Evidence based leaflets in maternity care. Compliance, coercion, and power have huge effect in maternity services.

Editor—The midwives from Sheffield show the insight that a qualitative study can provide when coupled with a more controlled empirical investigation.1,2 Both the studies and the accompanying editor's choice suggest that inequalities in power and status in the maternity services have a greater influence on what happens to women giving birth than either their hopes and dreams or the choices they feel informed to make.3 These studies are a powerful reminder that the physiological birth process without some degree of technological interference and tampering is rare. Midwives are portrayed in this hierarchical system as having little effect on the outcome of care. The authors suggest that when women can form a trusting relationship with a midwife they are more likely to ask questions and feel that they can make choices about their care, rather than simply being compliant. As members of a national consumer movement in Australia, we consider it to be a violation of human rights for women to continue to be subjected to routine hospital maternity care that is demonstrably not backed by research evidence on what is best for most mothers and babies. Far from being an illness, childbirth is a healthy, normal, and important event in women's lives. Women deserve to receive the model of care backed by research evidence—namely, one on one care from a known competent midwife throughout pregnancy, birth, and postnatally, with obstetric back up for the minority of women (10-15%) who need it. Yet for most women now this model of care is unavailable. We implore all women everywhere to take heed of the options available to them and call for reforms to the maternity services in their countries so that all women have the choice of being cared for by their own midwife. In Australia we have proposed a national maternity action plan (www.communitymidwifery.iinet.net.au/nmap.html) to inform governments and policy makers of the need for change.