7/25/2019 Women's Rights Are Integral to Prevention and Treatment of PPH.

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Womens rights are integral to prevention and treatment of PPH

G Taylor

Health Partners International, Lewes, East Sussex, UK

Linked article This is a mini commentary on A Weeks, pp. 20210 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.13098 .

This article by Weeks presents arange of different clinical approachesto prevention and treatment of post-partum haemorrhage. Physical treat-ments are discussed and the questionof their invasive nature raised in thiscontext. It is worth reecting thatthe potential for a health professionalto commit violence against women is

ever present, given their relativeposition of power, especially in anobstetric emergency. Even beingmade to lie down during childbirthcan be seen as disrespectful care andan infringement of womens rights .Many techniques and manoeuvresused to treat complications duringchildbirth can be perceived as vio-lent, resulting in women (and alsothe birth attendant) emerging fromthe experience traumatised. However,

in many cases, the action saves lives.The main questions to ask are: Is iteffective? Does it work? Is it neces-sary? Is there a choice?

Informed consent is critical, butnot always simple to obtain:although women are sometimes notgiven a choice, sometimes they areand they dont know what is, or how to make the right choice.

In a study of traumatic events inchildbirth, multiple and interlacedissues have emerged. Traumatic

childbirth events are frequently peppered with accounts of beingexcluded from decision-making, lack of informed consent, or patronising,impersonal, disrespectful and abusiveinterpersonal communication. Suchtreatment by health professionals isassociated with feelings of loss of con-trol, but women often blame them-

selves. (Soderquist et al. J PsychosomObstet Gynaecol 2006;27:113 9).

Clearly knowledge, decision-mak-ing and choice are essential forensuring a positive outcome. Healthproviders need to have an acuteawareness of the nuances of respect-ful maternity care. Provision of information and careful explanationof any intervention or treatment isessential throughout labour andbirth. Where possible, the decisions

of the woman in labour and herfamily should be followed.The link between respectful care

and the rights of women has beenarticulated in the Universal Rights of Childbearing Women Charter ( http://whiteribbonalliance.org/campaigns/respectful-maternity-care/ ). This isalso supported by the recently relea-sed WHO statement on Preventionand elimination of disrespect andabuse during childbirth (September2014 http://www.who.int/reproduc-

tivehealth/topics/maternal_perinatal/statement-childbirth/en/?utm_source=TRAction+Project+Event+Invitations&utm_campaign=2a8b9a44eb-Invita-tion%3A+Pre-Satellite+%40+HSR+Symposium&utm_medium=email& utm_term=0_d05e7ff741-2a8b9a44eb-118714001 ).

Although the concerns of respect-

ful care apply everywhere in theworld, resource-poor settings faceparticularly complex issues, aswomen may be less familiar withbiomedical concepts and Westernstyle health systems. Health workerscan be pressurised and demotivated.The solutions are not simple but oneway of ensuring women are preparedis to create general awareness andknowledge of the different methodsused for different kinds of difculties

during pregnancy and childbirth, not just during pregnancy but within abroad educational framework. Birthplanning is another approach used,which can give time for deliberationand space for women to let theirpreferences be known before they arein labour or in an emergency situa-tion when they nd it difcult tomake choices.

Disclosure of interests

Nothing to disclose. &

212 2014 Royal College of Obstetricians and Gynaecologists

Weeks

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