Stand and deliver


The stories of women who have broken out of their gender straitjackets to become bricklayers, pilots and priests are old news but what happens to a man who breaks the mould by entering an occupation which was hitherto exclusively female? Declan Devane is one of six male midwives (more on the terminology later) working in Irish maternity hospitals. He is keenly tuned into the issues that surround a man working with women at a time when they are going through one of the most intimate yet vulnerable experiences of their lives.

"Initially, I did midwifery because, to progress in nursing it is seen as a bonus to have midwifery experience. But once I started, I fell in love with the job," he says. His midwifery work to date has mainly been on the labour ward. "To be involved in the delivering of babies is such a privilege," he says. "Although you need similar skills in antenatal and postnatal care, I feel it is in the labour ward that my skills are at their best. On the delivery suite, you are constantly being tested. No two labours are the same and you are continually making decisions, which I find challenging."

The practice of midwifery has its roots in the home, where, in the past, every baby was delivered by women. It was only with the increase in hospital births that obstetric care (with male consultants in the main) took over as a profession in charge of delivering babies. In some ways, the female preserve of midwifery has - up to recently - been a comfort to women. So how do women feel when they are faced with a male midwife when they arrive in hospital in the throes of labour? One patient I spoke to had a negative experience of a male midwife (not the interviewee) when, half-way through her labour, he came on duty (at shift change) unannounced and then carried out specific interventions that had been decided on. These interventions included rupturing the membrances (breaking the waters) and shaving the patient in preparation for a Caesarean section, both of which were carried out in a way she felt was insensitive.

However, other women have been very satisfied with their experiences of male midwives. Rachel Twomey gave birth to her second child last month and Declan Devane was the midwife assigned to her in labour. "I got a shock when I saw him but I didn't really mind the fact that my midwife was a man. As time went on, I realised that he would be with me throughout my labour. Overall, I would say that he was great. His approach was gentle yet firm," says Twomey. Devane agrees that women are often shocked when he arrives as their midwife but he doesn't believe women should be asked if they have any objections to having a male midwife. That, he believes, would be discriminatory.

"I worked in England for a number of years before I returned to work in Ireland and there the women were told at their antenatal classes that there were male midwives on the staff. At one stage, there was a policy in which one of my female colleagues would go into the woman first and ask her if she had any objections to working with a male midwife. Invariably, women said they did. Later, this policy was seen to be discriminatory. For example, you wouldn't be asked if you had any objections to working with an Asian midwife. "I believe in informed choice - that is, that women should be made aware at antenatal classes that there are male midwives on the staff," he continues.

"In England, I had male colleagues who worked as community midwives and they had to go to the homes of women in labour to advise them on when they should go into hospital. If they couldn't do that alone, their role wasn't worthwhile at all." Devane believes the rapport he builds up with each woman he is assigned to is of the utmost importance. "I always go to see the women whose babies I have delivered the next day on the ward and they say to me that yes, they were shocked initially but they had no problems working with me. It is these women who form my practice.

"However, I am very reluctant to go into a woman in labour at shift handover," he says, adding that in Britain, once a midwife is assigned to a woman in labour, he/she stays with her until her baby is delivered. If this involves working beyond her/his shift, then the time is given back elsewhere. Irish maternity hospitals tend not to offer midwives such flexibility.

When it comes to the more intimate parts of the job, Devane says that he uses his instinct on whether the woman in labour would prefer one of his female colleagues to carry out the procedure. "For internal examinations, for example, I get a sense of how comfortable the woman and her partner are and if I pick up the vibes that they are uncomfortable, I ask if they would prefer one of my colleagues to do it. Usually, however, I'll encourage the partner to stay for internal examinations whereas generally, the man is asked to leave for such procedures."

Likewise when counselling women on breast-feeding, Devane says that he finds out how comfortable the woman is with him before he will assist. "When I first started in midwifery, I was more embarrassed than they were. Breast-feeding is a situation in which two amateurs are coming together to do something that is supposed to be quite natural. Usually, the need for help over-rides the gender of the midwife. But I will always ask their permission before I help them breast-feed," he adds.

Like many feminists, Devane believes that terminology is important. "It is important that I am seen to be a midwife who happens to be male rather than a male midwife," he says. And on the suggestion that he should perhaps be called a mid-husband, he adds that the word midwife means "with women", so a gender-derived alternative is not necessary.

Interestingly, Declan Devane's wife, Marcella, is also a midwife. She says that she often gets surprised reactions from people when she tells them that her husband is a midwife. "Such reactions are usually from within the medical profession rather than from lay-people," she says. "Being a woman, you can be more blase about a woman in labour. In some ways, because we all have to go through it, a woman can be less sympathetic. Ultimately, we have to rely on the women themselves to know what to do when they describe their pain. After all, you don't have to break a leg to be a good nurse, so why should you have to have a baby to be a good midwife?"