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Why change is needed in our maternity services
Melanie Butcher • 15 June 2021
We don't need to fix birth, we need to fix the system
Do you ever just take a step back from something and wonder, what the actual fuck are we doing? I’m looking at maternity services in the UK and wondering that right now.
Birth is a natural event. It’s not a medical event. It rarely needs intervention. Of course every family who has had a genuine emergency in child birth is hugely grateful for the experience and services of a medical professional. However, a lot of the problems seem to be CAUSED by the maternity system. Sweeps and other inductions for no medical reason increase the risk of further interventions which have worse outcomes for mums and babies. Why are we doing that? Medical settings, vaginal examinations, continuous monitoring. These reduce the chance of birth taking its natural course as they interrupt the natural balance of hormones. Why are we doing that?
It feels like it’s because of hospital policy and that policy states;
- ‘You can’t come onto the unit until you are at least 4 cms.’
- ‘Baby is measuring too large’.
- ‘You’ve gone past 40 weeks, your placenta might fail’.
- ‘We have to hook you up to continuous monitoring before we can admit you’.
These ‘rules’ aren’t person centred. They aren’t based on clinical judgement of the person in front of them. They often aren’t even based on the most up-to-date research. Often, policies are based on ease for hospital staff (baby has to be weighed now instead of having immediate skin to skin with mum), needing a paper trail (continuous monitoring), or to risk of litigation if they are shown not to have done ‘something’ (post dates induction for no other reason than estimated due date has passed).
As a birth doula, I am constantly educating families on how to ask for reasons and evidence behind big clinical decisions. I am helping them to make a medical birth space into a space more conducive to birth. I am telling them that vaginal examinations are not a requirement (Who ever decided having someone’s fingers in your vagina should give you access to maternity care?!). I’m explaining that there are risks involved with a sweep. I’m informing them that there are such things as wireless monitors, they can still move around and that continuous monitoring doesn’t actually improve birth outcomes. Suggestion that birthing on a bed is actually the hardest position to give birth in. If they chose those procedures for themselves based on non-biased information, because it feels right for them and their family, then fantastic. However, I often hear people coerced both kindly and with scaremongering. I hear them presented with only half the information. I hear their concerns brushed aside. I’ve had my own concerns and preferences brushes aside during my births. I hear people worn down with fear that their baby might die if they don’t submit.
I am also not a Doula who feels that everyone should birth in the woods with no medical attention or pain relief. I am pro INFORMED
choice. We just aren’t informing and equipping our expectant families on normal, physiological birth enough and we’re too quick to jump in with a solution when actually all that’s needed is a little time and support.
I am also not critical of the majority of midwives working in the NHS system, they go into midwifery for the right reasons and work hard to meet the expectations and knowledge levels of their degrees. And many of them are extremely caring and I know some also share some of my concerns. It’s just that they have to work within the guidelines of their hospital trust rather than using their experience, instinct, and a more holistic approach even where they can see it’s needed. Every intervention or monitoring that the trust recommends has to be offered. So where you might feel that a midwife understands your wishes, to be offered interventions that are against these, starts to break down trust. Also, where a birthing person turns it down, midwives have to document this. It starts to create a subtle conflict between midwife and birther. And it makes the person birthing start to doubt themselves. They start wondering if they should accept the suggested intervention if a medical professional is offering it to them. Causing more fear and therefore more difficulties in their birth. It must wear those midwives down too, making them jaded about birth, their careers and the process?
The way the system is currently run on policy and insurance issues, rather than birthing person led supported by midwifes who can use their training and experience autonomously, is wrong. It’s the reason that independent Doula’s are needed. It’s why birth trauma is on the rise. It’s why inductions are becoming the norm rather than the exception. It’s why birth is becoming increasingly medicalised. It’s a cycle that will continue unless we change the whole system.
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