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Informed Choice in Maternity Care

Informed Choice in Maternity Care

Mavis Kirkham


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Book Details


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