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Midwives and the right of women to give birth the way they want to

Midwives play a crucial role in enabling women to make choices about how they give birth. The White Ribbon Alliance/Flickr

Giving birth is a significant life event that should aim for a healthy baby and mother. There are growing calls for women to give birth in their preferred birth positions. But this requires midwives to be trained in a way that enables them to respect the choices that women make. The Conversation Africa’s health editor Joy Wanja Muraya asked Lydia Mwanzia to explain why women have the right to make choices, and the important role played by midwives.

What do international guidelines say about the rights of pregnant women during delivery?

According to the International Mother Baby Childbirth Initiative, women have a right to be treated with respect and dignity during labour and child birth by partnering with her in the decision making.

Giving birth can either be a wonderful experience or a traumatic one, depending on how women are handled by health professionals, particularly midwives.

If mothers are excluded from the decision making process during delivery – even when things don’t go as planned – their rights are being violated.

When care is not collaborative, an unhealthy conflict arises that may harm the mother or baby.

There are strategies that defend both the mother and baby from abuse, neglect and mistreatment. Examples of lack of respect include slapping or pinching during delivery, verbal abuse and the use of harsh or rude language.

Patient centred partnerships deliver the best outcome although it’s true that midwifery can be a tedious and psychologically draining profession that requires giving women a lot of emotional support.

What motivated your research on the rights of pregnant women during delivery?

One morning while at the entrance of a maternity unit in a referral hospital in Kenya I came across a pregnant woman who was on the floor and in pain. She was struggling to talk to a security guard.

She was in labour and I helped her to the delivery room where a quick assessment established that she was ready to give birth.

The midwife on duty advised her to follow procedure by lying on her back but the client insisted that her four previous births had been successful in the squatting position.

As the stand off continued, the baby was born in the squatting position and the midwife rushed to safely deliver the baby. Despite the conflict, it ended well with no complications and within minutes she was recovering in the postnatal ward with her newborn daughter.

But the mother was disappointed that her request was disrespected despite informing the midwife of her preferred birth position.

This incident triggered a study on women’s and midwives perceptions and preferences of birth positions at the hospital. It also interrogated what influences a woman’s view of the hospital birth experience or choice of birth place.

The study found that there were no significant differences between midwives and women’s preferences giving birth on their backs as encouraged in some cultures in Africa.

But research has shown that lying on the back for prolonged periods during labour and birth, may result in complications for both the mother and the newborn.

How can midwives influence a woman’s choices during birth?

Midwives have an obligation to routinely apply their knowledge and skill to ensure a normal progression from pregnancy to delivery and eventual breastfeeding.

Midwives should provide continuous support during labour and birth and they should respect women’s choices when it is within safe practice to do so.

Midwives have an obligation to provide women with drug free comfort and pain relief and to protect them from harmful procedures and practices. These are their rights. Midwives also have an obligation to give women the right information so that they can make informed collaborative choices.

Midwives play a very important role because they can greatly influence the choices women make about where they give birth as well as their preferred birth position.

How can midwifery contribute to better maternal and infant health?

About 65% to 75% of births globally are handled by midwives and happen without use of drugs or other techniques to trigger labour.

About 20-25% of deliveries are performed by specialist doctors who use instruments and often drugs during delivery procedures like Cesarean sections.

Midwives provide lifesaving interventions like providing emergency treatment during deliveries.

Midwives have offered safe maternal and infant care in situations where there are no doctors in countries across Africa. By increasing the number of trained midwives, healthier babies were born and less mothers died from pregnancy and birth related complications.

The World Health Organisation reports show that developed countries reduced maternal deaths by half in the early 20th century by providing professional midwifery care at childbirth.

Malaysia, Sri Lanka and Thailand halved their maternal mortality ratios within 10 years by increasing the number of midwives in the 1950s and 1960s. Over a further 15 year period, Thailand reduced its maternal mortality ratio from 200 to 50 maternal deaths per 100 000 live births by deploying even more midwives and by increasing the capacity of hospitals at the district level.

Between 1983 and 2000, Egypt doubled the proportion of deliveries assisted by skilled birth attendants and reduced its maternal mortality ratio by 50%.

By investing in the education, regulation and management of midwives, the quality of health care for both mother and child is continuously improved.

We should all appreciate that women’s rights during pregnancy, labour and after delivery underpins all maternity care.

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