‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

Abstract

Objective: to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth.Design: ethnography.Setting: tertiary hospital in Australian city. Participants: sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork.Findings: women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence.Key conclusions: informed consent is an oft-cited human right in health care, yet in maternity care the micropolitics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices.Implications for practice: as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.

Beyond autonomy: Care ethics for midwifery and the humanization of birth

“…These conditions culminated in priorities and cultural practices that were based in the symbolism of medical safety (and fitting within the 'flow' of the institution) rather than being what could be considered objectively as particularly safe practices. The discourses surrounding these practices, framed by the unconscious bias of 'medical safety' 4 , were reproduced in hospital policy documents, and therefore, in the information that was provided to women by midwives 5 .…”

“…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. 5,13,16 The politics and power relations of birth are most often visible only when someone resists them. Rhetorical autonomy is only called out in some instances, and for the most part, goes unchecked.…”

Mixed‐methods systematic review: Childbearing women's views, experiences, and decision‐making related to epidural analgesia in labour

“…The rates of women planning/not planning on using epidural analgesia before going into labour vary within the available evidence (Mahomed, Chin, & Drew, 2015; Orbach‐Zinger et al., 2008; Yoshioka, Yeo, & Fetters, 2012). Women who did not plan to have an epidural often had a wait and see or see how far I can get attitude, leaving all options open throughout the ongoing labour with informal birth plans (Morris & Schulman, 2014; Newnham, McKellar, & Pincombe, 2017; Raynes‐Greenow et al., 2007). The factors to be continuously evaluated to decide whether or not to request an epidural were pain threshold, ability to cope with pain, length of labour, and feedback received by healthcare providers during labour (Morris & Schulman, 2014; Newnham et al., 2017; Raynes‐Greenow et al., 2007).…”

“…Women who did not plan to have an epidural often had a wait and see or see how far I can get attitude, leaving all options open throughout the ongoing labour with informal birth plans (Morris & Schulman, 2014; Newnham, McKellar, & Pincombe, 2017; Raynes‐Greenow et al., 2007). The factors to be continuously evaluated to decide whether or not to request an epidural were pain threshold, ability to cope with pain, length of labour, and feedback received by healthcare providers during labour (Morris & Schulman, 2014; Newnham et al., 2017; Raynes‐Greenow et al., 2007). The women described the need for epidural analgesia if labour became intolerable, with some participants considering it as a last resort (Morris & Schulman, 2014; Newnham et al., 2017).…”

“…The factors to be continuously evaluated to decide whether or not to request an epidural were pain threshold, ability to cope with pain, length of labour, and feedback received by healthcare providers during labour (Morris & Schulman, 2014; Newnham et al., 2017; Raynes‐Greenow et al., 2007). The women described the need for epidural analgesia if labour became intolerable, with some participants considering it as a last resort (Morris & Schulman, 2014; Newnham et al., 2017). Some women planned to avoid an epidural, with this decision being guided by negative experiences of family members, fear of epidural insertion, concerns about maternal and foetal side effects and desire of being in control of a natural birth (Henry & Nand, 2004; Hidaka & Callister, 2012; Mahomed et al., 2015; Morris & Schulman, 2014; Newnham et al., 2017).…”