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A positive childbirth experience: transforming care of women and babies…
A positive childbirth experience: transforming care of women and babies for improved health and wellbeing
Autonomy
Hospital culture, its policy and practices are all set to the rhythm of ‘institutional momentum’—the machinations of hospital culture that propel women through (and therefore out of) the system to keep them ‘safe’.
Therefore, women make choices that align with hospital policies and practitioner preferences,13 ‘going with the flow’ of the institution rather than their birthing bodies.
Many routine medical practices, historically based in a lack of trust in women’s bodies to birth,17 do undermine birth physiology18, 19 and women are not necessarily informed of this.14
Women are unlikely to request options that have not first been presented to them, meaning a great deal of power rests both with practitioners, but ultimately, with institutional policies, which dictate which options are available and therefore how these birth options are presented
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¨We also propose that institutionalized birth as it is currently organised is inherently unethical; midwives and doctors are expected to place allegiance to hospital policy or cultural practices over respect for the wishes and needs of women¨
The other issue is the growing number of women experiencing (or disclosing) dehumanizing birth experiences perpetuated by doctors and midwives.
A care ethics approach would enable us to turn our perspective around and value relationships and caring first and foremost, highlight the unethical nature of regimented institutional birth and the damage caused by midwives’ busyness and their requirement to push women through the system.
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Ethics of care has developed over the last 40 years from diverse areas of study: feminism, education, psychology, political science, nursing and philosophy, drawn together by an interest in care as practice, and guiding concepts that include relationality, contextuality, vulnerability, embodiment and attention to power.
Tronto’s ethics of care consists of four primary elements: attentiveness, responsibility, competence and responsiveness.
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Transforming practices
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Micro-meso-macro
Human beings have responsibility to care for each other and this is at government (eg social care) and individual (eg humanitarian, family concern) levels.
Past - present - future
McCourt C and Dykes F. From traditional to modernity: Time and childbirth in historical perspective. In: McCourt C, (ed.). Childbirth, Midwifery and Concepts of Time. Oxford: Berghahn Books, 2009.
Costs
Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.
Individual WHO recommendations and how they impact on a positive childbirth experience
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Only interventions that serve an immediate purpose and have been proven to be beneficial should be promoted
A clear objective that a positive childbirth experience for the woman, the newborn, and her family should be at the forefront of labour and childbirth care at all times
Continuous support during labour improves childbirth outcomes, including enhancing the physiological process of labour
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Rights
Milli Hill positief over bevallen: je hebt het volste recht op goede informatie in elke fase van je zwangerschap en bevalling; wettelijk gezien is instemming pas geldig als het geïnformeerde instemming is
bevordert autonomie. uit wetenschappelijk onderzoek is gebleven kat vrouwen positiever terugkijken op hun bevalling als ze waardig en met respect zijn behandeld.
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