Professor Cathy Warwick CBE is the Chief Executive of The Royal College of Midwives and passionately advocates for woman-centred maternity care that respects the needs and experiences of the individual.
A major strength of maternity services policy in the United Kingdom is that, at its heart, is an acceptance by policy makers and professionals that women should have the right to make their own choices about the care they receive. Every woman is an individual who brings to pregnancy and childbirth her unique experiences which will shape her decisions around this life changing time. It is accepted that the role of the midwife or the doctor is to work in partnership with each woman helping her to understand the vast amount of information that she will receive, how it applies to her and ultimately to make her own choices from a range of possible options. We know from surveys that when women feel involved in decision making and feel they have been respected in their choices they are more satisfied with their experience of pregnancy and birth. This in turns means they can embark positively on motherhood.
However it won’t come as a surprise to hear that whilst it is very easy to talk about women centred care in theoretical terms, implementing such care can be a challenge and although across the UK there are many many examples of excellent practice there is still work to be done if all women are to receive such care.
The barriers to choice are many and varied. At the highest level one problem is that a woman’s right to choose is not enshrined in law. What happens therefore if a woman says she would like to choose a homebirth but the local maternity service says they have not enough midwives to provide this service? Perhaps one day this will be tested in court. When this has happened in other European countries the woman’s right to choose has been upheld.
This highlights however that often resource constraints are barriers to choice. How can professionals really work in partnership with women if there are simply not enough of them? When resources are short options tend to narrow down. Despite welcome increases in the numbers of midwives working in the UK we remain short of midwives and the pressure on their time is enormous.
Then there is the knotty problem of ‘the wrong choice’. Despite the rhetoric professionals can find it hard to support choices that they do not themselves believe are in women’s best interest and when safety is in question they may ask whether they are obliged to support a choice that they believe is unsafe. For example the healthy fit young woman who chooses to have her baby by elective caesarean or the third time mother choosing a birth at home having had two prior caesarean sections. Tensions between woman and professional can mount and need very careful handling.
And finally the issue of equality raises its head. If we really value choice and believe all women should be given choice we have to recognise diversity. Not all women start from the same place. Some women don’t even know how to access maternity care far less make choices within it. Some women will need interpreters. Other women will need additional support because of disability. We need to ensure all women are given the help they need if they are to get what the care that works for them.
Choice matters. It empowers women in the widest sense. Care should always be individualised and respectful. Many in the UK believe that a principle of choice is inherent in our maternity services but whilst this is true in theory in truth we still have some way to go to ensure this is true in practice. That is why I remain in my work a Champion of Choice.