Katz Rothman B. MIDIRS Midwifery Digest, vol 23, no 2, June 2013, pp 143-150.

The June Digest has what might be considered an unusual Hot Topic. It is informal and contains only three references. It is written by a respected and key figure in birth and feminism, Professor of Sociology at City University of New York, Barbara Katz Rothman.

Barbara’s list of publications is both long and impressive, and her article in this month’s Digest is as inspiring as ever. Although she addresses the difficult, controversial and potentially highly intellectual issue of how autonomy and caring could ethically be brought together, in Caught between autonomy and caring: still struggling towards and ethics of midwifery, she writes accessibly, using examples from her own experiences and observations, to bring to life what autonomy and caring might really mean for women, their supporters and midwives during childbirth.

Her paper explains to us why autonomy in isolation – ie, “it’s your choice”, and “we would advise this, but it’s absolutely your decision” so frequently heard, if choice is provided at all, is not always helpful. It explains equally well why ‘caring’ can so easily become paternalistic, even abusive. And yet, ask any pregnant woman what she needs from maternity services and one of the first things she says is supportive, kind, and caring midwives.

Of course, the other point (of many) that Barbara raises is that providing neutral information is well-nigh impossible, and decision making never occurs in a vacuum. Without even realising it, information provided by health practitioners is usually given in ways that are likely to result in the woman agreeing to what is on offer or what is being advised. Other work confirms that this is indeed the case, not only in midwifery, but in other disciplines.

Barbara carefully, and courageously refrains from providing any answers to this conundrum, suggesting instead that we need to tread an exceedingly careful path between enabling autonomy, while still engaging with women, and that when women are faced with decisions that are temporarily just beyond them (when for example they are in the throes of a powerful labour, or exhausted after a long and challenging labour), sometimes they need care more than anything else, and that this is usually best provided by a loving, known and trusted other. In Barbara’s words, ‘We want to find a way of providing care, a way of genuinely caring, that nonetheless respects autonomy, that allows someone to collapse totally and trustingly into her midwife’s arms and her care, and yet return her intact to herself. We are seeking a care that won’t diminish but enhance her as a woman, and as a mother’.

We need to tread an exceedingly careful path, because so many women report feeling coerced and traumatised during childbearing, and a woman’s legal status to be autonomous is so often questioned when she is pregnant, birthing, or is caring for a baby. Barbara is in no way advocating abandoning autonomy, and in our next (September) issue we will be addressing this issue of what autonomy means and its importance to women during childbearing.

Meanwhile, the new charity, Birthrights will be hosting the Dignity in Childbirth Forum on 16th October 2013 at the Royal College of Physicians in London, and is currently calling for submissions.

Katz Rothman B. MIDIRS Midwifery Digest, vol 23, no 2, June 2013, pp 143-150.

Photo: Becky Reed