What is ‘The System’ when it comes to birth?
A system is an organised structure that has rules, regulations and processes in place to ensure that it fulfils it’s function. Think of it like a factory, where there is a clear, measurable outcome and all the staff have to work within its set parameters.
The maternity health care service is the system where women are cared for during pregnancy, birth and immediately after. If the maternity care system was a factory, then the ‘product’ is the outcome of a physically well, healthy mother and baby.
The staff all have their roles and must adhere to the system’s policies, procedures and guidelines, aka the ‘rules’. They have to ensure that other parts of the factory are also adhering to the ‘rules’ so that requirements are continuously being met – i.e. that the output of well, healthy women and babies are continuously being discharged. This ensures that the system works at optimal capacity and that standards are maintained. This also means that those that work within the ‘system have a vested interest in keeping themselves safe whilst doing their job.
A system has a governing structure and boundaries, meaning the maternity care system has time constraints and boundaries it must adhere to, to ensure output. It must factor in staffing requirements and skillset mix, bed and room availability and resources all within these time constraints, balancing it all with the demand for the services to ensure everyone has their needs met. This is why pressure and coercion is so rife within the system, as it is trying to keep women ‘on track’ to adhere to their timelines and constraints.
The problem with all of this is that birth is unpredictable. It is messy, defying boundaries and transcending rules. Trying to get birth to adhere to the rules and regulations set by the system is like trying to put a square peg into a round hole. It just doesn't fit, and is why we are in this mess in the first place.
Within the system, a cervix must adhere to the set parameter of dilating 1cm per hour once labour is established, and must be measured every 4 hours unless otherwise indicated to ensure it’s compliance. A nulliparous woman (a first-time mum) must push her baby out within two hours. A multiparous woman (second baby or more) must push her baby out within one hour. Even placentas are put on a timeframe.
If these time constraints are not met then interventions are introduced under the guise of ‘safety’.
The issue with all of this is that the system is not set up to accommodate for individuality. It does not recognise variations from the ‘norm’ in consideration to individual circumstance or cultural differences. It’s only measurable outcome is a physically well and healthy baby, completely missing the mark of emotional wellbeing – of which the system completely fails women and instead routinely leaves them traumatised and feeling like their individual experience doesn’t matter.
The system is set up to support itself, not the women. If it was set up to support women then it would be a very different structure with very different regulations and guidelines which would implement current research into it’s practice and allow for individual experience. This is not going to happen anytime soon, so it’s up to us to remember that whilst the staff and team members must adhere to it’s rules, we as consumers, do not.
But the system does not tell you this, and it can be really hard to push back against constraints in the moment. Strong support and thorough antenatal education and preparation is one step we can make to support ourselves when birthing within ‘the system’.
Because you matter, and your experience matters.