White Ribbon Alliance

flickr ©Mark Biddle
< Return to Respectful Maternity Care

Empowering Pregnant Women for Positive Birth Experiences: Addressing RMC in the United Kingdom

September 26, 2014
Milli Hill is a freelance writer and the founder of The Positive Birth Movement. Her weekly column for BestDaily.co.uk covers birth, breastfeeding and early parenting, and she also writes for The Telegraph, the Huffington Post, and her own blog, The Mule. She has just finished editing Water Birth: Stories to Inspire and Inform to be published by Lonely Scribe later this year, and has contributed a chapter to The Roar Behind the Silence: Why Kindness, Compassion and Respect Matter in Maternity Care, to be published by Pinter and Martin in October. Prior to motherhood she worked extensively as a Dramatherapist and recently began Doula training. She lives in Somerset with her partner and three small children.

The focus of my response will be on UK maternity care, as this is where I am based and where the majority of Positive Birth Movement groups are. However I am aware that RMC is a global issue, and that different cultures face different issues in their efforts to promote compassionate care.

Running the Positive Birth Movement, and writing about birth nearly every week, women consistently tell me this: kindness, compassion and respectful care really matter. How a woman (and her partner too) are treated during and after childbirth can transform a difficult birth into something they feel at peace with; and by the same token, disrespectful treatment can be the root cause of trauma, even if their birth has been relatively straightforward.

The birth experience matters greatly to women, but we have somehow formed a cultural habit of discouraging them from admitting this. A culture of silence exists, not only around birth trauma, but also around any expression of women’s personal needs in the labour room. Nothing could have prepared me for the reaction when I wrote an article that addressed this, with the title ‘A healthy baby is not ALL that matters’.

In it I explained very clearly that of course having a healthy baby is of utmost importance, but that it should be OK for women to admit that other aspects of their birth experience matter to them too. I wrote about how hard women find it to voice these concerns in a culture that persistently tells them that what goes on in the delivery room is always acceptable as long as everyone survives.

I added that, “…if we continue to repeat that a healthy baby is all that matters, we open the doors for all manner of undignified or even abusive treatment to happen to women in the quest for absolute safety. We reduce a woman to being a mere 'vessel' for her child, and we quickly silence anyone who wishes to protest against any aspect of their care that they didn't feel comfortable with.”

The article quickly went viral. It was shared on Facebook over 60 thousand times, and read by over a quarter of a million people. I was contacted by women from across the globe, and their main message was ‘thank you’; thank you for throwing the spotlight on this, and thank you for saying that I matter too.

The response to the article is telling, but unfortunately, much remains to be changed. A problem we face when promoting respectful maternity care (RMC) is that, in current Western culture, women have been given the message so strongly that their birth experience is unimportant, and they do not have a very strong sense of their right to be treated with respect and dignity. Concepts like ‘human rights in childbirth’ can seem alien and baffling.

We need to raise women’s expectations and awareness of their rights and entitlements, and get the message out there that disrespectful or abusive treatment cannot ever be justified. Consent is a huge issue, for example. As well as ensuring that health care providers (HCPs) present rounded information in a non-biased way, we also need to make women aware that they have the right to be the key decision maker. At the moment there is an imbalance of power in the birth room that is being accepted because the risks and dangers of childbirth are being over-emphasised to the detriment of freedom of choice.

Women repeatedly say that one-to-one care – ideally the same midwife for pregnancy and throughout their labour - would be their preference, and midwives also state that they would be better able to do the job they love the way they want to do it, if they had more time to develop relationships and connect with the women they work with. Undoubtedly instances of disrespect and abuse (D&A) would be reduced if caseload midwifery were promoted over other models of care.

The day of birth remains vivid in the mind of all women for the rest of their life; for some, as an empowering experience, for others, as a time when they felt frightened, bullied, unheard or disregarded. We also need to address the fact that many HCPs will have had difficult and traumatic birth experiences themselves. How does this affect their practice? What are their expectations of birth? What are their emotional responses when they attend women in labour? Is there a place for them to voice their feelings? And how does this affect the overall culture of the maternity unit?

A recent series of papers on midwifery in The Lancet reported that the current levels of birth intervention are too high, a position that RMC has been advocating for some time. This also needs to be urgently addressed, however, at the Positive Birth Movement (PBM) we consistently hear that it is not always interventions themselves, but rather the treatment women receive, and in particular, whether or not they feel listened to, during birth and in the weeks that follow, that dictates levels of trauma or satisfaction.

We need a culture shift in our approach to childbirth, restoring the balance of power to pregnant and labouring women, and acknowledging the importance of a positive birth experience. The message needs to be spread that a healthy baby should be the baseline of women’s birth expectations, and that respect, compassion, consent, choice, dignity, and kindness matter greatly too.

At the PBM, we are trying to encourage women themselves to be the change-makers in childbirth. This is just one aspect and approach to change however, and I look forward to hearing more about the wider dialogue and strategy of the White Ribbon Alliance.

Relevant Links

A healthy baby is not ALL that matters, Bestdaily.co.uk, May 23rd 2014, http://www.bestdaily.co.uk/your-life/news/a573059/a-healthy-baby-is-not-all-that-matters.html

The All That Matters Project Women blog about what mattered to them in the birth experience: www.allthatmattersproject.wordpress.com

The Positive Birth Movement www.positivebirthmovement.org

Lancet papers on midwifery http://www.thelancet.com/series/midwifery

The Roar Behind the Silence http://www.pinterandmartin.com/the-roar-behind-the-silence.html