The power of attentive listening

An extract from ‘Birth Shock, How to Recover from Birth Trauma’ by Mia Scotland, with kind permission from the publisher Pinter & Martin.

Compassion is key to midwifery. Midwifery involves being able to be ‘with woman’ while those that she serves embark on their journey of pregnancy, birth and beyond. During pregnancy, during birth, and after birth, we know that the mother’s relaxation levels are important. Michel Odent, the natural birth obstetrician, writes that ‘when you meet a pregnant woman, it is your duty to protect her emotional state’. This is because her hormones affect the growing baby. We want the mother to be in the soothing/compassionate system often, so that her body can rest and restore and grow optimally. So that she can have the luxury of thriving, without her mind and body having to prioritise survival by managing threats, fears and concerns. Midwives are a part of this process, helping mums to feel valued and important by listening to them. Listening has many powers that we have yet to fully understand. Lown, the renowned cardiologist, wrote in 1996 about the lost art of healing and the importance of attentive listening. 

‘it is impossible to treat a patient optimally without the basic ‘care’ that allows for positive emotions to displace anxiety or hostility, which in turn influence healing processes within limits as is now scientifically understood at the levels of neurology, immunology, and endocrinology’

He also believed that listening to the patient led to more success, in terms of diagnosis as well as treatments – more useful than a myriad of fancy technical equipment. I know about the powers of listening first hand, because I am a therapist. Compassionate care and listening forms the basis of any good therapy. Research shows us time and time again that the type of therapy is much less important to recovery than the nature of the relationship between the therapist and the client. Being listened to by someone who is motivated and able to help you (someone who is compassionate) is very powerful for healing. I guess it has something to do with the activation of the placebo effect, along with the activation of the soothing/ compassionate system. In the midwifery field, Jennie Joseph, a remarkable midwife who runs a birth centre in Florida, has shown us the power of compassionate care during pregnancy. In her own words:

‘we figured out that just being compassionate, open, trusting, listening; those kinds of behaviours, have literally eradicated prematurity in the population of women that I serve, and I do serve the majority of women of colour, women who are at risk for these poor outcomes, suddenly they’re thriving’. Joseph, quoted from a BBC Radio 4 Interview, 2019.

Prematurity is the leading cause of neonatal death, and having a baby in NICU is a major cause of maternal PTSD, so to be able to eradicate this is a powerful force for health care. Jennie Joseph regards physiological and emotional support as synonymous. Her aims are not to have a live baby and a live mother, but to have a thriving baby and a thriving mother. ‘What I’m doing is not even expensive, it’s care that’s going to keep you safe, the outcomes are clear’. She argues that communicating to a woman that she is welcomed, supported, and that the midwife cares about her as a human being, makes this phenomenal difference to outcome. It makes complete sense to me, and it’s exciting that science is beginning to catch up with this intuitive wisdom, by providing us with neuropsychological evidence of why and how that works. The compassionate system in the brain and body releases hormones that activate our healing and wellbeing. This effect is stronger when we feel supported and nurtured by health professionals.

Compassionate midwifery is also important for labour and birth, as well as for pregnancy. In terms of reducing birth trauma, we know that compassionate midwifery serves to reduce the chances of developing PTSD (Ayers et al.). Compassionate care is a health intervention in its own right. When birth attendants listen to women who feel vulnerable, women then feel that the staff have their back, and then you are improving patient safety, reducing risk and increasing the chances of a good outcome. Women know this at an intuitive level – they sense compassionate care when they get it. They know that compassionate care is about the relationship between them and the midwife, and that it is an effective intervention for relieving their suffering (Menage, 2020). For fathers too, compassionate care from the staff is regarded as important. In a study looking at birth trauma among fathers, it was found that fathers value the relationship with the midwives. ‘When participants reported that staff were calm and communicated with the couple, this appeared to ease the father and act as a protective factor in their overall view of the experience and how they felt after the birth’ (Daniels, 2020).

- ‘Birth Shock, How to recover from birth trauma’ by Mia Scotland is published by Pinter & Martin, £12.99. https://www.pinterandmartin.com/

- Read a conversation between Mia and consultant clinical psychologist Michelle Cree: ‘There is not enough research, understanding, respect or admiration…’.

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