A few things to do before you arrive...

• Read the recommended readings in the reading list
• Found out about the range of local maternity services available to women; and some local and national data relating to childbirth
• Prepared some questions in order to talk to a pregnant woman about her choices for antenatal care and the birth of her child

Timetable
• Tutorial: ‘Is childbirth a normal process? If so, what is the role of the medical profession – both doctors and midwives?’ – based upon preparatory readings
• Health promotion: smoking, diet, exercise, and alcohol in pregnancy. What information is available within the practice? What services does the practice offer for antenatal care and childbirth?
• Visit to pregnant woman, to discuss her choices, and how she (and her partner/family) arrived at them
• Return to practice for debrief; write up findings

Aim: To view pregnancy and childbirth as normal processes and the implications of this for heath services; and to understand the factors that influence women’s choices around birth.

Learning Objectives

• Describe a normal pregnancy and childbirth
• List the possible choices that women can make in relation to ante-natal care and place of birth
• Discuss the different factors that influence women’s choices in pregnancy and childbirth
• Describe a health promotion intervention for pregnant women provided by the practice
• Critically consider the health promotion information available within the practice
• Practise blood pressure measurement and urinalysis.

Reflective writing


How did you view childbirth before today?
Have your views changed at all as a result of today’s meetings and discussions?

How important do you think it is that women should have choices in pregnancy and childbirth?
Do you think these choices could pose difficulties for the health care professionals caring for pregnant women?
How would you deal with patients making choices that you did not agree with?

Essential reading

Further reading

Links




In the news Oct 22nd 2010: Hungarian Midwife Agnes Gereb jailed for 5 years for attempting homebirth
Letter on the Free Agnes Gereb website from Wendy Savage and Sheila Kitzinger.


Read the hyperlinks in the timetable below and listen to this BBC radio 4 edition of Womens Hour about childbirth.





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Read about a women's right to choose and a history of abortion rights
Familiarise yourself with the counter arguments
See:

Birth and Power - A Savage Enquiry Revisited An examination of who controls childbirth and who controls doctors



Subjects for reflection.
  • A young woman comes to see you as a GP for advice. She is 12 weeks pregnant and her violent partner has just left her for another woman and moved abroad. She has 2 children aged 2 and 3 and has suffered with anxiety and panic attacks and comes in to see you frequently. She is crying when she sees you and says she cannot cope and would like an abortion. However she comes from a fervently religious family and they have told her that if she had an abortion she would be killing the unborn child and will go to hell.Consider: What support is available in her present situation to help her manage with her children and mental health? What different attitudes are there to when life begins? How are scientific, moral and religious definitions different? What does it mean to be human? Does thinking about this help her decision? What does she stand to gain or lose if she keeps the child or has an abortion?

  • How did you view childbirth before today? As a natural process that happened with minimal input from health care professionals? As something that happened in hospital? Have your views changed at all as a result of today's meetings and discussions? Consider: under what circumstances might you encourage someone to have a home delivery?

  • How important do you think it is that women should have choices in pregnancy and childbirth? Do you think these choices could pose difficulties for the health care professionals caring for pregnant women? How would you deal with patients making choices that you did not agree with? Consider: "too posh to push" Rates of caesarian section are highest amongst women with private obstetric care. Why is this? Why would women choose to have a caesarian rather than a vaginal delivery? Consider a woman with a high risk pregnancy who was traumatised by having an emergency caesarian section in hospital at then end of her last pregnancy who is determined to have a natural home birth this time.





Essential Reading

Johanson R,NewburnM, Macfarlane A. Has themedicalisationof childbirth gone too far? BMJ 2002; 324: 892. [[javascript:doWindowOpen('http://bmj.bmjjournals.com/cgi/reprint/324/7342/892','new_frame','width=600,height=420,menubar=1,toolbar=1,scrollbars=1,status=1,location=1,resizable=1',0)|http://bmj.bmjjournals.com/cgi/reprint/324/7342/892]]
Zander L, Chamberlain G. ABC of Labour Care: Place of Birth.BMJ 1999; 318: 721 3.http://bmj.com/cgi/reprint/318/7185/721.pdf
Ninth report: Choice in Maternity Services
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