Saturday, 9 April 2016

Still fighting for Birth Choices?

Conversations with women about birth choices show that women STILL have to fight for the right to choose where and with whom, if anyone, she would like to give birth.  

Sometimes, for many reasons, a woman may want to change her named midwife. There is a template letter on the AIMS website which helpful but using a template is not necessary.  Simply write a brief letter saying you would like to change your midwife and / or give the name of the midwife you want to have no further involvement in your care including during labour. There is no requirement to give a reason for wanting to change your midwife, exclude one from your care, or discuss why you would like to take this step.  A woman can suggest a favoured MW but there is no right to have a specific one.

I have borrowed this quote from the AIMS website which may be useful to remind midwives that a woman has an informed choice to decide where she may like to give birth.
QUOTE " I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'. " UNQUOTE

The NICE Guidelines (published Dec 2014) in 1.1 Place of Birth can add extra support regarding place of birth.  Quote sections that you will find useful to your circumstance.

While the NICE Guidelines talks about low risk women only, informed consent safeguards women to make choices regarding their place of birth and birth attendant(s) even if health care provider believes her status to be high risk.  That is, a high risk status does not preclude a woman from making decisions regarding her maternity care unless she is sectioned under the Mental Health Act.

It may be helpful to remind health care providers of the following: QUOTE "Care and support should take into account individual people's needs and preferences.

People have the right to be involved in discussions and make informed decisions about their treatment and care, together with their health or care team.

Give relevant information and explain the treatment and care in a way they can understand.

Support people's choices wherever possible. Each person is an individual, with their own needs, wishes and priorities. Treat everyone you care for with dignity, respect and sensitivity." END QUOTE

Lastly, a woman's right to a home birth is protected under the European Convention for Human Rights which will add further weight to your conversations with maternity care providers.

Some mothers have found that their wish for a home birth is being treated as a safeguarding issue and this implies that a referral to social services will or have been made.  If there has been written, spoken or implied indication that this is so, a woman has the right to know the reasons this referral was made or may be made.

Making a subject access request may help with focusing the minds of the intentions of those who are responsible for your care.

 A woman may want to write a letter stating that she is extremely concerned that that her pregnancy has safeguarding issues with implications that her unborn child is or will be subject to social services intervention.  A woman has a right to know how, by whom and when the decision was made and has a right to access to all information, formal or informal, hand written and electronic, including private email communication held by the hospital, showing her how the decision was arrived.

This link contains a template letter and further information about making subject access requests.

She may feel it necessary to state that any decision which contravenes the national home birth policies, NICE guidelines, and European Convention for Human Rights without transparent discussion with a woman of the rationale or any behaviour which contravenes these safeguards may be harassment and that she could seek legal advice regarding action she can take if she feels it becomes necessary to do so.

Use registered post to the Supervisor of Midwives (SOM)  on Duty or one whose name is known and you may want to copy your letter(s) with any with interest in maternity provision such as the Chief Executive, the Director of Obstetric and Gynaecology, your named consultant if you have one, and your MP either by post or email.

Sending a letter precludes issues with phone calls like 'forgetting' to call you back or saying that Midwife X is not on duty, busy elsewhere, or on holiday. Writing saves on the stress of talking and thinking at the same time especially if a woman feels that she is already being undermined in her birth preferences and she can say everything she plans to say without interruption.  Of course writing brings its own stresses but it is an opportunity to clarify the issues for the woman - and it becomes evidence to which she can refer to later.

Typically expect a 5 working day turn around for a response in writing which is how you are entitled to have it.  If the SOM decides to phone, listen calmly and engage her but a woman is  within her rights to ask for confirmation in writing of whatever they say over the phone or is free to email asking for confirmation of the details of the conversation that transpired and bullet point the main points of what was understood in the conversation.

I hope this is helpful to the women who are still fighting these battles.  Ideally maternity care will be simpler and supportive but there are, unfortunately, times when women feel embattled and responding in these terms becomes an option she feels she has to take.

It is never her fault that she feels like this.

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