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Human rights guidance launched to help improve maternity staff practice

  • 20 Comments

A lack of awareness about women’s human rights among health professionals working in maternity care is intended to be tackled with new guidance published today.

The guidance, mainly aimed at midwives, lays out the key human rights relevant to maternity services, such as the right to life, to not be treated in an inhuman way and to a private life.

“Women’s human rights are at stake in their maternity care and there’s a lack of awareness of these issues”

Rebecca Schiller

It shows how such rights are linked to issues like providing access to maternity services, assessing the need for pain relief, encountering female genital mutilation and ensuring patient involvement in treatment and care.

Designed to offer “practical assistance when navigating difficult decisions”, the guidance contains examples of everyday practice where human rights should be considered, as well as flow charts to help identify whether practitioners are complying with legislation under the Human Rights Act.

It also features examples of court cases involving maternity care where there were breaches of human rights laws by healthcare staff.

Whistleblowing in relation to breaches of human rights is also featured in the guidance, produced jointly by the Royal College of Midwives and charity Birthrights in collaboration with the British Institute of Human Rights.

The guide reminds practitioners tat the Human Rights Act, which contains a list of all 16 rights, was designed as a framework to avoid cases being taken to court.

“Health practitioners have a responsibility as guardians of women’s human rights, to ensure we are aware of exactly what these are”

Olivia Armshaw

It can be used to inform practice – such as challenging decisions with colleagues – and can be used to hold health services to account, said the document, called Midwifery and Human Rights: A practitioner’s guide.

Birthrights chief executive Rebecca Schiller said the guidance was needed to improve awareness of women’s human rights among healthcare professionals.

“From the advice Birthrights provide to pregnant women and their families and the training we undertake with midwives and doctors, it’s clear that women’s human rights are at stake in their maternity care and that there’s a lack of awareness of these issues amongst healthcare professionals,” she said.

Olivia Armshaw, a midwife who helped to develop the guide, added: “The care a birthing woman receives during her pregnancy and childbirth can have long-lasting effects – psychological, emotional physical and social.

Royal College of Midwives

Carmel Lloyd

Carmel Lloyd

“During this important time, her basic human right to control what others do to her body, is susceptible to violation,” she said. ”So health practitioners have a responsibility as guardians of women’s human rights, to ensure we are aware of exactly what these are, and how to protect and promote them.”

Carmel Lloyd, the RCM’s head of education, described the guide as an “invaluable tool” for midwives.

“Human rights are central to the promotion of women’s health and wellbeing, as well as to the provision of high quality maternity care, and this guide will enable midwives and other practitioners in the maternity services to provide better care for women,” she said.

  • 20 Comments

Readers' comments (20)

  • michael stone

    'During this important time, her basic human right to control what others do to her body, is susceptible to violation'

    The Montgomery Ruling made it very clear that 'a patient's basic human right to control what others do to her/his body' applies during maternity, but it applies in general. From my own discussions around end-of-life behaviour, it is not clear to me that HCPs are all fully-accepting of this right to, as a Judge recently described it, 'sovereignty over your own body':

    http://www.bmj.com/content/351/bmj.h6575/rr-0

    That sovereignty - ownership of your own body and life - fundamentally clashes with the idea that clinicians 'have a duty of care towards mentally-capable patients', at least in the way that 'duty of care' is often used, which might be why clinicians find this so hard to accept:

    http://www.bmj.com/content/350/bmj.h2877/rr-7

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  • For Michael stone

    Dr Elisabeth Kübler-Ross

    https://youtu.be/jTxOiq3V7Bw

    Author on many books including 'On Death and Dying', an excellent work recommended for all HCPs and members of public alike. Gives insight into the invaluable and grossly undermined work and understanding of the caring professions with dying patients.

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  • michael stone

    ANONYMOUS 1 OCTOBER, 2016 5:10 PM

    I was not writing about the understanding of 'dying' whether by the caring professions or by anyone else.

    I was writing about the legal situation in England post MCA - and it seems that 'Montgomery' has probably established the same legal situation in the UK more widely - of Informed Consent.

    It is now very clear that legally, whether dying or otherwise, clinicians are now confined to offering treatments and providing patients with clinical prognoses - but, crucially, clinicians are not legally allowed to [using my phrase here] 'protect patients from patient's own bad decisions'.

    I am aware, that this is very challenging for clinicians who wish to 'do good' and who want to see 'good outcomes'.

    With no expectation that you are likely to read it, I have explained why I am so 'insistent on this point' in my piece at:

    http://www.bmj.com/content/353/bmj.i2230/rr-7

    I don't look at youtube (the computers I use tend to lack sound) and I am not going to buy a book to follow up on Dr Kübler-Ross. However, if you post a url to something online and open-access, which describes her work/position, I WILL take a look at it.

    I might do a bit of web-searching for her name/work, but it might help - you seem to be familiar with her work - if you pointed at something. My instinct, is that she will not be writing about the same thing - the law around decision-making, especially when situations 'inherently contain uncertainty', which so vexes me in the context of lay-professional differences of interpretation.

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  • michael stone

    I've just done a quick web search for Dr K-R.

    She doesn't seem to have been discussing the same issues as those I write about. And she was, it seems, against euthanasia: I am also against euthanasia, but I am in favour of assisted suicide for the terminally-ill (but not with the type of self-defeating caveats which would have made the Marris Bill worse-than-useless).

    I am far more interested in the promotion of proper joined-up teamwork between family carers and GPs and DNs when EoL patients are at home, than I am in the psychology/spirituality of death - which is NOT to say that I would not want dying patients to be helped by all available means, PROVIDED THE PATIENT WANTS TO BE HELPED.

    As I wrote in a comment to a Marie Curie article:

    Patients are individuals, and tailoring of care to the patient, is surely even more important than usual when the patient is going to die ?

    I don't really see it as an in some way unacceptable for a terminal patient to 'be negative that he is dying': why, if a person is 'by nature secular and grumpy', would 'just give me enough pain relief so that I'm not in too much pain [as judged by me], stop 'trying to make me positive' and leave me pretty-much alone to die on my own terms' be 'an unreasonable response to dying'.

    Lots of things about 'holistic palliative care ' - notably 'supporting my spiritual needs' - seem to come from a faith perspective, which is fine if the patient shares that perspective.

    But the idea is surely to help dying patients, while respecting their individuality and their rights as self-determining individuals.

    Offering support - of all types - is of course a good idea and objective. Putting in place properly-designed and perspective-balanced immediately post-mortem behaviour for Community End-of-Life Death (which is not the case at the moment in England - especially for that 'perspective-balanced') is urgently necessary. There are lots of problems associated with dying, that still need to be addressed - but 'offer choices to individual patients, give individual patients information, but never 'shoehorn individuals into some standardised 'plan'' is surely correct.

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  • Stone. You comments just further confirm thst you do not have a clue. Why not leave it to those who do.

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  • michael stone

    ANONYMOUS 3 OCTOBER, 2016 6:05 PM

    Explain where my comments 'confirm that I do not have a clue' - that is how debate is supposed to work.

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  • michael stone

    ANONYMOUS 3 OCTOBER, 2016 6:05 PM

    You might care to throw your own hat into the ring [but I doubt it, as you cannot hide behind anonymity] by contributing to the series of rapid responses to a BMJ piece David Oliver has just written. Fisken has written a response:

    http://www.bmj.com/content/354/bmj.i5195/rr

    which I do not entirely agree with [as I pointed out in a subsequent response] - and what we disagree about, is this 'who decides' issue. As I commented:

    'This is the conflict between patient autonomy, and ‘safeguarding’, which seems to be so problematic.'

    Susanne Stevens has also responded - I agree with her, and with the point she started her piece with:

    'David Oliver is a great advocate for frail and elderly people, who unfortunately are too often seen more as a burden to others than individuals with individual opinions and the right to make decisions'

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  • M. Stone. The sad thing is you seem to consider yourself some sort of expert but lack the experience and when anyone tries to tell you anything you just ignore it just as you do most of the whole story of the dying process andvall the work that accompanies patients going through it. Unfortunately your intent here can only be roughly speculated on although having observed your commentary over time any speculation is most likely fairly accurate.

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  • michael stone

    ANONYMOUS 4 OCTOBER, 2016 10:18 PM

    We ALL 'lack the experience' because none of us who is writing has actually died.

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  • michael stone

    ANONYMOUS 4 OCTOBER, 2016 10:18 PM

    '... when anyone tries to tell you anything you just ignore it'

    No, I think about it. More than it appears you do.

    But I can only think about something which has been elucidated - and your 'you know nothing' is not an elucidation, that is a statement with no explanation to consider.

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