Women’s need must always be at centre of care says RCM in informed decision making briefing for midwives

on 07 April 2022 Midwifery Midwives RCM Member MSWs - Maternity Support Workers Pensions Pay and Agenda For Change Midwife Shortage NHS Unions

Supporting women to make decisions about their care that are right for them is behind a new briefing for midwives on informed decision making published today. There is a clear link between safer care and a maternity culture that listens to, and respects, women’s choices and decisions, says the RCM.

The briefing gives midwives an understanding of the legal and regulatory frameworks supporting informed decision making, so they can offer even more support to women making choices about their care, from hospital, to midwife-led units and into the community. This is important for all women, says the RCM, but particularly those with social risk factors and multiple disadvantages that renders them vulnerable to more ‘paternalistic care’.

“We know women really value midwifery support and advice when they are making decisions about their health, their pregnancy, and their baby. We need to make sure we are supporting them in the best ways we can to help them make what can be very difficult decisions, often amid whirl of information overload,” said Alessandra D’Angelo, the RCM’s Quality and Standards Advisor and co-author of the briefing.

There are, though, challenges within the system that can hinder midwives from supporting women as effectively as they want to. Chief among these is the chronic understaffing in maternity services. This often leaves midwives with insufficient time to sit and talk to women, outline the options they have and the reasons behind them, so that women are as informed as possible when they make decisions. Midwives’ fears of supporting women with a decision, then something going wrong and possible litigation are highlighted and addressed in the briefing. The RCM guidance reassures midwives of their professional and legal protection if they follow protocols on this.

The workplace culture and environment that midwives work in can also be a barrier to choices about care. “It is critical that systems, cultures and policies are all focused on one thing: being there to ensure women make the choices they want so that they have the pregnancy, labour, birth and postnatal care that meets their and their family’s needs,” said Alessandra. “Our collective or individual views about care, whatever they may be, should never be a part of this process. We have a moral, professional and legal duty to women to be there to help women make an informed choice with objective and unbiased information,” she said.

Those laws underpinning their right to informed choice are enshrined in human rights legislation in the UK and are backed by court rulings. The briefing highlights real life examples where those rights have been upheld

“This is all about being there for women, advocating for them, ensuring their decisions are as well informed as possible, then supporting them to ensure those decisions are respected. It is a fundamental part of our role,” said Alessandra. “Our professional code and laws not only compel us to do this but also protect us and support us in doing it. This and the RCM’s briefing should give us the confidence to put informed decision making and women’s needs right at the centre of care, where they should always be.”