Informed Choice

Can you standardise birth?

From the moment I read Childbirth Unmasked I became acutely aware that a woman’s innate power in birth had been usurped by a series of interventions and technological processes. Unfortunately the system designed to care for 1000’s of women, to prevent poor outcomes and ensure healthy mothers and babies, often fails to recognise the individuality within each mother and baby dyad and the physiological process is subsequently disrupted.

The maternity care system has evolved to provide what aims to be a standardised form of care across the UK. This has been achieved through national guidelines informed by scientific research, prepared by midwives and doctors working in collaboration. Local policies still exist and professionals are all different, so care will never be exactly the same, but ultimately it’s about providing a nationally recognised standard of care that protects over 700,000 mothers and babies each year.

However does this standardised service meet the needs of the individual? And does it even meet the needs of the physiological process of birth?

Can you standardise birth?

Our current society and culture lends itself to being comfortable with being guided, taught and dare I say controlled?  In general the population seek medical advice and take drugs to make themselves well, expect the education system to manage our children, and expect our lives to be saved by doctors and then expect legal recompense when things go wrong. Is it any wonder that we have created the healthcare system we have today? Maternity for the masses. Standardised healthcare, standardised education, standardised everything is much easier to provide in a constrained financial climate in a society where the majority are content to place their lives in ‘expert’ hands and be releinquished of personal responsibility.

I did this myself too. Happy to be told where to have my baby, signed a consent form for active management of labour and vaccinated my children as expected. The majority of people are happy to conform, it is in our nature. Not conforming takes courage and a sense of self belief that enables you to question not only the accepted way to live your life – cultural norms but also the expectations of family and peers and even your own intrinsic beliefs.

Sometimes it’s pregnant women that are non-conformists. A one size fits all approach does not always fit each individual and these are the women who approach pregnancy and birth questioning their care.

To be able to question a system that aims to provide the best care for you and your baby takes a lot of courage. This courage can come from different aspects of our self. For some women it is a deeply help belief that is unshakable by processes and guidelines. For others it is the culmination of extensive research, informing themselves and enabling them to take responsibility for their own birth process.

Unfortunately the nature of the system does not feel like it has room for questioning, and women continue to feel coerced into procedures and bullied into making decisions that fit the policies.

Surely being a well-researched woman, interested in her own care is to be commended?  Throughout my career I have sought to work with women who ‘challenge protocol’. My own personal belief system has enabled me to feel this as a privilege and not a dilemma. From women choosing home VBAC, to those declining induction, I have walked the journey with them and endeavored to witness the process as it unfolds, from their perspective, without judgement.

However many midwives and doctors when faced with what they see as a complex birth plan, declining various offerings of care, perceive these women to be difficult, demanding or even a danger to their own life and baby. Earlier in my career I couldn’t understand why my colleagues found these women so challenging. Over time I have learned to see things with an ‘insider’s’ eye, working in ever difficult circumstances, with lack of support and the threat of litigation growing every decade. Yet I believe in the process of birth and in the women that fight against a growing tide of medicalisation,  to keep the truth of our innate power alive.

As someone who has walked with a foot in both camps, I am hoping to explore the issues that both women and professionals face in this sphere of maternity care.  Perhaps if we start listening to each other we can begin to accept that truly individualised care and informed choice can be an accepted reality in modern maternity care, dissolving barriers that lead to women feeling broken, whilst recognising the human nature of the professional behind the corporate mask of the NHS.

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