FOCUS ON: Informed consent, the birth environment & postnatal planning
IN THIS ISSUE:
Author: Camilla Pickles & Kerigo Odada
Author title:
Camilla Pickles, Associate Professor of Biolaw, University of Durham, UK; Visiting Associate Professor of Law, University of the Witwatersrand, South Africa
Kerigo Odada, LLD Candidate at the University of Pretoria, South Africa; Legal t Network Coordinator at MAMA Network
Description: Pregnancy, childbirth, and the postpartum period are profoundly transformative experiences. Sadly, however, due to broader sociopolitical pressures, care during this time often materialises in ways that strip women and birthing individuals of their autonomy and agency, leading to feelings of dehumanisation, and extensive and long-lasting physical and psychological harms. This approach to care is increasingly being recognised as obstetric violence. In a groundbreaking thematic report on a human-rights based approach to mistreatment in childbirth and obstetric violence, the United Nations Special Rapporteur on violence against women specifically earmarked voluntary and fully informed consent as integral to promoting autonomy during facility-based childbirth and thus ensuring respectful maternity care.
Author: Alexandra Smith
Author title: Childbirth Educator, UK
Description: Deaf women are often routinely treated as ‘high risk’, are denied access to physiology-informed care, and experience invasive procedures without any choice in the matter. That women who are deaf or hard of hearing find it harder to make themselves heard, is strangely ironic - a dark symmetry that compromises the very principle of consent.
Author: Zalka Drglin
Author title: National Institute of Public Health, Slovenia
Description: The birth environment, encompassing the entire built and designed space in which childbirth takes place, along with the people within it, influences how the woman giving birth feels – whether she experiences safety, connection, and relaxation, or fear, withdrawal, and threat. This, in turn, affects how she responds as an embodied being and how the childbirth progresses. Birth spaces, through their inherent messages, can range in effect from pathogenic – perceived as threatening or even hostile – to salutogenic, embodying the qualities of a ‘birth sanctuary’ that women need while giving birth.
Author: Sophie Messager,
Author title: Women’s Life Transitions Mentor, Bridging Ancient Wisdom & Science, Author of ‘Why Postnatal Recovery Matters’ (Pinter & Martin, 2020))
Description: In most of the Western world, new mothers receive almost no support after birth. There is very limited support from the health system, as well as from their families and communities. I believe this is the case due to multiple factors, but the overarching one seems to be that, as a culture we have become blind to the needs of new mothers. We have forgotten that it used to be normal, even in Western culture, to offer them a period of extensive nurture and support during the first few weeks after birth. There is also an unhealthy pressure for new mothers to ‘get back to normal’ as if nothing had happened. Resuming ‘normal’ activities as fast as possible during the postpartum is mistakenly perceived as a sign of strength. This results in women struggling to meet their own needs and those of their babies, feeling ashamed of not coping, and keeping it hidden, leading to a negative cycle of loneliness and self-blame.
Author: Françoise Freedman
Author title: Medical Anthropologist at the University of Cambridge, UK; Founder of Birthlight
Description: It is now well accepted that parenting begins before birth (Glover & Capron, 2017). Still, the postpartum period is an extreme, intense and delicate time when care for the newborn shapes the foundations of relationships. However well prepared for birth parents were, and whatever the way of birth, babies’ entry into the world calls for an urgent postnatal education that meets parenting needs while attending to care. More than information, apps and checks are required to replace the proverbial ‘village’ rallied to nurture new or transforming family units. In a day by day, week by week steep learning curve, primary carers can benefit most from instant, easy- to-use and body-based resources which support them physically and emotionally through the wondrous but most demanding ‘fourth trimester’ of pregnancy with their newborns. While this is common sense and responds to a desire to alleviate generally reported distress, it is also based on research. Studies evaluating current forms of postnatal education/care, perinatal psychology and neurophysiology concord in supporting interventions that promote connection. In short, let’s call it ‘embodied postpartum’.
Author: Laura Marsland,
Author title: Private Pelvic Health Physiotherapist, Worcester, UK
Description: Pelvic girdle pain (PGP), encompassing symphysis pubis dysfunction (SPD) and sacroiliac joint (SIJ) pain, is a common musculoskeletal complaint during pregnancy, labour, and the postnatal period. Affecting up to 20% of pregnant women, it can significantly impact quality of life, functional ability, and emotional wellbeing (Wu et al., 2004). Pelvic health physiotherapists play a pivotal role in managing PGP, employing a multi-faceted approach informed by biomechanics, pain science, and patient-centered care. Every treatment session aims to meet the needs of the particular patient. No two treatments are ever the same based on clinical reasoning.
Author: Hayley Williams
Author title: Professional Singer and Singing Teacher
Description: As a professional singer and mother of two, the author realised that the knowledge, strength and coordination of the respiratory system gained through her training and profession had benefitted her hugely during pregnancy and postpartum recovery. This led to the creation of ExerciSing, a rehabilitative singing class for pregnant and postpartum women, created through cross- disciplinary research and years of vocal pedagogy practice.
Authors: Jane Barlow, Hannah Cann, Anna Pease, Kate Shiells, Jenny Woodman and Ruth McGovern
Authors titles:
Jane Barlow, Department of Social Policy and Intervention, University of Oxford, UK Hannah Cann, Southampton City Council, Civic Centre, Southampton, UK
Simon Barrett, Newcastle University, UK
Anna Pease, Bristol Population Health Science Institute, University of Bristol, UK Kate Shiells, Department of Social Policy and Intervention, University of Oxford, UK Jenny Woodman, Thomas Coram Research Unit, University College London, UK Ruth McGovern, Newcastle University, Newcastle upon Tyne, UK
Description: Although rates of Sudden Unexpected Death in Infancy (SUDI) have decreased over time in England and Wales (Office for National Statistics, 2020), there were still 711 sudden and unexpected deaths of infants between April 2019 and March 2021 (National Child Mortality Database, 2022). Infants in the most deprived neighbourhoods were almost three times as likely to die as those living in the wealthiest neighbourhoods (National Child Mortality Database, 2022), with almost all cases involving parents who had engaged in unsafe sleeping practices despite awareness of safer sleeping advice. This article draws on research that was conducted to gain a better understanding of the views surrounding safer sleep practices of families supported by statutory child protection agencies.
Author: Dr Jonathan Sher
Author title: Founding Partner of Scotland’s Coalition for Healthier Pregnancies, Better Lives while he was the former Deputy Director of the Queen’s Nursing Institute Scotland.
Description: Dr Jonathan Sher considers the cost of inaction on pregnancies and interconception / preconception health