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Women-centred care - what is it, why does it matter?


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.

Women-centred care picSometimes 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.

To find out more about the role of Supervisor of Midwives you can visit the NHS England website or to discuss some suitable birth options with PGP, visit 'Pregnancy & birth with PGP' on the Pelvic Partnership website and email us any questions via This email address is being protected from spambots. You need JavaScript enabled to view it.

What's the latest on breastfeeding and PGP?


Posted by Madeleine Speed, the Pelvic Partnership. November 2014

A new study confirms that women with PGP should be encouraged to breastfeed

Over the years, the Pelvic Partnership  has received numerous calls to the helpline on the subject of breastfeeding and pelvic girdle pain (PGP). Women are often tearful and distressed when they contact us about this subject and it's no wonder. They've often been surprised by advice to stop breastfeeding because they have PGP. A well-meaning healthcare professional, such as a GP or midwife, has told them to stop breastfeeding to overcome their symptoms of PGP faster than if they continue to give their baby breast milk. This advice is wrong and there is now a new study (see the online Wiley Library for the abstract) that suggests that breastfeeding is not detrimental to recovery from PGP, but can actually prove beneficial.

11.07.11 Bruces pics 19The benefits of breastfeeding

There are many health and wellbeing benefits of breastfeeding for both babies and their mothers. The World Health Organization and many other bodies promoting health and welfare (e.g. UNICEF, the NHS, NICE, and the NCT, promote the importance of breastfeeding. It provides all the necessary nutrients an infant requires to grow and thrive, it helps them to build immunity to childhood illnesses and it also protects mothers from some breast and gynaecological cancers as well as osteoporosis (which is particularly important to women who have PGP). In addition, for women with PGP, breastfeeding is one of the things a new mum can do for her baby even if her mobility is restricted. When PGP symptoms can cause difficulties with everyday childcare, breastfeeding is a way for mothers to enjoy spending time with their babies and to develop a deep relationship with them. So given all these benefits, why are some healthcare professionals advising women to drop breastfeeding to speed up their recovery from PGP?

 The myth that PGP is caused by hormones

This idea of breastfeeding slowing down recovery from PGP is probably linked to the incorrect and out-dated view that PGP is caused by hormone changes in pregnancy. We now know that PGP is a biomechanical problem caused by stiff or stuck joints and usually associated with a misaligned pelvis. Hormones certainly affect PGP and can contribute to pain and sensitivity but they do not create PGP. 

Many women have been urged to stop breastfeeding but have found their PGP symptoms continue. We also know from many women’s experiences that they have made a full recovery (by seeking treatment through manual therapy) while exclusively breastfeeding.

New evidence backs up our efforts to dispel this PGP myth

With nearly 12 years' experience of providing support and information to women with pregnancy-related PGP, the Pelvic Partnership has picked up a great deal of feedback from women and professionals on the subject of PGP. We always link our information to evidence-based research as this is important for the benefit of our key audiences: women with PGP (whom we seek to help) as well as healthcare professionals who are not aware of PGP and how it can be treated at any stage during pregnancy. So it is great to report that a new study has been looking at breastfeeding and PGP and its findings support our approach.

The study was published 20 October 2014 and took place in Norway covering a period from 1999-2011. It was a follow up of 10,603 women with single babies delivered (from an existing Norwegian Mother and Child Cohort Study) who reported pelvic girdle pain (defined as combined anterior and bilateral posterior pelvic pain) 18 months after delivery.

The study found that there were 829 women (7.8%) from the original study who reported having PGP eighteen months after the birth of their baby. The patterns of breastfeeding at five months post delivery were not associated with the persistence of pelvic girdle pain. Significantly, "the proportion of women with pelvic girdle pain 18 months after delivery increased as the duration of breastfeeding decreased."

Conclusion

Breastfeeding article picThe study suggests that far from breastfeeding prolonging a recovery from PGP, breastfeeding is actually beneficial for recovery from PGP. Looking at breastfeeding and pelvic girdle pain, the authors of the study conclude that "Among women with pelvic girdle pain, breastfeeding should be encouraged in accordance with the existing child-feeding recommendations."

Not everyone chooses to breastfeed and we fully support your decision not to breastfeed if it's not right for you, but the good news is if you wish to breastfeed there is no reason why you shouldn't.  

If you would like to read more about this study, it can be found via the online Wiley Library website

 
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Please note, the Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain and wish to support other women. We aim to pass on information based on research evidence where available. We are not medical professionals and cannot offer medical advice. The Pelvic Partnership takes no responsibility for any action you do or do not take as a result of reading this information.
 
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