A few weeks ago, I went to Brisbane to speak at the Homebirth Australia conference. This was an altogether fabulous experience, but it was so sad to hear that some of the best Australian midwives (like in so many other countries) are still being subjected to vexatious reporting and persecution in a number of ways, simply for supporting women’s choices.
I heard story after story of brilliant, caring midwives who did everything in their power to give great care to women and yet who have found themselves on the wrong side of the law simply by doing just that.
I don’t pretend to understand all of the legal underpinnings of these cases, but from discussion with well-informed colleagues I gather that there is a growing trend to assume that the midwife’s continued presence is interpreted as implying that she is complicit in any decisions that the woman makes. In other words, if a woman chooses to do something outwith the recommendation (like declining to transfer to hospital during a home birth, for instance, or declining induction for so-called prolonged pregnancy), and the midwife continues to stay with her and provide midwifery care, then that midwife is perceived to be condoning the woman’s choice. Which somehow makes her partially responsible for that choice.
This is absolutely outrageous.
In the UK, we have a duty of care to women. This means that we stay with them, no matter what choices they make, and even if they make choices that we don’t agree are the best. In my understanding, that is our legal and professional obligation. A midwife encountering such a situation would involve their Supervisor of Midwives (SoM), who (in my experience of these kinds of situations) will help check through that the midwife has ensured that the woman has all relevant information and documented everything appropriately. (I will acknowledge here that not every British midwife is as lucky as me in the SoM department. My SoM is fabulous and genuinely deserves a medal :D). Once the SoM is satisfied that we (for it is now a shared situation, which I can also tell you from experience can be a great relief for the midwife) have done everything required, the task is then to work out how to best support the woman. Throughout, it is understood that women are autonomous decision-makers and (MOST importantly) that we midwives and health professionals have a duty of care to them, regardless of whether or not they make the decisions that we think they ought to.
Again, I am very willing to declare my relative ignorance on such issues, but I just can’t understand how any system has so lost touch with the duty of care ethic that, if a woman makes a decision that is outwith normal practice, the midwife is expected to abandon her. Even worse than this is that, in many cases, the midwives who have been affected by this stance have told me they felt that they weren’t supported by the very groups and organisations who should have been the first to stand by their side and defend their actions and ideology. Instead, they were advised to withdraw care.
This surely cannot be the way forward?