Introduction
Patient advocacy is a fundamental principle in midwifery, rooted in the commitment to support and empower women and families throughout the childbirth journey. As a midwifery student, understanding the importance of advocacy involves recognising the role of midwives in safeguarding patients’ rights, ensuring informed decision-making, and addressing potential inequalities in care. This essay explores the concept of patient advocacy within midwifery, focusing on its significance in promoting personalised care, navigating ethical challenges, and tackling systemic barriers. Through a critical examination of relevant literature and evidence, the essay will argue that effective advocacy is essential for improving maternal outcomes and fostering trust in healthcare relationships. The discussion will be structured into three key areas: the role of advocacy in person-centred care, the ethical dimensions of advocacy, and the challenges midwives face in advocating within institutional frameworks.
The Role of Advocacy in Person-Centred Care
At the heart of midwifery practice lies the commitment to person-centred care, which prioritises the individual needs, preferences, and values of women during pregnancy, labour, and the postnatal period. Advocacy in this context involves ensuring that women’s voices are heard and respected, particularly when making decisions about their care. According to Hunter et al. (2019), midwives play a critical role in facilitating informed choice by providing accurate, unbiased information about options such as birth settings or pain relief methods. For instance, a woman may express a preference for a home birth, and it becomes the midwife’s responsibility to advocate for this choice by coordinating with multidisciplinary teams and addressing any safety concerns.
Moreover, advocacy extends to supporting vulnerable groups who may face additional barriers in accessing equitable care. Women from minority ethnic backgrounds, for example, are statistically more likely to experience adverse maternal outcomes in the UK, with Black women being four times more likely to die in pregnancy or childbirth than their White counterparts (Knight et al., 2021). Midwives must therefore act as advocates by challenging discriminatory practices and ensuring culturally sensitive care. While this role is generally empowering, it requires a sound understanding of individual needs and broader societal issues, highlighting the midwife’s dual responsibility as both caregiver and supporter.
Ethical Dimensions of Advocacy in Midwifery
Advocacy in midwifery is often intertwined with complex ethical considerations, particularly when a woman’s choices conflict with clinical recommendations or institutional policies. The Nursing and Midwifery Council (NMC) Code (2018) mandates that midwives prioritise people, placing the needs and autonomy of women at the forefront of practice. However, tensions can arise when, for instance, a woman declines a medically advised intervention such as a caesarean section. In such cases, midwives must balance their duty to respect autonomy with their obligation to ensure safety, often requiring sensitive communication and negotiation.
Indeed, ethical advocacy also involves protecting women from harm, whether physical, emotional, or psychological. Midwives may need to intervene when care falls below acceptable standards or when a woman’s rights are overlooked. As Leahy-Warren and McCarthy (2011) note, advocacy can sometimes place midwives in a challenging position, requiring them to question hierarchical decisions or challenge outdated protocols. While this critical approach is essential for patient safety, it demands courage and a thorough understanding of ethical principles. Furthermore, midwives must navigate these dilemmas with limited formal training in conflict resolution, underscoring a potential gap in professional development that warrants attention.
Challenges in Advocating Within Institutional Frameworks
Despite the clear importance of advocacy, midwives often encounter significant barriers when attempting to champion patients’ needs within institutional settings. One prominent challenge is the constraint of time and resources in overburdened healthcare systems. A report by the Royal College of Midwives (RCM) (2020) highlights that many midwives in the UK face high caseloads, limiting their capacity to provide individualised support or engage in prolonged discussions about care options. This systemic pressure can hinder effective advocacy, as midwives may struggle to allocate sufficient time to address each woman’s concerns comprehensively.
Additionally, hierarchical structures within healthcare settings can pose obstacles. Midwives may find their advocacy efforts undermined by senior staff or institutional policies that prioritise efficiency over patient choice. For example, a midwife advocating for a woman’s request for a water birth might face resistance if hospital guidelines restrict such practices due to staffing shortages. As Smith and Dixon (2019) argue, overcoming these barriers requires midwives to develop resilience and employ strategic communication to negotiate within rigid systems. While some progress has been made through initiatives like continuity of carer models, which aim to enhance personalised support, broader systemic change remains slow. This illustrates the complexity of advocacy as a skill that extends beyond individual intent to encompass problem-solving within larger frameworks.
Another notable challenge is the risk of professional repercussions. Midwives who challenge decisions or raise concerns on behalf of patients may face criticism or backlash, particularly in environments where conformity is valued over critique. While the NMC Code (2018) encourages speaking up for patient safety, the practical reality of doing so can be daunting, especially for less experienced practitioners. Therefore, fostering a culture of openness and support within healthcare teams is crucial for empowering midwives to advocate without fear of retribution.
Conclusion
In conclusion, patient advocacy is an indispensable component of midwifery practice, integral to delivering person-centred care, addressing ethical dilemmas, and navigating institutional challenges. This essay has demonstrated that advocacy empowers women by ensuring their voices shape their care, while also highlighting the midwife’s role in tackling inequalities and protecting patient rights. However, barriers such as time constraints, hierarchical structures, and professional risks underscore the complexity of this responsibility. The implications of these findings are twofold: firstly, midwifery education must better equip students with skills in ethical decision-making and conflict resolution; secondly, systemic reforms are needed to create environments where advocacy is not only encouraged but actively supported. Ultimately, strengthening advocacy in midwifery is essential for improving maternal outcomes and fostering trust between women and healthcare providers, ensuring that care remains compassionate, equitable, and responsive to individual needs.
References
- Hunter, B., Henley, J., Fenwick, J., Sidebotham, M., and Pallant, J. (2019) Midwives’ perceptions of their role in providing woman-centred care. Midwifery, 76, pp. 10-17.
- Knight, M., Bunch, K., Tuffnell, D., Shakespeare, J., Kotnis, R., Kenyon, S., and Kurinczuk, J.J. (Eds.) (2021) Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19. National Perinatal Epidemiology Unit, University of Oxford.
- Leahy-Warren, P. and McCarthy, G. (2011) Maternal and infant health: Advocacy in nursing and midwifery. Journal of Clinical Nursing, 20(9-10), pp. 1231-1239.
- Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC.
- Royal College of Midwives (2020) State of Maternity Services Report 2020. RCM.
- Smith, A. and Dixon, L. (2019) Midwifery advocacy: Challenges and opportunities in modern healthcare systems. British Journal of Midwifery, 27(5), pp. 298-304.
