The Myth of Women-Centred Care
How to Navigate the Maternity System
One of the biggest challenges many women face in pregnancy is realising that the maternity system is not always set up to support them. Understandably, most assume maternity services exist to ensure the wellbeing of both mother and baby.
So it can feel deeply unsettling to learn that care pathways may sometimes reflect the priorities of healthcare professionals or institutions, rather than the true needs of the woman.
Why would a doctor recommend something that might cause harm? Surely all maternity services are women-centred?
The reality is more complex. By looking at the history and culture of childbirth, we can better understand how the maternity system evolved, and why women today must learn to navigate it thoughtfully and carefully.
A Short History of Maternity Care
For most of human history, childbirth was a female-only event, taking place at home or within the community. Women were supported not just by midwives, but also by mothers, sisters, aunties, cousins, and friends. Birth was seen as a rite of passage, not dominated by fear, but honoured and celebrated.
With industrialisation and the rise of science, this collective birth culture collapsed. Birth was standardised, studied, and medicalised. More women moved into hospital settings, attracted by perceptions of safety and pain relief, even though infections in crowded hospitals initially increased deaths.
As medicalisation grew, routine interventions were introduced, often without evidence, and quickly became “normal” practice.
For example, in the second half of the 20th century, enemas and perineal shaving were routine in labour. These invasive procedures were unchallenged for decades due to the power dynamic between doctors and women. Only when evidence finally proved them unnecessary and harmful were they abandoned.
It begs the question: What are we blindly accepting today that future generations will look back on with disbelief?
The Evidence Problem
A study of Royal College of Obstetricians and Gynaecologists found that only 9–12% of guidelines were based on grade A evidence (Prusova et al. 2014). Instead of citing research, guidelines often reference other guidelines, perpetuating cultural norms as though they were facts.
Take vaginal examinations (VEs) as an example. VEs involve a healthcare professional inserting fingers into a woman’s vagina to measure cervical dilation. They are intimate, invasive, and treated as routine.
Standard guidelines recommend VEs every four hours in labour. Yet a 2022 Cochrane review concluded there isn’t enough evidence to know if this is the best way to assess labour progress. Cochrane reviews are considered the gold standard, so if even they can’t prove the benefit, how can we justify the practice?
Why do VEs persist? Because they provide a number for the chart. But research shows there is no universal pattern for cervical dilation. Forcing women into a linear model often creates pressure and fear rather than confidence and trust.
The risks of VEs, infection, premature rupture of membranes, or emotional distress, are rarely explained fully, even when “consent” is sought.
Whose Risk Counts?
Another key issue is how risk is understood.
For women, risk is personal and embodied. For healthcare organisations, risk is institutional, focused on:
Avoiding lawsuits
Reducing costs
Protecting reputation
The woman’s long-term wellbeing is often left out of the equation.
Take meconium-stained waters as an example. Many women are encouraged to have a caesarean when meconium is found, despite evidence showing:
Most babies born unwell do not have meconium-stained waters.
Most babies with meconium-stained waters are born healthy.
The main concern is Meconium Aspiration Syndrome (MAS), which is serious but extremely rare (0.067% or 1 in 1,677 births).
Yet women are often steered towards caesarean or induction, both of which carry their own significant risks. For the 1,676 women who undergo unnecessary surgery, the longer-term physical and emotional impacts are rarely factored into decision-making.
Protecting statistics for the maternity trust is not the same as protecting women.
What Can Women Do?
Most women will give birth within the maternity system, and opting out isn’t realistic or desirable for everyone. So preparation is key.
As Rachel Reed writes in Reclaiming Childbirth as a Rite of Passage, preparation is the first phase in the childbirth journey. It can include:
Independent antenatal education - outside the system, so you can advocate for yourself.
Cultivating self-trust - reconnecting with your instincts and intuition.
Staying active - nursing movement and posture to support optimal fetal positioning.
Designing a detailed birth plan (with plan B and C) so you’re prepared for different outcomes.
Building your community - creating a support network for the postpartum period.
Honouring your pregnancy - through ceremony or celebration, such as a Blessingway.
The maternity system is not deliberately hostile to women, but it is structured around institutional priorities, cultural norms, and incomplete evidence. That’s why so many women are surprised, sometimes devastated, when their birth experience feels less supportive than expected.
By preparing deeply, questioning practices, and reconnecting with your own wisdom, you can navigate the system while reclaiming birth as an experience of power, trust, and transformation.
✨ If this resonates with you, my online yoga courses go beyond movement, we explore preparation, mindset, and body awareness to help you approach pregnancy, birth, and motherhood with confidence, whatever path it takes.
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