Written by Georgia Clancy
The management and communication of risk in pregnancy and birth is a complex issue for both women and their maternity care providers, feeding into the choices they have and the decisions they make. The normalisation of the medical model of birth (van Teijlingen, 2005) can mean that the right decision is often considered to be the medical one because once a test, procedure or drug becomes normalised it can be difficult for women to resist or decline it without their responsibility as a mother being brought into question (Browner and Press, 1996: 156). The dominance of the medical model of birth can mean that so called ‘alternative’ birth options become indicative of irresponsible and even immoral behaviour, and women can be socially shamed for resisting normalised medicalised practices or ‘doctor’s orders’ (Viisainen, 2000). This can lead women to follow the status quo during pregnancy and childbirth without considering their options and making autonomous decisions.
In this piece, I will draw on my research exploring women’s childbirth preferences, decisions and outcomes in England today. The research included interviews with pregnant women and women with recent experience of NHS maternity care services, as well as a range of maternity care providers working inside and outside the NHS. Here I want to explore the account of Sally*, a private maternity care provider who had many years of experience supporting women through pregnancy, birth and the postnatal period, whether they chose NHS or private care. Sally had found, in her experience, that women were increasingly being threatened with social services during pregnancy and childbirth to ensure compliance with dominant medical norms and practices:
[…] they [NHS maternity providers] use the social services as a coercive tactic to get women to agree to birth interventions […] it’s women who are not following the standard medical pathway, so it’s women who are not doing what they’re told, and then if they happen to be not as well educated, or a single parent, then you will see it even more. And it’s just a, you know if um, ‘if you can’t do what’s best for your baby while it’s still inside you we might have to refer this on because how can we know you’ll do your best for your baby once he’s born?’ […] It’s subtle, but not that subtle, women pick up on it all the time and it’s definitely increasing.
– Sally, private maternity care provider
Whilst this piece exploring the threat of social services during pregnancy and birth centres on the account of one private maternity care provider, it is supported by earlier research and anecdotal accounts (see AIMS, 2017; Schiller, 2016). Indeed, Feeley and Thomson (2016) found that maternity care providers do report women to social services if they consider that their childbirth decisions made them ‘unfit to be mothers’. Sally believed that women’s behaviour in pregnancy and childbirth was observed by professionals as a proxy for their ability as parents, with the possibility that they will be reported to social services if they are not considered to be ‘good’ mothers. She subsequently suggested a number of factors which identify women as potentially posing a risk to their foetus/baby, including demographic information and those either not following or declining the normalised medical model of care. Indeed, Sally beliefs are supported by other anecdotal evidence from women deemed to be birthing ‘outside of the system’, not following ‘doctor’s orders’, young and single parents (see CommunityCare, 2017; Schiller, 2016).
However stigmatising, women who decline medical models of care, and in turn threatening women with the involvement of social services is problematic in a number of ways. Firstly, it suggests that the foetus/baby has needs and rights in conflict with, and more important than, those of the mother. However woman’s decisions should be respected by their caregivers and in the UK foetuses do not have legal rights, even though child protection procedures can be used if a baby is thought to be at risk of significant harm once born (BirthRights, 2017). Secondly, whilst providers may see the suggestion of social services as a form of protection, to women it could appear as a threat. This could create unnecessary fear and stress for women as well as damaging the provider-women relationship. It also misrepresents social workers as the ‘bad guys’ and may prevent women from seeking help and support from social services if they need it. Finally, the threat of social services may indeed prevent women exercising their birth rights and making autonomous decisions which they feel are right for them. Afterall, women can choose home birth, decline a screening test or vaginal examination for all sorts of valid reasons. As another participant in my research stated:
99.999% of women make really well-informed choices. They’ll really carefully always have their baby’s welfare, and their welfare, very close to their hearts, very close to their hearts. So when, I, I always say to women you know when doctors say to them, ‘oh you wouldn’t want to put your baby at risk would you?’ No woman, no woman does that. No woman puts her baby at risk, she makes choices that feel right for her.
– Ellen, private maternity care provider
This demonstrates the moral, and high-stakes nature of women’s childbirth decisions, and how discourses of risk and uncertainty may constrain women’s choice. Whilst it is unclear just how common the threat of social services is in maternity care, part of promoting choice in maternity care policy and practice means accepting that women may choose not to follow social norms or medical advice. Although this ‘informed dissent’ (Edwards, 2003) may call women’s ‘good’ motherhood into question, maternity care providers must understand and respect women’s birth rights, and any mention of social services used with caution.
*names and identifiers have been changed/generalised for participant anonymity.
About the author
Georgia Clancy is a research fellow at the University of Warwick. Her ESRC-funded PhD research explored women’s childbirth preferences, decisions and outcomes in light of the Better Births policy.
- AIMS. (2017) Handling threats of Social Services, available online at https://www.aims.org.uk/journal/item/handling-threats-of-social-services, accessed 22/06/21
Browner, C. H. and Press, N. (1996) ‘The Production of Authoritative Knowledge in American Prenatal Care’ Medical Anthropology Quarterly 10 (2): 141-156
- CommunityCare. (2017) ‘The next thing I knew, my unborn child had a social worker’, available online at https://www.communitycare.co.uk/2017/12/15/next-thing-knew-unborn-child-social-worker/, accessed 22/06/21
- Edwards A. (2003) ‘Communicating Risks’ BMJ 327 (7417): 691-692
- Feeley, C. and Thomson, G. (2016) ‘Tensions and conflicts in ‘choice’: Womens’ experiences of freebirthing in the UK’ Midwifery 41: 16-21
- Schiller, R. (2016) ‘The women hounded for giving birth outside the system’ in The Guardian, available online at https://www.theguardian.com/lifeandstyle/2016/oct/22/hounded-for-giving-birth-outside-the-system, accessed 22/06/21
- van Teijlingen, E. (2005) ‘A Critical Analysis of the Medical Model as Used in the Study of Pregnancy and Childbirth’ Sociological Research Online 10 (2): unpaginated
- Viisainen, K. (2000) ‘The Moral Dangers of Home Birth: Parents’ Perceptions of Risks in Home Birth in Finland’ Sociology of Health & Illness 22 (6): 792-814