No, #notallhcps, and yes, we are very lucky and grateful to have the NHS.
But I'm starting to feel that this platitude I put before making any comment on the abusive and coercive practices in maternity care is a lot like the excuses women make for their abusive partners. Because we all know we NEED the NHS.
Sexual and physical violence is perpetrated against women daily.
"But he does all these things for me, he looks after me, once he even saved my life!"So what does this relationship look like?
I have used the Power and Control Wheel as a basis.
EMOTIONAL ABUSE, COERCION AND THREATS
Women do not feel like they have the ability to make choices. They are guilted and coerced into consenting to things, or even consent because they don't want to "disappoint" the "lovely" HCP. They may even be told they won't be allowed in the pool or access to pain relief. This is not consent! If somebody doesn't feel like saying no is acceptable then their yes is meaningless. This sadly means that many women have been assaulted during their care.
INTIMIDATION
Playing “good cop bad cop” , bringing in senior staff to berate and bully, sending threatening letters. I have seen all of this as a doula.
ECONOMIC ABUSE
Free pregnancy and freebirth are an option but for the vast majority of women they won't be. Some try and are threatened with social services. We know that one to one care from a midwife is imperative for good birth outcomes. It's the one thing that doesn't happen. So women know that to feel even remotely safe they have to become part of the system. They may not be able to afford an independent midwife. They cannot leave the NHS because they know that they need it.
USING MALE PRIVILEGE
Although HCPs can be either sex, maternity care is hugely patriarchal and we enact the roles where women are told that the "system" knows what is best for them and they are merely the gestator of the baby.
USING ISOLATION
Women are told they must have a certain type of care, they aren't allowed to home birth, they aren't allowed a caesaerean, they aren't allowed to decline, they're not allowed to leave the hospital, they're not allowed to just walk out with their baby. They are given limited information or statistics tailored to the HCP's agenda. Women are left to languish on induction wards or labour alone, diminishing their morale. They may receive harassing phone calls and letters about their informed decisions. They aren't allowed their birth partner or doula to stay with them at any point.
MINIMIZING, DENYING AND BLAMING
Women are told that what happened to them was inevitable, or had to happen, or was necessary for their baby's safety. They are told (and I have witnessed this myself) that other women in different parts of the world have it worse and they are lucky! They are told to be grateful they have a healthy baby and not talk about the trauma they have experienced at the hands of the system. And of course the usual #notallhcps.
USING CHILDREN
Being told they are putting their unborn child at risk by requesting individualized care or declining interventions. They may have the threat of that child being removed from them if a social services referral is made. They may be told they will leave their existing children motherless if they choose a different pathway and die.
And of course not mentioned but very relevant...
THE HONEYMOON PHASE
This is where a women wants non-standard care and has broken some rule and somebody senior is assigned to promise her the world. Of course you can use the birth pool, of course you can decline VEs, of course you can decline continuous monitoring...
Only to get there in labour to find she can have none of those things that were promised.
I am fed up of women being minimised and gaslit over this. Yes we need the NHS. But that doesn't mean it can just do what it likes to us.
Update in 2020:
Truly independent midwives have had their insurance cancelled. Covid-19 means women are alone at appointments and bullied even more. Isolation and coercion are worse than ever. Women are told to be grateful for NHS workers risking their lives.
