Reflections on the Maternity Triage Event
Last week I attended a maternity triage engagement event organised by the local team.
It was warm, open and genuinely useful. It was encouraging to hear about the improvements underway and the thought that has gone into the work so far. Meeting members of the team face-to-face also matters.
Moving into real conversations shifts something.
There is clearly effort being made to listen and to improve.
And that has to be encouraged.
Why Engagement Matters – And Why It’s So Difficult
It is important that women,
families and birth workers engage with the Trust at events like this.
If we want services to change, voices have to be present in the room.
But we also have to acknowledge how difficult that is for women.
During pregnancy, most women are directing their energy toward preparing for birth and becoming a mother. Neurologically, this is a period of profound change. Research shows that the maternal brain is reshaped during pregnancy and early motherhood. Attention narrows. Priorities shift. Focus turns inward and toward the baby.
After birth, families are in a phase of intense adjustment. Sleep deprivation, recovery, feeding, bonding. It is not a time designed for attending workshops about system redesign.
Pregnancy and early motherhood are transformative, awe-inspiring periods of life.
They are relational.
Biological.
Human.
The industrial model of maternity care operates in an entirely different frame. It is procedural, risk-managed, target-driven and often corporate in tone. These two worlds sit uneasily beside each other.
When engagement processes are structured like corporate theory-of-change workshops, they can unintentionally exclude the very people they aim to centre. Not because women don’t care — but because the format does not match the phase of life they are in.
If we want genuine collaboration and integration, we need to think carefully about how and when we ask women to participate.
Language Shapes Culture
One thing that stood out to me was the continued use of the word “patient” throughout the session.
I understand that the Patient Experience Team are supporting this work and that the term was acknowledged at the beginning.
However, it continued to be used repeatedly.
(This team work right across the NHS Trust, where the word patient is the correct term)
But pregnancy and birth are not illnesses.
A pregnant woman is not automatically a patient.
She is a woman experiencing a physiological life event.
When we default to the language of “patient,” we subtly frame her as passive, unwell,
or in need of management.
Words matter.
Words shape power dynamics.
Words shape expectations.
Words shape behaviour.
Using “woman” or “service user” may seem like a small shift, but it reinforces something fundamental:
she is the expert in her body and her baby.
If we want women to feel confident, autonomous and informed, we must reflect that in our language at every opportunity.
Policy and Lived Experience in Tension
Immediately after the event,
I received feedback from a woman who attended triage in September,
and felt she was ‘not allowed’ to leave for six hours.
This sits in tension with the reassurance given during the session,
that women are ‘always told decisions are theirs’
& that autonomy and decision making are actively encouraged.
I know experiences on triage are mixed
- I have witnessed good informed, shared decision making in action.
(Oftentimes I think my very presence means that healthcare professionals ensure respectful care.)
Yet often at these events there is an unwillingness to accept that the less than ideal happens more often than not.
I do not share this to undermine the good work being done.
I share it because it highlights the gap that often exists between policy intention and lived experience.
On paper, choice may be clear.
In practice, women do not always feel it.
When women leave triage feeling they did not have genuine autonomy, that deserves reflection. Not defensiveness. Reflection.
Moving Forward
I remain encouraged by the willingness to host these conversations and to invite community involvement. I will be taking part in the working group and encouraging other doulas and service user representatives to do the same.
Constructive challenge and collaboration can sit side by side.
If maternity services are to evolve, they must bridge the gap between a corporate operating model and a profoundly human life transition. That requires humility on all sides.
Women’s voices matter.
But so does designing systems that make it possible for those voices to be heard.