...if medical professionals are overstretched, they cannot provide the high level of support that women require during pregnancy. Inevitably, with cuts to facilities, staff shortages and high birth rates, women don’t have full control over how they give birth.
Is a healthy baby the only way to measure a successful outcome during childbirth, or should more attention be paid to the mother’s wishes?
Dr Angela Davis
Despite more than half a century of campaigning, mothers are still being denied their human rights during childbirth, according to new research published online by History & Policy
In a study conducted by researchers at the University of Warwick, women of all ages and from a range of backgrounds reported their dissatisfaction over the lack of choice and information made available both before and during labour.
In her paper, ‘Choice, Policy and Practice in Maternity Care since 1948’, Dr Angela Davis explores the historic struggle that has taken place between those who would like to prioritise mother’s wishes during childbirth, and those who contend that a healthy baby is the only real measurement of a successful outcome.
In an interview with ScienceOmega.com
, Dr Davis, an academic from Warwick’s Centre for the History of Medicine, explained how in some cases, mothers’ human rights are viewed as secondary to concerns over cost and safety.
"In a number of historical cases, structural problems with maternity services and budgetary constraints meant that mothers didn’t receive the type of care that they wanted," Dr Davis began. "Women who wanted home births during the 1980s, for example, were strongly advised that this was not a good idea. GPs would often tell expectant mothers that they were unwilling to conduct these births. Essentially, medical professionals were asserting what they thought was best for women, rather than women themselves.
"Also, women who felt their labour was progressing at a faster rate than anticipated experienced difficulties relaying this information to medical staff," continued Dr Davis. "They found that they weren’t being listened to. In some cases, these patients had to go without epidural anaesthesia because it was too late."
Dr Davis conducted 160 interviews with women to explore their experiences of childbirth and motherhood. Whilst the social context has shifted in certain cases, she found the problems encountered by mothers today are similar to those faced during the 20th
"The lack of choice surrounding childbirth in modern Britain largely stems from cost cutting exercises," Dr Davis explained. "For instance, some of the women surveyed wished to give birth in local hospitals and units, but many of these types of service have been cut in response to the economic downturn. Respondents also reported a range of examples in which their choices were limited because of perceived risks. Even though they felt that they knew their own bodies and what was best for them, their decisions were deemed unadvisable. Because of the way in which the National Health Service (NHS) is structured, the facilities that mothers want are not always available to them."
I asked Dr Davis whether or not she believes that there is a lack of information when it comes to childbirth choices. How might women’s childbirth experiences be improved by better provision in this respect?
"I think that opportunities to provide information are being missed at various stages of the process; not only during childbirth but throughout pregnancy," she replied. "For example, women are often told what will be happening to them during antenatal care. However, they are not always asked about their preferences. In truth, this isn’t a static picture. There has been a move towards the provision of more information in the lead up to childbirth. Despite this progress, however, women’s choices remain limited. If it’s not possible to have a home birth through a midwife-led unit, further information on this subject isn’t really going to be of any use to you. Sadly, expectant mothers are frequently told what will
be happening to them, rather than being presented with a range of choices concerning what could
‘Women don’t have full control’
Of course, funding cuts are never good news when it comes to patient choice. As healthcare budgets are tightened, the range of available services is likely to shrink. So, to what extent have recent budgetary constraints adversely impacted women’s human rights in relation to childbirth?
"Maternity services are under significant pressure," Dr Davis replied. "With the best will in the world, if medical professionals are overstretched, they cannot provide the high level of support that women require during pregnancy. Inevitably, with cuts to facilities, staff shortages and high birth rates, women don’t have full control over how they give birth."
So, does Davis believe that safety is being used as an excuse to drive down costs? Are decision makers limiting access to ‘risky’ childbirth choices in order to save money?
‘Combination of factors’
"Within the context of the longer-term picture, I think that this was definitely the case," she replied. "For example, home births declined dramatically during the 1980s. ‘Risk’ was frequently used as a way for doctors to avoid home births. Research shows that whilst women giving birth for the first time at home are at a slightly increased risk, when it comes to subsequent births, there isn’t a significant difference between the home and the hospital. It was very interesting, therefore, to see how the media reported these findings when they were released in 2011. Despite the fact that most women giving birth at home are not at increased risk, it was typically reported that all women who had home births were at increased risk.
"Even so, risk isn’t the only factor keeping the number of home births low today," Dr Davis concluded. "We no longer have an infrastructure capable of supporting large numbers of home births. The community midwife structure simply doesn’t exist in the same way as it did in the past. This makes it difficult for women gain access to a range of services, including home births. Essentially, women’s choices are being limited because of a combination of factors."
To learn more about what Dr Davis thinks should be done to reinforce women's human rights during childbirth, check out her opinion piece on related campaigns...