Birth choice and human rights

// 7 August 2010

Tags: , ,

The bastards hard-working bods at Sky/BT have deigned to return the internet to me after more than two months in the web-free wasteland, and while I feel like a fish that’s finally been returned to water after some dude with too much time on his hands decided to stick a hook through my cheek and leave me gasping at death’s door on the deck of his boat while he and his friends congratulate each other on their manly hunting prowess*, it also means that I once again have access to hair-pullingly infuriating comments such as this:


Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.

Yes, according to The Lancet, a pregnant woman’s right to decide what happens to her body can and should be trumped by another person’s opinion of what’s best for her baby. This is despite legal precedent confirming that a baby only gets equal rights to the mother after birth.

The article in question argues that despite the results of last year’s largest ever study into home vs. hospital birth, which found that there is no increased risk of death in either mother or baby when low-risk women give birth at home, we should continue to approach home birth with “caution”. Why? Because a meta-analysis of studies undertaken in countries with vastly different medical models and approaches to birth found that neonatal mortality rates increased from 0.09% to 0.2% when a woman gave birth at home.

As Fertile Fem points out:

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.

Furthermore, despite acknowledging that there are numerous risks involved in hospital births, the author of the article associates ‘putting the baby at risk’ only with home birth. We are not encouraged to ‘proceed with caution’ when entering a hospital. (But I suppose at least in hospital the experts are in control, rather than pregnant women with their pesky purpose-built birthing equipment.)

This is undoubtedly a pro-choice issue. Like anti-abortionists, medical professionals who believe that women ‘do not have the right to put their baby at risk’ relegate women to the status of incubators, and untrustworthy ones at that. When ‘putting the baby at risk’ can range from failing to diet before you even conceive (a recent Times article argued that doctors need to be “more aggressive” about getting women to lose weight before they get pregnant), to eating blue cheese, to deciding that you would rather not put yourself at the mercy of time-pressed hospital medics who may use drugs to speed up what your body could likely achieve on its own or carry out an unnecessary episiotomy because it will improve your husband’s sex life (see here for some stories), a woman’s ability to live her life as she chooses is severely curtailed.

In this climate, the logical conclusion to The Lancet’s brand of risk aversion would be to place all women in a strictly monitored isolation room from the moment of conception to the day their baby is prised out of them.

Forcing a woman to give birth in a manner that is not of her choosing – be that due to a medical expert’s wishes being considered more important than her own, hospital midwives being too overworked to attend home births or the existence of a local NHS policy against providing certain birth choices – is a violation of her human rights, and something that every pro-choice feminist should be worried about.

See Fertile Fem’s post for more.

*Sky have also brought a number of what appear to be 24-hour extreme fishing channels into my living room.

Comments From You

FertileFem // Posted 7 August 2010 at 4:12 pm

Thanks for highlighting this issue, Laura. It is quite scary indeed that more and more often we are seeing calls to police pregnant women’s actions and choices ‘for the good of the baby.’

Kate // Posted 7 August 2010 at 5:36 pm

Great post! Basically, if there’s a time in a woman’s life where she’s not allowed to choose what healthcare to accept, or where to be, there is a time when her human rights are less than other people’s. If feminists are for that, then we can be unconcerned about birth choices. If we support the human rights of women, even pregnant women, then we have to be concerned.

Jazz // Posted 7 August 2010 at 7:11 pm

Thanks for this post. I am only 21 and I am absolutely terrified of giving birth- and not even because of the pain- I am afraid I will not have control of my body if i go into a hospital to give birth and that I might be given pain killers when I will not want them.

I am shocked and horrified when women are sometimes not treated as human beings but as incubators for the next generation.

After hearing stories of consent being taken from the man and not the women in labour I feel very conscious of creating a birth plan being as VERY prepared as possible and saving up for private care if it is needed to ensure both my child and I are respected before, during and after birth. All this thought as gone in to my birth plan for a hypothetical child! Those stories shocked and worried me to no end!

Troika21 // Posted 7 August 2010 at 11:06 pm

No! This is wrong.

Presenting the Lancet as analogous to anti-abortionists is very low and you damn well know it.

When a doctor says something like:

“but they do not have the right to put their baby at risk.” They do not intent this to be read as ‘we control your ovaries’; its a simpler and far less alarmist statement that, when giving birth, women have a moral obligation to provide the best possible care to their being-born child, and the writers in the Lancet feel they would get that within a hospital, rather than a living room.

Read back your own words, especially those two last paragraphs. Do you really believe that The Lancet is populated by social-reactionaries, eager to find some new way to lock down your uterus?

and

“Obstetricians! what the hell do *they* know about child birth!?!’, because these really do seem to be the core of your argument.

Putting faddish ideology before the health of a child is the height of irresponsibility.

Holly Combe // Posted 8 August 2010 at 3:58 pm

Presenting the Lancet as analogous to anti-abortionists is very low and you damn well know it.

@Troika21. I don’t think addressing a blogger who has dared to disagree with a respected medical publication as if she is a disrespectful whippersnapper, wilfully twisting the truth to gleefully wreak havoc, does your point any favours. Actually, I’d say you just end up lending weight to the one you criticise.

Telling women they have a “moral obligation” to give birth in a particular way may not sound as “alarmist” as saying “we control your ovaries” but that’s precisely what it amounts to (or, rather, “we control what happens to you, your body and your baby when you give birth”).

There is nothing new or “faddish” about babies being born at home. I was born at home myself. For the record, it didn’t happen in the living room. It took place on a bed and my Mum was accompanied by a Midwife and a Doctor who, funnily enough, managed to do what they had been trained to do, despite not being in a hospital.

Kim Shaw // Posted 8 August 2010 at 4:00 pm

It is indeed important to keep a critical eye to what happens to birthing women in hospital – as with all things. In that vein, I would like to highlight the imporance of focussing that same critical eye on the rhetoric of choice when it comes to home births. Firstly, women are not necessarily empowered within their homes (structurally or culturally), and their situations do not suddenly change just because they are in labour. Secondly, I believe that women should be allowed to make informed decisions, and to this end I offer a little of my own story and a piece of research I recently came across. I was saved by the immediate attentions of a crash team in a UK hospital when I suffered a major and unforeseen haemorrhage at my second birth (which had promised to be as ‘uncomplicated’ as my first). A home midwife simply would not have had the time, resources, or enough pairs of hands to save my life. As regards birth plans (great, I used them) and more complicated births, this article offers further insights: Crossley, M. L. (2007), ‘Childbirth, Complications and the Illusion of ‘Choice’: A Case Study’ in Feminism & Psychology, 17, (4), 543-563. Crossley was an informed feminist academic with a birth plan, who still found that ‘restritive immanence’ can take over in the birthing situation, and medical intervention can, on occasion, free us from the ‘tyrrany of biology’. She is (understandably) inconclusive as to whether medical intervention was a help or a hindrance – highlighting the complex nature of this realm. I am not an advocate of biological determinism, and I fully acknowledge that women are very often discriminated against in their various forms of labour because they inhabit ‘maternal bodies’ (nod to C. Gatrell’s Embodying Women’s Work, 2008). However, I feel that it is equally important for women not to be set up for potential feelings of ‘failure’ (or even death) by labouring under the illusion that all will be perfect and ‘natural’ at home – even in the UK.

Holly Combe // Posted 8 August 2010 at 4:49 pm

@Kim Shaw. I’d be surprised if many people labour under the illusion that all will be “perfect and natural” at home. As you indicate, being dominated by nature isn’t necessarily any more palatable than being dominated by the medical establishment and can be dangerous in itself.

In the absence of there being any such thing as a perfect scenario, I think the most important thing is for people to 1) be able to choose what is right for them personally and 2) to *always* be treated with complete respect and fully informed as autonomous individuals (as opposed to incubators without full human rights) if nature or circumstances move in a direction that the original plan may not suit.

Midwife Muse // Posted 8 August 2010 at 5:13 pm

I’m not sure if I am a feminist, or not. I am a mother and grandmother, also a wife, but I’m commenting here as a community midwife who attends homebirths and offers women informed choice.

Now my status has been established I’ll continue. The American home birth study should not be used by any midwife, obstetrician or ‘other’ to advise on the safety, for the baby, at a homebirth in the UK, to advise on that we need to wait for the Birthplace study being conducted by the NPEU.

At the present time I do have concerns with homebirths, in some areas, and a woman’s ‘right’ to them. The problem has arisen due to the severe midwifery understaffing which has arisen within many areas. When a woman has her homebirth she is, in effect, taking 2 midwives away from their usual work. Even when staffing is up to establishment there are times when this creates difficulties, at times when staffing is at an all time low then it becomes impossible. The woman having her homebirth may be depriving other women of routine care, antenatal appointments, postnatal visits even a birth at a stand alone birth centre (many of these are supported by community midwives).

My question is, what about these women’s ‘rights’?

http://midwifemuse.wordpress.com/2010/08/02/do-women-have-a-right-to-a-homebirth/

Feminist Avatar // Posted 8 August 2010 at 6:40 pm

Home births are hardly a fad. In a historical context, hospital births are the fad. Other than the very poor, people didn’t start birthing in hospitals until the 1930s and community midwifery and home births were still common into the 1960s.

And, while it is certainly true that women can die through complications if things go wrong at home, women also die in hospital from complications. Birth is a risky business and it should be a women’s choice where it happens.

Troika21 // Posted 8 August 2010 at 9:56 pm

@Holly Combe

The position of obstetricians is being mis-represented here very badly. Its a straw-man to claim that doctors are compelling women to undergo pregnancy, that they would prefer pregnant women to seal themselves away from society, or that they view women as “incubators”. This article makes it very clear that the author believes obstetricians view women as fatories.

Such distortion is shameful. Presenting the doctor who will deal with your pregnancy as disintrested and arrogant from the beginning, is not a sensible thing to do.

I’ll try and restate what I said earlier.

Doctors (by which I mean medical science) are not demanding women give birth their way, women have full control over their bodies and whats in them. The doctors are not trying to control anything, they are simply trying to apply the current best practise, which is to give birth within a hospital.

Far from being uncaring, control freaks as the author insists, the doctors are wrestling with being asked to (as they see it) compromise their ethics and best medical practise for a homebirth.

FertileFem // Posted 8 August 2010 at 10:54 pm

@Troika21 – “women have a moral obligation to provide the best possible care to their being-born child, and the writers in the Lancet feel they would get that within a hospital, rather than a living room.”

Really? You’re going to go down the whole ‘moral imperative’ road on a feminist website? You might as well say, “Women have a moral obligation to give life to their unborn child — despite how they feel about it personally and how it would affect their quality of life — and anti-choicers feel that would best be done by adoption, rather than abortion.”

Doesn’t hold up. Just because a woman has chosen to continue her pregnancy and have the baby, it does not mean the child’s ‘rights’ supercede hers before it is born or that she ceases to be a fully sentient human being who can make decisions about her own care.

Pro-choice does not stop once a woman decides to carry a pregnancy to term.

Read some history if you think home birth is ‘faddish ideology’. Births didn’t become mainstream in hospitals until the 1950s in England.

@MidwifeMuse – “When a woman has her homebirth she is, in effect, taking 2 midwives away from their usual work.”

Don’t lay the blame at women’s feet. An understaffing issue is solely an inadequacy within the NHS and should be addressed as such. Would you blame any other patient for requesting care they are fully and legally entitled to because it ‘takes care away’ from others? Try telling me that a cancer patient is selfish to request in-home hospice instead of dying in hospital because that takes a nurse off the ward floor.

Laura // Posted 9 August 2010 at 1:32 pm

@ Troika21,

The point is, giving birth in hospital is not necessarily best practice.

I’m not saying that all obstetricians view women as walking incubators, rather that 1) the beliefs underlying the statement highlighted in The Lancet editorial are very similar to those of anti-abortionists i.e. that the unborn baby is more important than the woman carrying it, and this justifies curtailing her freedoms; and 2) that there appears to be a trend in current medical practice towards the almost total medicalisation of what is a natural process; this can go beyond simply intervening when there are complications into actually causing harm or putting issues other than the mother and baby’s safety and well-being first.

Midwife Muse // Posted 9 August 2010 at 1:54 pm

FertileFem – I didn’t mean to ‘lay the blame’ at the woman’s feet, door whatever, rather I was attempting, obviously badly, to illustrate how a homebirth impacts on the provision of care to others. As you so rightly say ‘An understaffing issue is solely an inadequacy within the NHS’, it is not a pregnant woman’s fault and neither is it the midwife’s fault but, given that staffing is so bad, I ask again ‘What of the rights of other women?’

Also, comparing the provision of care to those who are terminally to those who desire a home birth is wrong on so many fronts but my main submission is that the maternity services rely almost entirely on NHS funding, care of the terminally ill recieves a large proportion of it’s domicilliary care funding through donations etc. Personally I think that is wrong, enough monies should come from the NHS to provide the care, but they don’t. Given that situation then perhaps appeals should be launched and charity shops established to raise extra funding for the maternity services.

gadgetgal // Posted 9 August 2010 at 2:04 pm

@FertileFem – agreed on your point about not putting the blame for a lack of adequate services on the women, it is the fault of government and NHS, not a woman for exercising her right to choose.

@Midwife Muse – surprisingly, although I agree with FertileFem that women shouldn’t be made to feel bad for the choices they make under the current system, I actually do have a lot of sympathy with your blog post, and what you are saying makes sense to me. I just wouldn’t put the blame on the women who make that choice, but on the NHS for allocating the resources.

As to this blog post I don’t have a lot of experience with women who have had home births, but I’ve had so many stories from friends who have given birth of doctors who refused to pay attention to what they were telling them about their own bodies whilst giving birth and causing many other problems in the future, and also from some of my family members who may have given birth in hospital but took over the birthing process and made the doctors follow them as they saw fit, resulting in less pain, less drugs, less stitches and no epidurals, so I’m reluctant to just follow what the medical profession says. Mostly they have good advice that’s worth paying attention to, but I know from personal experience that I know my body better than they do, so in the end the decision needs to be mine to make!

Kate // Posted 9 August 2010 at 2:23 pm

I’m with Troika21 on this, I think the term pro-choice is being badly distorted by some posters here. In my view you decide to continue with a pregnancy and you accept a degree of responsibility. If, and I’ll admit here it’s a big if, home births really do represent a high risk situation than I’d be pretty intolerant towards anyone demanding their “right” to one. However, I’m still a little sceptical that this isn’t another attempt to medicalise out the inconvenience of natural birth.

Holly Combe // Posted 9 August 2010 at 2:49 pm

What Laura and Fertile Fem said.

@Troika21. I’d also add that no-one here is suggesting that medical professionals are evil villains intent on controlling women. The problems attached to the power that comes with such an important role in people’s lives are surely far more complex than that. It’s all very well saying women have “full control over their bodies and what’s in them” but that rings rather hollow if “trying to apply the current best practise” comes at the expense of a patient’s autonomy.

Presenting the doctor who will deal with your pregnancy as disintrested and arrogant from the beginning, is not a sensible thing to do.

I don’t think “disinterest” is the issue here. I also have to say I find the statement above a bit chilling and think it does doctors who wouldn’t dream of lording their power over any patient (however difficult) a disservice. Surely medical professionals often wrestle with questions about ethics and best medical practise precisely because of the rights of the patient to bodily autonomy (regardless of clashes of views etc)? I’d suggest good nurses, midwives and doctors ought to understand that the involvement of a real live human being’s body in childbearing means that human’s rights have to be considered in every single part of that process, regardless of how “sensible” they think that person is.

FertileFem // Posted 9 August 2010 at 3:12 pm

@Troika21 – Just wanted to address this point again because it is often trotted out: “The doctors are not trying to control anything, they are simply trying to apply the current best practise, which is to give birth within a hospital.”

Besides the point that has already been made that it is not up to doctors to make decisions for their patients, only to make suggestions, the assertion that hospital birth is safer than home birth is NOT ‘best practise’ at all! If you’ve read the most up-to-date studies, (which Laura kindly included in her post), you would know that home birth is just as safe as hospital birth for low-risk women. No one is arguing that home birth carries NO risk, simply that it has no greater risk than hospital birth and, with regards to certain interventions, even less risky.

If hospital birth carried ZERO risk I would be more readily able to see your point (though I would still say that pregnant women have the right to take those risks) but you’re denying evidence from comprehensive studies in favour of biased opinion. To keep scaring women into believing they are putting their babies at grave and unnecessary risk by giving birth where they choose is irresponsible and unethical.

What about this horrific story, where a woman acquired a flesh-eating bacterial infection after cesarean surgery in hospital and remained there for FIVE YEARS, unable to see, hold or care for her son and with dozens of surgeries to repair even part of the damage done by the MRSA? No one seems to be alarmed by this! It’s just chalked up as ‘one of those things, an unfortunate accident. Yet if a single woman or baby dies or is seriously ill at or immediately after a home birth, we’ve got midwives being struck off and people ready to ban the option altogether. It’s plain hypocrisy.

All birth carries risk. It is up to women which set of risks they’re more comfortable taking. No one else.

FertileFem // Posted 9 August 2010 at 3:13 pm

Sorry, meant to include link for that story http://tinyurl.com/336aq46

Troika21 // Posted 9 August 2010 at 6:24 pm

@FertileFem

Everyone seems determined to interpret what I have written as if I’m making the case for a pro-life point of view.

Throughout this I have assumed that the hypothetical pregnant women I’ve been refering to are planning on having the child, are longing, wanting and making post-birth plans on support and painting the babies room, etc. I have assumed that they desire the child.

It strikes me that a very sensible thing to do is reducing risk to the health of the mother, like avoiding excessive consumption of alcohol, that sort of thing.

Perhaps that is what was getting snagged, I refered to the health of the child, and used it interchangeably with the health of the mother. If this is there area of disagreement, then I apologise for my unclear wording.

@Laura Woodhouse

What I despaired about over your article was that I’ve seen this kind of reasoning before. Dismissing the opinions of experts is a tactic used by creationists, anti-vaxxers and other quacks, and then try and push their ideas as natural, not cold and mechanistic. Homebirth is nothing like any of those, I have nothing against it if it is what a woman wants, but you used the same methods of promoting homebirth as an anti-vaccinationist uses to promote their cause.

I have nothing against a homebirth, if its what is wanted, I don’t think the idea should be promoted and I don’t believe that it should be supported by the NHS. It is best practise to give birth within a hospital, where advanced medical support is at hand should anything go wrong.

Laura // Posted 9 August 2010 at 7:01 pm

@Troika21,

I’m not trying to promote home births, just a woman’s right to decide what happens to her body. I don’t think a “natural” birth is necessarily better than one where medics intervene – such a position would amount to judging women for their decision to have the latter (or being subject to circumstances beyond their control, such as a medical complication), and as a feminist that is not something I wish to engage in. However, a simple bit of online research will show you that multiple women have suffered due to unnecessary procedures or administration of drugs during childbirth, and that indicates to me that some medics are not respecting women’s bodies or rights.

It doesn’t matter how many times you say that giving birth in a hospital is best practice, we simply do not have conclusive evidence to that effect. Having a home birth does not preclude having access to hospital support should the need arise. This has been pointed out a number of times now and I feel further discussion along these lines will be unproductive; everyone is perfectly capable of googling this themselves.

Gennie // Posted 10 August 2010 at 12:35 am

Laura – how do you decide that something is unnecessary? Birth is so frequently a retrospective process, doctors and midwives can only go by the information they are presented with at the time. My seatbelt was an unnecessary intervention this morning.

The best place for a woman to give birth is one where she feels safe and comfortable. I wouldn’t have a home birth, I respect a woman’s choice to have one, just as I hope that natural birth advocates can accept my choice to have a medicated delivery without asking if I am truly ‘educated’ and ‘informed’. If anything, that’s where I see parallels with the anti-abortion movement.

erinmidwife // Posted 27 August 2010 at 4:43 pm

Excellent — thank you!

The Lancet editorial was a huge disappointment. It is a shame that they did not actually investigate the Wax meta-analysis thoroughly enough to recognized the poor methodology and how the data did not support the authors’ conclusion.

I am shocked more attention has not been given to this disturbing assault on women. I wrote about it, and I hope many others will feel inspired to as well.

Sheila // Posted 29 August 2010 at 3:40 pm

But the flip side to the research that shows that there are unnecessary medical interventions doesn’t compare that to the times in our recent past where 20% of women died in childbirth or of post-natal complications. Nature taking its course would be a frightful thing for some women. Just because doctors and midwives get it wrong sometimes shouldn’t be a cry to bar their intervention, it should give rise to a cry for better medical and midwifery training, better patient education. I get so tired of the sanctimonious crap I hear from women who haven’t given birth about how natural birth is better. A body takes over in labour, sometimes doing what the woman doesn’t want it to do. You cannot always control your body though I agree where a person is able to say what they want those wishes should be taken into account. I wanted to give birth with a whiff of lavendar and a couple of pushes and was sold the lie by NCT and the natural childbirth sisterhood that anything less was a failure. To anyone pregnant or contemplating pregnancy out there, do what is indicated at the time, when you are in labour. Don’t worry about needing pain-relief or a caesarean or other interventions. It isn’t a competition. What matters is that you and your baby survive. Returning to the days pre-pain relief and pre medical intervention would lead to an increase in child and mother mortality and nobody can seriously want that. Many women (and their medical professionals) can’t evaluate whether they are low risk or not. Complications come up. I owe the life of one of my baby’s (at least one) to the fact that I was in hospital. I’m not saying don’t plan for a homebirth and don’t plan for a hospital birth, I’m saying that many women with inflexible views brought about by debates like this in the abstract end up very disappointed and with a strong sense of having been cheated or of anger when they don’t get the birth they want. It tends to be nature’s fault if you don’t get the birth you want, not yours and not the doctors. @Jazz, I’d be amazed if you are given pain-killers when you don’t want them. I wrote no pain-killers every time on my birth plan and had to be reduced to little better than a grunting aggressive animal before the medics would finally concede they should go against my previous adamantly expressed wishes and go along with my new wishes. Drugs are given where they are indicated. Keep an open mind and have them if you want them. This them and us attitude is detrimental to women’s care and that of the baby.

Have Your say

To comment, you must be registered with The F-Word. Not a member? Register. Already a member? Use the sign in button below

Sign in to the F-Word

Further Reading

Has The F-Word whet your appetite? Check out our Resources section, for listings of feminist blogs, campaigns, feminist networks in the UK, mailing lists, international and national websites and charities of interest.

Write for us!

Got something to say? Something to review? News to discuss? Well we want to hear from you! Click here for more info

  • The F-Word on Twitter
  • The F-Word on Facebook
  • Our XML Feeds