The Power of One

by Sandy Kirkman

When health professionals find themselves working in situations that seem, to them, to be wrong, it is easy to become discouraged. It is true that one single individual may have little impact on a well-entrenched system, but this presentation aims to explore how some such lone individuals have changed the world of childbearing women in the past, both recent and distant.

Having enjoyed a long career in midwifery, I can look back over four decades and find, (along with others to whom I shall refer), that the rose coloured spectacles are really needed. There is no golden age of midwifery lying neatly to hand in the middle part of the last century so we must continue to persevere and do it for ourselves.

Examples of pioneering practice will be taken from each decade from the 70s to the current noughties. As I am based in the U.K. it is inevitable that many of my examples will lie on that side of the world. However, some will be more local and more recent. It might even be more useful to participants to ignore the examples I give (most of which are referenced below) but, as I speak, to think of individuals they have known who have exhibited the power of one. It may be better still for each participant to work out how they could begin to exert that power in their own situation.


Poem 1
Autobiography in Five Chapters

By Portia Nelson

Chapter I

I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter II

I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I’m in the same place, but it isn’t my fault.
It still takes a long time to get out.

Chapter III

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in…it’s a habit.
My eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter IV

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter V

I walk down another street.

Poem 2

“We are the music makers”
Arthur O’Shaughnessy. 1844–1881

We are the music-makers,
And we are the dreamers of dreams,
Wandering by lone sea-breakers,
And sitting by desolate streams;
World-losers and world-forsakers,
On whom the pale moon gleams:
Yet we are the movers and shakers
Of the world for ever, it seems.

With wonderful deathless ditties
We build up the world’s great cities,
And out of a fabulous story
We fashion an empire’s glory:
One man with a dream, at pleasure,
Shall go forth and conquer a crown;
And three with a new song’s measure
Can trample an empire down.

We, in the ages lying
In the buried past of the earth,
Built Nineveh with our sighing,
And Babel itself with our mirth;
And o’erthrew them with prophesying
To the old of the new world’s worth;
For each age is a dream that is dying,
Or one that is coming to birth.

References (Unlikely heroes)

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  • Downe S (2002) Childbirth is what we believe it is The Practising Midwife. October 5 (9) 4
  • Downe S Gerret D Renfrew MJ (2004) A prospective randomised controlled trial on the effect of maternal position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia. Midwifery. June 20 (2) 157-168
  • Walsh D and Downe SM (2004) Outcomes for free-standing, midwife-led birth centres: a structured review. Birth 31 (3) 222-9
  • Drayton S and Rees C (1984) Elegance for pregnant mothers “They know what they are doing” Nursing Mirror. Aug. 15 159 (5) iv-vii
  • Fern E, Gordon B, Mackenrodt C, et al (1998) The Ipswich Childbirth study. A randomised 2 stage perineal repair leaving skin unsutured. British Journal of Obstetrics and Gynaecology. 105 (4) 435 – 440
  • Flint C, Poulengeris P , Grant A (1989) The “Know your midwife Scheme” a randomised trial of continuity of care by a team of midwives. Midwifery. Mar 5 (1) 11-16
  • Flint C (1994) Getting to know your client. Modern Midwife Apr 4 (4): 14-15
  • Kirkham MJ (1992) Labouring in the Dark: limitations on the giving of information to enable patients to orientate themselves to the likely events and timescale of labour. In Abbot P and Sapsford R (eds)
  • Research into Practice: a Reader for the Caring Professions. OUP. Milton Keynes.
  • Kirkham MJ and Stapleton H (2002) Midwife support needs as Childbirth changes. Journal of Advanced Nursing. 32 (2) 465-472
  • Lumley J (1990) Through a glass darkly: Ultrasound and pre-natal bonding. Birth Dec 17 (4): 214-217
  • Lumley J, Small R, Brown S, Watson L, Gunn J, Mitchell C, Dawson W. ( 2003) PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community – randomised trial. Biomed central Public Health. 3. 36 accessed January 2005.
  • MacArthur C, Knox EG, Lewis M (1991) Health Following Childbirth: An investigation of long-term health problems beginning after childbirth, (11,701 women) HMSO. London
  • Oakley A (1992) Social support and motherhood. Blackwell. Oxford
  • Vernon B (2003) 2003, a big year in the portfolio of evidence supporting midwives and midwifery. Australian Journal of Midwifery. Dec 16 (4) :3
  • Vernon B, Tracy S, Reibel T (2002) Evidence based leaflets in maternity care. British Medical Journal Jul 6; 325 (7354): 43
  • Rees C (2003) An introduction to research for midwives. 2nd edition. Elsevier. Oxford
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  • Sandall J, Davies J, Warwick C, (2001) Evaluation of the Albany Midwifery Practice. Florence Nightingale School of Nursing and Midwifery, Kings College, London
  • Sleep J, Grant A, Garcia J, Elbourne D, Spencer J, Chalmers I (1984) The West Berkshire perineal management trial. British Medical Journal Sep 8; 289 (6445): 587-590
  • Sleep J, Grant A (1987) West Berkshire perineal management trial – three year follow-up. British Medical Journal (Clin. Res. Ed.) Sep 26 295 (6601): 749-51
  • (Little C) Sleep J, McCandlish R Elbourne D,(1997) Opioids in labour. Lancet Mar 8 349 (9053): 727
    Sutton J (2002) The rhombus of Michaelis: A key to normal birth, or poor cousin of the RCT? The Practising Midwife Dec 5 (11): 22-23
  • Sutton J (2000) Occipito – posterior positioning and some ideas how to change it. The Practising Midwife Jun 3 (6): 20-22
  • Sutton J (2000) Birth without active pushing and a physiological second stage of labour. The Practising Midwife. Apr; 3 (4) : 32-34
  • Tew M ( 1990) Safer Childbirth? A Critical History of Maternity Care. Chapman and Hall. London
    © Birth International 2005

This paper was prepared for the Future Birth: With woman, with child tour, Australia March 2005.

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