A woman this week asked me one of the things that make me want to get on my soapbox about assertiveness and women’s rights. What she said was “are you allowed to give birth to a breech baby?” My response, as ever, to this type of question is “it you who allows or disallows your care providers to do anything to you or your baby. Nothing can be done to you or your baby at home or in a hospital setting, without your consent. You are a mentally competent adult making rational decisions about your care, and you, more than anyone, has the best interests of your baby at the foremost in your mind”.
The Nursing and Midwifery Council (NMC), that govern all practicing midwives, provide information to midwives and nurses on the issue of consent:
“Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Nurses and midwives must respect their refusal just as much as they would their consent”.
The problem may lie with the allocation of power and responsibility in maternity care. Midwives and doctors are in a uniquely privileged position to be able to serve women at such a vulnerable time in their lives. We train long and hard to amass knowledge to help those we care for, but we should not use this to control or coerce women into what we think they should do. We are after all “Professional Servants” (Mary Cronk). We are there to serve the families we care for, but it is also our professional duty to inform them of any risks associated with their choices. The Nursing and Midwifery council (which regulates all midwives and nurses) has rules and codes of conduct advising us how to support our clients such as:
1. You must treat people as individuals and respect their dignity
2. You must not discriminate in any way against those in your care
3. You must treat people kindly and considerately
4. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support
5. You must respect people’s right to confidentiality.
6. You must ensure people are informed about how and why information is shared by those who will be providing their care.
7. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.
8. You must listen to the people in your care and respond to their concerns and preferences.
9. You must support people in caring for themselves to improve and maintain their health
10. You must recognise and respect the contribution that people make to their own care and wellbeing.
11. You must make arrangements to meet people’s language and communication needs.
12. You must share with people, in a way they can understand, the information they want or need to know about their health.
Point number 2 was obviously not read or understood by midwives who attended a woman’s home birth. The woman was from a particular religious group and her partner was from a different ethnic group. The woman phoned me as a result of midwife harassment in her current pregnancy, and in telling me her previous birth experiences said the midwives at one of her previous births had made racist remarks! I was livid and asked if she had complained – no she hadn’t! this is so wrong on so many levels I don’t know where to start! Harassing heavily pregnant women, and going against their wishes in labour is not acceptable but racism from a so called professional is a disciplinary offence. I gave the woman information and advice to make written complaints about current and previous problems, and gave her AIMS contact details.
Another part of our rules concerns consent:
13. You must ensure that you gain consent before you begin any treatment or care.
14. You must respect and support people’s rights to accept or decline treatment and care.
15. You must uphold people’s rights to be fully involved in decisions about their care.
16. You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.
17. You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.
Whether your care provider will like or dislike your choices should be no concern of yours. I personally don’t like junk food, but understand that some people know the risks of consuming it, and still chose to do so. I may offer education about the risks, but wouldn’t dream of telling people not to do it just because I don’t like it myself. This applies to many areas of midwifery care, for example if you are told you are not allowed to give birth at home it would be good to ask if there are specific risks you need to be aware of, before thanking your health professional for their opinion, informing them that you will consider what they’ve said very carefully and let them know you will let them know your decision in due course (Taken from Mary Cronk’s assertiveness phrases). Consider how your care provider would actually be able to force you to do anything against your will (sadly, women have informed me of social services being used as a threat in some circumstances!).
REMEMBER: You do not have to ask permission to do anything which concerns your own body or your baby. Politely question your caregivers, do your own research then take responsibility for your choices! Your body, your baby, your choice!
Mary Cronk’s assertiveness comments on Angela Horn’s great homebirth website
AIMS the Association for the Improvement in Marternity Services has a great website and provides telephone support for anyone having trouble finding good maternity care. Please consider becoming a member or making a donation to their good work. x
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