Donnison JLondon: Heinemann Educational Books; 1977

Feeley C, Thomson G, Downe S Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: findings from a feminist pragmatist study. PLOS ONE. 2020; 15:(11)

Harris R, Ayers S What makes labour and birth traumatic? A survey of intrapartum‘hotspots’. Psychol Health. 2012; 27:(10)1166-1177

Katz Rothman BLondon: Junction Books; 1982

Katz Rothman BMiddlesex: Penguin Books; 1984

Kirkham M Fundamental contradictions. The business model versus midwifery values. In: Edwards N, Mander R, Murphy-Lawless J (eds). London: Routledge; 2017

Maternity providers' perceptions of women's autonomy and the law. 2013.

Lee S, Ayers S, Holden D Risk perception and choice of place of birth in women with high risk pregnancies: a qualitative study. Midwifery. 2016; 38:49-54

Homebirths a ‘Selfish’ risk. 2015. (accessed 29 April 2021)

Plested M, Kirkham M Risk and fear in the lived experience of birth without a midwife. 2016; 38:29-34

Reed R, Sharman R, Inglis C Women's description descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth. 2017; 17:(21)

Rigg E, Schmied V, Peters K, Dahlen H Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study. BMC Pregnancy and Childbirth. 2017; 17:(99)

Shallow H Deviant mothers and midwives: supporting VBAC women as real partners in decision making. Essentially MIDIRS. 2013; 4:(1)17-21

Lee S, Ayers S, Holden D Risk perception and choice of place of birth in women with high risk pregnancies: a qualitative study. Midwifery. 2016; 38:49-54

United Nations. Universal declaration of human rights. 1948. (accessed 29 April 2021)

Van Wagner V Risk talk: using evidence without increasing fear. Midwifery. 2016; 38:21-28

Vedam S, Stoll K, McRae D, Korchinski M, Velasquez R, Wang J, Partridge S, McRae L, Elwood Martin R, Jollicoeur G Patient-led decision making: measuring autonomy and respect in Canadian maternity care. Patient Education and Counselling. 2019; 102:586-594

Wagner MCamperdown, NSW: Ace Graphics; 1994

Is she allowed?

02 June 2021
Volume 29 · Issue 6


Dr Clare Davison discusses why midwives and other healthcare professionals need to acknowledge and support women's autonomy in maternity care

All women deserve access to a safe birth. All women, however, also deserve a positive and empowering birth experience and to be autonomous in their decision making. With the move from the community to the hospital, most women in the western world now give birth in large maternity hospitals, which need to be run efficiently. For the maternity service to run efficiently, it is deemed that midwifery care must be standardised, and tasks must be preformed. Kirkham (2018) states that ‘standardisation requires care to be defined as a series of tasks to be monitored rather than a continuing supportive relationship’.

Providing midwifery care in this way leads to midwives losing their autonomy and flexibility which is essential to woman-centred care. Polices, procedures and guidelines instead of ‘guiding’ the midwife's practice become rules that must be adhered to. With this policy driven practice comes the fear of deviating from the rules and the pressure for midwives to conform to them increases (Kirkham, 2018; Feeley et al, 2020). Providing true woman-centred care and upholding women's autonomy can be extremely challenging within this fragmented system, and this is the challenge that many midwives face on a daily basis.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month