Fundamentals of Midwifery: A Textbook for Students (55 page)

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Further reading activity

Human rights in childbirth (http://www.birthrights.org

.uk/) is a UK organisation dedicated to

improving women’s experiences of pregnancy and childbirth.

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More than cultural awareness, women seek specific information about pregnancy and birth. It

is suggested in the United States of America, that a third of women seek information from popular childbirth education books. Information however is variable, with inaccuracies in the presentation of scientific evidence and recommendations (Powell et al. 2009). Women may attend classes in the antenatal period wanting the opportunity to understand the process of childbirth and develop confidence in becoming a parent. Part of that process can be learning how to communicate with caregivers to make the choices and decisions discussed earlier, rather than them merely conforming to practitioner preferences and prescriptive policy guidance. Such learning could enhance that empowerment and personal control within the childbearing domain for women, their families and the wider community.

Birth preparation and the traditionally known ‘Parent Education’ classes have been part of UK maternity service provision for some time. During the 1960s and 1970s, a focus on active birth developed and aimed to give women information about labour that included birthing positions and breathing techniques (Walsh 2012). Such classes are provided through NHS midwifery services, and private and charitable organisations across the country, the National Childbirth Trust (NCT) being the largest non-NHS organisation that is paid for by individuals. Research has predominantly focused on birth outcomes, such as mode of birth or use of analgesia, as a measure of the effectiveness of antenatal classes, finding their merits to be consistently incon- clusive (Gagnon and Sandall 2011). There is some evidence that women’s experience of birth and parenting may be improved if they attend participant-led classes compared with more traditional classes (NICE 2008). Nolan (2009) also highlights that studies have universally failed to take into account the quality of the education provided. Recent research on the provision of birth preparation classes identifies consensus across stakeholders, that current provision is seri- ously inadequate and that midwives are inadequately prepared and supported in this role; also identifying that an expanded focus is needed on relationships and the transition to parenthood (Barlow et al. 2009).

The ‘Birth and Beyond’ package developed by McMillan et al. (2009) provides practitioners with a framework and content for delivering a quality programme of learning to women and families. However, this work did not explain how facilitators were meant to deliver it. Midwives are expected to deliver classes within their clinical role (NMC 2012) and traditionally within their working hours, despite their increased pressures and reduction in staffing levels more recently. Provision of birth preparation/parent education classes can therefore be a challenge for NHS Trusts. Midwives or health visitors receive little or no training on how best to facilitate them and there is no obvious quality assurance on the content and delivery of the sessions. Robust facili- tation by experts trained in adult education, more than just curriculum planning, along with satisfaction evaluation would demonstrate quality and urgently needs to be developed nationally.

Barlow et al. (2009) conducted research into the provision of birth preparation classes; at the time of the review an outgoing NHS Primary Care Trust (PCT) in a Northern city in England was becoming an example of an organisation looking to do things differently. The PCT con- tracted out these services to be delivered outside the conventional midwifery contracted time (Reports to the PCT 2010–13) by a small social enterprise organisation rooted in midwifery to pioneer and develop the service. Social enterprise business models are able to sit within the NHS framework working alongside other providers (DH 2008; DH 2010). Ethically and morally, not for profit organisations complement the NHS promoting organisational autonomy and staff engagement (Addicott 2011). This commissioned service in the North of England, was highly successful in improving parent attendance and quality of class provision. However, the venture was not re-commissioned despite excellent satisfaction scores from attendees. The state of antenatal education provision is therefore, somewhat precarious and subject to market forces.

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Activity 6.4

Write a birth plan for a woman who is pregnant for the first time, has experienced a normal pregnancy and is intending to give birth in a hospital labour ward staffed by midwives and obstetricians.

Write a birth plan for a woman for the second time after an instrumentally assisted first birth,who intends to have a baby at home with a community midwife attending.Think about the differences each woman will have. What might influence each of these women and who might have the greatest risk of a medically assisted outcome?
Key points

Women should be offered a choice for their birth place.

Screening and surveillance of the mother and fetus monitors for abnormalities.

Good midwife–woman relationships and education assists a woman in her decision making.