"Knights" or "Knaves"
"Knights" or "Knaves"
19 May 2011
Dysfunctional aspects of medical culture impact on quality and safety in childbirth but have been neglected in maternity services reform says Associate Professor Kerreen Reiger from La Trobe University’s Sociology Program.
Her recent article “Knights” or “Knaves”? Public Policy, Professional Power, and Reforming Maternity Services* argues that quality and safety discourse emphasizes reporting of human errors and mistakes within hospitals but ignores some problems embedded in the system itself.
‘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.’
Yet Reiger’s research examined distressing evidence given to public inquiries in Australia, England and Ireland in the last decade. Patterns of serious harm to women in maternity units were revealed, including unnecessary hysterectomies, genital mutilation and assault. Most worryingly, these cases were seen as individual ‘mistakes’ or ‘misdemeanours’ and often covered up or not reported out of professional or ‘tribal’ loyalty.
‘Until women’s complaints became public these issues were not seen as systemic problems of harm to women’, says Associate Professor Reiger.
‘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.’
‘Change is under way and obstetrics and gynecology 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’ she says.
Associate Professor Reiger concludes that a quality and safety framework to give women real autonomy in childbirth requires more than just good incident-reporting systems.
‘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.’
*A copy of “Knights” or “Knaves”? Public Policy, Professional Power, and Reforming Maternity Services is available on request.
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