Childbirth reform overlooks dysfunctional aspects of medical culture

Posted on June 8, 2011


Achieving real quality, safety and autonomy for women in childbirth requires more than existing systems for reporting problem ‘incidents’ in maternity hospitals.

Research by La Trobe’s Kerreen Reiger says dysfunctional aspects of medical culture impact on quality and safety in childbirth, but that this has been neglected in maternity services reform.

Her findings, based on distressing evidence given to public inquiries in Australia, England and Ireland in the last decade, have attracted wide attention.

Dr Reiger’s work ‘joined the dots’ between reports that show patterns of serious harm to women in maternity units, including unnecessary hysterectomies, genital mutilation and assault.

‘Most worryingly,’ she says, ‘these cases were seen as individual “mistakes” or “misdemeanours” and often covered up or not reported out of professional or “tribal” loyalty.’

Dr Reiger says until women’s complaints became public, ‘these issues were not seen as systemic problems of harm to women’.

Dr Reiger is an Associate Professor in Sociology whose studies focus on the management of childbirth and maternity unit cultures. She says talk of quality and safety emphasizes reporting of human errors and mistakes within hospitals but ignores problems endemic to the system itself.

Knights or Knaves?

Her recent article, titled ‘Knights’ or ‘Knaves’? Public Policy, Professional Power, and Reforming Maternity Services, was published in the journal ‘Health Care for Women International.’

‘In maternity care obstetricians tend to think of themselves as “knights” rescuing women from the dangers of birth. There are well-intentioned, committed and caring individual practitioners, but as a field obstetrics is clearly more than what individual obstetricians do,’ she says.

‘Modern childbirth systems are “obstetric-led” and the profession – in conjunction with state authorities -is primarily accountable for ensuring neither practitioners nor the systems of care cause harm to women and their babies.

‘The obstetric profession has been reluctant to reflect critically on its power and role, or on problems of inadequate professional leadership, individualism, ineffective collegial communication and lack of genuinely collaborative clinical work practices.’

However, change is under way, she says. ‘Obstetrics and gynaecology now faces significant internal challenges: changes in age, gender, and ethnic composition; staffing shortages and concerns about increased and costly litigation; fears over diminished professional status and loss of skills due to trying to improve work-life balance.

‘Policy incentives and educational strategies need to foster critical reflection and dialogue within the medical profession, including mechanisms for critical self-examination of attitudes to women.

‘Enhancing the capacity for genuinely collaborative relationships with women, medical peers and midwives is essential to improving quality of care.’