of the ward to fix a lamp and the women, bored and rebellious, all chant ‘push, push, puuusshhh’ at him as he struggles to fit the bulb.
The maternity ward is a site of political education for Sarah. It’s here that she, an upper-middle-class socialist, develops a sense of the limits of socialised medicine. There are trade-offs: the focus on efficiency and routine meant little consideration for the women’s preferences and babies’ desires. She sees this as a price very worth paying for birth ‘on the NHS’. Her book is a plea to middle class women like herself to ‘use it’ despite its inconveniences and indignities. This is what so marked it out from the positive birth stories I’ve (over) consumed, and the tales of victimhood at the hands of the NHS which have become so hideously commonplace. Sarah sends women to NHS hospitals with their eyes wide open, aware of the trade-offs. They are political agents, even when ‘snuffling stale chloroform from their nostrils’ and bickering over small rations of baked beans on the maternity ward.
Yet, wealthy socialist that she is, Sarah’s account is peppered by class condescension and casual racism. She fetishizes and caricatures her working-class ward mates - and mocks the accents of migrant nurses. Her greatest contempt is reserved for the very middle-class women she is trying to speak to. It is not comfortably bourgeois women like her who she thinks will dismiss the service, but rather the newer, lower middle class of women who will ‘cling to privacy like a household god’. She, from her privileged position, sees that privacy (unobserved bedpan use and the like) is a ‘false god’ which should be gladly given up in service of the communal experience.
the brilliant People’s History of the NHS project has written about ‘Sarah Campion’ here
But Sarah always has the comfort of knowing that, ultimately, other options are available to her. It feels at times like she is ‘playing’ at socialism and at working class life. With their new baby, she and her husband (another writer from a wealthy background) move into a terraced house in a working-class London suburb. She delights in the communal shed, communal cat, leaves her baby in his pram to cry in the communal courtyard (rocked by a reluctant neighbour) while she writes the book about her communal life. At one point, she fantasies about a National Nappy Service as she describes lugging a nappy pail down to the communal washing line but decides it would be too much of a luxury. Sarah wants her readers to know that she is not too good for any part of the experience of having a national baby in Postwar Britain, and neither are they.
Sarah concludes that there has never been a better time and place to give birth than in Britain’s brand-new National Health Service. I don’t think anyone will be saying that about the national babies born in the NHS’s 75th year. In 2023, diagnoses of postnatal depression and anxiety are rising rapidly, as is the maternal suicide rate. Staffing is at crisis levels. While Sarah might have had the choice as to whether to use the NHS at all, most women now don’t (a private vaginal delivery is about £20, 000). Instead, since the 1990s, they have been given the illusion of choice through a marketized service which intends to create every patient as a consumer. Home birth or hospital? Birth pool or epidural? But choice was always presented as a luxury, not a right, and in the last years of austerity pandemic government we’ve seen how rapidly it has been taken away, if indeed it ever existed at all.
National Baby felt genre-busting to me because Sarah insisted that women could be agents in a system in which they didn’t have full autonomy. National Baby blended the personal and political, the individual and the contextual, in a way accounts of birth ceased to do in the decades since. And yet, in National Baby I detect the beginnings of the trap that the left fell into all too quickly – believing that they could not ask too much, expect too much, lest it be read as a criticism of the NHS. Criticise it, and they’ll privatise it faster. Criticise it, and you are saying you think you’re too good for it, that you deserve better. Birthing women – with sexist stereotypes like ‘princess’ or ‘too posh to posh’ – are especially suspectable to this in British culture, with its particular constellation of misogyny and class anxiety.
The wildly diverging birth stories I was reading in 2021 were, in fact, produced by the same cluster of ideas about limited entitlement and individual responsibility that exist around birth in the NHS. Ours is a culture in which all but the most egregious instances of negligence and neglect are ok in maternity services, and responsibility for a ‘positive birth’ therefore lies with the birthing person. It is a culture that fetishizes ‘making the best of’ the existing conditions, because it would be impertinent to ask for more. (Substandard facilities? Nevermind, just pop on your electric tealight and pretend you’re in a spa!) I personally read the boilerplate reference to ‘tea and toast’ at the end of every British birth story as a little bit unconscious of virtue signalling: however heroic my birth, I am not too good for the basic, cosy comforts of our National Health Service.
mmm, national toast (I did enjoy it)
When I lived in London (somehow almost a decade ago), I used to go to a GP surgery tucked around the side of the Golden Lane Estate, a modernist utopian housing project designed in the 1950s. On the wall in the waiting room, there was a quote by the firm of architects, Chamberlin, Powell and Bon, who had designed the complex: only the best is good enough for ordinary people. I’ve thought about that lots in the decade since, when I’ve had cause to navigate the NHS than I did in at the time I occasionally attended that surgery. I want to reject the National Baby version of 1950s socialism in favour of that of the Golden Lane Estate. I don’t think the best is too much for any of us to ask. If we want a National Health Service, we need to take a long, unflinching look at the horrendous state of maternity care, and demand more.
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[1] not being with her baby for his first hours bothered Sarah very little – something I’m planning to write about in the future