Doctors need to actually listen to the women they treat

UK maternity care is steeped in patriarchy. Statements like this can sometimes cause outrage or ridicule, but I’m not sure why. We live in a world where most of our organisations and systems are built and run by men with men in mind, so it shouldn’t be much of a surprise that the labour ward is no different. The problem here, though, is that childbirth is a uniquely female experience, and the man-made structure that dominates and controls it is failing women on every front.

Women in the maternity care system often do not feel they are listened to or heard. This can have devastating consequences: a new University of Leicester MBRRACE report into cases of stillbirth found that over half of women had reported to concerns to their care providers such as reduced foetal movement, and that in half of these cases, there were missed opportunities to save a babies life.

Unfortunately some of the response to this terrible situation is often in itself patriarchal. Jeremy Hunt has pledged to halve stillbirth rates by investing in high tech monitoring equipment, ignoring the evidence which shows that plugging women into machines during labour is going to be far less effective than investing in human beings to be with women before, during and after the birth. The Cochrane review, for example, has shown that if women and their midwives build up a relationship, there would be a reduction in both premature birth and stillbirth, whereas other studies have also shown continuous electronic monitoring to be not only ineffective, but detrimental to women as it keeps them on the bed.

But just as individual women are not being heard, neither, it seems, is the evidence, and the determination to invest confidence – and money – in machines and technology and give this priority over human connection and relationships continues. Calls for less medicalisation in birth and more kindness, compassion and personalised care so often seems to fall on deaf ears, even when very clear and robust research shows that technological birth is not automatically safest.

Clear evidence now tells us, for example, that for many low-risk women, hospital is the least safe place for them to have their baby. The two major studies on which the latest NICE guidelines were based showed that, for first time mothers, the chance of episiotomy is nearly doubled if they choose an obstetric unit over a home birth. According to the NICE analysis, women having their second or subsequent baby are also five times more likely to have a caesarean in hospital versus home; over four times more likely to have an instrumental delivery and twice as likely to have a blood transfusion.

We do seem to be almost culturally deaf to statistics like these, and the notion that hospital birth is often the least safe choice is one that the majority of people are yet to be able to hear. In the meantime, women who voice their desires for a more holistic experience, perhaps at home or in a midwife-led unit, are often accused of being selfish and of putting their own experience over the safety of their baby. Indeed, the phrase, "birth experience" can even be used in a slightly mocking tone, in spite of the evidence that shows that everything that makes birth more enjoyable for women – a homely, dimly lit environment, carers they know and trust – also makes it safer.

In pregnancy women who try to advocate for their wishes or challenge the status quo are often reminded, “A healthy baby is all that matters”. Women know this, of course, and it is their top priority. But should it be the pinnacle of their expectations, or the baseline? Surely, above and beyond a healthy baby, women matter too? This phrase, whilst it may be well meant, suggests quite implicitly that women don’t matter, that they are a mere vessel. It’s used after the birth too, and women who want to raise concerns about traumatic experiences or even downright disrespectful care often feel completely silenced by it.

As women we have been raised to be polite to the point of submission: being "good girls" earns us praise as children, and often as adults too. In maternity care – indeed across all areas of life – this can mean we are easily silenced: not only are we raising concerns in a system that is not listening very well, but we are probably raising them in rather apologetic ways, with language such as, “Do you mind if I just ask?” when we should be saying, “I demand answers.” Submissive language also pervades women’s birth stories, which so often contain the phrases, “I was not allowed”, or “They let me” – unthinkable levels of compliance which you would struggle to find in any other areas of 21st century women’s lives.

In the wake of the recent Kirkup report into the deaths of babies at Morecombe Bay, an admirable drive towards increased safety risks having the counter effect of making women and midwives afraid to voice their desire for "natural" or "normal birth experiences"; indeed, all of those words have recently become loaded with negativity to the point that many will avoid using them entirely and choose phrases like "safe birth" instead. Levels of fear are at an all time high: women feel childbirth is dangerous and terrifying and midwives feels disempowered to reassure them otherwise.

Women who are not being listened to when they report concerns about their baby’s movements are just the tip of the iceberg in a system that is often more reassured by the beep of a machine than the touch of a hand. True improvements to could be made if the patriarchal grip was loosened – but can we trust women enough to put them back in charge of childbirth?