Paper short abstract:

This paper considers the (re)emergence of midwifery-led care in Europe and the entanglements of policy, care implementation, responsibility and human rights in maternal health, highlighting anthropology’s potential as a tool for reconciling the complexities of evolving maternity care delivery.

Paper long abstract:

Despite vast improvements in maternity care and lowered rates of maternal and infant mortality, there are worrying trends being reported in maternal health. Disproportionate rates of maternal and infant mortality increasingly cut along racial and economic lines. Obstetric violence and birth trauma are pressing issues, while rates of caesarean sections and obstetric interventions continue to rise. In response, maternal health policies increasingly focus on promoting models of ‘patient-centred care’, seeing choice in care as a means for re-establishing agency amongst women and improving services. Midwifery-led care has come back into prominence, given promising evidence that it can improve health outcomes and provide equitable, respectful and cost-effective care. However, maternity care practices are publicly and professionally contested and enmeshed in notions of safety, responsibility, autonomy and medicalisation. Midwifery-led care, often situated at the periphery of, or in tension with, obstetrics, faces socio-political, economic and practical barriers to implementation, even in countries where midwifery is fully integrated into the health system. As midwifery practice, or being ‘with woman’, and patient control increase, who is ultimately responsible for pregnant women’s care, and can this be shared? This paper considers the (re)emergence of midwifery-led care in Europe and the entanglements of policy, care implementation, responsibility and human rights in maternal health. I draw from ethnographic research on place of birth in East London and experiences working in a multidisciplinary team focussed on wider midwifery-led care integration in Europe, highlighting anthropology’s potential as a tool for reconciling the complexities of evolving maternity care delivery.