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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