The Freud Museum

Events Archive

24 June 2006

Psychoanalysis and Midwifery - revisited

Following the ground-breaking event in December 2004, this is a second conference exploring how psychoanalytic ideas and therapeutic insight can contribute to the practice of midwifery. The conference themes and talks have been based on questions and reflections submitted by midwives themselves. Introductory talks will be followed by discussion and time for questions.

Session 1: Working Relationships
Jennifer Johns (Psychoanalyst)
The idea of transference in psychoanalysis
Jane Bloom (Midwifery lecturer and group analyst)
Between ourselves: Midwives' emotions in training groups

Session 2: Unconscious communication in pregnancy and labour
Joan Raphael-Leff (Psychoanalyst)
Listening to hidden meanings followed by discussion with members of the panel

Session 3: Coping with uncertainty
Mavis Kirkham (Professor of midwifery)
Midwives Coping
Ricky Emanuel (Child psychotherapist)
The concept of "negative capability"
Annette Mendelsohn (Child psychotherapist)
Control, uncertainty and loss in a premature baby unit

To download a poster, please click here (c.37 KB).

Conference Report

We felt good at sunset. Our emotions during the day were more complex. But by the time some of us arrived at the Jeremy Bentham pub - where the greatest happiness of the greatest number is mandatory - we were ready to toast the Conference as we ordered drinks and nibbles. We hoped the other speakers and delegates were satisfied as they sped away in the bright evening light of summer.

We would like to begin by offering our deep thanks to the speakers - Jennifer Johns, Jane Bloom, Joan Raphael-Leff, Mavis Kirkham, Ricky Emanuel, and Annette Mendelsohn - for their thought-provoking contributions and intellectual goodwill. There was a rich range of style and tone on display: which induced subtly different thoughts and feelings. We would also like to applaud the delegates for coming to an unusual conference when a lovely June Saturday offered so many other distractions.

One of the glories of the first conference on Psychoanalysis & Midwifery [PAM-1] was the absence of tedious point-scoring and grandstanding. We were so gratified by the lavish praise of that December day that we made a fundamental albeit innocent error. Though it would have been doable and would have made money for the Museum, we didn't wish PAM-2 to merely repeat the format of PAM-1. Our hope was to attempt something daring: to imitate in our small way the great seminars that Bion had held in South America, in which professionals and trainees were invited to bring case material and personal experiences to the seminar, and Bion would comment extempore.

As many of the delegates of PAM-2 might know from the earlier publicity material, we began by inviting midwives to send in personal stories and comments, and also to bring them on the day. Some daring souls did write - with very moving material - and of course some delegates did share private experiences on Saturday. But this story-telling modality, and comments across the audience, rather than through the stage, never quite 'took off' in the way that we had hoped. Perhaps it was a failure of nerve on our part, since we still asked presenters to prepare (short) talks on specific topics within set themes, rather than abandoning ourselves entirely to the unscripted and unrehearsed.

We report this as a description only, not as a criticism. Another reason for the hesitation became clear during the day. And of course, we should have anticipated it. Unlike professionals in the talking-cure realm, those practitioners in the facilitating-birth realm do not get, nor are professionally required to get, regular clinical supervision whose primary purposes are not merely professional monitoring but also personal support and development. So they do not have a bank of experiences of that kind of case/storytelling. Towards the end of the day some of the delegates did begin to get this new aspiration and, most importantly, to believe that here was a group supportive enough to receive such fragile personal revelations. That it took some hours, and even some shared food, is not irrelevant, and the idea that midwives need support and supervision to be able to understand and carry the emotional burdens that are thrust on them became a touchstone for the day. It is astonishing that midwives do not receive such support, working as they do in an intensely emotional and potentially traumatic situation. And one which has such profound consequences.

At PAM-1 we were struck by a group-emotion very unusual in the staid realm of professional conferences. As speakers took emotionally animated positions based on theoretical preference and personal experience, there was a gathering restlessness and longing in auditorium for a group to come into being that would act as politicised citizens. Now consider these three remarks from PAM-2.

1: How can the Managers of Midwifery be made to understand the value of psychoanalysis? (female delegate)
2: Almost from the very beginning, the psychoanalytic professional community were able to insist, to each other and to the state authorities, how its work was to be done and supported. Central to this was the absolute requirement for all of regular therapeutic & clinical supervision. Why haven't midwives been able to do this? Why do they keep accepting ridiculous work loads: and why don't they demand therapeutic supervision? (Mavis)
3: I've been trying to understand why my colleague made me cry. (female delegate)

I was troubled and was irritably reaching for an explanation for the failures disclosed in these three remarks. There is yet another ordinarily radical question: Why do educated professional (and thereby middle-class) individuals put up with dreadful working conditions? I'd guess that as good people of liberal conscience they would look with pity, even look-down with pity, on battered middle-class wives who don't leave their brutish partners. There is even a named syndrome! How often do midwives utter Mavis's rhetorical question: Why do we put up with this? Of course this question is part of a set of similar questions that any health care professional might raise. And there we have again the confluence of socio-cultural-historical determinants that were explored in the first conference, by Mavis and others.

During the conference someone suddenly said Midwifery is a unique profession. Again it seems strangely hard to keep in mind and heart the truth and grandeur of this remark. A doctor might have to be present in the birth-realm to ensure a safe birth, or to prevent a death, but a midwife is there to ensure a happy birth - that a new human being enters the world with absolute love, joy and hope.

We will close on a positive note, remembering what was good on the day. It was valuable to be grounded in some theory from Jennifer, and Jane, on transference and the theory of group processes. In showing the brilliant and moving short film Milk by Oscar winning director Andrea Arnold, Joan gave a salutary reminder that all humans strive to rid themselves of emotional hurt and can, at times, share the burden of another person's pain. And we remain, like babies, bags of multicoloured fluids. Mavis's rhetoric told how much there remains to be appalled about. Her stories of miscommunication between midwives, or between midwives and other birth professionals, were tragic and familiar. The case material from Ricky and Annette showed that even when society has arrived at sufficient midwives, who are well treated, human life is so complex we must continue to refine concepts, such as those of psychoanalysis, in order to explain and heal. The unifying metaphor of knitting comes to mind to illustrate the 'containing' function of the midwife that Ricky spoke of.
Like all great films, Milk, offered its ideas in an understated metaphorical way. If it is not stretching the metaphor too far, what can or must midwives and psychoanalysts do when their minds are heavy with the milk of new ideas: and with whom must they try to connect?

Kalu Singh and Ivan Ward (Conference co-ordinators)

The projected second Psychoanalysis and Midwifery day builds on the success of the first conference and attempts to address some of its insufficiencies. There were many spontaneous comments of appreciation after the first day:

• Excellent day of brilliant ideas. Thank you so much.
• An enjoyable, inspiring and confidence building day.
• Fabulous, thought provoking - I needed this.
• A wonderful day, leaving me feeling excited and challenged.
• A fabulous re-energising day.
• I've gained personal insight into my own practice as a midwife.
• Would encourage more psychoanalysts to contribute to midwifery journals and to provide input to midwifery training.
• I enjoyed the multi-disciplinary approach. Very unlike the usual midwifery study days/conferences and very welcome.
• I feel as though by participating in the day I have valued myself as a midwife.

but also some criticisms:

• Not enough time for questions and comments.
• There were too many papers...
• In a way the structure mirrored the plight of midwives - having to process a vast amount of stimulation and not enough time or help to do that.
• Not enough from the psychoanalytic point of view.

The second conference will address these issues by:
• foregrounding the value of psychoanalytic concepts to midwifery
• allowing more time for discussion.
• addressing specific problems of midwives.
• asking delegates to send in questions and discussion topics beforehand.
• issuing papers or abstracts to delegates.
• providing lunch and name tags to facilitate interaction between participants.

FORMAT There will be three sessions in the day. Each session will consist of short introductions to the topic followed by a longer time for discussion and dialogue. Although there will be a number of different speakers, continuity will be maintained by speakers and chairs swapping roles between sessions. The focus will be on linking up difficulties in midwifery practice with areas of experience with which psychoanalysts are familiar. We expect that the conference will address such issues as: stillbirth (and SIDS), maternal death, aggression towards midwife from mother; violent partners, pain management, body and mind, individual differences between mothers, emotional strains of the job, undervaluing of midwives in society and NHS, chronic shortage of midwives, and others.

This session will focus on the transference and counter-transference implications of the midwife's work, in relation to her relationships with colleagues, other professionals and clients.
• the relationship between a midwife and a mother-to-be is a transferential one (both positive and negative)
• the midwife also has 'counter-transference' feelings towards certain mothers, which, if unacknowledged, may interfere with her work
• midwives may experience emotions which have come from the mother-to-be
• transference relations exist in the work group
Question: Can midwives learn to use the transference and counter-transference in their work?
Speakers and Titles: Jennifer Johns (psychoanalyst) The idea of transference in psychoanalysis 15 mins; Jane Bloom (midwife, group therapist) Between ourselves: Midwives' emotions in training groups 15 mins; Moderator: Joan Raphael-Leff

• irrational behaviour and unconscious motivation
• traumatic events and their psychological impact
• the concept of overdetermination
• symbolisation
• the meaning of seemingly trivial interactions and behaviours

Question: Can midwives learn to notice and interpret (implicitly or explicitly) 'unconscious' communications with the mother-to-be? Is this useful knowledge?
Speaker and title: Joan Raphael-Leff (psychoanalyst) Listening to hidden meanings 30 mins - showing and discussing the film Milk (UK 1998) 8 mins dir: Andrea Arnold. The film is a story of the emotional aftermath of still birth. Moderators: Jennifer Johns and Jane Bloom

Uncertainty on the one hand and the inexorable beat of time on the other - the midwife is pulled in two directions at once and has to cope with two sets of anxiety-inducing situations.
• the fact that each pregnant woman is different, and copes with similar experiences in different ways
• why past experience is not necessarily transferable from one person or situation to the next
• the need to control the unpredictable and how this affects midwifery practice. The spectre of death.
• how psychoanalysts cope with the strain of unpredictability - the analytic stance and occasions when it breaks down.
• the shifting sands of advice and protocols; changes in management structure;
• undervaluing and denigration of midwives; identity and morale; social systems as a defence against anxiety

Question: Can midwives learn to keep their knowledge, experience and preparation in the background, in order to deal with each mother-to-be as a unique individual in the present? Would this be useful to their practice?

Question: what is the difference between a supportive social structure and one that undermines the role of midwives (from a psychoanalytic perpective)? Can midwives protect themselves from the negative impact of these 'extraneous' forces?

Speakers and titles: Mavis Kirkham (midwife) Midwives coping 15 mins; Ricky Emanuel (Child psychotherapist) The concept of negative capability 15 mins; Annette Mendelsohn (Child psychotherapist) Control, uncertainty and loss in a premature baby unit 15 mins Moderator: Joan Raphael-Leff

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