Recently it has become clear to me that there is a large misconception about the mission of the human rights in childbirth movement. I want to take some time to clarify where I stand, personally, and where most of us within the movement stand, as a whole. But first, a little background and context.
Through my own experiences and throughout a decade in serving pregnant and birthing women, I have become all too aware of the disrespect and disempowerment that accompanies most women’s birth experiences. This is what has shaped me as an activist. As an activist, I am most invested in good outcomes for mom and baby, alike. This means that I am deeply invested in physical safety and health. And it also means that because we are complex, holistic beings, I am very aware that the physical outcome is not the only important outcome. A woman’s experience definitively shapes the way in which she becomes a mother, just as the baby’s birth experience directly impacts baby’s perception of this new world and how and whom he can trust.
The human rights in childbirth movement is committed to ensuring that a pregnant or birthing woman does not lose her fundamental human rights merely because of her pregnant status.
AT THE CRUX OF ALL OF THESE THINGS, IS THE RIGHT OF THE WOMAN TO BE THE ULTIMATE DECISION-MAKER.
The right to evidence-based care in any setting.
Evidence-based care is not practiced, as a rule, in most hospital birth settings. Routine, non-evidence-based management of labor and birth is. Women routinely have interventions that are medically unnecessary and even increase risks to them and their babies. For many women who desire a natural childbirth in hospital, this dynamic becomes a constant negotiation or even conflict. Examples include active management techniques, such as artificial rupture of the membranes and Pitocin augmentation; routine interventions which have proven undesirable side effects, such as continuous EFM, IV fluids for low-risk women; and interruption of the newborn bonding period, including premature cord clamping, separation of mom and baby, and mishandled breastfeeding management.
Of course, a woman’s right to scientifically proven best practices does not cancel out her right to choose alternatives to even that model. SHE decides.
The human rights in childbirth movement is not a natural childbirth movement, but rather, a movement that seeks to ensure that women receive the kind of care that they deem best. Whether that is a natural childbirth at home or a medicated birth in the hospital or a cesarean section, we believe in the rights of women to make these fundamental choices about their healthcare.
The right to informed consent and refusal.
True informed consent, as a rule, is almost never given to pregnant and laboring women. When lawyer / activist, Hermine Hayes-Klein, presented in a grand rounds at a Portland hospital on “informed consent” she insisted that real informed consent should be a 3-pronged process:
- Inform – give the objective facts as you know them, and also acknowledge what you don’t know.
- Advise - this can be subjective, “here is what i think you should do and why.”
- Support - which means support the woman in the choice between taking your advice and NOT TAKING IT.
A woman’s status as pregnant does not change her legal rights to make decisions about her healthcare. A mother is always the most invested person in the outcome of her child. Only she can make the choices that she deems best for herself and her baby. Her options should be presented free of coercion, her choices should be respected and she should be treated with dignity throughout her care. Personhood laws complicate the matter, giving fetuses the same rights as that of born persons. Which is why it is imperative to prevent the manifestation of personhood laws in order to maintain a woman’s autonomy during pregnancy and birth.
The right of a woman to choose the circumstances in which she gives birth, including access to competent care providers in any setting.
The safest way to ensure that women who choose homebirth receive the highest quality care is to ensure continuity of care. Collaboration and respect among different health care providers makes birth safer, and we need to simultaneously eliminate the criminal prosecution of midwives. This does not mean eliminating a need for transparency or accountability. What it does mean is creating a system of equality, whereby BOTH groups of providers are held accountable in the same way.
It is an unjust dynamic when one group of providers encounters criminal prosecution for undesirable outcomes, while the other receives professional sanction. We only need to look at cases like this one, in which an OB decapitates a child during birth and walks the streets free, to see the disparate and hyper unbalanced dynamic in which the system operates.
Access to reproductive health care.
There are differing perspectives within the movement on topics such as abortion. However, it is important to recognize the connection between reproductive rights and birthing rights. A woman’s right to access to birth control and abortion directly influence a woman’s birthing rights because the two are inextricably linked. See here for more explanation on the interconnectedness.
Simone de Beauvoir in her book, “The Second Sex” lays it out pretty brutally:
“It was as Mother that woman was fearsome; it is in maternity that she must be transfigured and enslaved.”
When women routinely say things like, “My doctor won’t let me…..” or “My doctor says I have to….” it is very clear that there is a severely unbalanced and confining power dynamic.
As a human rights movement, we are determined to break the paternalistic chains that define the present day maternity care system and place birth back into the hands of its rightful owner – the woman.
Who decides? I decide.