Supporting Physiological Birth Choices ~ The Role of Workplace Culture, Politics and Ethics
This book investigates the processes, experiences and sociocultural-political influences upon midwives who support women’s alternative birthing choice and argues for a shift in perspective from notions of an individual’s professional responsibility to deliver woman-centred care, to a broader, collective responsibility. The book begins by contextualising the importance of quality midwifery care with an exploration of the current debates to demonstrate how hegemonic birth discourse and maternity practices have detrimentally affected physiological birth rates, and the wellbeing of women who opt outside of maternity guidelines. It provides real life examples of how midwives can facilitate a range of birthing decisions within mainstream midwifery services. Moreover, an exploration of midwives’ experiences of delivering such care is presented, revealing deeply polarised accounts from moral injury to job fulfilment. The polarised accounts are then presented within a new model to explore how a midwife’s socio-political working context can significantly mediate or exacerbate the vulnerability, conflict and stigmatisation that they may experience as a result of supporting alternative birth choices. Finally, this book explores the implications of the findings, looking at how team and organisational culture can be developed to better support women and midwives, making recommendations for a systems approach to improving maternity services.
Endorsements
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‘This book centres on seminal research undertaken to examine the complex, multifactorial, organisational, professional and interpersonal elements that shape and influence midwives’ behaviour, role, expectations and clinical work. It offers a unique and poignant insight into the tensions, challenges and opportunities that many working midwives encounter as they navigate their way through an increasing polarisation between the alignment of a professional mandate anchored in a social model of enablement and advocacy for women and their families and employer expectations and constraints. A shortfall of skilled midwives is not unique to the UK. However, this is not occurring solely because of retirement; attrition is a major issue, be it midwives switching to work part-time or leaving midwifery because they do not receive the support, respect or resources to enable them to provide personalised skilled care. This research presents an important resource for all maternity stakeholders to consider and reflect upon when shaping humane, dynamic, supporting organisations that enable midwives to thrive’.
Dr Ethel Burns, Senior Lecturer Midwifery, Oxford Brookes University
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‘This timely and articulate book urges us to think more deeply about the socio-cultural and political influences that shape midwives’ practice and the care that they are able to offer to birthing women and people. Drawing on her original feminist narrative inquiry research, Claire Feeley vividly describes how UK midwives responded to women’s requests for ‘out of guidelines’ birth choices and explores what can be learned from their responses. Using midwives’ firsthand accounts of the challenges and enablers they experienced, a compelling argument is created: that compassionate leadership, trust in staff ability and in maternal autonomy are critical for high quality, respectful and culturally safe maternity services. An essential and thought-provoking read for everyone wanting to understand current debates in maternity care’.
Billie Hunter, CBE, FRCM PhD, BNurs, RM, RN Emerita Professor. Cardiff University
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‘This brilliant book is commanding and provocative in its argument for a truly equitable maternity service. From the vantage point of how midwives support physiological birth, Claire Feeley makes visible fundamental tensions in maternity care concerning birthing women and peoples’ choices. Feeley’s assessment of why ‘out of guidelines’ birth choices have come to be viewed as so problematic provides a comprehensive and considered account of the socio-culturalpolitical landscape of present-day services where medicalisation, standardisation, risk, governance, and litigation issues are the norm. Drawing on the views and experiences of midwives employed in the UK’s National Health Service, this book shines a light on the barriers women and birthing people can face when asserting their autonomy, and also why midwives leave. Feeley is visionary in her conception of collective responsibility and the centrality of organisational culture and system-wide solutions towards more equitable maternity services. This book is essential reading’.
Dr Carol Kingdon, Reader in Medical Sociology, University of Central Lancashire, and Hon. Research Associate, University of Liverpool and Liverpool Women’s NHS Foundation Trust
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‘Claires passion for supporting physiological birth is infectious and her work incorporates a holistic approach to midwifery care. This book will provide the evidence base for midwives in practice to centre the needs and wishes of women and enable them to support physiology and individualised care’.
Cheryl Samuels, ‘Holistic Midwife’ and Lecturer, University of Suffolk
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‘I propose that all those with an interest in maternity services should read and be guided by the findings and proposals in this book. We must learn from what works – meeting the needs and facilitating choice is possible when there is a culture of mutual respect, support and compassionate leadership. The text offers evidence-based practical solutions in an engaging and clear format – an absolute gem and gives me hope for the future’.
Sheena Byrom, OBE, Midwife, Co-Founder ALL4Maternity
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‘Just finished reading your book, it is so good, so important, and so well written! I have felt rather despondent about midwifery and maternity services in the UK since I returned from practicing in New Zealand in 2012, it captures much of what I have been concerned about and I realise that part of me had ‘given up the fight’, as it has felt too big a challenge. But, reading this reminds me that it is too important to give up on… Congratulations on this work, thank you for articulating it so well’.
Dr Tomasina Stacey, Midwife, Senior Lecturer King’s College London
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‘Claire Feeley’s book comes at a critical time for midwifery. Centring the ethical concept of bodily autonomy, so intrinsic to midwifery practice, she identifies the tensions that arise for midwives, who are philosophically bound to be ‘withwoman’, when women make decisions that do not comply with recommended guidelines. That such a book needed to be written is already an indictment of maternity systems worldwide and their inability to provide individualised care. As reports of obstetric violence and birth trauma rise, this book provides an important contribution in its incisive discussion of the current pressures, but its real effect is in the offering of a solution – where midwives’ professional responsibility to provide safe care can comfortably co-exist with women’s choices, regardless of what that choice might be. A must-read for anyone interested in the culture, ethics, or practice of childbirth’.
Dr Elizabeth Newnham, Senior Lecturer, University of Newcastle, Australia
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‘This is such an important book addressing the ethical, cultural, and political challenges faced by midwives supporting physiological birth choices and women navigating maternity care in the current climate. The author is extremely knowledgeable on the field of personalised care and the complexities associated with its implementation in the real world. This is an essential book to understand how we got here in the first place and how we can move on, putting women and birthing people at the helm and facilitate whatever choice they make, in any setting they choose’.
Lia Brigante, Midwife, RM, MSc