Sheila Kitzinger 2017-18 Programme Events
Transforming Consent in Maternity Care
11 October 2017
Birthrights gathered a small group of maternity leaders, policy makers, service users, academics and legal experts for a seminar on “Transforming Consent in Maternity Care”. The event was hosted by Green Templeton College Oxford, as part of the Sheila Kitzinger Programme and we are grateful to the College, the Kitzinger family and Programme team for their enthusiasm, support and funding.
The day started with an exploration of the key facts of the judgment of the Supreme Court made in the Montgomery v. Lanarkshire case. In this case Mrs Montgomery, a pregnant diabetic woman with a large baby, was not informed by her obstetrician of the chance of shoulder dystocia – which she went on to experience with profound consequences for her and her son. Although Mrs Montgomery had repeatedly expressed concerns about giving birth vaginally, the obstetrician said that she routinely chose not to explain the risk of shoulder dystocia to diabetic women because the risk of serious injury to the baby was very small and that if she did explain it, ‘then everyone would ask for a caesarean section’.
Seminar participants agreed that, while there had been concern that the Montgomery judgement offered a radically different interpretation of consent, in reality it simply brought the law in to line with GMC guidance, recognising standard best practice as well as what women say they want and need. The court highlighted a need for two-way dialogue between a woman and caregiver (presented in a way that the woman can understand) and insisted that any material risks and benefits should be presented to her and that those discussions should be personalised to her circumstances. It deprecated the use of consent forms and, in synchronicity with the recommendations of the Better Births report, solidified the need for relationship-based care, that flexes around the needs of individual women in order to ensure that women and babies are safe.
After wrestling with the philosophical and personal impact of autonomy the group turned to the challenges of achieving the training, structures, systems and cultures that facilitate care that enables lawful consent to be given, paying particular attention to how this could be achieved through the Maternity Transformation Programme and other existing initiatives, alongside the difficulties faced by clinicians in the dynamic birth room environment.
There were a number of recommendations from the seminar group. Birthrights are currently consulting with the participants and other key national bodies and service user groups to develop these.
A joint report with Birthrights was published in April 2018 entitled Transforming consent in maternity care (PDF).
What does it mean to be an adolescent in the 21st century? Implications for health and healthcare
Young people (10-24) represent one fifth of the UK population. However, there is evidence that the specific needs of young people are often neglected by secondary and primary care.
Adolescence is a time of physical and emotional transition and growth. Concepts of self, attitudes to risk; peer influence; and the ability to understand the ‘other’s’ perspective all undergo major change. Many health problems present specific challenges in this age group, including those that may first present in adolescence (such as sexual or mental health problems) and those where clinical management may need to evolve alongside the development and priorities of the adolescent (such as in chronic problems including diabetes and eczema). Additionally behaviours that influence health throughout the lifecourse may be first experienced or established at this time (for example smoking and diet).
The world is also constantly changing with rapid technological advances, social media, communication platforms and political changes. With the support of the Sheila Kitzinger Programme, we are holding a one-day workshop involving advocates, adolescents, experts and relevant health professionals to consult on what it means to be an adolescent in the 21st century, and the implications of this for health service development and provision. Through sharing experiences of service design and delivery, we will consider how to support and nurture autonomy in adolescents as they develop skills in managing their health, and how services can evolve and develop to be acceptable and responsive to the needs of young people as they transition to adulthood.
Global midwifery education
A seminar on global midwifery education took place on 9-10th July 2018 at the University of Oxford under the auspices of the Sheila Kitzinger Programme at Green Templeton College. This seminar brought together about 40 academics, women’s advocates, and national and global organisations, as well as midwives and students. Together they shared knowledge and perspectives, debated current issues, and made recommendations for this important topic, which has such potential to save the lives of women and newborn infants globally, and to improve the quality of care.
The seminar focussed on evidence-informed practical solutions, drawing both on research evidence and on country case studies. The meeting built upon the joint WHO-ICM-UNFPA global consultation on “Strengthening quality midwifery education to achieve Universal health Coverage(UHC) 2030” convened in March and will inform the developing global report for midwifery education. A report from this seminar will be produced, which will be made widely available.