The mess, grit, and dirt of the post-partum stable

No cheerleaders, nor midwives, no older women who had walked Mary's path before.

Imogen Ball

Imogen is a writer, mum, and priest on a new housing development in the South-West of England.

A Korean style historic illustration of the nativity.

Kim Hueng Jong (Korean, 1928-), Christmas Scene.

Clean, calm and collected,

That’s how it would have been.

The stable of filtered imaginings,

A picture perfect scene.

Perhaps more messy -

Undignified, unexpected, unseemly -

A not-so dream-like site,

As a king’s birthing barn that night.

Our unimagined stable.

No perfectly planned polaroid,

But in mess, mud, blood,

Is God with us

The stable of our Christmas cards, illuminated shop window scenes, and our children’s nativity plays is neat and tidy. A newborn babe lies quietly sleeping in a straw-filled trough, wrapped perfectly in a Persil white blanket. The mother, clothed and clean, looks on adoringly, standing over her child. Any animals present are gentle, still, and lying on the ground, unaffected by this unusual occurrence in their home. This is the stable of our imaginations.

However, the Bethlehem stable was the delivery suite for the Saviour of the world. And even a Saviour’s birth includes mess. I have experienced a variety of delivery rooms over my three pregnancies and each one has been messy. From birthing pool to theatre there is noise, blood, water, and tears. Birth is messy. And that’s not even beginning to acknowledge the mess that would have been in the stable to begin with! Despite this, the stables we see and celebrate never include the mess that Jesus would have been born into.

Birth is also extreme. It pushes the woman’s body to the limit of her physical and emotional capacity. She has laboured - aptly named for it is indeed hard work. Her body has been torn to enable this little life to be pushed or pulled into the world. She is exhausted. And now the work begins to sustain this little one outside of the womb. While inside he has been given all that he needs, now outside they must learn together how to feed. As the newborn babe is held close to his mother, he recognises her rhythmic heartbeat, his temperature regulates, his smell and touch encourages her milk to develop, and as he feeds, he contracts her womb for the placenta to be born and her body to begin to heal. They are still dependent on each other in these early hours.

Usually, this extreme and messy moment is done in community. It is not something we embark on alone. We have a support network of skilled people to help and guide us through birth. We have birth partners who encourage us, champion us, and remind us of our body’s innate ability to birth this baby. But Mary did not have this normal group of cheerleaders. There were no midwives at her birth, no older women who had walked this path before. Only her new husband, afraid and unsure of what his young wife was about to do. And then soon after, the Shepherds arrived. A bunch of slightly smelly, nocturnal chaps walking into a delivery room. Although they would have been familiar with mess, noisy animals, and birth, I’m not sure I would have rejoiced at their unexpected arrival. Somehow though, Mary graciously welcomes them into the space of what was probably a very messy stable.

Perhaps instead of the sanitised stable of our imaginations, we might consider an alternative imagining - the messy stable of the Saviour. A stable where the humanness of birth, of mother and child, and of life’s mess is fully felt. Because it was into the mess, grit, and dirt that the Saviour came. And it was from this mess that he was going to save.

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Article

Care

Comment

Economics

Ethics

2 December 2024

4 min read

NHS: How far do we go to feed the sacred system?

Balancing safeguards and economic expediencies after the assisted dying vote.

Callum Elwood

Callum is a pastor, based on a barge, in London's Docklands.

A patient eye view of six surgeons looking down.

National Cancer Institute via Unsplash.

“Die cheaply, protect the NHS” It sounds extreme, but it could become an unspoken policy. With MPs voting on 29th November to advance the assisted dying bill, Britain stands at a crossroads. Framed as a compassionate choice for the terminally ill, the bill raises profound ethical, societal, and economic concerns. In a nation where the NHS holds near-sacred status, this legislation risks leading us to a grim reality: lives sacrificed to sustain an overstretched healthcare system.

The passage of this legislation demands vigilance. To avoid human lives being sacrificed at the altar of an insatiable healthcare system, we must confront the potential dangers of assisted dying becoming an economic expedient cloaked in compassion.

The NHS has been part of British identity since its founding, offering universal care, free at the point of use. To be clear, this is a good thing—extraordinary levels of medical care are accessible to all, regardless of income. When my wife needed medical intervention while in labour, the NHS ensured we were not left with an unpayable bill.

Yet the NHS is more than a healthcare system; it has become a cultural icon. During the COVID-19 pandemic, it was elevated to near-religious status with weekly clapping, rainbow posters, and public declarations of loyalty. To criticise or call for reform often invites accusations of cruelty or inhumanity. A 2020 Ipsos MORI poll found that 74 per cent of Britons cited the NHS as a source of pride, more than any other institution.

However, the NHS’s demands continue to grow: waiting lists stretch ever longer, staff are overworked and underpaid, and funding is perpetually under strain. Like any idol, it demands sacrifices to sustain its appetite. In this context, the introduction of assisted dying legislation raises troubling questions about how far society might go to feed this sacred system.

Supporters of the Assisted Dying Bill argue that it will remain limited to exceptional cases, governed by strict safeguards. However, international evidence suggests otherwise.

In Belgium, the number of euthanasia cases rose by 267 per cent in less than a decade, with 2,656 cases in 2019 compared to 954 in 2010. Increasingly, these cases involve patients with psychiatric disorders or non-terminal illnesses. Canada has seen similar trends since legalising medical assistance in dying (MAiD) in 2016. By 2021, over 10,000 people had opted for MAiD, with eligibility expanding to include individuals with disabilities, mental health conditions, and even financial hardships.

The argument for safeguards is hardly reassuring, history shows they are often eroded over time. In Belgium and Canada, assisted dying has evolved from a last resort for the terminally ill to an option offered to the vulnerable and struggling. This raises an urgent question: how do we ensure Britain doesn’t follow this trajectory?

The NHS is under immense strain. With limited resources and growing demand, the temptation to frame assisted dying as an economic solution is real. While supporters present the legislation as compassionate, the potential for financial incentives to influence its application cannot be ignored.

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation.

Consider a scenario: you are diagnosed with a complex, long-term, ultimately terminal illness. Option one involves intricate surgery, a lengthy hospital stay, and gruelling physiotherapy. The risks are high, the recovery tough, life not significantly lengthened, and the costs significant. Opting for this could be perceived as selfish—haven’t you heard how overstretched the NHS is? Don’t you care about real emergencies? Option two offers a "dignified" exit: assisted dying. It spares NHS resources and relieves your family of the burden of prolonged care. What starts as a choice may soon feel like an obligation for the vulnerable, elderly, or disabled—those who might already feel they are a financial or emotional burden.

This economic argument is unspoken but undeniable. When a system is stretched to breaking point, compassion risks becoming a convenient cloak for expedience.

The Assisted Dying Bill marks a critical moment for Britain. If passed into law, as now seems inevitable, it could redefine not only how we view healthcare but how we value life itself. To prevent this legislation from becoming a slippery slope, we must remain vigilant against the erosion of safeguards and the pressure of economic incentives.

At the same time, we must reassess our relationship with the NHS. It must no longer occupy a place of unquestioning reverence. Instead, we should view it with a balance of admiration and accountability. Reforming the NHS isn’t about dismantling it but ensuring it serves its true purpose: to protect life, not demand it.

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation. If we continue to treat the NHS as sacred, the costs—moral, spiritual, and human—will become unbearable.

This moment requires courage: the courage to confront economic realities without compromising our moral foundations. As a society, we must advocate for policies that prioritise care, defend the vulnerable, and resist the reduction of life to an equation. Sacrifices will always be necessary in a healthcare system, but they must be sacrifices of commitment to care, not lives surrendered to convenience.

The path forward demands thoughtful reform and a collective reimagining of our values. If we value dignity and compassion, we must ensure that they remain more than rhetoric—they must be the principles that guide our every decision.