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And so do their mums and dads.
I had two conversations with women this week about frustrations with the current maternity system that seems to value compliance with guidelines over proper discussion and consent. The current maternity system full of wonderful staff, genuinely trying to do their best. But there are a number of things that stop it working well.
1. Doctors and midwives have different training and different approaches. Doctors are taught that birth is only normal in retrospect, their job is to look out for what might need help, and to save the day. They only see those that need help, which reinforces their viewpoint. Most have never seen a straightforward birth, let alone a home birth. The approach is to reduce the issues down to deal with responses to specific issues. Midwives are trained that birth is a normal life event, and to promote what leads to straightforward birth. They are skilled at observing both with equipment and also their eyes and ears. They take a more holistic approach. However the doctors' approach is the prevailing culture and many midwives struggle to keep women focused in a hospital setting.
2. Fear based maternity care, partly due to litigation worries, but also because of doctors only ever seeing the problems, and not knowing about the simple ways of helping a labour. Sometimes I feel like I'm in a dodgy garage when I hear doctors and midwives talk to women, as they are almost sucking air through their teeth. "Oh, you're over 40" <sucks air> "that's a big baby" <sucks air> "well, we'll allow you to go to 41 weeks, but then it'll have to be an induction/caesarean."
3. Situations are presented as black and white, when most of the time they are grey. Only 9-12% of maternity guidelines are based on top quality research. (This was from research by obstetricians, and published in an obstetrician journal.) Some of the clearest and best quality research is not acted on. For example in the NICE caesarean guidelines it states that all women should be told that having another women with you in labour, with or without training, reduces your chance of having a caesarean. So your mum, sister, friend or doula. Just like other humans doing their job, many doctors do not have time to read up on the latest research and rely on what they are taught in college. One client had to teach her obstetrician about hands off breech birth. He had never heard of it.
4. Blanket policies not individualised care. Research shows that individualised care has better results.
5. Women and babies are seen as being at odds. This is highly offensive. I've heard 'We're just thinking about the baby.' As if the mother isn't?!! And actually when women make the decisions about their body and their baby outcomes are better.
6. The language and approaches used seem to forget that it is up to the woman to accept or decline each and every appointment, monitoring/test, and intervention for her and her baby.
7. The basic needs of a woman in labour for all to go well are completely forgotten, or not even known. Once an obstetrician at a birth I was supported asked in rather frustrated tones 'Why is it that every time I come in this room the lights are off?' Lights, noise, lack of privacy are so common in hospitals that no one questions them. Despite it being basic biology of labour. Yet women think that everything will be done to help them have a straightforward birth, which isn't how the system works.
The good news is that things are changing - hopefully! Last year the government published Baroness Cumberlege's national review of maternity services 'Better Births'. Her recommendations covered all the above:
joint training for doctors and midwives;
personalised care, not blanket guidelines;
women making the decisions.
She also called for
'caseloading' which is where midwives are but into small groups to care for women right through pregnancy, birth and postnatally. So your known midwife, or one of her close colleagues would be your midwife for the birth, whether at home, in hospital or even for planned caesarean. That continuity of carer has the best outcomes, including reducing the still birth rate.
more home births and birth centre births, in line with the latest research which shows they are at least as safe as hospital births and have greatly reduced intervention rates.
Here's some more information about the initiative, from the Royal College of Midwives.
What can you do?
Every hospital now has to have a 'Better Births' programme and show what it is doing to meet these recommendations. You can write to your head of midwifery or to the chief executive of the hospital trust and say why you would like these changes to happen, and any others you'd like to see. It's also an opportunity to praise your midwives and doctors and say what you liked about what they did.
Every hospital trust has, or should have, a maternity services forum, now called 'Maternity Voices' or similar. Your midwife can tell you about it. Or ask the hospital PALS team. They need women and men to attend, but also to send feedback and questions to the chair.
And support your midwife. They have to cope with very challenging and conflicting situations. I don't know how they do it. I see them trying to keep things normal and protecting the woman but at the same time reporting to the consultant. There's a joke that goes 'How many midwives does it take to change a light bulb? Five. One to change the light bulb and four to stop the obstetrician interfering.' And of course women are stuck in the middle. How lovely it would be if things were less confrontational for everybody.
What do you think about all this? Let me know.
I am a doula and antenatal teacher based in Bedfordshire.