Societal Values and the Search for ‘Informed Choice’ in Maternity Services During the Period 1991–2022, England

This chapter uses a case study of the pursuit of ‘informed choice’ in maternity services in England during the period 1991–2022 to examine what impacts on the creation of societal value. Graaf et al. (Adm Soc 48:1101–1127, 2016) identified responsive, performing and proper governance as three types of governance which are often sites of societal value conflict. They provide the framework of analysis. There are several reasons why a study of the ‘informed choice’ in maternity services in England is useful for trying to understand societal conflict. In the last 20 years, there has been a move away from medical interventions to a natural birth approach, due to demands made by women’s campaigning groups in the 1980s and 1990s. Health professionals have had to respond to these demands. At the same time, the National Health Service (NHS) adopted public management reforms with the introduction of targets and increased use of evidence-based medicine to determine clinical practice, accompanied by budgetary pressures. These changes have brought politicians, managers and health professionals into uneasy alliances, all working towards slightly different versions of public value. Maternity services are significantly different to other health care services because women are not technically ill, although there are elements of risk involved in giving birth. The analysis will examine the changing roles of professionals, particularly midwives, during this period. This chapter has drawn on an analysis of reports and strategies into maternity services and ‘informed choice’ between 1991 and 2022. The views of women and midwives are examined by drawing on academic research and research used to inform campaigning.