Sunday, 23 September 2012

Reflections on Freedom for Birth

Freedom for Birth, a new documentary film about human rights in childbirth, was screened in over a thousand locations across the world last Thursday, and I was there, keen to take part in a 'Mother's Revolution' supported by leading lights from the field - Ina May Gaskin, Sheila Kitzinger, Michel Odent - all calling for women to 'take back birth'.

The film took as its focus the plight of Agnes Gereb, the Hungarian midwife currently under house arrest for attending women in illegal home births, and the related case of Ternovszky vs. Hungary, in which the European Court of Human Rights ruled that every woman has the right to choose where and how she gives birth.

Quite clearly, there are some circumstances in which the compromise of freedom and the violation of human rights are tangible, for example when imprisonment is involved, or, as in another case touched on in the film, a woman's baby was taken away on the grounds of negligence because she has refused medical intervention at birth. In such instances, outrage and revolution are needed.

In the USA, the film clearly highlights, soaring rates of intervention and poor rates of maternal morbidity are a wake-up call for change. In a land where most birthing women have very little choice about where and how they give birth, and where the majority of obstetricians have never seen an unmedicalised delivery, I felt quite excited by the prospect of an American Ternovszky, taking her case all the way to the Supreme Court, explained in the film by Hermine Hayes -Klein, a Lawyer & Research Director of Bynkershoek Institute's Centre for Reproductive Rights:

With any case, you only have to go to the next court if the lower court doesn't honour the right. Anna Ternovzsky turned to Hungary and said: "Hey, don't I have the right to choose the circumstances in which I give birth?" And they said: "No you don't!" If they had said "Yes" that would have been the end of it. She wouldn't have had to go to the European Court of Human Rights. She only had to go to Strasbourg because Hungary was failing her. Similarly, within the United States, if a birthing woman turned to the state of Indiana and said: "I have a problem with the fact that my midwife might go to jail if she supports me giving birth at home" and Indiana said, "Well sorry, the doctors of Indiana think that home birth is child endangering you and you don't have the right to endanger your child's life" then she could bring an action all the way to the Supreme Court of the United States.

Then the Supreme Court would have this question before it, a first question, just like the European Court of Human Rights faced this for the first time. This question of "Well geez, what are the rights of birthing women?"... Does a woman have the choice of how she brings a baby into the world?" And I would like to think that the United States Supreme Court would acknowledge, as Strasbourg did, that American women have the right to choose the circumstances in which they give birth.

But if it didn't, then that too I think would spark a revolution in American women because it would really bring home for them the problem with birthing in the United States. So either way, the holding has the capacity to generate a revolution whether from the top or from the bottom.

So - America is on the cusp of much needed change. But what about women in the UK, like me? The general feeling in the after film discussion was that we are 'lucky' in the UK that we do not have midwives being imprisoned, nor do we have the hugely medicalised, obstetrician led system of the US. Perhaps, then, we are alright as we are, and don't really need, or even want, a birth revolution? As a hospital midwife sitting next to me put it, "This is great, but it's preaching to the converted. The majority of women I meet aren't interested in changing the system. They're quite happy to just have their epidural and get it over with as soon as possible." 

Whether or not this is true or simply patronising to women is up for debate, but certainly, it does raise the question of whether it is equally a human right to choose to be numb for birth or even bypass it altogether with an elective section. But if a woman makes such choices simply because she's terrified and lacking accurate information - is she truly free?

At the other end of the spectrum, some women choose to 'free birth' without any midwives to attend them, because they have felt violated by a previous hospital birth experience, or decide, in spite of being higher risk, to have a home birth because they feel that in hospital they are likely to be victims of unnecessary intervention. I repeat - if a woman makes choices simply because she is terrified and lacking accurate information - is she truly free?

What all of these women have in common is that they are birthing in a climate of fear - be it fear of childbirth or fear of intervention. Freedom for Birth calls on women themselves to take responsibility for the birth revolution, to 'take back birth'. But in reality, this is not as simple as it sounds. For as much as a woman may understand the politics of birth, her human rights, and that she is giving birth in a world in which far too much unnecessary intervention is taking place, how can she be sure that the intervention she is being offered is unnecessary?

Nine months pregnant, or even nine centimetres dilated, and told that she or her baby are at risk, she is faced with an impossible choice: to stick with the books she has read telling her to trust her body, or to accept intervention being offered by experts into whose hands she has placed her safety and that of her unborn baby. You are too far past your due date, she is told, you have been in labour for too long, you are getting tired, you are not progressing, your baby is too big, your baby is too small, your waters have been broken for too long, you are too old: the risk is increasing. 

"Increased risk" is a term pregnant and birthing women hear all the time, and it is often almost impossible to get to the bottom of. Research, if you can find it, is limited, or old, or contradictory. You may feel you want to challenge the powers-that-be, but struggle to find any concrete evidence that contradicts their view. Rightly or wrongly, the impression is given that lives could be in danger, and, rightly or wrongly, most women unsurprisingly choose to forgo their hopes of a natural birth, and accept intervention.

Again, I repeat: if a woman makes choices simply because she's terrified and lacking accurate information - is she truly free? Across the board, it seems, birth choices are being made for negative instead of positive reasons, a sure sign of oppression. Birth freedom is being eroded throughout the Western world, sometimes in ways that are glaringly obvious, at other times in ways that are complex and hard to unpick. One thing seems certain: this may be a 'Mother's Revolution', but if women, midwives and obstetricians do not work together to address the climate of fear and the unavailability of truly accurate information, then there will never be true freedom for birth.

Take Action:
Free Agnes Gereb
Petition Amnesty to Support Persecuted Midwives in Europe
Petition the European Parliament to investigate human rights in childbirth
Support threatened UK Independent Midwives
The Birth I Want - campaign for continuity of care and birth choice in the UK
AIMS - write to Jeremy Hunt, Secretary of State for Health
Freedom for Birth
Human Rights in Childbirth (HRiC)

Please let me know of other resources to add to this list.






4 comments:

  1. I think you are absolutely right that women cannot make choices about birth if they don't have accurate, evidenced based information about birth. Home birth, hospital birth, natural and medicalised birth, and elective c-section all have risks and benefits, and women cannot choose the right option for them without a full understanding of these. At the moment antenatal education is often poor or driven by a desire to persuade women to make choices based on cost or ideology instead of their personal circumstances and the best evidence.

    Many women choose to give birth in hospital because they want access to the best obstetric and neonatal care. Hospital is also the only place you can get epidural pain relief, which the NHS guidelines body NICE says should be available to all women who want it. The Care Quality Commision has highlighted the issue of women not receiving the pain relief that they wanted as a problem. There have been posts regarding denial of epidural pain relief on forums such as Mumsnet which have had so many responses that they’ve made the national press.

    Is pain relief a human rights issue as you suggest? Barrister Helen Mountfield wrote a piece on the subject of childbirth and human rights for the Birth Trauma Association, and it included this:

    “Article 3 of the European Convention on Human Rights is the absolute right not to be subjected to torture, or treatment which is “inhuman” or “degrading”. The European Court of Human Rights says that this means that vulnerable people, especially those in the care of the state, must be given protection against inhuman or degrading treatment (Keenan v UK).

    Article 3 does not only prohibit deliberate torture. Neglectful failure to provide the care which is necessary to avoid preventable suffering can amount to inhuman or degrading treatment (Price v UK). Article 3 can, therefore, be violated by those who fail to ensure that adequate provision is available to ensure that such unnecessary suffering is avoided.”

    Real freedom means accepting other people's choices, even if they are different from ours. The Treat Mums Right campaign is fighting for genuine choice for women:

    The right to choose how and where they give birth.
    Freedom to make informed choice, and respect for their decisions.
    Accurate, unbiased information about labour and birth.
    To be treated as a competent adult, with respect and dignity.

    Please visit us at www.treatmumsright.org.uk and join us!

    ReplyDelete
  2. As a pregnant woman, currently navigating my way through the confusing NHS approach to home births, I whole-heartedly agree that fear is dominating my birth 'options'.

    I niavely asked about having a home birth, and was totally unprepared for the barrage of conflicting information and implied judgements about my selfishness that I received.

    I'm not trying to pass responsibility on to anyone else, I simply thought that if the NHS want me to make a 'fully informed' decision about my birthing options, then surely it would be simple to point me in the direction of trustworthy, up-to-date research. Or at least have the medical professional I'm being encouraged to 'consult' with explain what research/evidence is informing their opinions and assumptions.

    Sadly when I have asked specific questions like 'why do you assume that?' or 'what research is that opinion based on?', no one answers my question, they simply give me variations of 'each hospital uses different research, so we believe that although you are considered low risk, home birth increases the risks'. One midwife openly told me that this 'discouraging' is led by a 'fear of litigation'. So it seems there's an accepted, unspoken policy to make hospital deliveries the only appealing option.

    A month ago I was simply curious about home birth and trusted the maternity system to point me to unbiased information so I could make a decision. But now I realise that even though I don't want to, I'm going to have to fight for a genuinely, informed choice.

    I'm also aware that after fighting this fight, it may end up being a total waste of energy as I'll probably end up in hospital due to 'staff shortages' or a perceived 'increase in risk' that then frightens me into going into hospital, and therefore having to trust the medical professional who have now shown how messed up the system is.

    Hopefully when my baby comes (due in december) everything goes to plan and the stressful process I'm currently going through is redeemed by a positive birthing experience and healthy baby. But for now I'm feeling drained, and find it difficult to imagine a genuinely positive, supportive situation. Wish me luck.

    ReplyDelete
    Replies
    1. Katie. Lovely to hear from you. Fantastic points.

      Please do at least two things -
      1 - contact The Birth I Want via Facebook or their website, and tell them your storty
      2 - write to your MP

      And 3 - please also feel free to get in touch with me, I am in Somerset Uk, I'm a trainee Doula, and would be happy to help you out in any way I can.

      Love Milli x

      Delete
    2. PS my email milli@birthinsight.co.uk

      Delete