ABSTRACT
In this chapter, we share three stories from Kathryn, experienced as a consultant midwife working with midwives and doctors in two innovative Birth Centres called ‘Serenity’ and ‘Halcyon’ in Birmingham in the UK. Kathryn describes the experience of three women who, with added complexity (vaginal birth after caesarean (VBAC), breech and twins) gave birth in the Serenity Birth Centre. All the women may well have chosen to freebirth or have high-risk homebirths if flexibility had not been offered. Keeping women at the heart of care and giving ourselves space to be flexible when women seek a natural birth environment and want to make ‘off-menu choices’ can help keep women engaged in our system and enable the achievement of both physical and emotional safety. Hannah ends this chapter with some advice for midwives about the need to honestly discuss risk with women and make clear when risk escalates and do this without coercion. She discusses learning to both ‘dance in the grey zone’ and be really direct about mounting risk. Formalised processes of collaboration, documentation and reflection can help ensure that our care is safe for all women, their babies and families, but which also support us as midwives. Kathryn and Hannah draw on their experiences working with women who make ‘off the menu’ choices, and the midwives who care for them, to provide guidance on how midwives and obstetricians can support women, while also respecting their fundamental human rights.
