Saturday, September 21, 2013

human rights and childbirth

A number of Australian midwives and birth activists are watching with interest the campaign demanding human rights in childbirth, particularly in European countries where midwives may face criminal proceedings when they attend women for homebirth.

For information on this movement, and details of the next conference, click the hyperlink:
Birth Rights in the European Union: Mobilizing Change
Monday November 4th 2013
in Blankenberge, Belgium

Rights .... choices

The meaning of phrase 'human rights and childbirth' may be debated at length. Notions of individual freedom, fairness, equality, respect ... - such ideals are often at odds with what happens in the real world.

Human rights in the European Union should not be very different from those in resource-rich Australia, or developing countries such as Papua New Guinea where national maternal morbidity and mortality rates are among the highest in the world.  Yet the choices that are available for women in childbirth vary enormously from place to place, and between socio-economic groups, as variable as differences in outcomes.

What are the intrinsic *rights* of any (human) woman in her childbirth experience?

Let's consider this question: Does a woman have the right to demand the type of birth she considers best?   

Does a woman have a *right* to a birth that requires expert medical, midwifery, and nursing services, and a host of related ancillary services, in order to achieve her chosen birth: induction of labour, regional anaesthesia (spinal/epidural), or even elective caesarean?  I am not asking if a woman can access these elements of her choice - ability and right are two different matters.  And many readers may claim that it's easier in Australia today to access elective caesarean on demand than to access a maternity service that has a good track record with spontaneous, unmedicated, (garden-variety-natural) birth.

I would suggest that there is no human rights imperative in medically managed birth.  In modern maternity services there are professional/legal duties of care, to help and not to harm, but the access to surgical intervention or medical treatment is limited by factors such as availability of the necessary resources, and professional willingness to support the woman's individual choice. 

Which brings me to the other side of the question, Does a woman have the right to demand the type of birth she considers best?

Does a woman have a *right* to a birth that avoids medical intervention and optimises her chance of working in harmony with natural physiological processes?

Not really.  Perhaps there is more of a right in this situation than in the former, because the woman is the only person able to give birth spontaneously, and she does have the right to refuse any 'help'.  But in essence the woman's ability to proceed along the natural pathway, and give birth to a healthy baby without complication, is not about human rights.  It's about a finely tuned process that relies on physical, hormonal and emotional elements that can be either supported and protected by those who are with the labouring woman, or terribly messed up, to the detriment of the mother and her baby.  Even if 95% of women who received optimal support and care (whatever that looks like) through their childbearing experience were able to proceed naturally and spontaneously to great births, the other 5% of women who wanted natural births would miss out.  It's not a right unless it can be applied to all.

Effective maternity services are ones that provide the 'best practice' options for all women, placing the individual woman at the centre of the package of care that is available for her.  In most cases, it is not possible to plan or choose the outcomes.  Careful decision making throughout the journey enables the woman to access the best care, and thereby expect the best outcomes. 


Decision making is a process that constantly evolves as we move through a childbearing episode.  The trump card that a woman has is 'Plan A' - her capacity to do it without assistance or education or coaching or therapies or any outside help*. But it's the fine line between Plan A and Plan B, when intervention is likely to lead to better outcomes - that may call for expert and timely professional action.

There are times when the best option is not clear, when doing one thing may avoid one potential risk, but for some increase another.  This question of risk-utility analysis in decisions around childbirth is huge, and will, I hope, continue to occupy the minds of each generation of mothers and their professional care providers (whoever they are) for as long as childbearing continues.

I fought/aggitated for the rights of women to have their husband/partner present in hospital births in the early 1970s. I gave birth to my fourth child in a birth centre in 1980 - my personal statement of ownership of my birthing potential, and moving out of medicalised childbirth. I mention this because I have seen and experienced the changes in maternity care over 40 years in 2 continents, and am now nearing the end of my period of usefulness as a midwife.

The physiology of the birthing process requires a woman to minimise the activity of her neocortex - her thinking brain - and work with her intuitive brain as she progresses towards the climax of giving birth. This is where the authentic midwife is able to be guardian of the space, so that the woman is free to do the primal, hormonally driven (rather than intellectually driven) work of giving birth. The reality in my mind is that this is not a matter of empowerment or conscious choice - or of any sort of legal *rights*.

A woman's body will do the work of birth if it can, whether she likes it or not, because we are wonderfully made.  On the other hand, decisions about interventions which are designed to protect the wellbeing of mother and/or baby, when obstetric complications arise, are influenced by wealth and availability of /funding for maternity services.

*Note that I am not advocating for 'free' birth: Giving birth under 'Plan A' is an option regardless of place of birth or professional services available.  A woman can give birth without assistance or education or coaching or therapies or any outside help in the care of a midwife, a doctor, a hospital or any other service.

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