Women are meant to be the primary decision makers in their own care – this was established by the Montgomery Ruling 5 years ago – yet a new study by Birthrights and Mumsnet has found that:
*24% of the mothers surveyed say their decisions and opinions about their care were not respected
*30% say their decisions and opinions were not sought
In a world where women should be kept fully informed and included in their care in pregnancy and as labour unfolds it comes as no surprise to me that this is not happening. As an advocate of communication, options and assertiveness, I speak to expectant and new mums all the time about the challenges they have faced with their care.
And while there are also very positive experiences where women have been included, respected and listened to, this should not stop us from wanting to see change so this becomes the norm for all pregnant women.
As a mum of three, a former doula and a busy antenatal teacher who has worked with thousands of women I have experienced, witnessed and heard about different issues with decision making. The main problem, as I see it, is the balance of power – there can be a sense of ‘we know best’ from some medical professionals who don’t want to enter into any kind of dialogue, let alone have discussion around options or to feel challenged in any way.
Women can feel intimidated and less likely to question, to gather information, to make a truly informed choice about options. I always recommend that, where possible, women don’t attend appointments on their own and that they go armed with written questions.
And in labour, it may be that options are reduced but women need to know that and they also need to know what options are still available. Open communication throughout labour is so important.
– Balance Of Power –
The maternity environment needs to change so that the intimidation is gone and so that balance of power is tipped towards women, with more open and honest communication and teamwork. And the fear around childbirth also has to ease because that’s where the power of the medical expertise lies. Labour and birth can be long, exhausting and challenging and there can be different medical issues involved but it is actually rarely dangerous. With labour and birth, women need to know that the medical expertise is there if they should need it but they also need encouragement, support, respect, kindness and good communication.
Even with medical interventions, birth can be calm and respectful. Caesareans, induction and epidurals are not bad – they can be very positive options. It would be great if maternity services were able to look more at solutions and strategies rather than just blocking with a no.
Something I hear a fair bit often goes like this: “I wanted to move about but I had an epidural so I was stuck on the bed and my options went out the window.” But for women who have an epidural it can be really beneficial to see how they can still move around the bed to encourage gravity, to give the baby the room he may need to get into a better position and to allow the pelvis to expand during birth. An epidural might not mean the end of movement, being upright and instinctive.
I once listened to a new mums talk about how she was told to stay on her back on the bed even though her instinct was to get up ‘because there’s no point being upright now’ and she then needed forceps. Who knows how different that might have been if she had been listened to?
A birth I will always remember was when an emergency happened and a baby needed to be born quickly – it was handled professionally and calmly by all the medical staff who needed to be involved and the parents were able to remain calm. The strength in that scenario was that the medical expertise was there, silently and it was shown by calmly doing what needed to be done and with good communication with the parents. Afterwards the parents felt that they were in safe hands because there was not panic, they were not scared.
– Allowed –
Maternity services can be beset with issues of consent and deadlines – with the sense that it could be dangerous if a pregnant woman doesn’t do as she is told. And language can include must, should, couldn’t and can’t.
The number of times I have heard ‘will I be allowed to…?’ In my own small way I am trying to change that, encouraging expectant parents to see labour and birth from their perspective, not a medical one, so they can say what they need and – with their birth partners – keep asking questions about their options, to be as fully informed as possible. It would help if the language could change and for all maternity services to be more open and supportive.
So, if you are currently pregnant, what can you do about this?
- I have a module in my antenatal course which focuses entirely on options – what can change them, what questions to ask, what you can do. You need to know what can impact your options so it is important to be informed and to be feel able to ask questions.
- Know what could help your labour and birth and what might not.
- Be honest with yourself – what feels right for you?
- Speak up
- Ask questions and ask for a second opinion if you don’t feel supported
- Write a plan – this is not about rigid requests but about focusing on what you think will be helpful for you, requesting open communication and support.
- Talk to someone like me so you feel more assertive and confident about your options.
And yes I know there are brilliant midwives and doctors doing amazing things. Let’s celebrate brilliant practice but let’s also raise awareness of the problems that lie within the maternity system as a whole so that communication improves and pregnant and labouring women are not shut down and excluded in their own care.
Please don’t hesitate to get in touch with me here.
Janine Smith | A specialist in pregnancy, birth and early parenting