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Weeks

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 a
range of different clinical approaches
to prevention and treatment of postpartum haemorrhage. Physical treatments are discussed and the question
of their invasive nature raised in this
context. It is worth reflecting that
the potential for a health professional
to commit violence against women is
ever present, given their relative
position of power, especially in an
obstetric emergency. Even being
made to lie down during childbirth
can be seen as disrespectful care and
an infringement of womens rights.
Many techniques and manoeuvres
used to treat complications during
childbirth can be perceived as violent, resulting in women (and also
the birth attendant) emerging from
the experience traumatised. However,
in many cases, the action saves lives.
The main questions to ask are: Is it
effective? Does it work? Is it necessary? Is there a choice?
Informed consent is critical, but
not always simple to obtain:
although women are sometimes not
given a choice, sometimes they are
and they dont know what is, or how
to make the right choice.
In a study of traumatic events in
childbirth, multiple and interlaced
issues have emerged. Traumatic

212

childbirth events are frequently


peppered with accounts of being
excluded from decision-making, lack
of informed consent, or patronising,
impersonal, disrespectful and abusive
interpersonal communication. Such
treatment by health professionals is
associated with feelings of loss of control, but women often blame themselves. (S
oderquist et al. J Psychosom
Obstet Gynaecol 2006;27:1139).
Clearly knowledge, decision-making and choice are essential for
ensuring a positive outcome. Health
providers need to have an acute
awareness of the nuances of respectful maternity care. Provision of
information and careful explanation
of any intervention or treatment is
essential throughout labour and
birth. Where possible, the decisions
of the woman in labour and her
family should be followed.
The link between respectful care
and the rights of women has been
articulated in the Universal Rights of
Childbearing Women Charter (http:
//whiteribbonalliance.org/campaigns/
respectful-maternity-care/). This is
also supported by the recently released WHO statement on Prevention
and elimination of disrespect and
abuse during childbirth (September
2014 http://www.who.int/reproduc-

tivehealth/topics/maternal_perinatal/
statement-childbirth/en/?utm_source=
TRAction+Project+Event+Invitations
&utm_campaign=2a8b9a44eb-Invitation%3A+Pre-Satellite+%40+HSR+
Symposium&utm_medium=email&
utm_term=0_d05e7ff741-2a8b9a44eb
-118714001).
Although the concerns of respectful care apply everywhere in the
world, resource-poor settings face
particularly complex issues, as
women may be less familiar with
biomedical concepts and Western
style health systems. Health workers
can be pressurised and demotivated.
The solutions are not simple but one
way of ensuring women are prepared
is to create general awareness and
knowledge of the different methods
used for different kinds of difficulties
during pregnancy and childbirth, not
just during pregnancy but within a
broad educational framework. Birth
planning is another approach used,
which can give time for deliberation
and space for women to let their
preferences be known before they are
in labour or in an emergency situation when they find it difficult to
make choices.

Disclosure of interests
Nothing to disclose. &

2014 Royal College of Obstetricians and Gynaecologists

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