I used to not be very adventurous with food. I wasn’t a fussy eater as such I just hadn’t been exposed to different types of food when I was young so I was quite cautious. I was gently introduced to the world of flavour through a korma curry when I was 20, and now elbow people out the way to the hot and spicy counter and love trying new things. I have even had a go at ordering off the menu, either driven my taste buds or that nothing on the menu was my thing. And mostly this has been a good experience, with me, the customer humoured and accommodated. Occasionally there is a stony ‘no’ (it’s just not possible in pre-cooked greasy burger joints) and on the very rare occasion I was in fear of being ejected from the premises for even daring to imply the menu was inadequate (a rather snotty pretentious restaurant in my view).
Is modern birth services options like a menu? Who develops the menu and how is it presented? How easy is it to order off the menu and what is that experience like?
Practically the menu is mainly the clinical guidelines that help clinical staff decide the best thing to do based on the evidence available. My experience is that whilst some commonalities can be found, local clinical guidelines vary due the rest of the stuff that has a significant but rarely acknowledged impact on what ends up on the menu. Stuff like personal views, experiences, beliefs and ‘how we do things round here’ impact on what is in a clinical guideline. I was once, some years ago, in a team who were updating breech clinical guidelines at a maternity unit when I was told to tone it down (I think I was including the option of active, upright breech birth section) or I would never get it past the obstetricians. This was despite my arguments that giving being required to give birth on your back in stirrups as per the current guidelines had no research basis at all. My text remained in (stubborn me).
I am aware that in some maternity services the users of that service, the women and their families, have no input into the development of clinical guidelines that directly affect them; the menu is off limits in terms of deciding what’s on offer. Perhaps a chef would argue that only she/he, the expert, would know what food is best to serve. But of course we are not talking about food, we are talking about birth and who is the expert at birth (my vote is birthing women).
But what if nothing on the menu takes your fancy. Hold the beef and potato stew, I’m hankering after roasted snails cooked with pineapple and paprika today kinda thing. Well, from listening to many women’s breech birth stories, there are mixed responses but a common one is of a sad battle to get their pineappley snails/not on the menu birth choices. Some women are given the ‘no can do’ response (think greasy burger joint) and others are made to feel very alienated, ostracised and even stupid from even asking for their desired snails (think snotty restaurant). Some even leave the entire food joint and go and find a nice chef (in another maternity unit or independent midwife) who will listen, respect and facilitate their choices.
Ordering off the menu is hard work, it can be stressful and women share that it harms their relationships with care providers who won’t consider their needs. Perhaps then we need to look who and how the menu is developed. Including the people who use the service in clinical guideline development is a no-brainer, it is empowering and enabling and forms partnerships of trust and respect. Maternity Service Liaison committees do sterling work in this area. Involving service users in research and building and sharing of knowledge around birth is also common sense. What’s important to those giving birth should be the central starting point for developments and innovations. Ordering from the birth menu that you shaped is much easier than choosing off the chef’s version of culinary heaven.
And finally we need to consider if we need a different type of menu; is there a new way of doing things out there? The maternity services review certainly thinks it’s time for a change. The proposed personal budgets will certainly go some way to empowering women in their birth choice and feel more like the buffet style approach to birth. They offer you to take a plate and fork and add the tasty morsels you desire to build a meal that really tingles your taste buds; your own unique birth journey how and where you want it.
Pineappley snails are not for everyone, but nor is beef stew. Let’s change the birth menu and the mindset of choice.