Protecting human rights in childbirth

BLOG: Happy International Day of the Midwife!

On International Day of the Midwife 2021, Sophie Russell, Consultant Midwife at Lewisham and Greenwich NHS Trust and a Birthrights Trainer, gives us an insight into a typical day and reflects on how human rights impact her work as a midwife.

Each day in my role is unique, rewarding and challenging; here is a snippet of a typical day at work for me. I hope this shows you how valuable consultant midwives are especially on a day we reflect on the impact of midwives across the world.

In the morning I review a book chapter that I have written on breastfeeding for a multiple births pregnancy book and I’m always staggered by the statistic that globally breastfeeding could prevent more than 800,000 deaths a year. Midwives play such a crucial role in supporting mothers to breastfeeding and on international day of the midwife I am reflecting on how many babies midwives have helped to survive and thrive and how many women midwives have supported and listened too.

I sort through emails during my lunch break and often flick through interesting articles that I think will be useful for our maternity journal club. I enjoy discussing research with my colleagues and supporting midwives can the skills at critically analysing good and not so good research.

In the afternoon I start my birth options clinic. I meet a variety of women and families in my clinic and I enjoy the diversity that each of these conversations bring. One lady I have the pleasure of supporting in her pregnancy wants to wait for spontaneous labour after 41+6 weeks of pregnancy. This appointment is an hour long appointment to allow time to listen to the woman’s preferences and explore the options which include detailed discussions around the benefits and disadvantages of each option. I studied a Masters in Medical Ethics and Law in 2012 and wrote my dissertation on the competing demands of maternal and fetal rights and this academic study has most definitely helped inform these discussions.

Part of this birth options discussion will include a conversation about the ‘material risks’. Judgment in Montgomery v Lanarkshire Health Board (2015) UKSC 11, paragraph 87 stated that ‘the test of materiality is whether, in the circumstances of the particular case, as reasonable person in the patient’s position would be likely to attach significance to the risk’. For clinical practice this essentially means listening to the woman, getting to know what is important to her in this situation and explaining all of the material risks. I do really enjoy these conversations as it keeps me up to date with current research and I feel that I am doing my best to support the woman in making an informed choice.

After I have had the birth options appointment I will document the plan and offer a follow up consultation to facilitate any further questions. I will then disseminate the plan to my colleagues so that the rest of the team are able to support my colleagues.

At the heart of some of the decision that I facilitate in my birth options clinic are the moral considerations of the maternal and fetal conflict. I think that very few people would disagree that the right to decide what happens to one’s body is a fundamental principle in medical ethics and law. Often this view can become clouded in pregnancy due to the unique position of the fetus. I offer support to my colleagues when they raise concerns about their position in supporting birth options which can raise moral considerations. In these situations I offer support in terms of being physically available to support birth choices and academic advice. I often discuss the court judgement in Paton V British Pregnancy Advisory Service (1979) with my colleagues  in which Sir George Baker P stated, ‘’the fetus cannot in English Law, in my view, have a right of its own at least until it is born and has separate existence from the mother. This permeates the whole of the civil law of this country.’’  Although some people would expect the Courts to protect the fetus, by granting the fetus legal protection, this would cause an unacceptable restriction on the pregnant woman’s self-determination and bodily integrity.

In evening I am usually answering lots of emails and queries and supporting some national project to reduce maternal and neonatal morbidity and mortality. I thoroughly enjoy this work as I feel that I am making a contribution to reducing adverse outcomes and it keeps me on my toes and up-to-date with all the latest research and evidence.

Happy International Day of the Midwives to all the midwives around the world who support women through pregnancy and beyond. Thank you for everything that you do in supporting women to birth confidently and safely.

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