Sunday, April 05, 2009

Every Woman Every Choice ???

Every Woman Every Choice

It's a catchy slogan!

What does it mean?

Is it something we want in maternity care?

I found this slogan on a campaign letter from Maternity Coalition - an organisation that I have belonged to, and helped to build, for the past 15 or so years.

In today's world of fast electronic communication there are many statements and articles that come to my email inbox, that I read quickly and delete. It's not that they are unimportant - it's more likely that I don't see the need to engage with them at the time.

However this slogan caught my critical eye.


Does this refer to every woman, regardless of her other health needs, her location, her wealth or personal circumstances?


Which choices are these? Drugs to induce or stimulate labour, or to relieve pain? That's been an 'acceptable' choice in most maternity services for the past few decades. Elective caesarean - that seems like the easiest to organise these days.

How about care of a known midwife who will attend a birth at home or in a birth centre that's committed to promoting physiologically normal birth? Now that's a choice that is supported by solid research evidence. Let's organise that!

Anyone who has attempted to 'choose' the latter will know that it doesn't happen easily. Birth centres are booked out; many women booking in a birth centre are transferred out to 'standard' care at some time, under strict protocols; many midwives are reluctant to accept caseload midwifery; and so on. Homebirth is available with public funding in a few locations, and with independent midwives in a few others.

How many women who have had a previous caesarean birth, for whatever reason, are able to choose the sort of care that makes vaginal birth likely? Not many. Look at the statistics, such as the recent Victorian Maternity Performance Indicators.

The notion of 'Every Woman Every Choice' is NOT a goal that I can share. At best it's just a hollow slogan; at worst it's a sellout to medical and technological dominance of women's lives. And although it appeared in a Maternity Coalition (MC) statement, it's actually in conflict with the statement of purposes of that organisation.

The Statement of Purposes of MC, within its constitution, includes:
"iv To protect pregnancy and childbirth as a natural process"

Protecting pregnancy and childbirth as a natural process means that we argue AGAINST the 'every choice' trend. It means that we focus on learning how to work in harmony with our sensitive physiology, and that we promote care options that demonstrate excellent outcomes.

I would prefer that every woman has access to appropriate maternity services. Of course defining what is appropriate would not be easy. What is appropriate for a woman who lives in a city or rural area; whether she is 16 or 46 or somewhere in between; whether she is having her first baby or her 9th?

Every pregnant-birthing woman deserves access to maternity services that protect wellness in an equitable way. Midwives can provide that level of maternity services for the majority of women, and midwives working with medical, obstetric and anaesthetic hospital services can provide appropriate maternity services for those who experience complications or illness.

Should Every Woman have Every Choice?

Even if that were a realistic notion, I don't think it's something a government should be asked to provide within its package of funded and regulated health care.

Our society is not equitable. Money buys choice for the few.

Should Maternity Coalition, or any other ethical body support the notion of 'Every Woman Every Choice'?


The following comment has been received from Lisa Metcalfe, NSW President of Maternity Coaliton.
All of your points about the reality of choice are true, however we have taken this step to counter the current trend in intervention and lack of control or choice that you so clearly express. How can our maternity system support obstetric care and elective c/s but not a woman who chooses a midwife and only deep water for pain relief??

If the political, medical and social world will accept the choice for elective c/s then there must be equal acceptance of the the choice to birth with a known care provider in a location that is acceptable to the women. This campaign is specifically designed to highlight all of the issues that you raise and include the troublesome issue of the potential loss of the ability of midwives to have a private practice because of National Registration requirements.

MC is not walking away from any of its commitment to birth as a natural process, but by highlighting just how hard it is to achieve this we may still break through the discriminatory maternity service provision in this country.

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