Women, pregnancy and birth – How do we as midwives share knowledge and evidence with women who have choices to make?

@WeMidwives tweet chat 27.11.18at 20.00 BST – #WeMidwives

Three Scenarios to set the scene

1.At a hospital appointment a woman pregnant with her third child explains that she is very happy with the plan that she is to be monitored in the hospital setting regularly because she won’t need to see her community midwife anymore who she has no confidence in. She then goes on to say how she really doesn’t want her community midwife to visit her in her home for post-natal visits. We have a long chat and I explain that she has the right to change her midwife. I advise her to call the team leader to arrange for a different midwife to visit postnatally.

2.A woman having her second baby, the first being born at home, comes to my department at 40 weeks for an appointment. We are puzzled why she has been booked into the Day Assessment Unit for a routine appointment, as this is a high risk department and this woman has a low risk pregnancy. During the visit the woman shares with us that she is fed up she can’t have a home birth this time. She informs us her Community Midwife said no to a home birth but she can’t tell us why. We talk, we look into her pregnancy records/her medical history etc., we talk more. We arrange her home birth.

3. A woman post-caesarean birth:“I’d heard of Skin To Skin contact but no one had ever mentioned it to me during my pregnancy. All I knew is that they’d take our baby to neonatal as soon as she was born so I never would have questioned it if it didn’t happen. Luckily we were lucky to hold our premature baby before anyone else thanks to the skill and expertise of the midwife – we now know that in different circumstances this may not have happened”

For many of you these recent scenarios from our practice will be familiar.Regardless of the actions of the midwives, what is interesting in the context of this chat is the fact the women, two of who had used the maternity services before, were not aware of their rights.

Midwives use their knowledge, experience and professional judgement when helping women with decision making but this must be reinforced with ethical regard.  These tenets are basic aspects of women centred care and are very clearly defined in The Code (2015)

The wonderful thing about being an NHS Midwife is meeting the myriad of different women in our society, each one of them unique. Women about to have their first baby,women with mental health issues, women who have experienced a traumatic birth and want an elective caesarean section, women who have had caesarean section and would like a vaginal birth, women who decline induction of labour and women who are keen to be induced. Women who are immigrants. These are just some examples of the women we meet every day and who are in our care. These women have choices. How do we as midwives share knowledge and evidence with women who have choices to make? Is there a disparity in how women are given information?Some midwives give a lot of information, some less, how do we exactify this and should we?

Women can easily find as much information as they want about pregnancy and childbirth. They have access to a wide range of information via the internet, social media,television, books, articles, access to Royal College Guidelines, NHS and private ante-natal education, voluntary sector groups, peer support groups, doulas, partners, friends and family.

Lagan et al(2010) reported 94% of women used the internet to supplement information already provided by health professionals, with 83 % stating they used it to influence their pregnancy decision making. Almost half of respondents reported dissatisfaction with information given by health professionals and lack of time to ask health professionals questions as key factors influencing them to access the Internet.

Milli Hill is the founder of the Positive Birth Movement (website here - https://www.positivebirthmovement.org) . We asked Milli about what made her start this movement “I founded the Positive Birth Movement because I could see so many women having births that left them feeling sad, disappointed or downright traumatised. I could see a really major power imbalance in the birth room, embodied in phrases like, "they let me" and "I was not allowed". I felt that if women came together, and used the power of social media, they could communicate more with each other about birth, tell stories - positive and not so positive -share their wisdom, and somehow take back childbirth. What began as one group in my own home quickly snowballed to hundreds of groups across the UK and the world. All the groups are volunteer run by and free for women to attend. Women gain from hearing positive messages from other women about what birth is actually like, dispelling common myths, fears and scare stories. They also appreciate being able to get advice from other women about their choices and rights. I think we have done a lot to raise awareness to women that, no matter what happens in their birth, they are still the key decision maker”

Contemporary midwifery models necessitate informed consent, choice and autonomy as basic aspects of women centred care.  Evidence suggests women feel greater satisfaction with childbearing when they are in control, involved in decision making and are encouraged and empowered to work with midwives on their terms (Aune et al 2013).

Ante-natal care and education should collaborate with women, acknowledging and respecting their expertise underpinned by maternity services that respond to their needs. Personal autonomy should be understood and respected by midwives and by the maternity services.

Supervisors of Midwives (SoM) were strategically placed to ensure maternity services respond to the needs of women, at a micro level supporting midwives to care for women as individuals and at a macro level managing change within the maternity services (Jessiman and Stuttaford 2012).  With the cessation of statutory supervision who offers that extra layer of support for choice and change, for women& midwives?

As health professionals we must be aware that some of the quality and consistency of the education and information available to childbearing women may be questionable and many contributors to the genre are no expertise or experience, but should we also consider:

 What is the value of healthcare education if you don't know your rights?

Let’s use this time to share ideas and thoughts on how we can encourage and support women, and each other, to defend and debate women’s rights to choose and to strengthen our ethical practice (NMC 2015)

@ediemoonbeam https://twitter.com/ediemoonbeam?lang=en

and @jennythem https://twitter.com/jennythem?lang=en

November 2018

References

Aune, I. & Dahlberg, U. (2012). The woman’s birth experience - The effect of interpersonal relationships and continuity of care. Midwifery,29, 407-415

Jessiman, W. C. & Stuttaford, M. (2012)Supervisors of Midwives as human rights defenders. British Journal of Midwifery, 20, 428-431

Lagan, B. M., Sinclair, M. and George Kernohan, W.(2010), Internet Use in Pregnancy Informs Women’s Decision Making: A Web-Based Survey. Birth, 37: 106-115. doi:10.1111/j.1523-536X.2010.00390.x

Nursing & Midwifery Council. (2015).The Code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.

Websites

http://aims.org.uk

http://birthrights.org.uk

https://www.england.nhs.uk/publication/better-births-improving-outcomes-of-maternity-services-in-england-a-five-year-forward-view-for-maternity-care/

https://www.gov.scot/publications/best-start-five-year-forward-plan-maternity-neonatal-care-scotland/pages/8/

https://www.maternityaction.org.uk

http://matexp.org.uk

http://rcm.org.uk

http://rcog.org.uk

http://sarawickham.com