Читать книгу Better Births - Anna Brown - Страница 25

This chapter considers ethical issues which impact women and maternity healthcare professionals as a result of care delivery during the childbearing continuum. Women have to make informed decisions and face a myriad of choices during their journey. Equally, care providers have an obligation to provide the best available evidence and information to enable women to make choices about the model of care that is available to them, places of birth and modes of delivery. Midwives seek to deliver care that is effective, ethical and takes into consideration their professional autonomy and responsibility (NMC 2018). New professional standards for midwifery proficiencies indicate that key domains include ‘an accountable and autonomous midwife who provides safe and effective care as colleague, scholar and leader’ though models of continuity of care and carer (NMC 2018 p. 16). These expectations have ethical implications which can influence the outcomes of a woman's birthing experience and a midwife's scope of professional practice.

It is reasonable to suggest that women's experience of childbirth is influenced by the care providers and the environment in which the birth takes place. The power dynamics between the midwife's autonomy to provide care, which is embedded in knowledge, and a woman's input to the process is crucial to birth outcomes. The place of birth impacts on the woman giving birth and on the midwife's social and spatial relationship. This includes the dynamics of control in which the birth event takes place. A woman is empowered to feel in control in a ‘home’ environment where she is familiar and comfortable; whilst a midwife has knowledge of the complex settings in a hospital environment. The midwife is therefore perceived by the woman to be in control. As such, it has been argued that hospital births do not generally accommodate the midwifery construct of a belief in the competence of a woman's body to be able to birth a baby and be an active participant in the childbearing process (Davis and Walker 2010).