One memory of my former career as a police officer sticks with me: stood in a soft play with a college who gently touched the member of staff and explained, ‘if I touch you without your consent, then I commit a crime. It's called battery.’ The definition of battery under English law contains the words, ‘undesired touching of another.’ As a PC, my training was based around the boundaries of consent; that everything we did and said was subject to the law and to the public. The police ‘police by consent’, which means that the public allows the police to step into a role where they enforce public peace, with the understanding that this consent is dependent upon public approval of their actions and their ability to secure and maintain public respect.
Browsing Twitter of late has made me wonder how the issue of consent is approached in maternity services. Often, midwives will hear birth stories where a woman felt as if she had lost control of her birth and wasn't listened to regarding the autonomy of her own body. Listening to a friend's birth story, she told me: ‘nobody gave me a choice, things were just done to me, I was a passive participant in my birth.’ Birth trauma is a very real issue that can affect women for years, or even decades. At a recent ‘Healing birth’ meeting, a woman reflected on her daughter's birth 28 years previously, and how it still affected her.
Having heard both Millie Hill and representatives from Birthrights speaking at different events, it is obvious that human rights in childbirth matter—they are paramount to how women experience maternity care and how they feel they are treated with respect. When approaching this issue, it can seem rather simple, and to be honest, it probably is. However, consent within medicine and maternity care is suspended against a backdrop where, historically, patient voices were not heard. It was said that the ‘doctor knew best’, and doing ‘as you were told’ was just what you should do; however, this stance does not make for holistic care.
Documents such as Better Births (National Maternity Review, 2016), Changing Childbirth (Department of Health and Social Care, 1993) and Compassion in Practice (Department of Health and Social Care, 2012) all enshrine the person at the centre of care. We care by consent; we do not know best. We may have knowledge that others do not; however, it is incumbent upon us as practitioners to educate those who we care for, so they truly have informed consent and autonomy over their own bodies, and a choice in how their care pans out. There is no ‘you are allowed’; merely ‘how are we going to care for you?’ or ‘how are we going to achieve this?’. Women and their families place themselves into our hands at a very vulnerable time of their lives, and they trust us to take care of them to the best of our ability.
I do think that this is sometimes difficult to grasp for some. We have such knowledge, and we see so much, that experience and history reminds us of how it can go wrong and how often. As someone with this experience, it is hard to stand back, knowing what you know, and advocate a choice that, as a practitioner, you do not feel is right or sound. However, it is not about us and our knowledge: we are merely educators and facilitators of choice and informed care. Our aim is to inform women of the evidence and support them in their choices.
I think back to my friend's words, about how she felt like a spare, unheard part in her own birth story, this fills me with horror as a woman and as a midwife. I do not want anyone in my care to feel unheard, or to feel discarded at such a time in their lives. Whenever humanly possible, we should make space for these conversations, continually advocating choice so that, when a woman leaves our care, she leaves knowing that she was at the centre of it and that her voice was heard.