What does individualised maternity care look like and how can you advocate for this in your pregnancy? And how does the language used by healthcare professions affect the way you make decisions about your care? This is something I have found myself discussing a lot this week…
I have always considered myself to be a midwife who has always cared for women in a personalised way. When previously working in the NHS this was slightly more difficult whilst working under time constraints, but I would try to adjust and extend appointments for women when needed. Now working independently, I have unlimited time to discuss and explore research and information with my clients on a day-to-day basis. This allows me to truly personalise their care and experience during pregnancy, birth and beyond.
Maternity care should be underpinned by local and national guidelines. My work is guided by this guidance, but I also seek information from a variety of other sources. This may include research from other parts of the world, informative books from authors such as Sara Wickham and of course reaching out to other independent midwives for support and their experiences. Individualised care does take time. I spend many hours reading and researching on behalf of my clients, and I really enjoy this. I feel that I have developed my knowledge further in the last year than I have done in the entirety of my career.
Individualised care involves discussing guidelines with clients but assessing clients’ individual needs and preferences. Take for example if I book a client who has a sibling with type 1 diabetes. In this instance, I would offer them a glucose tolerance test (GTT) as per the guidelines and discuss with the pros/cons of this test. We would discuss what the risks are to the woman and the unborn baby with diagnosed/undiagnosed diabetes in pregnancy. How would a gestational diabetes diagnosis affect a pregnancy care pathway and most importantly would this affect the clients views of their own care preferences. If they opted not to have a GTT – what are their options ongoing in their pregnancy. Would they like a fasting blood sugar test, or a week of monitoring their sugars instead? Or what about a “wait and see” approach, and re-discuss testing later on if they feel anything has changed? Individualised care means discussion all options, not just using a “one size fits all” approach.
How information is given to you and the language used also hugely impacts on your decision making. Let's take a stretch and sweep offer at 39 weeks, as per UK guidance. Lets say you know what a stretch and sweep is but haven’t read up on the pros/cons of it…
Midwife “So you’re 39 weeks pregnant, I can give you a stretch and sweep today if you consent to this? Do you know what a sweep is?”
You “I’ve heard about a sweep, but what does this do? Are there any risks?”
Midwife “ Oh no its low risk really. If we do a sweep now, it might reduce your need for induction at 41 weeks – which is recommended. So if we do this today, we could then do another in a few days time and then hopefully you will go into labour. If not, we can offer you an induction at 41 weeks? You might get a bit of bleeding and there’s a small chance of your waters breaking but it’s unlikely”.
OR… we could reframe the wording like this…
Midwife “At 39 weeks, NICE guidance suggests we should offer stretch and sweeps to everyone at 39 weeks. Do you know what a stretch and sweep is and what the risks/benefits are?”
You “I know what a stretch and sweep involves, but not the risks/benefits”
Midwife “A stretch and sweep is a form of induction, and the reason that it is offered is that it nay make it slightly more likely that you will go into labour without formal induction methods. The benefits of a stretch and sweep is that it may encourage your body to go into labour, if you are wanting to avoid an induction and you would be opting for this from 41 weeks. However, sweeps can be uncomfortable and may leave you with some period-like cramps for 24-48 hours, which may interrupt your sleep and rest. It is also not guaranteed you will go into labour because of the sweep, and this could also negatively affect you psychologically, potentially impacting the natural flow of hormones that you need to go into labour. There is also the chance that some bleeding may occur from the sweep, which may need to be checked at the hospital. The other risk factor is should your waters break during the procedure, we would then have to offer you an induction within our local guidance timeframe if you don’t go into labour, which may result in increased monitoring, interventions and the need for pain relief in the hospital. Would you like some time to think about this?”
Now I know I’ve gone to both extreme ends of the “information giving” here, but many times I have experienced midwives advising sweeps as a “low risk” procedure, which it really isn’t. The way the information is given to you and the language used will hugely affect your decision making. This is why asking for extra time or longer appointments should you need further support to make decisions in your care is really important and is my number one tip for navigating your maternity care!
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