The Myth of Equitable Care

Waiter, waiter, I have a fly in my soup!

Shhhh, quiet, or everyone else will want one!

It can seem just this bizarre as we navigate our way through the maternity journey. With scant resources and staff stretched so thin the system is at breaking point, logic flies out of the window and reason drowns in the soup. 

I hear it a lot:

“We can’t do that, it wouldn’t be fair on everyone else”

“We have to ensure equitable care for all”

Can’t have your doula AND your partner at your bedside? 

Not allowed a homebirth because of staff shortages mean that you might be taking a midwife away from a woman in hospital?
Blocked from using the Birth Centre because you are planning a VBAC?
Separated from your partner-carer, despite being in a wheelchair?
Get the feeling your midwife thinks you’re a rich princess having a doula?
Being told that if you get what you need to feel safe, that it may endanger others or leave them without any care?
Being told you can’t have a companion for your scan because someone else might get jealous, despite your obvious anxiety?

One mother was told that because there was only one birth pool, and more than one labouring person wanted to use it, no one could.

Doulas are regularly told there is no way to fill a hot water bottle for their clients to use to ease contraction pain. If we were to use the kettle in the staff kitchen, wouldn’t everyone else ask as well?

Parents are regularly told they can’t be visited by a Lactation Consultant or doula.

Nikki Mather is a doula whose local hospital has a very long list of ‘can’ts’:

“Can’t take battery powered candles

Can’t use essential oils

Can’t have food for partner – must eat outside

Can’t come back inside if partner goes outside at any point during labour

Can’t have another family member as a birth companion if the partner has Covid-19

Can’t use fairy lights

Can’t have toast after birth, only digestives in case of theatre transfer”

Are you being made to feel guilty for wanting, nay needing, a certain kind of care to feel safe and satisfied?

One doula told me:

“Client intent on choosing warm compresses vs OASI: ‘we do the same for everyone now or it’s not really fair is it, dear?’”

It sounds so reasonable and simple, doesn’t it? Ensuring fairness, sameness, equality of care for all. 

Except it isn’t simple. Maternity care isn’t a factory production line. Not all pregnant people are the same. We come to you, trailing our whole life stories behind us. Not just our medical history, but our hopes, fears, dreams, anxieties and challenges, our religious beliefs, our social and family situation, our mental health. We require individualised care – that’s a posh way of saying that we need you to SEE us, HEAR us, be interested in what makes us feel safe, satisfied and in control. Most importantly, we need you to be keen to understand our terrors and traumas. 

When NHS resources are so scant, and the philosophy behind our much-loved institution is care for all, free at the point of contact’, it can feel selfish to ask for more than what we’re being told is our fair share. But hang on a minute: 

Equitable care doesn’t mean making it the same for everyone! It means adapting your care to the individual circumstances of the person in front of you. It means understanding that people are not created equal – there may be a whole host of challenges that prevent us having the same opportunities, health outcomes or social support as others.

“Equity means that needs are equally met – whatever those needs might be. Equity means that everyone is listened to, no matter how long it takes for them to communicate. Equity means that everyone is seen and no one is judged.  Equity means that we do all that we can to level the playing field and ensure that the disadvantaged and the marginalised are given all they need to create equality.” Verina Henchy

So sometimes, some people need a step up. Sometimes, we might need something extra. Something that other people don’t need.

Recently, during the covid-19 pandemic, visiting my mother in hospital, I heard a patient on the phone to a friend, complaining that the “woman opposite has visitors every day; it’s not fair!” Just before leaving, I was able to chat with her for a minute or two, empathising with how awful it must be to have no visitors at all, and to tell her that my mum was dying.

Treating those two women the same would not have been equitable care in that situation, would it? 

Equitable doesn’t mean treating everyone the same! 

“Equity is equal access to services as THEY need. I don’t want equitable access to prostate exams.” Emma Ashworth

So STOP telling people they can’t have something in case everyone else asks for it too. We’re not idiots and are perfectly capable of understanding that care needs to be tailored to the individual needs of that person.

If you are working in the NHS and you feel tempted to tell someone they can’t have what they need to feel safe in your care, considering campaigning for maternity services to be adequately resourced, rather than telling people to put up and shut up. Consider flagging up the stuff that happens unnecessarily that uses up resources and wastes money. Maybe report the time you spend on admin rather than caring for people. Perhaps investigate the inefficient systems that result in missed appointments, equipment wasted or more time needed to sort out a complaint because families didn’t feel valued in your system. 

We don’t fix a broken system that creates a shed load of disparities by reducing everyone down to the lowest common denominator. Let’s listen. Let’s lift people up. Let’s love them through their incredible adventure.

If you’re a birthworker and you want to talk about disparities in care and how we support families to get the care that they deserve, why not come to our workshop on consent. You can read about it and book here.