Getting beyond the polarisation of childbirth: First meeting
Professor Sue Ziebland and Professor Lesley Page
Process and preparation
With support from the Sheila Kitzinger Programme at Green Templeton, we invited a small group of key people, known to represent divergent views, to meet in a neutral safe space, to discuss where there might be common ground.
A preparatory Zoom meeting was held, with invited experts from user groups, charities, academics, practitioners and opinion leaders, to identify which people of influence to invite and to inform the ambition for the meeting. We concluded it was vital to represent different standpoints, especially if we could bring together people who might not normally share a platform.
Invitations for a half-day meeting chaired by Professor Charles Vincent were sent to a carefully selected group by Sir Michael Dixon, Principal of Green Templeton College, Oxford. The invitation letter stated that we were inviting people ‘willing to engage in seeking common ground for care that is higher-quality, safe and just (for users of services and staff) and human rights-based. We may also identify some areas where agreement may not be reached, and perhaps some where either immediate changes can be recommended, or specific research is needed. We want to create a safe space for a conversation on this sensitive topic, in good faith, so that together we can start to draw the debate back from the polarities’
It was decided not to pre-set an agenda and instead to allow the group to decide on priorities for the conversation.
The meeting: Monday 17 July 2023
All invitees were prominent opinion leaders and care was taken to ensure that different perspectives and experiences were included and that a safe space was created to support honest and respectful discussion. The meeting intended to bring people together, recognizing that there are strong views. The main aim was to listen to each other, surface divergence of views and then collectively develop a forward vision.
We collectively agreed that:
- All attendees had the best interests of mothers, fathers, children and staff at heart
- Nobody had a fixed ideological position
- Everyone attended in good faith
- The meeting would be treated as confidential
- We would not reveal who attended, nor use social media unless all agreed
Attendees were invited to reflect on the following questions:
- What do you value about our current approach to childbirth and maternity services?
- What concerns do you have about our current approach and practice?
- What changes would you like to see?
The group was invited to identify areas where they might work together, which led to some discussion about the aims of the meeting, which not all had interpreted in the same way. Some saw the intention as being to discuss issues specific to ‘normal birth’. Others wanted to discuss safe birth more broadly. It was clarified that the meeting arose from a perceived need to discuss polarisation about physiological birth, within a broader discussion of safety in maternity care.
Key takeaways
There are important findings from existing inquiries that need to be used to develop policy collaboratively.
An agreement is needed, based on reproductive and birth rights, on the ultimate aims of maternity care and what a safe birth ‘looks like’. Different professions and user groups do not consistently have a shared view on this.
The wider science underlying the physiology of pregnancy and birth should be better recognized, understood and communicated.
Personalisation of care and dynamic consent is vital. Women should be supported to pursue their preferred mode of birth in the context of trusted relationships with service delivery teams, and understanding of: the health of the parent and baby; the values and preferences of the mother and family; the evidence that relates to their specific situation.
Neither ‘normal birth’ nor heavily interventionist birth should be ideological. Instances where a specific approach has been prioritised above women’s care needs, preferences and safety considerations have caused harm.
Multi-disciplinary clinical teams need to work together to bridge professional boundaries throughout the perinatal pathway, re-focusing on the needs of the woman, her baby and family.
Change is needed within policy, organisations, and the professions to enable evidence-based and birth rights-based practice.
Our group could help to articulate the different ways to achieve a ‘good’ birth and contribute to a more joined up conversation nationally by identifying where shared/supportive decision making is done really well (and what factors support this good practice). This would be a positive drive towards better national care.
Our group could be a powerful influence on the national conversation, demonstrating its ability to find common ground and common values. The ability to deal with polarisation is vital, across the country and within Trusts. This group has access to a wide network of different people, and could reach many stakeholders. Improving care requires fundamental organisational change to help achieve the ultimate aims of good maternity care.
We face deeply complex and nuanced issues including differences in viewpoints raised in our meeting. Participants recognised that these are not served well by polarisation and wanted to move beyond these divisions.
Our proposed next steps are:
- Start with the statements and next steps on which the group agrees and disagrees.
- Based on these, identify further areas of agreement about the ultimate aims of good maternity care.
- It was agreed that it was preferable to go one step at a time, achieve something tangible and then build momentum.
