Navigating the maternity system can be a daunting experience. If you go to one trust there may be consultant midwives to help you achieve the birth you want and to have regular contacts with antenatally to discuss the right plan for you if it falls ‘outside of the guidelines’. At other trusts and hospitals these services might not be available to you but there will be managers that you can access via your community midwife to have discussions regarding your care. If all else fails you have the option to act with your feet and find a more supportive hospital or trust.
At all times, midwives and obstetricians have an obligation to attend you in pregnancy, labour and birth. This does not give them the right to undertake any care without your prior consent. You can accept or decline anything you want because you retain body autonomy throughout. So why is there so much variation between the care you receive in practice?
Firstly guidelines vary depending on the leadership in trusts and the motivation to make changes within practice. The evidence may be strong and robust but as NICE (2007) states most guidelines take 3 years to implement. By which point there may have been even more research in that time opposing/supporting these views. Staff are insured by practising under their trust guidelines and so make recommendations to you based on these to cover their registrations and careers (You however do not have to follow these ‘guidelines’). However they also should be practising under their professional bodies and providing you evidence based, unbiased and up to date information regarding your care at all times. This requires time to give you every piece of information (assuming the health professional is up to date on your particular choice) which is incredibly challenging in an ever stretched maternity service. Often it’s easier to just say ‘we recommend this’ and end of conversation because of the time and staffing restraints. Most healthcare professionals hate working like this and feel awful about not being able to give the time but they aren’t given much of a choice.
Secondly risk management in maternity services is high. Litigation is high. Instead of looking at all the factors, analysing and making recommendations for change; knee jerk reactions often occur on one element therefore suddenly making changes which weren’t necessarily based on evidence but on one individual case.
Thirdly it’s easier and more time effective to group every single person into the same category rather than making individual plans. For example: All post date inductions of labour being recommended at 41+3 or 5 depending on where you live. One person may smoke, have a raised BMI and a poor diet but still be midwife led care and therefore have higher individual risks of stillbirth in comparison to a fit, healthy non smoking woman with good fetal movements. Only 50% of babies are born spontaneously by 41 completed weeks. Whilst stillbirth at term is a risk for any pregnant women putting everyone in the same category is not individualising care; and it’s not balancing the risks effectively. Often the alternatives aren’t discussed unless they are prompted by you.
So what can you do to ensure you are in control of the decisions which are right for you and your baby? Using BRAINS can help you make the right decision for you
BENEFITS – what are the benefits of what you are proposing?
RISKS – What are the risks of what you are proposing?
ALTERNATIVES – Is there any alternatives? Is there any national guidelines or other hospitals which do things different or offer an alternative?
INSTINCT – Does my instinct tell me this is the right thing to do?
NOTHING – What if I were to do nothing what are the risks and benefits?
SMILE – Smiling releases endorphins which are great in labour and is a great form of communication with the health professional to let them know that you are done with the conversation and can be left to make up your own mind.
‘Control’ is hard in pregnancy, labour and birth because you have to let go of your conscious control in order for your body to take over and labour effectively. But you still retain autonomy and control over the decisions within your care. When you understand or have decisions explained to you, putting you in control of your body and your birth you begin to feel more confident, calm and comfortable and therefore have a much better experience than someone who is just swept along by the maternity system. KG Hypnobirthing with Bumpstobabbas helps you understand how to negotiate and feel confident in achieving the birth that you want. Half of all hypnobirthing focuses solely on your choices and decisions during pregnancy and birth to give you the knowledge and power you need to have the most positive birth possible.
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