By Kathryn Gutteridge, 4th June 2021
For a moment I thought I was reading about a maternity case that occurred last century or certainly in some far-away country where women’s rights are not acknowledged. But no, it is England in 2021. It was not so far a departure from the Handmaid’s Tale and that era of womanhood is long gone – or is it?
I am writing this as a midwife of many years and as an experienced psychotherapist who has worked within the NHS maternity services all of my long career. I am also the founder of SANCTUM Midwives, a pregnancy care centre that supports, educates and campaigns in respect of women who have experienced sexual abuse in their lifetime.
Over the course of my professional career, I have seen and implemented the development of sensitive and woman-focused pathways and guidance that has recognised that personalised care is the optimum model for childbearing. Many years ago, I witnessed liberal use of sedatives in childbirth and practices that were crude and by and large unevidenced. I hardly thought that I would see the use of brute force lawfully sanctioned to compel this woman (and, previously, in a very similar case, the woman in a Court of Protection hearing in March 2021) to experience treatment determined for them, and not by them.
Judging whether someone has ‘capacity’ to make decisions is burdened with bias. In my practice and experience, mental capacity is ever-changing and not knowing either of these women I make no judgement about the assessment and finding of lack of capacity. However, the basic principles of the Mental Capacity Act 2005 are clear.
I am somewhat concerned that both these women may have been assessed as lacking capacity to fit the predetermined desired outcome of bringing them into hospital against their will.
Reading the judgment from Mr Justice Holman, I was angry beyond words. It should never have been brought to a court of law. In my experience and that of many Perinatal Mental Health Midwives (who’ve described their experience in another blog here), women who present with a range of anxiety-based disorders are best cared for in a relationship-based model of care, which incidentally these midwives are skilled to offer. In abundance.
This anxiety-based diagnosis is manageable by therapy and sometimes medication to control the anxiety triggers. I know I have worked with many women with these kinds of diagnoses. I could not find in the judgment any recommendation of therapy for this woman apart from prescribing a strong sedative (Lorazepam 2mgs) prior to leaving home in suspected labour. There is no record here either of the benefit of a trusting relationship with her midwife as recognised in the National Maternity Review, Better Births.
Home birth today is an established and safe option for women who are pregnant – it’s even, in some cases, the most appropriate place for birth to occur. I note that two medical professionals gave expert opinion to the judiciary: Professor James Walker (retired obstetrician) and Dr Glover (a psychiatrist instructed by the Official Solicitor, acting for the pregnant woman). Where is the expert opinion from a midwife? I assume in delivery of antenatal care thus far a midwife or midwives have visited the home to establish antenatal care and to assess maternal and fetal wellbeing. Surely the opinion of an experienced midwife in this field could have given some weight to the argument for a home birth or at least some decision about an alternative place to birth such as a midwifery unit within the hospital. In my practice this has usually been a realistic and safe option where women have requested alternative place of birth. Surely this would have given this women a less stressful environment where her labours would have been supported by midwives skilled in this area of care.
This is patriarchal medicine and law at its worst and in complete collusion with each other This woman has been subjected to compulsory (sedated) attendance in hospital in the name of maternity care. A concern with the foetus’s well-being (despite the fact that the foetus has no rights until born within our legal system) seems to have surreptitiously influenced the judge’s decision in this case.
What the judge has done here is to create a precedent that any woman who has an anxiety disorder and requests birth outside of the regular menu of choice may be subjected to strong-arm maternity care – or may fear it, even if in fact the legal process is never instituted. For many women the impact of these experiences during their pregnancy care and birth will cause deep and long-standing trauma. Obstetric violence is a familiar term to me and I am careful in my use of this phrase. However, I cannot think of a better description to illustrate what has happened here in the UK in 2021.
It fills me with deep sadness that these cases have been dealt with in this way, when a gentle and knowledgeable midwife, skilled in relationship-based care, might have achieved a different outcome.
Instead, we have birth by court-order and the annihilation of vulnerable women’s childbearing rights.
My midwife heart weeps.
Dr Kathryn Gutteridge is a Consultant Midwife & Clinical Psychotherapist. This opinion piece reflects her own views in her capacity as a midwife. She tweets @Sanctummid
Image by Steve Johnson on Unsplash