Jane Norman is Professor of Maternal and Fetal Health, and Vice Principal People and Culture at the University of Edinburgh. She graduated in Medicine in Edinburgh in 1986. Her research and clinical activity focus on improving outcomes for pregnant women and their babies. She is particularly interested in understanding and preventing preterm birth and stillbirth. She also led the University of Edinburgh’s successful bid for an Athena Swan Silver Institutional Award in 2015.
Childbirth has changed significantly in the UK over the last century.
In the early part of the 20th century, the majority of women had their babies at home, and the risk of death for both baby and mother were 10 to 100 times respectively the risks faced today.
In the 21st century, women are arguably more knowledgeable than ever before about their pregnancy and birth. The ‘paternalism’ of the middle part of the 20th century, where unproven interventions such as routine episiotomy and enema were commonly applied, without pregnant women sharing in the decision-making, has happily disappeared. The recent Montgomery v Lanarkshire ruling[1] has emphasised that it is the pregnant woman’s right to be given information on the advantages and disadvantages of different birth options, and to make a choice between them.
Women have real choice about the place that they have their baby. Although hospital is the commonest place of birth, a home birth, or birth in a midwifery unit are readily available options, are endorsed by both the medical and midwifery professions. Access to different options around place of birth are also reasonably well supported by the NHS.
In contrast, women have much less choice over the timing and method of childbirth.
Although the National Institute for Health and Care Excellence endorses the option of a planned (elective) caesarean without medical reasons if requested, ‘if a vaginal birth is still not an acceptable option after discussions and offers of support’, many pregnant women still find it difficult to identify a hospital and/or a clinician who will carry out their request.
Women similarly have no choice in the timing of birth: although there is now a lot of evidence that induction of labour from 39 weeks of pregnancy is safe for mother and baby (and does not increase the risk of caesarean section), this option is not routinely available to women unless they have a “medical” reason, such as a small baby. Real choices about method and timing of birth are therefore limited.
In the UK, women’s right to control whether or not they get pregnant has been hard fought for and won in the 20th century, with fertility treatment, contraception and abortion all available (to a greater or lesser extent) in the UK NHS.
Is it not time that women have proper choices about how and when they have their baby? Of course there are advantages and disadvantages of all options (and none are risk free), but is it not time that women are allowed to make the decision that is best for their own and their baby’s individual circumstances?
Women’s choice should no longer be limited to what is considered ‘natural’: those who wish to avail themselves of modern medical technology should be allowed to do so.
Empowering women to make choices that health care providers may not make for themselves is not ‘dangerous’, and pregnant women who ask for what they want should not be viewed as ‘dangerous’ either.
[1] Supreme court case ID UKSC 2013/0136