Informed Choice

Choice and Control

National guidelines recommend that women be listened to within a culture of respect, in which she is in control (NICE, 2014). Well, the Care Quality Commission (CQC) has just published its findings from the latest maternity survey, which asks women who have given birth in 2017 about their experiences of the maternity services, with responses from around 18,000 and it would appear to confirm that womens’ experience of care is slowly improving with each survey.

Around 77% of respondents felt they were always involved about decision making during their labour and birth, a small increase from 75% in 2015.  So it is understandable that health care professionals may feel that on the whole women seem to be happy with the care that they receive. However this does actually leave 23% of women who felt involved ‘sometimes’ or not even at all.

Every day across the UK  women are talking to each other, sharing their birth experiences, debriefing and supporting each other and questioning the ‘routine care’ that occurred during their labour and birth, the choices that were declined and the lack of body autonomy felt during the birth process. They come together in each other’s homes for mutual support and in cyberspace on forums and social media groups. These are not isolated cases.

As a result of the mutual support and learning that is happening,  doctors and midwives are seeing what are often called ‘complex’ birth plans being presented to them that detail the care the woman would like to receive  or decline. This is more than ‘I would like to move around’, it includes declining vaginal examinations, monitoring of the baby or a routine induction at 42 weeks.

Anecdotally I suggest that such requests and choices are often not well received. Being presented with a list of requests that flies in the face of nationally recommended guidance, raises questions for the midwife or doctor and challenges their experience, knowledge and professional accountability. How can a woman having her first baby consider that she knows more on this subject than a consultant obstetrician or midwife with years of experience? Surely the medical profession knows best?

Choice and Control

But is this something new? Are women becoming more assertive in the 21st century?

The National Childbirth Trust has been campaigning for women’s’ choice in pregnancy and birth for over 50 years:

“Letters began to flood through the door from women sharing unhappy stories of childbirth. Some wrote of being left alone in stirrups to labour for hours by themselves; others of how they had gas and air forced on them against their will; of fathers not allowed on maternity wards; and of babies taken away from their mothers as soon as they were born.”

Maternity care has definitely improved and health outcomes for mothers and babies, hospitals can look like hotels in some parts of the country, with partners welcomed. But if we look more deeply the cracks start to appear. Having worked with childbearing women since 1999, listening to their stories, and helping them come to terms with their experiences,  women continue to feel bullied, coerced and traumatised by the experience of their baby’s birth.

“I felt bullied by the local supervisor of midwives who rather than offer help and support tried to push me into hospital and made me feel that what I wanted to be doing was wrong.”

More than a healthy woman/healthy baby

The survey of women’s experiences of maternity care (CQC) in 2013,  showed that two thirds of women who responded regarding how involved they felt in their care, reported feeling that their “wishes were not listened to, not being able to make choices and feeling bullied.” If this was the case from a snapshot of 907 women who responded to that particular question, how many women out of over 700,000 per year giving birth in the UK feel the same way? Of course it could be said that only the women who felt they had a negative experience would be responding to that question, but it still is definitely a significant amount.

The internet and social media has brought women together across the UK, with easy access to discuss experiences, share stories both positive and negative and enable them to feel part of a community. Women are here, sharing their experiences, feeling bruised from birth both mentally and physically, recovering from a process that for some took away only their sense of control, self-esteem and confidence in their ability to birth and mother their baby. This is not only about a healthy woman and a healthy baby – healthy goes much further than the physical.

Being Childish

The National Society for the Prevention of Cruelty to Pregnant Women was founded in 1960, and has evolved to become AIMS, the Association for Improvements in Maternity Care.  It serves women through their website; evidence based informed choice publications, and local contacts. I have always signposted women to them as a national organisation that works in collaboration with policy makers, and was surprised to be told once by an NHS manager that I was ‘childish’ in my actions to inform women that they can seek advice and support from this organisation. Despite the inherent rudeness of such a comment, I realised how deeply ingrained it is within a system that some should see that informing women of their actual rights and choices as an opposition to the ‘hand that feeds you’.  That language stayed with me for years and has affected my own self-esteem and courage to be fully present for women.

I cannot begin to understand how it could feel for a woman to be treated in the same way, at a vulnerable time when her baby’s needs are paramount to her.  I do not believe women making informed choices put their own needs above their baby. They see labour and birth as a co-dependent event that requires a delicate balance to ensure the safe passage of their baby into this world, and the safe emergence of an intact woman and mother, not just in body, but in mind and spirit too.

 

  1. Read this by Beverley Beech “Challenging the medicalisation of childbirth”

http://aims.org.uk/Journal/Vol23No2/challengingmedicalisation.htm#3

 

References

CQC Statistcal report into women’s experiences of maternity services 2017

http://www.cqc.org.uk/sites/default/files/20180130_mat17_statisticalrelease.pdf

 

CQC report into women’s experiences of the maternity services 2013

http://www.nhssurveys.org/Filestore/MAT13/MAT13_maternity_report_for_publication.pdf

 

From mother to mother : the National Childbirth Trust archive

http://blog.wellcomelibrary.org/2015/09/from-mother-to-mother-the-national-childbirth-trust-archive/

 

Intrapartum care for women and babies: key recommendations

https://www.nice.org.uk/guidance/cg190/chapter/key-priorities-for-implementation

 

Association for Improvements in the Maternity Services

http://www.aims.org.uk/

 

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