If you are a birth professional, how you answer this question is likely to be key to your day to day practice, affecting every detail; from the decisions you make when you attend a labouring woman to the way you feel and behave in your staff coffee room.
And if you are a pregnant woman, how you answer this question – who is the expert? – may also be key to the path your pregnancy takes, to the way you feel before during and after labour, and indeed to the entire birth story of your child that will be yours to tell or to guard for the rest of your history.
Who is the expert? This question can be at the root of division. In the wake of the recent Kirkup report, a doctor writing in the Irish Medical Times had this to say:
“Qualified obstetricians are the ultimate experts on childbirth. Their level of education, professional expertise and skill means they must be in charge. They are not the partners nor the equals of midwives, they are quite simply the higher authority because that is what decades of training and experience has made them.”
It’s easy to get angry with his commentary or even dismiss him as a misogynistic dinosaur. But, whilst his choice of words is undiplomatic and somewhat extreme, I think his attitude is a fair reflection of the hierarchy of power that exists in maternity care: certainly from a pregnant or labouring woman’s perspective. Most of the birth stories that inspired me to set up the Positive Birth Movement in 2012 were under the spell of this hierarchy: obstetricians at the top, midwives in the middle and pregnant women firmly at the bottom, looking up to the professionals, having little control, and disempowered.
The Positive Birth Movement has a tag line: “Meet Up, Link Up and Shake Up Birth!”. By simply connecting women to other women, via social media, and in our hundreds of ‘real life’ groups, we aim to empower women with the simple message that when it comes to childbirth, they have choices and options. This idea sounds pretty straightforward but you’d be surprised how radical many people find it.
It remains extremely difficult for a woman to challenge ‘the experts’ when it comes to childbirth. If she is told, “You must do this…or else this…”, she will very often feel that she has no option other than to follow ‘doctor’s orders’. Of course, if medical advice was always completely consistent across the board, then one might feel that it was right and fair to follow it without question. However, via the power of the network, women are discovering just how much advice can vary, from doctor to doctor, from trust to trust, from country to country.
Discovering a baby is breech is a classic scenario in which a pregnant woman may feel that she has very few options. When Mel Lyons’s midwife felt her bump at 35 weeks, she suspected the baby was bottom up and a week later, a scan confirmed this. Mel, who had been planning a home birth, found that the breech diagnosis immediately had a huge impact on her level of choice:
“We had already been told by the midwives that they wouldn’t be able to support a home breech birth. At the scan we were told that the next option would be an attempt at an ECV if we wanted it, to try and turn the baby, and that if that didn’t work, or if we declined, then we’d be scheduled for a c-section at 39wks.”
To see the full article:
Image: Wouter Tolenaars @Fotolia