Growing up, I never really felt like I fit in. Luckily there was a bunch of us misfits, and we were our own clique. I honestly wasn’t bothered. I could see others desperately trying to be cool, and it looked like hard work for low reward and no guarantees. It seemed obvious to me that if you weren’t naturally cool, if you had to (visibly) work at being alpha, then you couldn’t hope to be admitted into the popular gang. And the life of a hanger on seemed miserable. I was utterly average, and actually quite grateful for that because it made me blissfully invisible. I could endure the horrors of puberty in peace.

The thing about adolescence is that we have to transition from care-free and innocent childhood via unforgiving puberty to reasonably well adapted adult human with some academic qualifications to boot. It’s a big ask. Made virtually impossible by the fact that an adolescent typically knows everything already and would quite like to be left alone now please. I like to think of it as chrysalis time, a totally unscientific theory that I made up in my post about Only Daughter (https://midwifemotherme.com/2024/04/13/conversations-with-my-13-year-old-girl/), who is currently in flux. I feel that, for most kids, it’s a system that works well enough. And we shouldn’t overthink it. Of course it’s true that some cocoons are more solid and constraining than others, and those kids might need assistance breaking free. Other kids seem to be born with fully formed butterfly wings, no cocoon needed. Most are somewhere in between. I like to think we used to be given more chrysalis time back in the day, but then again, I’m gen X and we were not over-parented! Now, chrysalis time is closely monitored and we are quick to label our kids if they seem a little too disengaged. We want to help, for sure. Maybe because we remember how difficult it was, and we want to reach out to them and make it bearable by showing understanding and compassion. Labels are a good way to do that. As Laura Kennedy says in her excellent book (Some of our Parts) about living with labels,

“Diagnostic labels clearly possess some appeal, if only as a means of explaining or giving a name to the friction so many people feel in navigating the world around them.”

Only Daughter is currently deep in her chrysalis and, not gonna lie, is often perceived as rude. Because she cannot be arsed to speak to you if she can possibly help it, unless you are a die-hard K-Pop fan. Good luck with that! Is she therefore autistic/ADD/some other form of neurodivergent? That could be a handy get-out-of-gaol card, and I could make that happen for her. But should I? To quote Laura again:

“My aloofness – for which I’ve been criticised since I was old enough to stare rudely at people without speaking when disinclined – ceases to be rude because it is transmogrified into something I can’t help… I usually CAN help it…  but rudeness is just easier sometimes… because sometimes you can’t be arsed to perform…”

She rather bravely acknowledges that this disinclination to adhere to social niceties might be a perfectly normal (if selfish) way to behave if you are ‘low on motivation,  tired, overwhelmed, low on desire to be liked or unwilling to prioritise the immediate comfort of others at the expense of your own.’ Hang on, she seems to be describing any pubescent human! She is, quite rightly, alert to the fact that some, unlike her, will find it impossible to behave otherwise, to mask, and that for those people, life will be much harder. But she also acknowledges that we all, in some respect or another, ‘move through the world as though our shirt has shrunk in the wash.’ The literature calls it masking but she would argue that most of us moderate our behaviour around others in line with social and contextual expectations. Because it makes our lives easier, and we know it. Or, perhaps I should say, we learn it. And some of us are quicker learners than others. I’ve lost count of how often I’ve apologised for/on behalf of my daughter. Could I let myself off the hook for having a seemingly spoiled (rude) child by attributing her poor behaviour to autism? Tempting, to be sure. Because if she truly can’t help it, then she no longer has to try, and I no longer have to apologise. In this day and age, it’s OK to be neurodiverse, and that’s a good thing. This benefits those whose brains will simply shut down when sensory imput is just too unmanageable. We will absolutely make adjustments in the same way we make adjustments for people with visible disabilities like wheelchair users. We wouldn’t expect a blind person to see, a deaf person to hear, or a wheelchair bound person to walk. But here’s the thing: a blind person might have a bit of sight, a deaf person might have some hearing  a wheelchair user might have some mobility. BUT: ignoring their impairment just because they can sometimes manage in our ablist world  is wrong. Just because you can do something if you absolutely have to (because there’s literally no alternative, but you’ll spend days recovering from the effort) shouldn’t mean you have to routinely do it especially when, with a bit of good will, a simple work-around can often be implemented. Work-arounds benefit every one. Every parent knows this. Because using a pram on public transport used to be an absolute mission. And now it’s vastly easier. It’s only when we really listen to differently-abled people that we suddenly see the obstacles. Even though these were actually glaringly obvious. Suddenly we realise that we, too, were jumping through ridiculous hoops just because that was the norm and who were we to complain if we were lucky enough to be able to perform. Cos we didn’t want to be labelled as non-conforming. Or rude. Despite the fact that there’d be a better way if you’d just had the nerve to ask. Or the ovaries of steel needed to make a fuss.

We recently had a woman – who had an autism diagnosis and a traumatic first birth – who was about to have her second child. She felt she could use her autism to bypass all the usual labour care and had somehow got her 10 page birth plan circulated to all the labour ward midwives. Well. I’m gonna be very honest here and confess that I was a bit divided about this. Loyal reader, you know how I feel about 10 page birth plans. But like me, I know you’ll feel dreadful for this poor woman who is so terrified, so traumatised by what happened that she feels she has to use the autism label in order to get what she needs. Which included jumping the queue in the assessment unit, getting priority access to a pool, refusing to engage with the midwife, refusing to let anyone monitor her labour’s progress, or her baby’s well-being.  That takes ovaries of steel. Not gonna lie, it came across a bit rude. Seriously, why come to hospital at all if you’re going to refuse care? How can we care for you if you treat us like the enemy? We endeavour to treat every woman in a uniquely individual manner, and will always do our utmost to respect her wishes.  While I’m highly aware we sometimes get it wrong, it’s never because we don’t care. We’re human too though, and sometimes we’re traumatised, and often we’re scared. Because we hold so much responsibility, and we cannot live with ourselves if we let something happen to your perfect baby. We follow our guidelines because they help ensure that we don’t miss anything that could negatively impact your care. Sometimes it makes us seem robotic and devoid of common sense. It’s a dilemma! And sometimes a woman feels that using the autism label will force us to use that least common of senses. Is that so unreasonable? As I’ve said before (somewhere in the middle) fear makes both sides less smart. Our 10-page-birth-plan woman is freaking out so she sends out a combative list of demands; midwives are terrified because this plan simply doesn’t allow us to do our job properly so we’re inclined to push back . Because any repercussions to the baby will be devastating to the midwife. That’s just a fact. One which isn’t often considered though. That isn’t to say there can’t be some middle ground. We can almost certainly meet most of her needs; we know that it’s in everyone’s best interests that we do. Believe me when I tell you that no-one wants a meltdown, and we will happily bend over backwards to avoid one. Because we really do care. It’s our job, our raison d’etre.  But. It’s easy to forget that in the good old bad old days, women were expected to speak English, eat English, dress English, pray Anglican, maintain a very British stiff upper lip, lie nice and still, have your enema, don’t make a fuss… Well. How many brave women stood up and caused a stink in order for all women to break the rigid and pretty brutal mould. And how grateful are we all to them now? If we’ve learned anything, it’s surely that everyone is different and women shouldn’t have to fight for non-traumatising care.

Not gonna lie, we clearly didn’t do a great job first time round for our traumatised and autistic woman but  seriously, first babies are unbelievably hard to give birth to,  and things rarely go according to birth plan. We still work super hard to make the birth bearable, but it’s not easy to keep the tiny perfect babies healthy and well.  For this, we need to work in partnership with the mother. We’re dealing with many burning airborne projectiles as standard, while constantly on the look out for new ones being thrown in. We cannot guarantee anything, but we will do our absolute best whoever you are. Maybe you don’t speak English, we’ll use interpreters; perhaps you have special nutritional needs, we’ll serve you vegan, diabetic,  gluten-free, hallal, kosher, vegetarian, low salt, pureed; you want a home birth, we’ll send midwives to your home; you want a planned cesarean,  we’ll do that, just name your date; you want a water birth, we’ve got plumbed-in pools; you want soft lighting and fairy lights, we got you covered. You’re welcome! But. She’s chosen to give birth in a very busy London hospital. We’re pretty darn good, but we’re not magicians. She may be autistic but we do kinda expect her to understand that. It would also be wonderful if people realised that we don’t interfere with labouring women for fun. The doctors would much rather hang out in their room, watching Netflix, scrolling through their socials, catching 40 winks, letting us midwives get on with things, rather than conduct an emergency cesarean, let alone an unnecessary one. But they will do (with the mother’s informed consent) whatever needs to be done (as per imperfect-but-research-informed guidelines) for that mother baby duo to ensure a good outcome. Both mentally and physically.

So yes, labels can be useful to initiate changes that will benefit everyone because they can help/force neurotypical people to see things in a different light, which promotes understanding and communication.  Which means less fighting for what you need. But give us a chance to care for you, we beg you. You don’t have to leave your cocoon, but perhaps make a little space inside it for us to look after you.

For Only Daughter, I’m giving it time. I’ll  still be calling her out on any rude and inconsiderate behaviour. I’ll also continue to smooth her path in any way I can. Let’s get through adolescence. Some butterflies take longer to emerge. I’ll be in the cocoon. With a chisel, just so I can carve out some windows to the world. And maybe a door!