Risk And Choice In Maternity Care

This title is directed primarily towards health care professionals outside of the United States. This book explores the complex interrelationship between risk and choice in maternity care, taking a close look at how "high" and "low" risk are defined and what impact this has on a woman's ability to exercise informed choices throughout pregnancy. It offers an international collaboration that highlights different perspectives on debated issues, with chapters on maternity care in the UK, United States, Australia, and Ireland contributed by midwives, obstetricians, risk management experts, and sociologists. The aim of this book is to illustrate the changing reality of risk management as it relates to maternity care, and to highlight risk management concerns that may limit the choices available to pregnant women. Clarifies how applications of risk affect the choices pregnant women are able to exercise. Locates pregnancy risk considerations within the overall scheme of risk management. Analyzes practitioners' responses to the requirements of risk management. Presents risk management and choice from the risk manager's perspective, providing an understanding of risk as a "macro concept" in health care. Highlights medico-legal opinions on exercising choice, underscoring the need for accurate information and the ability to make informed decisions. Two chapters examine women's perspectives on risk labeling and the impact this has on choice - one in which the concept of safety within maternity care is discussed, and one in which the views of women with defined risk factors are explored and their ability to make choices is evaluated. Two chapters written by health service risk managers discuss the differences between an inner-city approach and a rural approach to the debate surrounding risk and choice. Discusses midwifery's focus on "normality" in childbirth and considers how this viewpoint affects the risk dialogue, including a chapter on clinical trends in maternity care. An obstetric perspective on risk refutes criticisms of obstetricians as being more likely to impose risk labels and limit choices by discussing how risks and choices are presented and considered within obstetric care. Explores the debate surrounding a woman's right to have a home birth in Ireland, in light of its risk management climate. Two chapters discuss the collaboration between service users, midwives, and obstetricians in Australia regarding the organization and delivery of maternity care, as well as the views concerning risk among indigenous Australians. Perspectives from nurse-midwives in the U.S. discuss the complex relationships among nurse-midwives, obstetricians, and pregnant women with regard to choice, including views on risk within immigrant communities.

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

Current maternity policy advocates choice and control for women in maternity care, and promotes women as active childbirth consumers and decision-makers. However, evidence that women receive true choice within contemporary maternity services is lacking, and continued and pervasive barriers to choice continue to have profound consequences for many. Choice, Control and Contemporary Childbirth explores the narrative childbirth experiences of a group of women, outlining current policy and providing an overview of the relevant discourses to which women are exposed when making choices for maternity care. This book is unique in presenting narratives that reveal varying identities for women across their maternity exerience, illustrating how maternity choices are simulataneously promised and constrained. It provides practitioners, service providers and policymakers in maternity care, and all those with an interest in birth provision, with profound insights into both women's experiences of childbirth and how choices can be better facilitated in future. 'Maternal choice and control are a challenge in contemporary society, with the changing demography of the population, the rising birth rate and financial constraints. Collecting this diverse information in one publication is timely and an invaluable resource for the practising and academically active midwives, obstetricians and health service managers.' - From the Foreword by Tina Lavender

More than 30 years ago, the Institute of Medicine (IOM) and the National Research Council (NRC) convened a committee to determine methodologies and research needed to evaluate childbirth settings in the United States. The committee members reported their findings and recommendations in a consensus report, Research Issues in the Assessment of Birth Settings (IOM and NRC, 1982). An Update on Research Issues in the Assessment of Birth Settings is the summary of a workshop convened in March, 2013, to review updates to the 1982 report. Health care providers, researchers, government officials, and other experts from midwifery, nursing, obstetric medicine, neonatal medicine, public health, social science, and related fields presented and discussed research findings that advance our understanding of the effects of maternal care services in different birth settings on labor, clinical and other birth procedures, and birth outcomes. These settings include conventional hospital labor and delivery wards, birth centers, and home births. This report identifies datasets and relevant research literature that may inform a future ad hoc consensus study to address these concerns.

This book investigates why women choose 'birth outside the system' and makes connections between women's right to choose where they birth and violations of human rights within maternity care systems. Choosing to birth at home can force women out of mainstream maternity care, despite research supporting the safety of this option for low-risk women attended by midwives. When homebirth is not supported as a birthplace option, women will defy mainstream medical advice, and if a midwife is not available, choose either an unregulated careprovider or birth without assistance. This book examines the circumstances and drivers behind why women nevertheless choose homebirth by bringing legal and ethical perspectives together with the latest research on high-risk homebirth (breech and twin births), freebirth, birth with unregulated careproviders and the oppression of midwives who support unorthodox choices. Stories from women who have pursued alternatives in Australia, Europe, Russia, the UK, the US, Canada, the Middle East and India are woven through the research. Insight and practical strategies are shared by doctors, midwives, lawyers, anthropologists, sociologists and psychologists on how to manage the tension between professional obligations and women's right to bodily autonomy. This book, the first of its kind, is an important contribution to considerations of place of birth and human rights in childbirth.

Over the last hundred years, pregnancy and childbirth has become increasingly safe – yet it is still a site of risk, and a contested ground on which health professionals and pregnant women both face high costs of error. In this context, all those involved in managing pregnancy and birth are expected to identify and mitigate risk: pregnant women are subject to increasing surveillance to ensure the safety of the unborn foetus, and every aspect of childbearing is increasingly medicalised. This publication brings together fascinating social science research to explore the ways in which risk is both created and managed in pregnancy and childbirth. The introductory chapters reflect on the changing social context of childbirth, in particular the medicalisation of both pregnancy and childbirth with development of specialist practitioners, such as obstetricians and midwives who claim to have the knowledge, technology and skills to identify and manage the risks involved. The next three chapters that examine the ways in which women’s behaviour during pregnancy is constructed as potentially risky -- for example smoking, drinking alcohol and taking drugs, and how these risks are monitored and mitigated. The final two parts of the book address the construction of and responses to both medicalisation and risk in childbirth. Altogether, it represents a valuable insight into the complex world of pregnancy, childbirth and risk. This book brings together editorials and articles originally published in special and open issues of Health, Risk and Society.

This book is the first comprehensive international overview of maternity services. Drawing on concepts of risk and social citizenship, it explores the relationship between welfare regimes and health policy by comparing and contrasting provision for childbearing women. Each substantive chapter focuses on a different country, presenting detailed contextual information on health care provision, maternity interventions and birth outcomes there. They discuss key issues such as birth rates and fertility patterns, the role of patient choice, attitudes to place of birth and maternity entitlements among others, and the countries covered represent diverse welfare regimes, including Ireland, Scotland, Sweden, the Netherlands, Germany, Italy, Japan, the United States, Canada, Australia and New Zealand. An extended introduction and a conclusion draw the book together and place it in the context of the literature on comparative welfare regimes. It is an important reference for students and academics interested in comparative social policy, health services research, and maternity services and policies.

Midwifery Continuity of Care is a robust ‘how to’ guide to establishing midwifery continuity of care. Written by a team of international experts in their field, this book highlights lessons learned to help develop new ways of planning, implementing, evaluating and sustaining midwifery continuity of care for the benefit of women, babies and communities. Summarises the evidence for midwifery continuity of care to support policy makers, commissioners of maternity services and health service executives with their implementation of midwifery continuity of care Practical real world examples, stories and experiences to bring to life the diversity of ways that midwifery continuity of care can be implemented Highlights a range of issues for managers and leaders to be aware of, including organisational, industrial and safety and quality issues Explores how building alliances can enable midwifery continuity of care to flourish, addressing scaling up and sustainability Evolve Student and Faculty Resources: eBook on VitalSource An inspirational video interview with author, Jane Sandall