A recent discussion article by Dr Ellen Tilden and colleagues has proposed that the principles underlying good end-of-life care are relevant to maternity care.
The US Institute of Medicine guidelines on end-of-life care propose four core principles:
- Patient autonomy
- Person-centred care
- Honouring individual perspectives and preferences
- Honouring social support for the individual
The idea that people should be able to share in decisions about their care, including limiting it, was first written about in 1899 by Simon Baldwin in The Natural Right to a Natural Death.
Birth and death are similar in some key respects – they share common cultural social, emotion and spiritual dimensions. In both, the art of the carer staying close yet doing nothing is important. There are also important differences. The outcome in palliative care is known, but the outcome in maternal healthcare is surrounded in uncertainty about where the boundaries of childbearing safety lie. The second big difference in birth is that there are two lives involved, mother and baby.
Given high rates of neonatal and maternal poor health and death, the enthusiasm for a medical approach, erring towards over-intervention, is understandable and emerges ultimately from compassion. However, it does lead to problems the world over and perhaps experience from end-of-life care is relevant.
One of the most popular midwife led maternity units in UK, the Serenity Birthing Suite in Birmingham, was designed with inspiration from end-of-life care in UK. It is an example of exceptionally high standards of care, including one of the best examples of family inclusive design in the UK.
Tilden EL, Snowden JM, Caughey AB & Lowe NK (2016), Reframing US maternity care: lessons learned from end-of-life care, Journal of Midwifery & Women’s Health