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25 weeks: a few words about choice, birth and ‘the system’

This week I’m making a bit of a departure from my usual pregnancy updates to make a more serious point. I have begun thinking about making a birth plan, being only too aware that it will only ever be my birth preferences – no-one can genuinely plan for childbirth with any certainty. And I’ll be honest – I’m a bit scared.

Several things have influenced my thoughts about birth recently – articles and stories I have read, the inspiring Born to Safe Hands conference I attended in Bolton last week, activity on social media – all of which have led me to question the nature of ‘the system’. Why are maternity services which should be based so much on trust currently so deeply entrenched in fear and suspicion? Mothers are afraid of giving birth, obstetricians are skeptical of ‘normal’ birth, midwives are averse to perceived harmful interventions, all clinical staff are terrified of mistakes and recriminations – all points I have come across recently that highlight a vicious cycle of mistrust, fear and defensiveness that cannot continue.

Of course the elephant in the room here is the Morecambe Bay scandal – a systemic failure of such epic proportions it can hardly be believed. The actions of some truly irresponsible individuals and a complete breakdown at every level in the appropriate way of dealing with it led to the tragically avoidable deaths of both babies and mothers. I hadn’t felt qualified to comment on the situation, not being a clinical health professional, but I certainly have an opinion as someone who works for the NHS and cares passionately about maternity care, especially as I’m currently on the receiving end of it.

The knock-on effect of Morecambe Bay is huge, and the opportunity presented by the recently announced national maternity review to learn and implement change cannot be missed. However, the Kirkup report is still fresh in people’s minds, the wounds for the families still raw, and the fingers of blame are still being pointed as nobody wants to appear in the wrong. Midwives and obstetricians should be on the same side of the fence, but they’re still too busy trading insults over it about whose garden is better. Meanwhile, pregnant women are left to one side unsure of who to trust, pulled in opposite directions by competing cultures who both claim to provide the best care for them.

A large problem with the whole issue of maternity services in general is the fact that midwives and doctors are all lumped together as entirely separate professions and tarred with the brush used to paint the worst of them. I have good professional relationships with both midwives and obstetricians and have seen the collaboration and mutual respect that characterises the best of both careers – but the average woman without the benefit of this perspective could be forgiven for being perturbed. The media stereotypes of the militant midwife obsessed with pushing ‘normal’ birth at all costs, and the condescending consultant too willing to cry high risk and slice women open as the ‘safest’ course of action without giving her a choice, are in no way helpful to resolving the issue. I would like to argue that these extremes of the spectrum are not common practice – or maybe I’m just hoping they’re not.

So, I am scared about what my labour and birth will entail. I’m unsure if my perceived level of risk of recurring pre-eclampsia will enable my wish to deliver in the alongside midwifery-led unit at my local hospital to be granted; I’m afraid of a repeat of my last labour – induced, restricted and frightening; I’m resigned to the fact that I will be attended by whichever midwife happens to be on shift when the time comes and that I’ll have to place the ultimate trust in someone I have never met before; and I can only hope that everyone caring for me, doctor or midwife, has my best interests and those of my baby at heart – and treat me as a person capable of thinking for herself as a result.

In the meantime, I’ll think of my preferences for birth, and hope that I can finally have a say in at least some of it. I think that all women, barring any terrible unavoidable circumstances, deserve two things in childbirth – to remain in control and to have a choice over what happens to them. To have those AND be supported by a close-knit multi-disciplinary team without fear, agenda or prejudice would really be something. Maybe I’ll get lucky. Maybe one day we all will.


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I’m linking up with Ghostwriter Mummy’s Maternity Matters

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11 thoughts on “25 weeks: a few words about choice, birth and ‘the system’”

  • Great post, Jenny. The positive pregnancy debate frustrates me no end. There is no such thing as a ‘normal’ birth – it raises such unrealistic expectations. The polarisation of views that midwife-led care is always best, and obstetricians always do unnecessary intervention is really unhelpful too. They say they want to remove fear, but I think these views contribute to it. If you and I as women who work within the NHS in relation to maternity issues get befuddled about it all, what chance do others have? No easy answer to all this, I know. But I hope you a say in how you want your little one to be born, and that your preferences are taken into account xxx

    • Thanks so much for commenting Leigh. None of this is going to be fixed easily, but we can all try and do our bit as individuals and hope those providing the care do the same. xx

  • Birth Choice is something I feel very strongly about. No matter whether you have a low or high risk pregnancy, you should be given the opportunity to make an informed choices about your care. Even if things don’t go to ‘plan’, women should still be active participants in the decision making process. Rates of birth trauma would be reduced if women could feel in control of what was happening to their bodies

  • Fab fab oat. I think you’re right and it’s too easy to forget that amidst the finger pointing and blame allocation here are women who deserve to be treated as such. Choice is so so important and women need to feel empowere in every aspect of the decision making. I hope you’re able to come to an agreement that makes you feel supports and empowered. I have every faith that you will x x
    Thanks so much for linking up to #MaternityMatters x xx

  • I’m suffering with the same anxieties at the moment. I’ve had two water births and been really happy with my deliveries, especially the second one. Unfortunately I suffered a PPH after my second delivery which makes me higher risk this time. My consultant says yes to a water birth, my Midwife says no. I’m not clear what will actually happen when I arrive on delivery and I’m anxious about not having the water because it helped me so much previously.. Obviously I want a safe delivery for this baby most of all but it doesn’t really help the worry.

  • As a midwife it pains me that women feel such dread at the prospect of their care in labour. How have we got to this point, where midwives and Obstetricians are perceived to have such polarised views, and thankfully something I have not seen in practice. It is healthy to have debate as it encourages to think about and challenge our practices. Why can’t we work in collaboration, with mutual respect for our colleagues and the women and families we care for, to ensure women’s choices are informed and supported?

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