Recently, Australia’s Nursing and Midwifery Board drafted a new code of conduct and shocked many by replacing references to ‘woman-centred care’ with ‘person-centred care’.
The glaring change was noted after the Board invited submissions to comment on the new code.
A Board spokesperson, in an article in The Advertiser, said the word ‘person’ had been proposed to reflect the person and the family receiving care.
However, after submissions flooded in to protest the change, the Board agreed to retain the term ‘woman-centred care’ in the midwifery code.
Midwives are inherently proud of the origin of the name of their profession.
Believed to originate from Middle English ‘mid’ (with) and ‘wyf’ (woman) the literal meaning was ‘with woman’, meaning a woman who is with another woman as she gives birth.
This has long been one of the central tenets of midwifery: being with and supporting a woman through one of the most important events in her life.
The Importance of Woman-Centred Care
Yet for the last one hundred years, care during pregnancy and birth has been mostly the domain of doctors and hospitals. As a result, woman-centred care has been eroded at the expense of hospital policies and litigation.
Even Australian women who choose to give birth outside the hospital system are losing their ability to access woman-centred care, as home birth midwives are being restricted in terms of the type of care they can offer.
Many comments posted on social media flatly disagreed with the proposed change. Those most concerned pointed to the potential erasure of women from midwifery care at a time when so many are working to increase the standard of woman-centred care.
In many high-income countries, such as Australia, birth outcomes focus on achieving a physically well baby and mother. While this is the goal for those giving birth, and for anyone associated with maternity care, there is little room for the needs of individual women and how birth might affect their mental health.
In today’s birth culture, interventions and c-sections are incredibly common – even expected. Estimates suggest less than 2% of women in hospitals have intervention free births. Birth trauma is more frequent, as a result, and leaves women with debilitating mental health issues such as post-traumatic stress disorder.
The system in which women give birth has slowly taken on a more ‘one size fits all’ approach. There is little room for the individual woman to receive personalised and specific support from a known care provider.
Midwifery care used to be exactly that. Even today, although some hospitals have group practice midwifery programs, places are limited and women are often unable to access the type of care they are drawn to.
This is despite significant evidence that shows care from a known midwife provides women and babies with the best physical and emotional outcomes.
So what does this have to do with changing a word in a code of conduct?
Many midwives strongly agree women have long been treated as unimportant baggage at the births of their babies. If not erased, women have certainly been shoved aside.
For many, the use of ‘person’ instead of ‘woman’ is one more act of control, and yet another step towards making women completely invisible in midwifery care.
Among those who commented on social media, there were those who believed not supporting the change from woman to person was taking a transphobic stance.
Hannah Dahlen, a respected midwife of more than 25 years, and professor of midwifery at Western Sydney University, made this comment on her Facebook page:
“I so want to respect and provide care that is not harmful and contributes to empowerment, but at the same time women’s issues in this space are so fragile and I don’t want to see them made even more invisible. I will call the individual I am working with whatever they want to be called or treated as but I will also, on a global and political level, fight for women’s rights in the space of childbirth because they need fighting for. Hopefully with this approach we meet everyone’s needs”.
Perhaps what should be remembered is, at its heart, traditional midwifery care focuses on the individual person and the family who bring a baby into the world. Today’s maternity system has removed that focus, using control and domination over women’s rights and their bodies.
Women are fighting every day to reclaim birth from a patriarchal system. To include transgender or non-binary parents isn’t the problem, but should it be at the expense and exclusion of women? What do you think?