Don’t Fear The Maternity System, Learn To Understand It.
How to understand your maternity care, make informed choices and feel more confident about pregnancy and birth
One of the things I feel most passionately about when I teach is helping women and their birth partners understand how the maternity system actually works, because I think it is very difficult to feel confident about your choices when you don't understand the system that you're making those choices within.
Maternity systems are designed to provide safe and effective care to the people who need them, but they are also designed around systems, pathways, policies and processes that allow them to provide that care to large numbers of people, while balancing safety, patient satisfaction, cost and staff wellbeing.
The need to follow these systems means that women are often grouped according to their individual needs and risks. This is important for providing appropriate care, but it can also create a generic approach, with women and families being directed down particular pathways and sometimes feeling as though they are simply moving along a maternity “conveyor belt”.
This can mean that women aren't given truly personalised care, particularly if they don't know that they can question the pathway they have been placed on, ask about alternatives or make different choices.
And when you add this to the frightening stories about birth that we're surrounded by, the media coverage of maternity services and the fact that many of us have very little exposure to real birth within our own families, it's really not surprising that many people develop a fear of the maternity system before they have even considered getting pregnant.
Why understanding your maternity care matters
The problem with this fear is that almost all women and families will become involved with the maternity system in some way during pregnancy and birth.
Even if you plan to avoid it as much as possible, you can never be certain which direction your pregnancy or birth will take. There may come a point where accessing maternity care becomes essential, or simply something that you choose to do because it feels right for you.
And when that happens, I would much rather you felt confident navigating the system than frightened of it.
So, rather than fearing the maternity system, I want you to understand it.
Because when you understand how the system works, why it works in the way it does and, importantly, that you have choice within it, you are much better placed to use it to your advantage.
That doesn't mean you need to challenge every recommendation or assume that the professionals caring for you are wrong.
It means understanding that you are part of the decision-making process too.
NHS England explicitly says that informed decision-making is central to personalised maternity care, and that people should understand their options, the risks and benefits, and be supported to make decisions about their care. (1) It also describes shared decision-making as bringing together the clinician's expertise with the patient's preferences, circumstances, goals, values and beliefs. (2)
To support you with navigating the maternity system I have provided you with five things I think every pregnant woman should understand about it.
1. Understand why maternity care is organised around policies, guidelines and pathways
Maternity care has to operate within a system that manages risk, resources, professional responsibility and the needs of a large number of women and families.
Staff are expected to work within policies and guidelines because these help them provide safe, consistent and efficient care.
This is important. Policies and guidelines exist for good reasons, and they provide an important framework for safe care.
But it is also important to understand that these policies and guidelines are there for staff to follow. They are not rules that you, as the person receiving care, are obliged to blindly follow.
Even NICE makes clear that its guidelines are not mandatory and should be considered alongside the individual needs, preferences and values of the person receiving care. (3)
If the care being suggested to you doesn't align with your wishes, culture, beliefs or circumstances, you can ask questions.
You can ask:
Why are you recommending this?
Is this a generic recommendation or one based on my personal, specific risk factors?
What are the benefits and risks?
Do I have other options?
Can I have time to consider this?
What happens if I decline?
Of course, that doesn't mean every decision is straightforward, or that declining a recommendation won't have consequences that need to be discussed. It means that you deserve to understand what is being recommended, why it is being recommended and what your options are before making a decision.
A recommendation is not necessarily the same thing as an instruction that you have no choice but to follow.
2. Remember that your safety is about more than whether you and your baby are physically okay
We hear the phrase “Well, at least you and baby are safe” so often. Of course, physical safety matters enormously. It is the basis of everything. But I don't believe we should be expecting only the basics...
Psychological and cultural safety matters. Feeling respected and listened to matters. Your experience matters.
These things are personal to you, and they can have a significant impact on how you experience pregnancy, birth and the early days with your baby.
A birth can be medically uncomplicated and still be a deeply difficult experience for the person who lived through it.
Equally, a birth that involves intervention or unexpected changes to the plan can still be a positive experience when someone feels informed, involved, supported and respected throughout. If they felt safe…
This is why I believe that good maternity care must consider more than simply whether you and your baby are physically safe.
I believe we should be expecting more than “the very least”.
3. Understand your choices during pregnancy and birth
And I mean choices in far more aspects of your care than you might realise.
That includes choices about where you give birth, who supports you, what care you accept, what you decline and, even down to, whether you access particular care at all. You have choice in almost everything.
This is where good quality information becomes so important. You don't need to become your own midwife or obstetrician. You don't need to know every guideline or understand every medical term, but you do need enough information to understand your options and make decisions that feel right for you.
One of the most useful tools I teach women and their birth partners to use when making decisions is the acronym, BRAINs:
B – Benefits: What are the benefits of this option?
R – Risks: What are the risks?
A – Alternatives: What other options are there?
I – Intuition/Info: What is my gut telling me? What other info do I need?
N – Nothing: What happens if we do nothing for now?
S – Space: Can I have space and time to consider these options?
This can be a really useful framework when you're faced with a decision, particularly when you are feeling overwhelmed or put on the spot.
You can download my free BRAINs decision-making tool here and keep it with you throughout your pregnancy.
4. Who can support you during pregnancy and birth?
One of the things that can make the maternity system feel confusing is that there are lots of different professionals involved in providing care, and their roles and areas of expertise can be very different.
A midwife and an obstetrician have very different roles, for example, and even within midwifery there are many different specialities.
A midwife who works predominantly on a busy labour ward, where many of the women she cares for have increased risk factors and births are more medicalised, may have a very different experience and skill set from a community midwife who regularly supports physiological birth and homebirths.
Neither is necessarily better than the other. They simply have different roles, different experiences and different areas of expertise.
This is something worth considering when you are thinking about what you want from your birth.
Where you choose to have your baby, which professional you discuss your choices with and what sort of support you expect from the people caring for you can all influence your experience.
It is also worth remembering that the person looking after you may not be the person making every decision about your care.
Understanding who is who, what their role is and who you can ask for support can make the maternity system feel much less overwhelming.
5. How to make informed decisions about your maternity care
This is perhaps the most important point of all.
Now, I don't mean that you need to ignore your midwife or obstetrician’s suggestions!
But I do mean that you need to seek out good quality, evidence-based information and take the time to understand your options and make decisions that are right for you.
It can be very easy to just “go with the flow” and do whatever is recommended, particularly when you're pregnant for the first time and you're surrounded by professionals who know far more about pregnancy and birth than you do. Sometimes, of course, the recommendation will be exactly what you want to do! But what you need to remember is, that among all these experts, you are an expert too… an expert of yourself, of your own body and mind. And an expert of your baby. You are the only one communicating with them on an extracellular level, every minute of every day. This wisdom should not be dismissed.
Being an active participant in your care doesn't mean you have to challenge everything or assume that the professionals looking after you are wrong. It simply means understanding that you are part of the decision-making process too. In fact a hugely important one.
Remember that you can trust your maternity team and still ask questions, you can accept a recommendation and still understand why it has been made, you can change your mind, and you can make different choices from someone else without either of you necessarily being wrong.
The aim isn't to become an expert in maternity care.
The aim is to become confident enough to participate in your own care, because it’s your birth, your body and your baby.
If you would like to learn more about consent, bodily autonomy and your rights in maternity care check out the BirthRights website.
So where does hypnobirthing fit into all of this?
This is one of the reasons I decided to create Birth Your Own Way and teach antenatal and hypnobirthing.
Not because I think labour should be pain-free, or that you need to be a silent goddess through your contractions, but because I am passionate about women understanding their choices and feeling confident enough to make them.
And I know that women are so much more capable and powerful than many often realise.
This isn't just a belief.
I have seen women birth in their power, time and time again, and I never stop being astounded.
For me, preparing for birth isn't about preparing for one perfect version of how your birth should happen. It's about understanding how birth works, learning practical tools to help you cope, understanding your options, preparing your birth partner and thinking about how you might make decisions if things don't go according to plan.
Because birth is unpredictable.
Sometimes things don't go according to plan, sometimes intervention is needed, sometimes the birth you imagined looks completely different by the time your baby arrives and sometimes we need this incredible maternity service that we have available to us, and it does exactly what it is supposed to do…
It saves lives.
I don't want you to fear the system, I want you to understand it.
Because when you understand it, you are much more able to use it to your advantage, ask the questions you need to ask and make choices that are right for you.
And that, to me, is a much better way to approach birth than being frightened of the very people who may one day be there to support you.
Preparing for birth doesn't mean preparing for everything to go perfectly. It means preparing yourself to understand your options, make decisions and feel confident navigating whatever your birth brings. Knowledge gives you confidence and authority. Fear takes it away.
That is what Birth Your Own Way is all about.
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