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Book Details
Abstract
Informed choice in maternity care is government policy and is therefore an important issue in the education of midwives and obstetricians. This book brings together key research in the area and provides a forum for the concerns of all involved. Contributors are drawn from a wide range of perspectives, including service users, lay support groups, midwives, social scientists, obstetricians, nursing and law. Informed Choice in Maternity Care is timely, topical and covers a number of current debates.
MAVIS KIRKHAM is Professor of Midwifery in the Women's Informed Childbearing and Health (WICH) Research Group at the School of Nursing & Midwifery, University of Sheffield, and a prolific midwifery author. Her previous publications include The Midwife-Mother Relationship (Palgrave, 2000), Developments in the Supervision of Midwives (Books for Midwives, 2000), and Reflections on Midwifery (Balliere Tindall, 1997).
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Contents | v | ||
| Acknowledgements | xi | ||
| Notes on contributors | xii | ||
| Introduction | xv | ||
| 1 Why can't women just say no? And does it really matter? | 1 | ||
| Introduction | 1 | ||
| What do we know about choice in maternity care? | 2 | ||
| Women's experiences of constraints to choice | 5 | ||
| Limiting impacts of maternity services | 5 | ||
| Women's ways of being in the world | 14 | ||
| In what rhetorical space does choice arise? | 18 | ||
| How much does choice really matter? | 19 | ||
| Could the rhetoric of choice be transformed into one of ethical decision-making? | 22 | ||
| 2 Informed choice in maternity care | 31 | ||
| Background | 32 | ||
| Consent | 33 | ||
| Legal issues | 35 | ||
| Saving life – to intervene or not? | 37 | ||
| Recording consent | 38 | ||
| What about 'birth plans'? | 38 | ||
| Pregnancy and advance refusals of treatment | 39 | ||
| Re T | 40 | ||
| Capacity | 41 | ||
| What is a free choice? | 42 | ||
| Informed consent | 42 | ||
| Some screening issues | 44 | ||
| HIV screening: a case in point? | 46 | ||
| The pregnant woman and the foetus | 50 | ||
| Pregnant drug-users: the US experience | 52 | ||
| Human Rights Act 1988 | 53 | ||
| 3 How midwives used protective steering to facilitate informed choice in pregnancy | 57 | ||
| Introduction | 57 | ||
| Outline of the study | 58 | ||
| Controlling the agenda | 59 | ||
| Protective gatekeeping | 61 | ||
| Maintaining the hierarchy | 65 | ||
| Trust | 68 | ||
| Summary | 69 | ||
| 4 Can leaflets deliver informed choice? | 71 | ||
| The MIDIRS Informed Choice leaflets | 72 | ||
| Evaluating the leaflets | 73 | ||
| Measuring informed choice | 74 | ||
| Were the leaflets used? | 75 | ||
| Did any of the leaflets deliver informed choice? | 77 | ||
| A cautionary note | 77 | ||
| Ultrasound scans | 78 | ||
| Screening for Down's syndrome and spina bifida | 79 | ||
| Informed choice overall | 79 | ||
| What does this say about leaflets? | 80 | ||
| Informed choice – a difficult objective | 81 | ||
| Is maternity care different from the other health care settings? | 82 | ||
| Is this just about leaflets – what about other media? | 82 | ||
| Conclusion | 83 | ||
| 5 Is there a difference between a free gift and a planned purchase? The use of evidence-based leaflets in maternity care | 87 | ||
| Background to the Informed Choice study | 88 | ||
| Research design and methods | 89 | ||
| Background to the phase one study of the ethnographic units | 92 | ||
| Funding arrangements for purchasing the Informed Choice leaflets | 93 | ||
| The Informed Choice leaflets in everyday practice | 94 | ||
| Different understandings of the concept of 'informed choice' | 99 | ||
| Informed choice, equity and consumerist values | 105 | ||
| Choice, inequality and stereotyping | 106 | ||
| The evidence imperative, informed choice and professional accountability | 107 | ||
| The overall significance of the Informed Choice leaflets | 111 | ||
| Conclusion | 112 | ||
| 6 The culture of the maternity services in Wales and England as a barrier to informed choice | 117 | ||
| Obstetric authority and its implications | 118 | ||
| Fear and the technological imperative | 120 | ||
| Midwives in the middle: balance and vulnerability | 123 | ||
| Rhetoric and resistance | 131 | ||
| Childbearing women's response to the maternity service | 132 | ||
| Contrasts in scale and culture | 133 | ||
| Conclusion | 142 | ||
| 7 Information used by pregnant women, and their understanding and use of evidence-based Informed Choice leaflets | 147 | ||
| Study participants and methods | 149 | ||
| Approaches to obtaining information | 151 | ||
| Women's understanding and attitudes towards evidence-based information | 155 | ||
| Planned use of the Informed Choice leaflets | 157 | ||
| Discussion | 161 | ||
| Conclusion | 165 | ||
| 8 Integrating MIDIRS Informed Choice leaflets into a maternity service | 169 | ||
| Introduction | 169 | ||
| Context | 171 | ||
| Processes | 173 | ||
| Learning from this experience | 178 | ||
| Conclusion | 182 | ||
| 9 Should doctors perform Caesarean for 'informed choice' alone? | 185 | ||
| Introduction | 185 | ||
| Ethics | 187 | ||
| Risk/benefit? | 191 | ||
| Mother | 191 | ||
| Baby | 197 | ||
| Basic medical concepts | 200 | ||
| Professional vested interests | 200 | ||
| Women's changing status | 201 | ||
| How should we respond to 'requests'? | 202 | ||
| Unanswered research questions | 203 | ||
| Conclusion | 203 | ||
| 10 Negotiating elective Caesarean section: an obstetric team perspective | 211 | ||
| The research | 211 | ||
| Thematic analysis | 212 | ||
| Ongoing persuasion | 214 | ||
| Higher client expectations | 216 | ||
| Time and information | 218 | ||
| 'A healthy baby' | 220 | ||
| Categorisation of pregnant women | 222 | ||
| Loss of obstetric experience | 224 | ||
| Being manipulative | 227 | ||
| Hidden agenda | 229 | ||
| Discursive and interactional resources | 230 | ||
| Conclusion | 232 | ||
| 11 Birth experiences of South Asian Muslim women: marginalized choice within the maternity services | 237 | ||
| Background | 238 | ||
| Theoretical dimensions of race | 239 | ||
| Institutionalised racism | 240 | ||
| Study aims | 241 | ||
| Methodology | 241 | ||
| Access and recruitment | 242 | ||
| Data collection and analysis | 242 | ||
| Findings | 244 | ||
| 12 The misleading myth of choice: the continuing oppression of women in childbirth | 257 | ||
| Compulsion, not choice | 259 | ||
| Control, not choice | 259 | ||
| Damaged midwives, damaged women | 262 | ||
| The end of the story | 263 | ||
| 13 Choice and bureaucracy | 265 | ||
| Identifying choices | 267 | ||
| The choices which are taken for granted | 268 | ||
| Definitions | 268 | ||
| Making choices | 269 | ||
| The package of care and its implications | 271 | ||
| Unequal interactions | 274 | ||
| Consent and choice | 278 | ||
| Control of professional work | 280 | ||
| Control of one's own experience? | 281 | ||
| Balancing caring | 282 | ||
| Is partnership possible? | 282 | ||
| Culture, scale and choice | 283 | ||
| Choices and processes | 286 | ||
| The future | 287 | ||
| Index | 291 | ||
| A | 291 | ||
| B | 291 | ||
| C | 292 | ||
| D | 293 | ||
| E | 294 | ||
| F | 294 | ||
| G | 295 | ||
| H | 295 | ||
| I | 296 | ||
| J | 296 | ||
| K | 296 | ||
| L | 297 | ||
| M | 297 | ||
| N | 298 | ||
| O | 299 | ||
| P | 299 | ||
| Q | 300 | ||
| R | 300 | ||
| S | 300 | ||
| T | 301 | ||
| U | 302 | ||
| V | 302 | ||
| W | 302 | ||
| Y | 302 |