Q&A with charity Birthrights

Birthrights is the UK’s only organisation dedicated to improving experiences of pregnancy and childbirth by promoting respect for human rights.

They provide advice and legal information to women and birthing people, train healthcare professionals to deliver rights-respecting care, and campaign to change maternity policy and systems.

As part of the #NotNeurotic series, I spoke to Birthrights’ Programme Director, Maria Booker, and Advice Officer, Jo Rhys-Davies.

SG: What are the most common issues you see in your work, where mothers and birthing people’s rights are not respected during birth?

Birthrights: The most common theme running through feedback we receive is women and birthing people not being listened to and not being respected as the ultimate decision maker in their maternity care.

Through our advice line, we hear everything from women who would like a caesarean birth being told it is not what is best for them, to individuals who want to give birth in a midwife-led birth centre or at home being told that they are “not allowed”. We also hear from people cajoled or coerced into an induction or into procedures during labour, without understanding their options, and from women who have been neglected on the post-natal ward. We even hear from women who have been referred to social services because a healthcare professional has not agreed with their choices, even though they are legally entitled to make them.

Where do these issues stem from?

That’s a good question. We think it’s a combination of factors. National policy, as well as the law, wholeheartedly supports “safe and personalised” care, as well as choice, but somehow that is not always what women experience.

Safe and personalised care requires enough staff to be able to give each individual the time and care they need, including being looked after by the same midwife or small team of midwives. The evidence shows this continuity of care makes a huge difference in terms of reducing premature and stillbirth and reducing the need for forceps/ventouse, episiotomies and epidurals. However at present, there is a shortage of around 3,000 midwives in England, and a survey conducted by the Royal College of Midwives (RCM) in the autumn, during the pandemic, found that 83% of midwives did not believe their Trust had enough staff to run a safe service.

Offering the best care also requires a healthy team culture, where staff feel supported and work well together, and where everyone is open and transparent about mistakes and willing to learn from them. However, there is a staggering degree of burnout amongst maternity professionals with two thirds of midwives considering leaving the profession in 2018, with indications that this has increased during the pandemic, and around a third of obstetric and gynaecology trainees not completing their training. Obstetric and Gynaecology trainees also report more undermining behaviour/bullying than any other speciality of medicine.

Part of the explanation for these high attrition rates is that staff are not well supported. A recent survey by Make Birth Better showed that 49% of midwives surveyed said the only support they had received during the pandemic was peer support. Often maternity staff are doing an amazing job given the circumstances they face. But ultimately, if we don’t look after staff, they will not be able to care for pregnant women and birthing people effectively.

We still see remnants of paternalism; the attitude that the healthcare professional has seen this all before and “knows best”. Perhaps even more widespread is a lack of understanding amongst staff about the legal context in which they operate. Staff can have a misplaced sense of obligation to protect the fetus, even though the fetus does not have legal rights of its own until it is born. Pregnant women are nearly always trying to do what is best for them and their baby, but the factors they will consider go wider than purely clinical considerations. The shadow of a clinical negligence case, or being reported to the regulator for not following guidelines, will often loom large in a doctor or midwife’s mind. This can sometimes eclipse supporting an individual’s decision, even though the law is on the side of healthcare professionals who do respect and uphold women’s choices.

What basic birth rights are all mothers and birthing people entitled to?

All women and birthing people are entitled to safe, dignified, maternity care that respects their right to make their own decisions about their body. You always have the right to have your basic needs met – for example, being able to access food, water and pain relief.

You have the right to be given evidenced based information and to have an open, two way discussion about any reasonable care option. You can decline any proposed treatment, intervention or medication for yourself or your baby. In addition, if you ask for something, your care team should do everything they can to say “yes”, and only say “no” if they have a good reason to do so.

You have the right to choose the circumstances of your birth, including where you birth and who is with you, unless it is necessary to restrict this right – for example, due to coronavirus. However, any restriction must be proportionate. Whilst giving birth on your own is not something to be undertaken lightly, you cannot be compelled to go to hospital and it is not illegal to give birth without assistance. When things go wrong, people have a right to complain and for that complaint to be properly addressed.

All women and birthing people are entitled to safe and personalised care. This means that some people will require extra support to access and participate in their care in the same way as others – for example, women who do not speak English as their first language, or people with a physical disability or mental health condition. Maternity services must make sure they are offering an equitable service to all women and birthing people.

Why are these so important? What is the impact of not having these rights respected?

All the evidence shows that a positive birth experience is linked to feeling in control of decisions and having a good relationship with your carers. The opposite is also true – feeling violated and unsafe can lead to significant and ongoing trauma, which impacts not the only the person who has given birth but the whole family. If we want to establish and sustain a healthy and safe society, healthcare – including childbirth – needs to be offered within a framework of human rights.

How is Birthrights working to make birth better for everyone?

Birthrights runs an email advice service for anyone who is pregnant or has just given birth. You can email us at advice@birthrights.org.uk. We also have a range of factsheets and information on our website. Birthrights also trains around 1,000 maternity professionals each year, providing an introduction to human rights law, and how it relates to everyday situations in maternity care. Finally, we use what we learn from working with pregnant women and from maternity professionals to inform our policy and campaigning work.

We have recently launched an inquiry into racial injustice, which will be a big focus for our work this year. Black women are four times more likely to die around the time they are having a baby, women from a mixed ethnic background are three times more likely to die, and Asian woman are twice as likely to die as white women. This inquiry will focus on women’s lived experience and what needs to be done to create real change. If you could like to submit evidence, you can find out more here.

How can mothers, birthing people and their partners/families advocate for these rights, both before and during birth?

During antenatal care, remember that you have the right to be given evidence-based information and to have a two way discussion about all reasonable options. Remembering the BRAIN option can be useful at any stage of maternity care – ask the healthcare professional to explain: the Benefits, the Risks, and the Alternatives. What does your Intuition say? What would happen if you did Nothing? Often you do not need to make an immediate decision – you could say something like: “Thank you for that information, I will let you know my decision at our next appointment.”

If you are not being listened to during birth, say something immediately to a member of staff. Use clear language such as: “stop”, “I don’t consent”, “I don’t feel listened to” or “you are hurting me”. Ask healthcare professionals to give you a few minutes alone with your partner/supporters to gather your thoughts. Women and individuals can also ask to speak to the senior manager on call, or contact the Patient Advice and Liaison Service (PALS).

There are lots of useful resources on our website and you are very welcome to contact our advice service at advice@birthrights.org.uk if you would like personalised advice.

You can find Birthrights online, on Twitter, Facebook and Instagram

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