What matters to women in birth? – Women’s Voices

This is the second of three blogs. The first blog looked at the growing concerns around how we can support women to have a less medicalised birth.

To find out what really matters to women in birth and what matters for a positive maternity experience, we thought it best to ask women themselves what they needed to support them and what mattered to them when it came to birth.

So we asked two very large Facebook groups for their views and this is what women said mattered to them.

• Safety – was mentioned over and over. This is understandable as a woman and her baby being well after birth is often the biggest worry that everyone has. Birth can be unpredictable and anxiety during pregnancy and birth can be high until a family is holding a baby in their arms. While safety was a main point, women didn’t want safety to compromise their choices in birth or compassionate care.

• Communication – Women again and again spoke about communication. Knowing what was happening to them, what was happening to their baby and being given clear understandable explanations throughout birth was regarded as vital to support a positive birth experience. Even when their birth had changed direction or become an emergency situation, women wanted this clearly communicated to them and their families. Language and its effect on women in birth was flagged up by so many. Lots of women spoke of the hurt caused by language that was abrupt, harsh, and even cruel. Language matters greatly and can massively impact how a woman feels about herself and her birth experience.

• Listen – Many women spoke about the importance of being listened to during birth. Some commented about not being believed when they said they felt something was wrong, or being ignored when feeling their birth was progressing a certain way. Some said they felt that with their first birth, they were not listened to because it was viewed the staff knew more about birth than they did. Women voiced they wanted to have their opinions, worries and concerns listened to and also their partners. One woman commented that a baby belongs to both parents, they both matter, and both their views should be listened to. If a woman feels she is not listened to it can raise doubts, cause frustration, and even lead to trauma. When women are not listened to it can result in poor care or harm coming to a woman and/or her baby.

• Individuality – Women stated they were individuals and wanted to be treated as such. They wanted to be considered regarding culture, diversity, personal beliefs, opinions and personality. Others spoke about the need to consider the emotional well-being of a woman, are they frightened, anxious or feeling overwhelmed? Individuality also came into the area of care. Women wanted care that reflected not, guidelines, policies and rules, but women, babies, families, choice and good care. One comment spoke about the importance of reading a woman’s notes to have a full picture of her background before appointments. Why is this important? One woman spoke about having disclosed about having been a victim of rape and the things she didn’t want to happen during her birth, such as having her hair stroked. Yet despite this, it was distressing to hear that all the things she had requested NOT to happen, sadly did happen. Knowing a woman’s wishes is so important to giving individual care and supporting a good maternity experience.
• Involved – Being involved in their birth, care and choices was vital to women. Women wanted control of their bodies, and information to make good, informed choices. They wanted information that was honest and unbiased. Women wanted to be able to make choices about what happened to them and their babies. Even in emergency situations women wanted to feel they had involvement in the care they received. One mum called Donna wrote, “Making sure the mother is involved with any decisions before they are made, after all it’s her body and her baby. I found out by reading my notes months later that a doctor had consulted with another and decided that I was not for a section and my baby was not for resuscitation and my baby died getting stuck during a vaginal delivery even though I begged for a section, my baby was born right on viability at 24 weeks, she had rights and they did not respect or care for her rights. It’s been 8 months since our daughter died.” It was also mentioned about birth plans and their value as they were often not looked at or respected. Being involved at every stage of birth was very much part of a positive birth experience.

• Consent – NO means NO! Women did not want to be forced, coerced or guilt-tripped into having medical procedures or any form of care that they didn’t want. Sad to say some women spoke about being restrained and forced to have medical procedures they hadn’t consented to. One spoke about being made to have a catheter because staff were too busy to take her to the toilet. Never should a woman feel she has undergone anything in her care that she didn’t consent to, in fact, it was referred to as ‘clinical rape’.

‘Consent, compassion and sensitivity’, what is said and how it’s said to you can stay with someone for years after the birth. Pain and medical factors fade but how people treated you can stay with you forever 

• Environment – Women wanted to birth where they chose and to be supported to do this. They wanted more MLU units, but also for maternity units to be more family-friendly. Warm, calm, welcoming, and comfortable, with bright colourful positive rooms and small things to make them feel more homely. Women wanted to be able to dim lights, play their music, take in personal processions and have space to move around. Some spoke about less clinical operating theatres to reduce fear. Also, women spoke about partners being sent home and not being able to stay to support them physically but also emotionally. Part of this was ensuring that there was plenty of staff including midwives but also maternity support workers and peer support workers to provide not only medical care but emotional care too.

• Good care – By far the most comments were regarding the care women received. Women wanted care that was consistent and had continuity, especially when it came to consultant care. One woman said she saw 10 midwives during her pregnancy and birth. They wanted to be encouraged, reassured and treated with respect. They wanted relationships with staff built on trust. Many said being busy should not equal poor care. Some spoke about the importance of eye contact with those caring for them, rather than the person staring at a computer screen or medical notes. Women said they wanted acknowledgement of previous trauma, or a difficult birth and this to be reflected in the care they received. One woman spoke about after losing her baby being placed on the ward and being able to hear everyone else’s baby crying. Women wanted genuine empathy, to have someone stand in their shoes, and see things through their eyes. One woman told how she gave birth at midday but had to wait till 7 pm on the evening to be stitched with no pain relief. Another spoke about a student midwife who came to apologise for the care she had seen given the day before. Undoubtedly good care has a massive impact on a birth experience. It can be the care given during birth that can make the difference of a birth being a good experience, or being traumatic. Women also voiced that when mistakes happened they wanted staff to be honest, admit when things have gone wrong and then apologise. Good care matters!

Women in birth want to feel supported, treated with dignity, valued, trusted and listened to. They wanted to be reassured, encouraged, given the correct information and helped to make informed choices. They wanted to feel involved in their and treated as individuals. They also wanted mistakes to be owned up to and apologised for.

So when it comes to birth what mattered most? The main things that women said they wanted were, compassion and kindness, to feel safe and well cared for.

Thank you to Clare Kay and the Birth Trauma Association Facebook group for the word cloud and all those that shared their thoughts, experiences and stories.