“Oh, no! it is like a rope,” said the second man who touched the tail.

“Oh, no! it is like a thick branch of a tree,” said the third man who touched the trunk of the elephant.

“It is like a big hand fan” said the fourth man who touched the ear of the elephant.

“It is like a huge wall,” said the fifth man who touched the belly of the elephant.

“It is like a solid pipe,” Said the sixth man who touched the tusk of the elephant.

*

There is an ancient parable about a group of blind men who having never come across an elephant before seek to learn about this magnificent animal by touch. Each man feels a different part of the elephants body, such as a tusk or a leg, and then explains it to the others. Of course each man’s description is so different from the other that they are in complete disagreement on what this creature could be.

The point of the parable is to highlight that we have the tendency to base our ‘truth’ on our own experiences, often ignoring other people’s experiences and coming to conclusions based on our own thoughts.

The parable goes on to explain that the men, stop talking and instead start listening to each, collaborating in order to ‘see’ the whole elephant.

In time the men realise that they were all partially right, and all partially wrong. Why? Because our subjective experience may not be the totality of the truth. This teaches us that while an experience can be true for us, this isn’t the case for others. It shows us the need to evaluate when there maybe a lack of information available to us and also the need to respect different perspectives.

I love this parable because it always makes me think about pregnancy and birth.

We all know that birth is physiologically within the ability of women, that it can be powerful and wonderful. We know that evidence suggests certain circumstances and environmental factors support birth to be possible without intervention and a positive experience for all in attendance. It could be that this is our subjective experience or it maybe that this is what we know from the information we have be presented with. This may include where or how a woman should birth. It may include the way pain in birth can be managed or supported and how this can impact on the woman and her baby. It may be what the physiological norm is for the birth process. This ‘truth’ that we may have experienced or come to understand can mean us seeing birth a certain way.

However this isn’t the absolute truth. We know that often the birth experience is very different for everyone. So their ‘truth’ or perspective may be very different. This can be based again on their experience personally, where the place of birth was because of limited choice or interventions that were needed due to complications etc. It maybe that birth was traumatic, or that they lost a baby. So the perspective they may hold on birth can be completely different.

This can cause difficulties when looking to improve services or provide care that families really need. It requires those who make the choices around birth to see the whole ‘truth’ not just one ‘truth’ that maybe be shaped by their own perceptions of how birth ‘should’ be.

Each family is individual with different needs. These needs will be moulded by past experiences, culture, personal beliefs and circumstances. Some families are struggling with economic hardships, social issues, physical or mental health conditions. This all can alter how they view what they need to support them in their pregnancy and birth.

So what can we learn from the parable of the blind men and the elephant?

That when it comes to pregnancy and birth sometimes we need to ‘stop talking and instead listen’. While we have many forms of evidence and reports on which to draw our ‘truth’, as well as our own experience, we need to listen to families and what they are voicing about their individual needs. Hearing their perspective can be powerful, it also allows us to gain a full picture, a reality of them and their circumstances. It also allows for individualised care. Sometimes what we may see as a priority is far what what another person actually needs.

Here is an example.

We know that the evidence is that women who are classed ‘low risk’ should be supported to birth at home or in a midwifery led unit. Why? The evidence shows that it is supportive of physiological birth and means less interventions. All good. This seems to be a whole ‘truth’. Yet is it?

For a family considering a birth at home or in a MLU there is a lot consider. Many have voiced that their home or local midwifery led unit is a distance from the local maternity unit, sometimes up to 2 hours away. This being the situation they have felt that ‘should’ anything go wrong that it is too big a risk to take and so choose, often reluctantly, to birth in the nearest hospital maternity unit instead. Some may say that this is because there is ‘too much fear around birth’. I would agree that we have a lot to do to support women in birth, reduce fear and keeping them safe emotionally. However for that family, the choice they make they have to be able to live with. While reports or evidence may give knowledge that is one ‘truth’, a family may have a very different view of the choices they wish to make. Any choices we make always come with consequences so sometimes families may feel that it is just too big a risk to take, however small that risk may be. While we can share the knowledge, or as in the case of the parable, the part of the elephant we have examined, we need to also hear other perspectives. Sadly it can be the case that certain recommendations in birth are pushed on families, without an understanding of their actual wishes and needs. It doesn’t matter how evidence based something is, if it isn’t right for that individual great harm can be caused especially emotionally by coercing women into things that they feel are not right for them.

As service providers you may feel you see clearly. Yet are you?

How can you make sure you are seeing the whole picture when looking to provide maternity care?

Listen.

In the many years that I have supported women after traumatic births one clear theme is constant, that women feel they are not listened to. Both in antenatal care and also during birth. Listening to the concerns and perspectives of others is vital.

We also need to collaborate to see the whole ‘truth’, which includes not only an other person’s perspective, but needs. If a woman suffers with anxiety she may need the reassurance of a maternity ward, or, she may need the comforts of her own home, each is valid. The choice should be available for what is right for her, in her circumstances, and then support given for those choices as much as possible. This can be especially challenging if a women is considered ‘high risk’ which can limit choice.

This applies too when looking at improving or developing maternity services. We need to see the whole ‘truth’ and other perspectives. As service providers you can think you see clearly. But engagement with those that need maternity services gives a fuller understanding of what birth is to each family. Choice is important and the giving of choice allows for a more positive experience. Yet what if that choice challenges our view of how birth should be?

No one is truly right, no one is truly wrong. Each personal experience brings with it much that we can learn from, as too can the services on offer, both positive and what needs to improve. Rather than let our subjective experience, or limited information become our whole truth, let us listen, work together and see the many perspectives that others can offer so we can continue to support birth for everyone. Doing this when it challenges our own perspective can be hard, but doing so reduces the risk of harm to others.

Yes our birth elephant can be described many ways. Each partially right to that person. Yet together we can see birth as a whole, powerful, unique, and yes sometimes scary just like the magnificent creature that is a real elephant.

“Blind Men and the Elephant” by Pamela Zagarenski
Birth – The elephant in the room