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

By: Milli Hill, Founder, Positive Birth Movement

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 (PBM) 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 PBM 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) are treated during and after childbirth can transform a difficult birth into something they feel at peace with; conversely, disrespectful treatment can be the root cause of trauma, even if the birth was 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 entitled, “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 spread the message 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 must 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 accepted because the risks and dangers of childbirth are over-emphasised to the detriment of freedom of choice.

Women repeatedly say that one-to-one care—care provided by the same midwife for pregnancy and throughout labour—would be their preference and midwives agree. Midwives state that they could do the job they love the way they want to if they had more time to develop relationships and connect with the women they care for. 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. The overuse of interventions needs to be urgently addressed, however, it is not always interventions themselves, but rather the treatment women receive—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 to restore the balance of power to pregnant and labouring women and acknowledge 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 but that respect, compassion, consent, choice, dignity, and kindness matter greatly too.

Relevant Links

This post was lightly edited for clarity from the original posted by the White Ribbon Alliance.

To promote the WHO’s consensus statement, ”Prevention and elimination of disrespect and abuse during childbirth”, follow #EndDisrespect and contact Natalie Ramm at nramm@hsph.harvard.edu for a copy of our social media toolkit.