Doula Courses | Education | Doula
By Emma Ashworth
Today, March 8th, is International Women’s Day, a day to celebrate the strength, power and, of course, history, of women. I want to share some history which affects every woman or birthing person who has a child: The history of hospital birth and home birth. How did we come to birth most of our babies in hospital, and is it the safest option?
[Read more…] about The history of hospital birth and home birthBy Sharon Bridges
During my mentoring session with Michelle Every, facilitator of Supporting Every Birth, Michelle suggested that I write an article on the experience from a grandparent’s point of view. Around this same time, my daughter bravely made a Vlog offering support and sharing her own experiences, so I felt this was a suitable subject for me, following the loss of my first grandchild, Cillian.
Cillian was a little blessing we were told was on his way on Christmas Day 2019. I had lost my daughter Sophie in 2018, which made Christmas a difficult time, as it was Sophie’s favourite time of year. My older daughter, Hannah, had been planning to start a family in 2018, but following the loss of her sister she decided to wait until we were in a better frame of mind to welcome and nurture a new life, so this news was indeed very special. Hannah was only around the 6 weeks stage, and a bit nervous telling family, as my niece had sadly suffered a miscarriage of her first little girl in November 2019. Sure, what could possibly go wrong, when we had already been through so much loss? The 12 week scan showed everything appeared to be going well, and the 17 week scan confirmed this, but there was a brief mention of a little fluid on the kidneys. The hospital staff were more concerned with adhering to Covid-enforced restrictions to answer the questions of an anxious first-time mother, so Hannah decided to have some private scans carried out. Again, these showed no major cause for concern, and revealed that we were expecting a little boy. A small heart defect was indicated, along with the fluid in the kidneys, so Hannah was referred to the Foetal Medicine department in the Royal Victoria Hospital, which is really the highest level of care on offer in Northern Ireland. The specialist could still find no reason to worry, and felt that perhaps by delivering early and having a look at the heart, Cillian had a good life ahead of him.
How did that go so wrong? At 32 weeks, Hannah went through an amniocentesis to put her mind at ease before being induced, and at his point we discovered our beautiful little man had Patau’s syndrome, Trisomy 13. None of us had ever heard of this. We were familiar with Down’s syndrome, as I have a cousin who has had a wonderful 45 years of life so far with this condition, and that was the reason I had advised against this invasive procedure. If our worst-case scenario was Down’s syndrome, our grandson would still be so loved and a welcome member of our family. We were not prepared for this news in any way, and it felt like a horrible, cruel trick. We were given this news on a Wednesday, and told Hannah would be induced on the following Saturday. I still believe that where there is life, there is hope, and on those nights I stayed with Hannah before she went into hospital, we made memories with her little bump. We told him how much we loved him and wanted him to be part of our family, although Hannah and her husband Paul did not want to be given any false hope. My heart was completely shattered, but I kept it inside when I was with them, but when I was alone in the middle of the night, that is when the tears came.
Saturday the 27th June 2020 arrived, and Hannah and Paul had to report to the maternity hospital alone. Throughout lockdown, Hannah had to attend all her maternity appointments alone, but there was no way was I letting her face this unsupported. Having been induced 3 times myself, and also working in a maternity hospital, I was aware that we were probably in for an arduous journey of days, rather than the hours they were both expecting. I felt sick all day waiting for news, but it was only when the night staff were on duty that I was allowed to join them at the hospital. It was a horrible stormy night, as if Belfast was offering me her sympathies, but I made my way to the special Snowdrop room, which would be my home for the next few days.
That first night felt like it went on forever, as the niggling cramping of early labour began, but it was evident there was not much progress to be made. I guess that’s when my doula brain kicked in, and I encouraged Hannah and Paul to get some sleep. The last thing you will feel like doing is eating and drinking, but it is vital that you all keep your strength up and stay hydrated. The staff were amazing, every one of them, who treated us with such compassion and empathy. Sunday was another long day, and between us we decided Paul should go home overnight for a proper rest and meal, while Hannah and I had our last bonding time with little bump, watching silly comedies that reminded us of happier times with Sophie.
Our perfect, precious little Cillian arrived and departed this world on Monday 29th June, born sleeping, still warm when the midwife handed him to me. It was surreal, being handed this beautiful little boy by someone who said ‘I am so sorry for your loss’. I wanted so much to try to resuscitate him, as I ached so much for him to breathe, that I put my mouth over his tiny mouth and nose, just waiting for a sign of life. I longed so much to hear those first little cries, but this was not to be, Sophie had already welcomed her little nephew to her as he entered the world. As Hannah and Paul comforted each other and expressed the rawest of emotions, I held Cillian to my heart and allowed one tear to escape, before reuniting him with his mummy.
The Snowdrop room in the Royal Victoria Hospital had been set up in 2018 by a family who had gone through this life-changing experience, and although it is in a maternity hospital, it is separate from the labour wards and delivery rooms. We had a sacred place to spend as much time with our special little man as we needed. I won’t go into all the sentimental things we did as it was personal to us as a family, but we were so thankful that we had that time with Cillian, and he was treated as a person in his own right by all of the wonderful staff, who not only looked after Hannah, but myself and Paul also.
My reason for sharing this with you is really just to give you a little background on our family dynamic, but I would like to share some suggestions to any grandparent who is facing the same scenario. Yes, you want to scream, and cry, and curse, so do it, when and where appropriate of course! Your child needs you to appear strong and calm, no matter how sick you feel inside. Your child is still, and always will be, your child, so you place your own pain aside and care for them first. Be there. I was told I may not ‘be allowed’ into the hospital, but no force on this earth would have kept me away. Make your memories, before and after the birth. That little heart is still beating, those little ears can still hear you and recognise your voice. Believe me, you will thankful that you did. Acknowledge that tiny life as part of your family. One thing that particularly touched me was a text message from my own mother, saying ‘I am so proud to be his great grandmother, and I love him’. This also reinforced in me the assurance that your mother is, and always will be, your source of strength, and in her eyes you are forever her child. You may want to consider what you would like to dress the baby in, or put in the cot with them, but the hospital staff were a great help to us as we had not really given this a lot of thought. We picked a little outfit for Cillian, and the staff gave us a beautiful memory box containing 2 little blankets and teddy bears. One set went with Cillian, and the other stays with us. I have a ring that I had made containing Sophie’s ashes, and I placed this in his little hands overnight, so know it has an extra special meaning to me. Take photos, lots of photos. These will be all you will have to look back on, so make the most of every opportunity. It is not as morbid as it sounds, trust me.
Of course, there are practical things that need to be considered, such as registering the birth and death, or receiving a certificate of stillbirth, and arranging a funeral. Again, the hospital staff took care of so much, and we are eternally grateful for their support. There is so much more I could share, as a mother, a grandmother, and now a doula, but we experience every moment in our own way, and our journeys are all unique. Rest assured, you will get through this, your child will get through this, and there will be happier times ahead, but you will always have that little angel tucked away in your heart.
Cillian showed me that my calling was to become a doula, and I intend to offer my services to any woman facing this experience, who may not have family support around her. I will honour his memory, give him this legacy, and breathe the meaning into his existence that I was unable to breathe into his little body, and he will always be my first grandchild.
For Cillian Noel O’Gallachoir, 29th June 2020.
Further information and support:
SOFT UK: A charity providing support and information to parents of children with Trisomy 13 (Patau’s Syndrome), Trisomy 18 (Edwards’ Syndrome) and other genetic differences, before and after birth. https://www.soft.org.uk/
Sands: A charity which supports those who have been affected by stillbirth and neonatal death. https://sands.org.uk/
Miscarriage Association: A charity to support people affected by miscarriage: https://www.miscarriageassociation.org.uk/
Supporting Every Birth: Nurturing Birth’s interactive workshop created for doulas and birth workers looking at supporting both clients and themselves through all birth journeys including baby loss. https://nurturingbirth.co.uk/retreats-and-workshops/supporting-every-birth/
By Michelle Every
What do you say when someone – a doula client, a friend, a relative – tells you that they have experienced a miscarriage or stillbirth? Michelle Every offers some support, information and signposts.
When I trained to be a doula in 2007 I was astonished and saddened that supporting baby loss was not mentioned on my course. Then as I gained experience and connected deeper into the doula community I noticed that loss was not something that I saw being discussed.
In 2014 I felt a strong conviction to change this so I created the Supporting Every Birth workshop. I wanted to create a safe space to explore loss with a focus on self-reflection and group participation and give time to consider where we are with our own grief being curious and honest with ourselves around our own views and opinions on loss
When talking to doulas about baby loss the two phrases I most often hear are “But what will I say?” or “I worry I will say the wrong thing.”
There is fear around the power of language.
What we do or do not say is not just relevant to supporting loss or supporting clients. It is relevant in every exchange we make in our everyday life. How we respond to what we hear can have a significant impact on the person sharing. Have we heard them or are we focusing too much on our own answers or our own story? How can we offer space, actively listen and resist the need to fix?
When I am considering my choice of words I keep the Nurturing Birth values of respect and compassion at the forefront of my mind. These values lay a great foundation when considering language, can shape my conversations and prevent me from saying something in anger or frustration.
Is what I am about to say respectful and compassionate?
Coming back to supporting loss, what do you say to someone who has discovered their baby has died during pregnancy? Or what can you say at a labour when the baby is born not breathing and has died?
I volunteered for the Miscarriage Association for fifteen years. When I answered the phone and listened to people share their own stories of loss I would hear how the countless times their family, colleagues and friends had said unhelpful things such as “Everything happens for a reason” or “Just move on.”
From my experience of facilitating loss support groups I am aware how a spoken phrase can bring much comfort to one person only to upset another. No one way works for all. It is good to remember that grief is a natural, unique and personal response to losing something important to us. As doulas we want to validate this uniqueness while acknowledging the challenge that this can bring to us personally. We are required to offer support in the moment and respond to what we see and hear rather than having a pre-planned and prepared response.
Maybe we are beginning from the wrong place. Instead of starting at what we will or will not say it might be helpful to start with what can we be. How can we be our most authentic self and respond to the needs of the family we support?
On the Nurturing Birth doula courses and within mentoring we talk about being rather than doing. Our skills are listening, holding space, being client led, responding to needs in the moment. We go to births with no guarantees or certainty and yet we go with confidence that our presence and commitment to the family will make a significant difference
Is this any different when the baby does not survive?
We can create the same environment, listen with the same focus and respond in the same way.
To be honest, and to give a little away from my workshop, not much changes in the support we offer in loss compared to supporting clients with live babies.
We simply doula.
The Miscarriage Association has created some excellent resources which come from supporting loss for many years, including this video -when you do not know what to say, simply say “I am sorry.”
How do you feel about supporting families through baby loss? Do you have concerns on what to say? I would love to welcome you on to the Supporting Every Birth workshop to explore the topic more. My desire is that every doula feels able to step into this role and offer support.
If you would like to talk to me more about the Supporting Every Birth workshop please get in touch – michelle@nurturingbirth.co.uk
Book review by Natalie Stringer
The AIMS Guide to Resolution After Birth, by Shane Ridley, is available from the AIMS shop as a printed book or on Kindle, for £8: https://www.aims.org.uk/shop
“An absolute must-have resource.”
This book from the Association for Improvements in the Maternity Services (AIMS) is an absolute must have resource guide. It will point you in the right direction to find answers and peace following a challenging birth where you have experienced traumatic events.
All information provided in this book is completely up to date being published in 2020, therefore all signposting to relevant websites are accurate and still in practice.
There are so many different, confusing avenues you may need to explore when wanting to raise a concern or make a formal complaint after birthing a baby. This book very easily allows you to recognise and guide you towards the best route for your individual circumstance. It is UK specific and highlights the different organisations in England, Scotland, Northern Ireland and Wales, so you can contact the relevant people in your country. There are some time limits when making a formal complaint within the NHS Maternity system, and these are highlighted in the book. Therefore having this guide to hand to dip in and out of when you feel comfortable, will help you piece together what you need in a time frame that suits you, but does not exceed the cut off point.
There are template letters provided in the book that you can work with to raise a concern or make a formal complaint. Numerous support organisations and charities are listed throughout the book, enabling you to seek out who can help guide you through this process, if necessary.
The book also provides a great insight into how to prepare for a subsequent birth and who to liaise with, as this will help ensure certain traumatic events do not reoccur again. Guidance on how to write your ‘birthing decisions’ is a great resource and will give you the foundations to make this birth better and more in-line with your own personal needs. It provides different options for you to choose the best support for you throughout your next pregnancy, labour and birth. This will help ensure you can feel more emotionally and physically in control of your decisions and your autonomy.
Exploring how you feel about your difficult birth experience and/or the care you received is discussed in Chapter 3 of this book. I know this will be so comforting for many mothers and birthing people who decide to put pen to paper and allow their experience to be validated. This may just be a starting point that encourages you to recognise that you do indeed wish to raise a concern or make a complaint. For others it may provide enough emotional release and your resolution may end there.
The language used in the book can be a little difficult to digest in some places. Although written thoroughly and very clearly, some areas can be a little heavy on abbreviations and putting a sentence together in places may need re-reading a few times to help it sink in or understand which organisation or charity has been written about.
Ultimately, many readers will be looking to find much needed answers and therefore it can be used as a reference book. So it may be a case of finding the relevant chapter(s) for their individual needs rather than reading the book from cover to cover. The contents pages at the beginning make it easy to navigate through whilst missing out sections that are not relevant to you. However, I believe every birth worker should read every page of this book and refer to it often, not only to recommend to their clients who need to seek resolution after birth but also to locate relevant information very quickly.
As part of ‘The AIMS Guide To’ series of books I believe this one will help many, many birthing people find their inner strength and courage to explore not only what happened during and following the birth of their babies, but also find the light to indeed seek resolution.
The main success of this book is giving parents the permission to find a way to raise their concerns or make formal complaints about their birth experiences. Together, if more people feel listened to, respected and supported when choosing to revisit their difficult experiences in order to find answers, they will be paving the way for a better maternity system for birthing people now and for the next generation.
Book review writted by Nurturing Birth Doula Natalie Stringer.
Natalie can be found at www.equilibrium-birthing.com or on the Nurturing Birth Directory: https://nurturingbirthdirectory.com/doulas/united-kingdom/kent/sevenoaks/natalie-stringer/
Nurturing Birth doula and writer Emma Ashworth interviews Yuval Topper, trans man from Yorkshire and birth father of three to find out more about his experiences, and how doulas can better support trans men during pregnancy and birth.
Emma: Tell me about yourself, where you’re from.
Yuval: I am married to Matan, I’m from Israel but I live in the UK and I’m a trans man with three children who I gave birth to.
I had my oldest son (Lyrie) and my daughter (Aria) in Israel – my son in hospital and my daughter at home, although I had planned a home birth for them both. It’s not easy to have a home birth in Israel, and most midwives will not come once you reach 42 weeks, so at just over 41 weeks I was getting quite nervous. I decided to take castor oil which did seem to trigger labour – but also may have been why my Lyrie passed thick meconium when my waters broke, so we transferred to hospital.
Emma: How did Lyrie’s birth go?
Yuval: I really hadn’t wanted to go to hospital. I had gone to a different hospital at about 26 weeks with reduced movements. The experience in the hospital wasn’t too bad, and my baby was looking healthy, but then shortly afterwards a national newspaper contacted me, wanting to write about my ‘story’. Matan and I decided that we really didn’t want to talk to them – and they ran the story anyway – the first trans man to be pregnant in Israel. It was not positive coverage. The hospital denied that it came from them of course, but it really made me wary of contact with unknown medical staff.
Lyrie’s birth was quite traumatic. As is common in Israel I was made to have interventions that I didn’t want, such as an episiotomy and ventouse. I was also mis-gendered a lot. In Hebrew everything has a gender. In English I might be mis-gendered when someone talks about me, ie using she/her rather than he/him, but in the Hebrew language this can happen when someone speaks to you directly, and this happened a lot during his birth.
I really wanted to be completely naked while I was in labour, but the staff kept covering me which felt really irritating and against my body’s instincts. I did wonder whether they felt uncomfortable seeing my non-conforming body which is why they kept trying to cover me.
After Lyrie was born and I was moved to the postnatal ward, I had a frustrating conversation with a midwife or nurse who kept telling me how unusual the situation was, and she’d never come across it before, but she was fine with it. She was clearly out of her comfort zone and continuing to repeat that she was “fine with it” showed that she maybe wasn’t! Next day another staff member came round to see me and asked whether I was going to “stay a woman” now!
Emma: That sounds really exhausting
Yuval: Yes, I was feeling that I had to justify my existence rather than focus on my baby. But it didn’t end there. Although they gave Lyrie a registration number in the hospital, I had lots of problems when it came to register his birth. They would not allow registration from a man, and that forced me to re-register myself as a woman, register Lyrie and then register as a man again. The process is complex and for a while it was unclear whether they would re-register me as a man, which would have left me with unmatched identification such as my passport and driving licence.
Emma: What happened with Aria’s birth?
I again planned a home birth with Aria, and this time had a very positive birth at home. However when it came to registering her I had even more problems! The Registrar refused point blank to register her and actually told me that Lyrie’s was a “one time offer”! We did manage to register her in the end but it took so much time and effort, and for no benefit to anyone at all. It was transphobia, pure and simple.
Emma: So then you moved to the UK?
Yuval: Yes, and I became pregnant with our third child, Liam. At around 12 weeks of pregnancy I was phoned by the hospital and asked to come in for a scan – they had found a problem on my blood tests. My husband was away and my friend was unable to come with me – I was really nervous about attending an unknown hospital in a new country. Did they even know I am trans? How would they treat me?
In the end I went with a midwife that I had met once before, who I knew was trans friendly, and that she would support me to advocate for whatever I needed – but as it turned out I could not have been better cared for.
When I went to the appointment I received the devastating news that Liam had died at around 10 weeks of pregnancy. Despite the shock of the news I felt extremely well cared for by the obstetrician at the hospital. She made sure to ask me my pronouns, not assuming that I would prefer he/him (which I do) as some trans people prefer they/them or something else. I was otherwise treated just like anyone else – no one tried to ask me whether I was now going to stay as a woman! They were kind and supportive and recognised that I had just lost my baby, and my gender changed nothing about that.
Emma: When you were pregnant with your fourth baby, how did this influence your care decisions?
Yuval: When I was pregnant with Teagan – or Tig as we call him – a medical condition meant that I needed to have frequent scans and tests. My body had become Kell+ sensitised. This is a very rare condition which is very similar to being RhD Positive, but there is no equivalent with Kell+ to the anti-D treatment. I am Kell- and my husband is Kell+, so each baby has a 50/50 chance of being one or the other. As with RhD, this doesn’t matter for the first baby, but if any baby has a different blood type to the birth parent, and if this blood mixes, this can cause problems for subsequent babies. It seems likely that Aria’s blood, which is Kell+, mixed with mine during her birth. This means that my body became sensitised to it and my immune system is then able to attack the blood cells of any Kell+ baby.
We discovered through the NIPT test that Tig was almost certainly Kell-, which was a huge relief, but we could not know for sure. This did lead to a very stressful pregnancy, and I decided that I needed the support of a midwife that I knew, so we hired Hannah, the independent midwife who had been with me when I learned that I was miscarrying Liam. Having Hannah was a huge help, although I was also receiving excellent support from the NHS as well. In the end I birthed Tig at home together with Hannah and my friend Mari, and these photographs are the ones that Matan and I decided to share, and which have gone viral!
Even though the care in the UK was far more trans-friendly than I experienced in Israel there were still serious issues. For instance, the lab rejected my blood tests a number of times as my medical record has me recorded as male, and the lab tests were for pregnancy related conditions. This caused delays and could have impacted on mine or Tig’s health. I was also frustrated that, like in Israel, I had to have my name recorded on Tig’s birth certificate as “mother” – but here I also had to add in my occupation. So Tig’s birth certificate says “Mother… occupation – Full time dad”!
Emma: I love that! I do hope that the NHS will be able to update its systems to better support trans and non-binary people with all aspects of health care. It’s great that that you got the support from the staff. I’m wondering what, as doulas, we could do to better support trans or non binary clients?
Yuval: I think my biggest request would be to not make assumptions! For instance, many people assume that trans people don’t like their bodies. This is really not the case for many people! Many of us are very happy with our bodies. Different people do have different feelings about their body parts though – especially the genitals and the chest. Some people really struggle with the names of genitals and prefer to use different names. Others are happy to use the regular names. Where appropriate and relevant, just ask. However, consider whether you need to know – don’t just ask just because you’re curious. Also listen carefully for the words that the person you are supporting uses, and use the same words. For instance, if they mention chestfeeding, use the word “chestfeeding” rather than “breastfeeding”.
Please don’t assume what our pronouns will be, but ask what we prefer to use.
It can be really helpful to have the discussion about what kind of advocacy would be useful to us when we are in labour, or in hospital if we’re planning a caesarean. Please check whether, for instance, we’d want you to correct people using the wrong pronouns or words to describe the body that we have already said we would prefer to not use.
Ask if there are any other aspects of care that the doula should know and ensure that the medical staff know, if relevant. For instance, some trans men may be even more likely than women to object to having their breast/chest exposed or touched – especially those trans men who have not had top surgery (breast removal surgery).
Otherwise, trans people have the same needs in pregnancy and birth as anyone else, so once the differences have been discussed, please just support us as you would everyone else. Like birthing women, we want to have births which are right for us and personalised support where we are each asked what we need as an individual.
Yuval lives with his husband Matan and three children in Yorkshire, UK. To follow him on Facebook, click here: https://www.facebook.com/yuvaltopperez
If you are looking for doula support, please visit the Nurturing Birth Doula Directory.
Nurturing Birth would like to thank Tara Leach for permitting us to use her birth photography images in this article.
‘Your Child’s First Adventure’. ‘Tara Leach is a Manchester-based birth photographer. She is interested in documenting all births and all adventures. To get in touch either see her on Facebook or email taraleachphotography@yahoo.com
By Emma Ashworth
What is the Montgomery ruling?
‘Montgomery’ refers to a legal case, formally known as ‘Montgomery V Lanarkshire’, where Montgomery is Mrs Nadine Montgomery, and Lanarkshire is the Lanarkshire Health Board in Scotland. The case was brought after Mrs Montgomery’s son was severely injured during his birth. During pregnancy, Mrs Montgomery was very concerned about her forthcoming birth because she felt that her baby was too big for her to birth vaginally. She had diabetes, was very small herself, and the baby appeared to be large. However, her obstetrician did not offer her a caesarean birth as an option to consider.
During the birth, Mrs Montgomery’s son experienced a very severe shoulder dystocia. After a variety of interventions he was born by caesarean, and now lives with cerebral palsy and a damaged shoulder.
The injuries that occurred during his birth are rare, and, statistically speaking, were unlikely to occur even with the risk factors that Mrs Montgomery had. However, the legal case came about not because of the complications themselves, nor how they were handled, but because the obstetrician made the decision to not share the information about the possible outcomes of a vaginal birth and a caesarean with Mrs Montgomery, thus stopping her from being able to make an informed decision herself over what was right for her. Ultimately, the case came down to whether or not information was shared to support informed decision making – and, the case found, it was not.
What did it change about consent and birth?
Before the Montgomery case, what doctors shared with pregnant women depended, basically, on what other health care providers were sharing. They could decide to limit what information they shared with women as long as other doctors were doing the same. This was known as the ‘Bolam Test’, and it states, “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. This applied to all areas of medicine, and led to many outdated principles still occurring (eg immediate cord clamping) because, from the practitioner’s point of view, if they did what most other doctors did, they had more protection against being sued.
With Montgomery, all this changed. Rather than just relying on what most other people did, practitioners are now obliged to share information on ‘all material risks’, meaning any risk (of an intervention or NOT intervening) that might be important to that pregnant woman or person, irrespective of what was normally done by their colleagues. If followed, this gives the pregnant person information they need to be able to make an informed decision about their own care.
Why do doulas need to know about it?
Sadly, no single legal ruling can resolve all of the problems that we have within the maternity system. Montgomery has given us a hugely valuable legal framework to support informed decision making. It means that the pregnant woman or person must be offered information to ensure that they are able to make an informed decision about their care. If your client isn’t experiencing this, you can suggest that they raise this as an issue with their health care provider, and remind them that they alone can make decisions about their body.
Unfortunately, there are downsides to this ruling in practice, if not within the aims of the law. The ruling states that providers should ensure that they take “reasonable care” to ensure that “patients” are aware of “material risks”.
The text reads, ‘The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.’
What this should mean is that individualised care is offered, with doctors and midwives ensuring that women are given information that is relevant to them, personally, depending on their personal needs and wishes. What is happening in reality is that doctors and midwives misunderstand this to mean that they have to tell women of every possible horrific outcome that might happen if they decide to decline an intervention, or birth outside the hospital. They seem to be forgetting that their obligation is to offer a balanced picture of all of the material consequences of interventions and non-intervention (when was the last time that you heard all the potential risks of an induction, for example?), and they also seem to be forgetting that women are not obliged to listen to any of this!
Pregnant women are still autonomous beings, and they alone can decide what they want to hear. Our clients do not have to attend meetings with doctors or midwives who they don’t feel are supportive of their rights or decisions if they don’t want to. They don’t have to listen to a stream of possible horrific outcomes if they don’t want to. If they want the information, they can choose to ask for another midwife or doctor, and they can point out that being told only one part of the picture is coercion, not informed consent, and is going against the Montgomery ruling just as much as not being offered information is.
Further reading
The online content of Nurturing Birth’s Expansive Doula Course has a video on consent which includes information on Montgomery. This presentation is also available to Nurturing Birth graduates who purchase the online modules after completing their Intensive Doula Course.
AIMS has published a helpful article on the Montgomery ruling by a solicitor who looks at the ways it can be used in medical negligence cases within maternity: https://www.aims.org.uk/journal/item/montgomery
The MDU (Medical Defence Union) has a web page on Montgomery which clearly explains the legal situation: https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent
Birthrights is continuing its work on consent, following the Montgomery ruling, by offering workshops to midwives and doctors on this topic, and they are part of a team launching an app for women to use in labour: https://www.birthrights.org.uk/campaigns-research/montgomery-and-consent/
Emma Ashworth is a Nurturing Birth doula, a trustee of AIMS and she is currently the AIMS Journal Editor. She has a special interest in consent and has written extensively on women’s rights in birth. Her book, “The AIMS Guide to Your Rights in Pregnancy and Birth” is available from AIMS. You can find Emma at her Nurturing Birth Directory listing here…
Sophie Brigstocke,
Nurturing Birth
Telephone: 07305 044482
Email: info@nurturingbirth.co.uk