Posted by Madeleine Speed, the Pelvic Partnership. January 2015
This article looks at what 'women-centred care' means within the NHS and how it can empower all women. We think it is also of key interest to women who have Pelvic Girdle Pain (PGP) and who are reading this blog because it is included within the Pelvic Partnership website. Knowing about the NHS and the value it places on women-centred care can help you to make choices about your body, how you give birth and the kind of support you require. We hope it will also give you the confidence to decide what you want rather than accepting a choice made by your healthcare professional or a member of your family. There are also some ideas about what to do if you feel you are not being heard by your midwife or obstetrician and suggests some approaches to help you to be able to discuss your birth preferences and obtain the help you need to get the kind of birth experience you want.
Sometimes it can feel as though giving birth is some kind of process on a conveyor belt where the whole system is weighted to benefit the healthcare professionals, hospital shifts and midwifery units and the needs of individual women are given little or no regard. Of course, there is some (or even a lot of) exaggeration in the tabloids when they cover what goes wrong within the NHS. However, personal experience or the treatment of friends and family can attest to how hospital care sometimes feels weighed to the benefit of administrators, statisticians and budget holders rather than doctors, midwives and the people for whom they are caring.
This level of care can seem quite at odds with what the term 'women-centred care' implies. It should convey the importance of healthcare professionals’ remembering that each woman has individual needs, expectations and aspirations when it comes to the kind of care or treatment she wants. For many women, this is particularly important when considering birth options. The expression 'women-centred care' implies the importance of the woman's needs ahead of the needs of the hospital's shifts, the ease and comfort of the midwifery team or the particular preferences for birth options of a given member of the professional team.
So how does the best practice in the theory of 'women-centred-care' get upheld in everyday life?
The good news is that there is an organisation that is working to push up the quality of care within the Health Service. This is the National for Health and Care Excellence or NICE. The NICE website states that "NICE's role is to improve outcomes for people using the NHS and other public health and social care services. We do this by:
- Producing evidence based guidance and advice for health, public health and social care practitioners.
- Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services.
- Providing a range of informational services for commissioners, practitioners and managers across the spectrum of health and social care.
Since 1999, NICE has provided the NHS, and those who rely on it for their care, with an increasing range of advice on effective, good value healthcare, and have gained a reputation for rigor, independence and objectivity."
There are some NICE guidelines known as CG62 that were published in March 2008 and are particularly relevant to us because they offer best practice advice on the care of healthy pregnant women. Being aware of these guidelines should inspire confidence that we have the right to ask for what we want and for our needs to be respected and acted upon.
This NICE guideline CG62 from March 2008 offers
" best practice advice on the care of healthy pregnant women. Women, their partners and their families should always be treated with kindness, respect and dignity. The views, beliefs and values of the woman, her partner and her family in relation to her care and that of her baby should be sought and respected at all times. Women should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If women do not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. Good communication between healthcare professionals and women is essential. It should be supported by evidence-based, written information tailored to the woman's needs. Care and information should be culturally appropriate. All information should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English. Every opportunity should be taken to provide the woman and her partner or other relevant family members with the information and support they need."
Sometimes knowing what the expectations are can give us much more confidence to know that we have the right to ask for our wishes to be acted upon and this is really useful as it may help us to feel empowered at times when we feel it may be easier to just keep quiet and be pushed along by the opinions of the professionals.
What happens if you feel your midwife, for example, isn't respecting your wish to have a vaginal birth with PGP?
She may believe that a caesarean section would offer you less stress on your pelvis and a much easier birth as a result i.e. she may genuinely believe that this birth option is best for you. Knowing the guidelines should support you, you might feel more comfortable about taking issue with her. As long as she has explained all the pros and cons of having a vaginal birth and all the pros and cons of a caesarean section, if you still feel very strongly that you want one birth option rather than another, your midwife should respect your views. And if she doesn't seem to support your choice? Then you can ask to see the Supervisor of Midwives or SoM.
SoMs are there to ensure that care is safe and woman-centred. Their SoM role is independent of the hospital they are employed by, so they are not service managers (although this may be another of their roles) when they are acting as a SoM, but are there to ensure that midwives are following the Nursing and Midwifery Council rules, and also following national guidance, or if they are not doing so, that this is with the choice and consent of the woman for whom they are caring. An SoM is on call for every maternity service 24/7, and is available both to you and to midwives. You can call her to help with discussions about birth options between you and your midwife. She can also help you decide on a plan which suits your needs with PGP and with which your midwife or doctor will support you.
If you are having problems persuading your midwifery team to uphold your wishes for your labour and giving birth, do get in touch via the website. Sometimes options such as a water birth or a vaginal birth on all fours can ring alarm bells for healthcare professionals because they are not used to them for women with PGP. We can discuss with you the benefits of these for women with PGP and support you in your discussions with the SoMs about why your choice is a good option with PGP.