Posts tagged birth rights
Risk vs. rights: the home birth debate
10On the BBC News website today, we learn that British medical journal The Lancet has published an article declaring home births “too risky” for infants and stating that, even though giving birth at home is associated with fewer risks for the mother (“shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections”) women should “not have the right to put their baby at risk.”
Well. Ain’t that sweet? It’s as if the women’s rights movement never happened! We are but pods, oh masterful overlords. Guide us in your infinite wisdom so that we may bear unto you the fruit of our wombs, and happily give of ourselves all that will never be granted us in return. Ommm.
But wait, hasn’t planned home birth been found to be just as safe as hospital birth for low-risk women? Yes. Yes it has. But that doesn’t matter because The Lancet has an explanation for those faulty data.
Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location…Most studies also rely on different midwifery models for home delivery, which are not generalisable.”
Not generalisable? You mean like the different midwifery models and health care systems used (but not controlled for) in the AJOG study upon which The Lancet is basing its opinion? Comparing home birth in the UK (where trained midwives attend around 90% of births and where there is a free-at-the-point-of-use national health care system) with home birth in the US — where only 8% of births are attended by midwives (some of whom are not certified) and where affordable, accessible antenatal care is not always easy to come by — is like looking at apples and oranges and declaring them the same because they are round.
Putting aside the fact that the AJOG study conflates outcomes unique to significantly different countries with a cohesive, well-rounded, controlled study of planned home birth in nations under similar health care systems, there remains a big problem with any argument that gives ultimate authority to someone other than the mother: human rights. If you believe that all decisions about a competent person’s care should remain with the individual in question and that patients, no matter their ‘ailment’, have the right to take advice into consideration but ultimately reject it, without threat of censure if the desirable outcome does not materialise, then you can’t very well say that women, even those considered high risk, are ‘not allowed’ to opt for a home birth.
The reasons for this are two-fold: one, because the definition of ‘high risk’ is subjective and varies greatly from one trust, hospital and health care provider to another. Some women are told they are high risk because they are obese, or over 35, or because they had a previous caesarean section. Hell, my friend was told she was an unsuitable candidate for a home birth because there was limited parking nearby and her rug wasn’t washable! If parking spots and interior furnishings are enough to deny a woman her right to choose, what would become of those in more ‘sinister’ predicaments, like being old or fat? The concern is that maternity units will begin labelling otherwise healthy women as ‘high risk’ (even if they’re not) and refusing them home births due to their own staffing problems, convenience or biases. It already happens all the time (“If it’s a busy night you’ll have to come into hospital, dear”) so without an NHS-wide list of which conditions and situations would contraindicate a home birth, each woman desiring one would have to hope against hope that she was being correctly assessed by an objective, patient-centred, evidence-based, fully-staffed maternity service which, at the moment, the UK does not have.
Secondly, all of this is beside the point! Even if a woman was pretty unquestionably high-risk and would statistically be safer in hospital, it would be a violation of her autonomy, agency and, yes, her human rights, to be forcibly hospitalised for observation and interventions which she may not have consented to, ‘for the sake of the baby’. Take all of the arguments for being pro-choice and apply them here — until a baby is independent of its mother’s body, it is a woman’s choice what she does with it (and where and with whom).
The vast majority of births proceed normally (or would do if they weren’t interfered with) and need little medical assistance. Many births that would have been fine on their own are tinkered with, sped up or subject to impersonal, litigation-wary hospital policy, creating their own set of complications and crises. Some women, even if they don’t need or make use of the medical assistance, are comforted by having it on stand-by. That is how our current culture frames birth; Better safe than sorry! Just in case!
But some women feel much safer and at ease in their own environment, at home, and believe in their body’s ability to give birth. Punishing mothers for doing what is best for them on the minuscule off-chance of untreatable catastrophe for the baby is akin to berating a parent whose child choked to death on a piece of food while she was at work for leaving him with a trusted care provider who didn’t also happen to be a paediatric surgeon or emergency medical respondent.
Things happen. Tragedy happens. People die, including babies. It’s always horrible. It’s always sad. Sometimes it is preventable, sometimes it isn’t. And some people will never understand even considering taking that risk, no matter how small. I get that. It’s a visceral, emotional reaction to the cultural narrative we’ve become woven into; of harm reduction at all costs, of no child left behind and one loss being one too many.
But the thing is, there is ALWAYS a chance of complications, no matter which setting you choose. Women die in hospitals during or immediately after childbirth all the time, from haemorrhaging, fatal clots (often incurred after caesarean surgery) , infections (often acquired in hospital) or human error. In cases where a woman, or her baby, would have lived if they hadn’t been in hospital — if she hadn’t had the induction that led to the caesarean that led to the her fatal embolism or the baby’s respiratory failure — do we blame them? Do we ban hospital birth and say it’s risky? No. Because ALL birth carries some element of risk. Giving birth is giving life, and life comes with risk. Are we really so terrified of mortality, or so arrogant, as to think we can eliminate it completely?
Ensuring that pregnant women have all of the information and support they need to make the decision best for THEM (not some patronising attempt to strong-arm, scaremonger or strip them of their rights and give them to people who ‘know better’) — and then trusting and respecting that decision — is the only acceptable position on this, as far as I’m concerned.
And I am concerned. I’m very concerned about what this means for pregnant women’s rights. Are you?
What about the men? Allies, privilege and collaboration
3
There’s often a lot of talk within feminist discourse about involving men in creating change. At points, it does feel like we’ve done all we can to press for new laws, new attitudes and less cultural biases against women. So we surmise that, really, it’s men who need to be taking on more responsibility, creating their own brand of activism and making adjustments, not us. In many areas of women’s rights this is (somewhat) true. While men maintain the upper hand in all of the institutions that govern our lives, there’s only so much we can do before we get the rights we deserve. Ideally, we would have many men in our feminist revolution. If they don’t join or at least acknowledge our movement, it will continue to be more of an uphill struggle than a swift climb towards progress (short of violent protest and economic overthrow, of course, which I do admit to fantasising about on occasion after a run-in with a particularly virulent strain of misogynist or capitalist).
Why, then, does my visceral reaction to certain groups of men trying to get more involved seem to be: ‘Oh, sod off! What do you know about it? Stop making this all about you!’ I’ve noticed that this reaction happens a lot more when it comes to things that are and always will be the exclusive domain of women (pregnancy, birth and breastfeeding) than for things which have nothing to do with biology and everything to do with social conditioning, like gender roles.
For example, men who campaign for more involvement in their children’s gestations and births and demand more antenatal and maternity resources devoted to helping dads-to-be cope with becoming fathers. They want more attention paid to them at antenatal appointments, a bigger role at the birth and literature and support aimed at helping them help their partners succeed at breastfeeding. On paper and rationally, I know that men wanting to be more involved in these things is good, and fair. If it gives a father a greater sense of responsibility and attachment towards his child before it’s even born, I’m all for it. If it helps break down, in his mind, the cultural norm in our society that says babies are women’s business and men are only to provide for them financially and practically, all the better. However, I can’t help but bristle and feel a bit exasperated at the sense of self-importance and inflated vision of a father’s role in these areas that some men exhibit. Perhaps it’s because these issues, like abortion, are to do with our bodies, not theirs. It sometimes seems like just another way to assert control in an area where women should be holding the reins. It can bring to mind those who claim to care about equality but continually challenge the idea of female oppression by pointing to the substantially less common crimes or injustices against men (like male victims of female-perpetrated domestic violence and rape, or job discrimination), which can come across as just a way of saying, “Yes, yes, we know you’re oppressed, but you have been for ages and you’re used to it. But what about us?!”
Just like I can try to be an ally to people of colour and gay/queer/trans individuals, I cannot ever live their experience and know it’s not really my place to demand that greater (already precious and rare) resources be devoted to educating me and ensuring I don’t further screw things up for them. While acknowledgement from the majority/the oppressor is important in securing equality, so is the minority/oppressed’s need to feel safe in their own spaces and that they are creating change with their own voices and own grassroots empowerment; otherwise, ‘success’ will still feel like something that was done for or to that group to make the privileged feel good about themselves, not built on the movement’s own merit, for those most effected by it.
Fathers should be encouraged to ask that schools and medical professionals address them as well as mothers when it comes to their kids’ educations and health; that media outlets not portray them as helpless, bumbling idiots; to campaign for a longer and better paid paternity leave in the postnatal period; to require their employers to offer flexible working hours and situations so they can take an active and equal role in their children’s care; and to raise their boys without macho expectations and their girls without some preconceived idea of femininity. Additionally, all men who want to be feminist allies should be actively speaking out against domestic and sexual violence, the insidious nature of the sex trade, the gender pay gap, the objectification and sexualisation of girls and women and gender stereotypes that constrict both sexes, amongst others.
But when it comes to our bodies and what we do with them, especially reproductively, the utmost sensitivity and restraint should be exercised. Even if the aim is not to control but help and learn, remember that we have been fighting for the right to absolute authority over our bodies and childbearing decisions for centuries and have, in most areas, still have not been granted full autonomy in this regard. Our trust will not come easily. Our need for support from our partners but ultimate command of ourselves means, for many men, relinquishing the role of decision-maker or complete equal. Men may have to take a back seat at times and they should become comfortable with that, not feel threatened or marginalised by it.
Sometimes, it really is all about us.
Reclaiming Birth
13
I wrote a guest post over at The F-Word last week, getting the word out about a march and rally called Reclaiming Birth, which took place today. The aims of the march and of the participating organisations can be read in this handout. In summary, they are:
- Ask the health service to provide more midwives so that every woman is supported throughout her labour and never left alone
- Provide access to at least one stand-alone birth centre in every local area
- Disseminate good information on and the option to choose home birth, birth in a midwife-led unit or birth in an obstetric unit in every area
- Maintain at least one case-loading midwifery group, free at the point of use, for every area
- Launch an inquiry into maternity care at King’s College Hospital Foundation Trust, London, which recently terminated its contract with the Albany Midwives Practice
Here are some photos from the event.
I was really impressed with the number of people there, including quite a lot of men and many, many children. One little girl, no more than 7 or 8, was leading chants and blowing a whistle while shouting “Choices! Choices!” and “We need midwives!” There were grandfathers, great-grandmothers, teenage boys with shirts reading “Born at home,” mothers of all different ethnic backgrounds…it was really fantastic. I felt inspired, empowered, invigorated and part of a community and a movement that really cares about women and their families.
If you want to help Reclaim Birth, please write to your MP, the Secretary of State for Health and to the Maternity Services Liaison Committee at your local obstetric unit. You can email letters directly through the NCT website. Please take a few minutes to send a couple emails, and then pass it onto others who care about birth and ask them to do the same. This is our chance to demand real change to the maternity services, providing women with the choices, continuity of care and positive birth experiences that every one of us deserves. Let’s make our voices heard!
A new kind of war story: PTSD in childbirth
11The following is a guest post from one of the most influential bloggers in my life. When I found her site I was just starting to get really interested in and writing about the intersection of mothering and feminism and the veritable minefield of hot-button issues out there. Among the nearest and dearest to me is birth advocacy. I’d written about birth issues before but Jill at The Unnecesarean helped inspire me to take that advocacy to the next level — activism. She is a fiercely feminist protector of women’s bodily rights, their choices and their lives. In short, she kicks ass. I am honoured to share her words on my site.
____________________________________________________
Via Lauredhel of FWD/Forward, who included the following warning:
WARNING: story of obstetric assault and PTSD symptoms. More accurately labelled “obstetric trauma”, not “birth trauma”.
In the article, How childbirth caused my PTSD, which appeared on Salon.com, Taffy Brodesser-Akner writes of being violated against her consent by a doctor while on Pitocin and Stadol.
The delivery of my son didn’t start with a rush of water, or cramps that left me hunched. It was a decision, an edict, and with it, the drip Pitocin, a drug that induces contractions. The contractions came big and loud, almost immediately at one minute apart. My cervix wouldn’t dilate, though. I was eventually given the narcotic Stadol, which caused me to hallucinate through a very long night. Twenty-four hours later, clear-headed but still not dilated, I told my doctor I didn’t believe the induction was working, that I wanted to discuss other options. But before I knew it, he began painfully separating the membrane guarding my bag of waters.
“He isn’t examining me,” I yelled at my husband. “He’s doing something.”
In a hushed tone, the doctor asked the nurse for the hook, a mechanism that breaks your water.
“Why did you do that?” I asked when it was done. “I thought we were going to talk about it!”
His voice was cold, flat. “You’re not going anywhere,” he said.
She discusses how the diagnosis of PPD she received a week after birth didn’t fit, as she “felt that [she] was stuck in fight-or-flight,” then received a PTSD diagnosis that seemed to fit her symptoms. When she searched the Internet for information, she didn’t find a warm reception.
Just around the time I was figuring this all out, the Wall Street Journal published an article discussing postpartum PTSD. It referenced a now-famous study by Harris Interactive for Childbirth Connection, in which 9 percent of postpartum women screened met criteria for a diagnosis of PTSD, according to the mental-health diagnostician’s Bible, the DSM-IV.
Not surprisingly, it elicited a giant eye-roll from bloggers. “Something about applying the term PTSD to childbirth irks me,” said Hannah Tennant-Moore, a blogger for Babble’s Strollerderby. “PTSD is most commonly associated with war veterans and victims of extreme violence; applying it to new mothers makes maternity seem like a pathology.”
Over on Jezebel Jessica Grose sneered, “Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event?” She went on to say: “Certainly having a bowling ball of a baby shooting out your vag isn’t a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.”
The article goes on to quote a pediatrician from the University of Chicago claiming that “[f]ifty years ago, women were anesthetized for childbirth” and are now awake to experience what he calls “misadventure[s] in the delivery room.”
The pediatrician follows the cultural script of pinning the trauma on this trend of women being awake to witness the rare events in which “the mother’s life [is] at risk or the baby’s.” He stated that having a baby is opting into a normative experience and that it is difficult to find people to turn to when you’re one of “the other 2 percent” who do not have uncomplicated births, and “[w]hen you find it’s totally different from what you were told it would be, it’s traumatic.”
Rupturing membranes without consent while a woman’s body is being slammed with pharmaceutically induced contractions is not a mere “misadventure” of childbirth itself. This is a violation of patient rights, autonomy and human decency. It’s the act of a doctor who clearly would have preferred for his patient to be anesthetized as in pediatrician’s scenario of days past so that whole annoying “informed consent” thing wouldn’t get in his way. The obstetricians that the author consulted about her birth raised questions about the necessity of the induction in the first place.
Slapping women in the face with the unrealistic expectation line serves only those wishing to perpetuate the status quo and blame women for creating their own PTSD. While is it true that the rareness of death in childbirth contributes to a “couldn’t ever happen to me” factor that is exacerbated by the unrealistic “I can control this from ever happening to you” or “you or your baby will die right now/tomorrow/next week/next month unless you do everything say” sales pitches from care providers, the time has come for women discussing the trauma associated not with childbirth but with coercive over-management of childbirth to not be thrown into some sexist, ableist Cassandra metaphor.
Akner no longer feels like “the only person who survived a normal life cycle event damaged and ruined” thanks to the community that she has found, a community that will probably continue to increase in numbers concomitantly with the increase in the number of unnecessary inductions and cesareans.