Beyond Consent: Supporting Women’s Choices
The day focused on how midwives and other healthcare practitioners can support the choices that women make around pregnancy, birth and the postnatal period, discussing key issues around informed consent, risk, support, coercion, advocacy, autonomy and choice.
To say it was a bit mind blowing would be an understatement.
I was there with Pinter&Martin, to sign books with fellow P&M author Mark Harris, who was also presenting in his fabulous energetic way. As usual I couldn’t help but illustrate a few of the speakers – so here’s a short summary in pictures – I hope I’ve done them justice!
Helen Calvert, of #MatExp (a fantastic online meeting point of birth professionals and non professionals to raise issues and discussion about birth and best practice – get involved if you haven’t already) brought women’s perspectives to the table in the first seminar, bringing that fine balance of experience alongside education to the group.
She asked – ‘How can we support women?’ And some of the responses are noteworthy: ‘make sure they know they have choices to begin with’, ‘giving of care means [meeting] emotional as well as physical needs’, ‘you’re never going to find a mum that wants to be treated just like everyone else’, and ‘what made it a positive experience was passionate and respectful care throughout’.
Words that echoed from the seminar – choice, compassion, empathy, dignity, understanding, respect, trust, support, and empathetic use of language – were brought together under the term #heartvalues – a wonderful reference for care giving.
In the main lecture theatre, Lisa Bacon followed Nicollet’s introduction to the conference, and asked that the students ‘consider [their] place and contribution in taking the profession forward’. Lisa has taken up a new post as Director of Midwifery, Counselling & Psychotherapy.
Lesley Page set the tone for the day and quietly instilled a foundational sense of confidence and warmth into the room. To the students she says ‘you will make a huge difference to the women you are looking after’. And she means it. There is encouragement in her voice but also an urge to be confident and to take responsibility for their roles.
‘Stalwart Pioneer’ Denis Walsh extended Lesley’s fountain of knowledge, talking inspirationally about the primacy of women’s experiences and emphasis on ‘multi-professional working’.
He talked eloquently about the professional context of baring children in an historical framework – ‘the medicalisation of childbirth is a consequence of not believing the body is fit for purpose’ he says, and of the professional expectations of midwives and caregivers he talks with humour, and yet an underlying seriousness – ‘there is a legal responsibility to present the choices’.
Denis finished with a pertinent take home question ‘courage, trust, love – all of these things are happening in the birth – they’re not in the notes though are they?’
I was looking forward to meeting Kati Edwards and hearing her spoken word, but I wasn’t prepared for it to be so affecting! Strong, directed words and a passionate performance put us all straight – and as a fellow artist it gave me a huge amount of joy to see such a powerful and well articulated creative response. Go Kati!
The final speaker of the morning was Julie Frohlich, consultant midwife at Guy’s and St. Thomas’. She engaged the audience in research findings and ‘risk’ in birth, asking ‘what is high risk?’. ‘It is very important we talk about absolute risk’, and being careful to avoid a ‘one size fits all conclusion’ she reminds us that ‘one woman’s minor risk is another woman’s major risk.’
The afternoon session started with an eye opening presentation on best practice of vaginal examination, by Mary Stewart. Mary talked of the education of VE with examples of how some trainee midwives learned about this delicate practice, ‘we were taught how to put the gloves on but not how to talk about it.’ She gave examples of bad practise, and warned about respecting woman’s wishes ‘there’s a big difference between agreeing to do something and consenting to do something’, commenting about language that ‘using the word ‘need’ is highly problematic’.
Having experienced inappropriate language from caregivers I have first hand of the powerful effect words can have – especially when a woman is in such a vulnerable state as pregnancy – and I found this presentation a sobering and very necessary education for students about the effects (intentional or not) that midwives can have on the women they care for.
The emotional charge was still pretty profound as the next speaker – Wendy Warrington, Outreach Midwife – talked of the Strengthening Families initiative, supporting vulnerable women and families. Her work in early intervention of higher risk families and perinatal mental health left me awe inspired and actually quite teary. What an incredible journey, and what amazingly brilliant work this project does. I urge any city council to look at this project as a benchmark in investing in vulnerable families, in their heartwarming and obviously very effective work.
We had a short break before Mark Harris hit the floor with a high energy, hilarious and engaging performance. Mark amazed the audience with honesty and no-bullshit approach to caring for women. He continued Denis’ theme of the context of birth and it’s recent history ‘childbirth has been influenced by evolutionary testosterone imperative!’ and ‘evidence is not to be believed, it is to be tested’. Mark talked of the ‘unconscious cycle of communication’, and of how the language we use shapes our culture, finishing with the powerful effects of speech ‘our words create our worlds’.
Finally, Johanna Rhys-Davis of Birthrights gave us an insight into human rights and law in childbirth, with an important perspective on the context of birth and women’s rights – ‘we think it is fundamental to reclaim the discourse around human rights for women’. She talked of the right for women to their ‘physical and moral integrity’ and gave international examples of law cases on place of birth and the practice of caregiving. Inspiring.
Phew. Having revisited the conference here I am once again amazed at the depth and diversity of the midwifery profession – the expectations and responsibilities for midwives and care givers are enormous, the need to understand the historical contexts of the medical profession is so important, and the necessity to untangle, and reposition oneself within the ‘administration’ of the maternity services vital to be able to care with confidence. I admire anyone entering the role of care giver. The reasons for becoming a midwife are emotive – to support, to help to ‘care’ for women, and I think it is vital that students and midwives do not loose sight of these fundamental reasons whilst navigating the journey and context of their profession.
I take my hats off to you all!!