For me there are three things that need to be considered here from a feminist point of view:
- A misogynistic health care system which doesn't centred women and can often led to poor communication, lack of proper informed consent and patronising attitudes to women. This is driven by ideology over evidence based medicine. It prevents discussion of a range of options and pushes women into situations and care pathways which don't suit their complex and very diverse needs.
- A defensive health care system which tends to lead to earlier intervention - which is the result of poor research in many areas of maternity care - because of the above mentioned ideological bias and because women's health is given second class treatment.
- Lack of staffing within maternity units because government won't fund it - again because of second class treatment - to the detriment of women's care.
- Lack of adequate understanding of birth fear and its causes. This is due to attitudes and ignorance. All the research I've seen on the subject (and I've read a LOT) points to a hell of a lot of things that come as a direct result of points 1,2 and 3 as well as a lack of understanding of the effects of trauma and abuse and how this impacts on childbirth.
- Lack of funding for training of staff - in particular removal of burseries - which particularly affects women because they tend to be more likely to go into nursing and midwifery.
- Staff and funding shortages leading to intolerable pressure on staff who are then leaving the field in greater numbers than they are being recruited. Which harms women in hospitals and women working in the field.
- Sexist attitudes which pressure women into particular fields in medicine, as they aren't regarded as 'good enough' or because of child care issues to be in certain fields. Gynocology and General Practice are the big two. This restricts the careers of women who are pigeonholed rather than encouraged to fulfil potential. It is true that women might well want to be cared for by women in childbirth; but that shouldn't come at the cost of restricting women's careers either. It simply means we need more female doctors to match demand and ways to enable women to pursue careers which are regarded as 'more ambitious'.
(As an aside to this, I note with that one of the reasons that men might be more attracted to gynocology might not be sexually based, but financially based. There is a lot of money to be made in private practice because of poor care within the NHS, ignorance in general practice of things like 'what is normal' and 'what women should put up with' with reference to birth injuries and lack of adequate funding for fixing women after childbirth. There is a hell of a lot of women who turn to private care for birth injuries because they just aren't getting the help they need from the NHS.)
There are so many factors going on here. I do think reducing it to the idea that it should be 'women who care for women' doesn't really help the situation on any level.
If anything it helps to drive the problem that if its a 'woman's problem' then its something men don't have to think about and something that can just be forgotten and neglected as an area of health. Because its 'not important as it doesn't affect us'.
As much as it might pain us to admit it, having a few male advocates in the mix who say 'this is our problem too, we all had mothers and this affects every man as a result' might well help change the dynamic. Thats not to say, the field should be dominated by men either. Nor that men should speak over or for women. Just that they might well have something additional to add that ultimately benefits us all.
(Another aside. My midwife went into birth fear as a speciality because of sexist attitudes because he was male. He felt that as a result he had to listen to what the women he was treating were saying particularly hard rather than just going along with the system as it was, in order to simply build relationships and be trusted. He was not granted this automatically in the same way as a woman. I do think it worth reflecting on how toxic masculinity negatively affects women not just directly through sexual abuse etc, but through the breakdown in trust and communication between men and women in general. Given that men in maternity feature as doctors and this isn't going to change, perhaps we need to reflect on ways that might help improve trust and communication across the board. Otherwise we really are looking at separatism and that might only serve to make social sexism worse not better. The point is there must ALWAYS be female consent for this and a woman can always say no - and there should be the resources available to enable this choice)
I don't know. I just see the issue from a number of different angles and considerations. And I think this entire thread has got bogged down in things which utterly neglect the reality of maternity services in this country.