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Balancing the Power in the Maternity system.

I find it hard to work in hospital maternity wards. In the South African private sector, the majority of obstetricians who are in charge of all the deliveries, not ‘births’ but ‘deliveries’, are autocratic in their decisions to ‘cut’ (doctor speak for perform a caesarean), vacuum, slice episiotomies or to induce their patients. Not ‘clients’ of course, but ‘patients’. There is little consultation or discussion, the patients are told, jovially, because they’re paying, that doctor knows best, and that they’re exceptionally fortunate to have a healthy baby. We all know that scenario.

In the public sector, where the births are also referred to as deliveries but are overseen by midwives, the lack of parental autonomy is even more pronounced. ‘Patients’ are seldom greeted by name, and abuse ranges from patients are being slapped across the face in labour, yelled at that they will kill their babies if they don’t behave, punished by being left on their own to birth their babies, or told to clean up their own ‘mess’ after giving birth.

My initial reaction is inflammatory. The balance of power must be addressed, the victims of the system need my help. We, who know better, should rise up and address these issues with sirens blaring, guns firing on semi-automatic and grenades exploding. David and Goliath stuff. Except that Goliath wins almost every time.

Albert Einstein, bless him for his wisdom, said ‘No problem can be solved by the same level of consciousness that created it’.

I need to draw far enough away from the situation that my incendiary reactions are not sparked by what close up can only be termed obstetric violence. From a distance I see victims and perpetrators caught in an unhealthy power dynamic in an over mechanized system that dehumanizes everybody, ‘patient’ and doctor alike.

You can’t have a rapist without a victim of rape, a bully without someone more vulnerable to abuse, a dictator without an oppressed populace. They feed one another. The midwives who are abusive to laboring women pick the most vulnerable women to be mean to; the teenagers, the refugees, the HIV positive women, the sex workers. For all that these women might be screaming or whimpering in pain in labour, they are voiceless victims in the system.

If I look deeply into the continuum of power, an interesting pattern around masculine and feminine archetypes emerges. These are not gender classifications. I know plenty of aggressive women and many wimpy men. In Chinese medicine the archetypes would be referred to as yang and yin. In the West the archetypes are probably clearer in their masculine and feminine forms. On a continuum of power from the extreme exploitation of the tyrant through balanced equity of power down to the total disempowerment of the victim, the negative masculine energy holds the most power and the negative feminine energy holds the least. Positive masculine and positive feminine qualities sit balanced in the center.

Power traits

Negative Masculine

Positive Masculine

Balance of power

Positive Feminine

Negative Feminine







Closed hearted








Warrior energy


Transcends emotions

Standing in Truth


















Secretive yet Gossiping


Martyr complex




Victims and abusers feed one another within this dynamic. By fighting for the oppressed, or trying to torch the system, the problem doesn’t go away, the dynamic remains the same. We have simply switched sides. We are still caught in a negative feedback loop where nobody is happy.

Unequal distribution of power is killing our planet through plunder and extinction of species and greed for more power. It is also killing the heart of the maternity system, because it is so hard to stay open hearted in the midst of so much fear and passive aggression.

What would Albert Einstein, Nelson Mandela, Ghandi, Martin Luther King or Aung San Suu Kyi do?

They would step out of the oppressor/oppressed loop and stand in their own balanced power in the center. Nelson Mandela was considered a fool to engage in dialogue with the Afrikaners and British Colonialists, who were responsible, either through their actions, or through their ignorant disdain, for imprisoning him for twenty-seven years for challenging the Apartheid regime. After his release, he didn’t trust that what they had done to him was acceptable or good; he simply trusted in the underlying goodness of their souls, beneath the fear that caused them to incarcerate him for all those years. He said, “The best weapon is to sit down and talk.” Our response to his trust was a global, unanimous love for the man. He imagined the best in his oppressors and brought out the best in them.

A centered place of power is a place of wisdom, truth, authenticity and clarity, but it is also a place of love and the ability to listen deeply to everybody.

If we think that it is only the women who are being slapped in labour who are in pain, we are caught in judgment and are not yet looking deeply enough. The midwives who are yelling at them are in pain too. No-one listens to them, they are undervalued, overwhelmed, emotionally overloaded and burnt out.

If we think that the obstetricians who don’t recognize the emotional needs of patients and infants are too focused on golf or on the latest technological gadget, we need to look deeper. They have insurance premiums that require that they attend a minimum of thirty births a month if they are to survive financially. Try doing that without a few cesareans a week! And in too many academic institutions worldwide, the hearts of medical students are forced closed during their training, as an unspoken part of the curriculum. They are taught that they have to hold it together at all costs and never show their feelings. They are taught to become authoritative and to give the impression of knowing it all, under the mistaken illusion that this will make patients feel safe. It is a lonely, often frightening place to be, where there is no debriefing and no skills training in compassionate care for themselves or their clients. They too need to be heard, they too want a better world for everybody. They too, hurt deeply under their masks when their patients are in pain or the midwives are abusive.

The doctors might think that a better world is one where they have more technology, the midwives might think that a better world is one where they have more power than their peers and can become like the doctors, the patients might think that a better world is one where they never have to see that midwife again and where they can seek retribution for their violent birth experience. All those things matter and are good. They need to be taken seriously.

But they will not change the system.

Let’s move into the center of our power. Let’s become like Mandela. Let’s be wise and listen to all sides of the story with equal interest and empathy. We are all in pain, and we all need love.

by Robyn Sheldon