Medical authority and expectations of conformity: undermining person-centred maternity care

By Anna Nelson.

There is an ongoing ‘maternity crisis’ in the UK, and too many women and birthing people face barriers to accessing respectful, person-centred maternity care. Charities, campaigners and journalists continue to emphasise the consequences of this state of affairs, both for individuals and for society more widely. Individuals may experience harm to their mental health or broader wellbeing as a result of their birthing experience, and this may also be contributing towards a wider erosion of trust in maternity services. It is vital to also recognise that certain groups– such as Black and brown women, those for whom English is not a primary language and those with disabilities – are likely to be disproportionately impacted.

There is no straightforward solution, as the problems underpinning this situation are multifactorial and layered. To bring about meaningful and sustainable change, therefore, it is essential that we first carefully parse the factors which coalesce to undermine choice and care during childbirth. My paper, ‘Medical authority and expectations of conformity: crystallising a key barrier to person-centred care during labour and childbirth’, contributes towards this task.

In the paper, I underscore the coercive nature of medicine as an institution, which imposes normative expectations upon, and exercise control over, birthing people. I argue that the exercise of medical authority operates to produce an expectation of conformity with medical norms or recommendations, and that in the birth context this converges broader cultural expectations placed upon pregnant and birthing women (and other birthing people) to be ‘good’ and ‘self-sacrificial’ mothers, such that it constrains birthing people’s ability to make choices which diverge from these norms or recommendations.

I examine the impact of this convergence of medical authority and expectations of conformity across both the birth space and the court room. Doing so is important, as both the healthcare and judicial systems are powerful institutions which hold the ability to, as argued in the paper, “shape and constrain the choices that are (actually) available to birthing people.” I argue that while the courts have the potential to offer a powerful counterbalance to the coercive potential of medical authority, they instead have a tendency to reify this instead – demonstrating in many instances a seeming suspicion of those who seek to deviate from medical norms or recommendations. This is particularly troubling when failure to conform to medical authority can itself contribute towards questions about a person’s decision-making capacity, which may ultimately lead to a referral to the court.

Access to person-centred, high quality birthing care should not rest on an individual’s ability to advocate and fight for their own rights during labour and birth. Midwives and obstetricians seeking to deliver such care should not have to fight against the system within which they work. Instead, delivering such care should be the foundational organising principle of the maternity system, and every birthing person should experience this as a matter of course. Therefore, fixing the current problems demands that we look at the systemic and institutional barriers that are in place, and that we place the responsibility for change at an institutional rather than individual level.


Paper title: Medical authority and expectations of conformity: crystallising a key barrier to person-centred care during labour and childbirth

Author: Anna Nelson

Affiliations: University of Sheffield

Competing interests: None

Social media accounts of post author: @Anna_Nelson95

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