Carlisle & Eden Maternity Voices Online Discussion
Choice in Pregnancy & Birth
Thursday 4th March 2021
Written by Hannah Murgatroyd
In 2019 CQC Women’s Experience Survey showed that ‘Choice in pregnancy & birth’ was
something that women in our area felt was lacking. The Maternity Voice Partnership in North
Cumbria we asked to make this a priority to find out what the key issues (with regards ‘choice’)
were for maternity service users in our area are.
Sherrelle Smith & I were tasked with leading the online workshop. When planning the online
discussion, we were clear that we wanted simply to be the facilitators of the discussion & to
provide opportunities for the participants to expand upon key themes within the topic of ‘choice’.
We advertised the online discussion & we had twelve participants attend on the day. This included a mixture of service users & professionals involved in maternity services.
We began the workshop by asking the question ‘What does choice mean to you?’. During the
planning stage, we knew we had to provide open questions in order to gain an unbiased insight
into the participants experiences & opinions on this topic. From the service users who responded to this initial question, a common theme was ‘choice’ in pregnancy & birth was not consistently promoted in our area & that in some cases their individual choices had been limited.
It was really helpful to have professional’s perspective represented in the workshop. It provided
some balance to the discussion & allowed for opportunities to hear how the service can respond
when issues around choice are raised. In this instance, we were fortunate to have a senior midwife present for the discussion. She responded to some of the points raised by service users which was really beneficial to the discussion.
It became clear that although there were processes in place to support the individual choices of
service users, the service users themselves aren’t always aware of these & they aren’t consistently promoted & supported by all professionals coming into contact with them throughout pregnancy & birth.
The discussion moved naturally to discussing some of the impacts of the Covid-19 pandemic;
both on maternity professionals & service users. After a service user had mentioned the perceived lack of choice in our area around the Homebirth service.
It was explained by the midwife manager how the pandemic affected staffing & ambulance
services; and this was given as the main reason why Homebirth services had been interrupted &
affected negatively over the past year. But the professionals wanted to reassure service users that they were working hard to ensure that Homebirth was still encouraged & supported within our area. We discussed issues around service users feeling there is still an element of ongoing lack of support for Homebirth as a birthplace choice within the area; but service users were pleased to hear from professionals that there had been some recent positive & successful planned Homebirths within the Trust.
The recent addition of the Continuity of Carer team was another topic that was raised towards the beginning of the discussion. It was viewed by all as a really positive addition that would be
invaluable in promoting & support for service users choices in birth & pregnancy. It was widely
agreed that having continuity in the midwife supporting you throughout your pregnancy would
provide a more personalised approach. And would hopefully encourage service users to feel more
confident to discuss their choices.
The discussion moved on & we heard from service users who had experienced more high risk
pregnancies & some consultant led care during their pregnancy & birth. Each of these service
users mentioned feeling as though they had been given little to no choices as a result of being
labelled a ‘high-risk’ pregnancy and placed under consultant led care. Service users gave
feedback that when discussing their births with consultants, that there were instances when
options or choices were mentioned or promoted to them. Particularly when the pathway of care
led to the service users being put forward for an induction.
As an MVP, we agreed that the topic of ‘choices’ around induction was clearly a subject the
service users felt strongly about the need to be more informed. The MVP members agreed that a
further separate online discussion was required, focussing specifically on induction & how choices in birth & pregnancy are supported, encouraged & promoted by all service professionals when the pathway of care leads to recommendation for induction. It was agreed as an action for the MVP team to go away & arrange at a further date.
Arguably one of the most important topics we introduced within the online discussion was ‘Choice in place of birth’. We heard contributions from service users, who commented that place of birth is regularly not discussed as an option during antenatal appointments until late in pregnancy (around 36 weeks). It was agreed by all that when this is the case, this is much too late & does not allow service users the space & time to go away & fully research & consider their options.
There was really helpful input from service professionals, explaining how the hospital room can be adapted to make them feel less clinical for service users. It was discussed whether this is promoted & encouraged enough to service users before they attend the hospital setting; whether service users are aware of these options for creating a less clinical birthing environment. It was reassuring to hear from midwives who worked at the Cumberland Infirmary that there are ongoing efforts to promote calm & homely environments within the maternity unit.
It became clear that for service users, the issue of when & where ‘choice’ is being discussed. The
impact of Covid-19 was once again raised by service professionals as a contributing factor.
Antenatal appointments are often short & service users are not currently able to bring anyone with them to regular antenatal appointments. Service users commented on feeling as though they lacked that vital support during these appointments; someone who could encourage them to discuss their chosen choices & advocate for them when they felt uncomfortable to do so. We
discussed whether service users were encouraged to discuss their birth preferences before the 36 week mark. All service users present who responded to this question agreed that it had not been presented as an option by their midwife, but if they requested to discuss it sooner in their
pregnancy then they had been able to do so. We again discussed whether service users were
consistently made aware that this was an option. Service professionals sought to reassure that
midwives are always happy to discuss birth preferences at any point during antenatal
appointments.
The next topic discussed was how & where service users in our area are gaining information to
help support their choices in pregnancy & birth. The Maternity Notes App (Badgernet) was given
as the main point of information sharing between service users & professionals. However, some
service users commented that they had been unable to access the leaflets due to technical issues with their devices. It was mentioned that there was a lack of information about local services specifically more generic national information is on there. The MVP team agreed that a further discussion on how women find using the Badgernet Women’s Notes Appp would be useful.
The final topic which was raised in the online discussion was ‘pain relief’ as a choice within birth.
Service users commented that the Covid-19 pandemic has led to a lack of antenatal classes & as a result, women feel less informed about their choices for pain relief in labour & birth. Service users commented that they had not been encouraged during antenatal appointments to discuss
choices for pain relief in labour & birth; but also that they would have found it incredibly beneficial
to have had this discussion with their midwife during antenatal appointments. It was also
mentioned that with a lack of antenatal classes presently, it would be useful for service users to
have access to a list of approved & reliable websites or online resources where they could find
useful information to help inform their choices on this subject.
There was an important final discussion around the power dynamics involved between service
users & maternity professionals. It was agreed by both the professionals & service users who
attended the discussion, that it should be a partnership. And service users should be encouraged
to remain the chief decision maker; encouraged by professionals to remain in control of their
choices & empowered to know that they will have their choices listened to & respected.
The MVP were pleased to hear feedback from both service users & professionals that this online
discussion on ‘Choice’ was both informative & a positive experience for all who attended.
The main points from the discussion were noted & the MVP members agreed on further actions
that would be beneficial to develop at a further date.
We thank everyone who attended the meeting for their time & valuable contributions.
Hannah Murgatroyd
March 2021