This is Part 2 in a series on Oppressive Midwifery Laws.
While Delaware takes the cake for its heavy handed tactics to prosecute and eradicate the homebirth midwife population, Arizona wins the medal for stripping pregnant and birthing women of their rights to informed consent and refusal.
Arizona has some of the strictest homebirth regulation in the country, including a ban on midwife attended VBAC or multiple births. But if the proposed legislation goes through as written it is about to get much worse.
Forced Vaginal Exams
The proposed legislation states that midwives will be required to perform vaginal exams in labor. Specifically, the expectations outline:
The progress of active labor for primiparas by monitoring whether dilation occurs at an average of 1 centimeter per hour until completely dilated, and a second stage not to exceed 2 hours;
Normal progress of active labor for multigravidas by monitoring whether dilation occurs at an average of 1.5 to 2 centimeters per hour until completely dilated, and a second stage not to exceed 1 hour.
Um, excuse me? So, now, if I am a woman in the state of Arizona, I have less rights to informed refusal, and even more expected interference in terms of hands in my vagina than if I were to birth in hospital? My head has been spinning since I first read this.
Forced vaginal exams in labor reeks as bad as state mandated vaginal ultrasounds prior to granting permission for abortion. This kind of interference by a government body over women’s choice is unconscionable.
There could really be no greater place of vulnerability and no more profound image of subjugation than the forced penetration of one’s sexual organs.
Big Brother Monitoring
Not only will pregnant women seeking to birth at home need to fill out informed consent and refusal paperwork to be filed with the state (which is in and of itself a clear intrusion and violation of privacy rights), the attending midwife will also be required to notify the nearest emergency room as soon as a woman begins labor, and when her labor ends.
What?! Yes. You read that correctly. The E.R. staff, and anyone else they choose to notify, will be on standby whenever a planned homebirth mom goes into labor.
Restrictions on Providing Care
- VBACs are limited to one prior cesarean, that occurred more than 18 months prior, that did not include any complications, and that was not performed due to failure to progress or CPD – in other words, a very, very narrow margin of women with prior cesarean will qualify.
- No multiples
- A woman who carries past 42 weeks must have her care transferred.
In other words, the women who fall into any of these categories are subject to only one kind of birth in one kind of setting. The most likely of which is surgery, considering that half of the hospitals in the country will not even allow attempted VBAC’s. I spoke to one former AZ midwife who told me that if she refused her VBAC clients, surgery was their only option (her local hospital did not allow VBAC) unless they chose to birth unassisted at home.
Forced consent or Dropped Care
The proposed legislation states that a midwife is responsible to inform her client that she must terminate her care if
…certain medical conditions arise or the client refuses intervention.
This one here gives me the shakes as much as the forced vaginal exam. I’m sure the state would have us believe that women do, in fact, have a choice. Their choice just needs to align with what the State deems the “right” choice. It’s like the most patronizing way of painting an illusion of supposed choice.
And it is one of the most frightening and obvious ways of the state overstepping their bounds with regulation. Human Rights in Childbirth lawyers, Hermine Hayes-Klein and Indra Lusero, in their letter to Arizona Department of Health, write:
Ideally, the regulatory system will set forth the parameters of a certain profession without constraining the privacy or free market rights of potential consumers even when the risks to consumers is grave. The right to refuse unwanted medical treatment and the right to make decisions for ones children are constitutionally protected privacy rights……
The proposed guidelines threaten this right at R9-16-109 in each instance where the client’s ability to choose midwifery services is automatically restricted. The focus of the regulations should be on the profession of midwifery, and not on the choices of the client or the nature of her body.
And this is the crux of the argument. When regulation steps on the toes of women’s choices, that is where the regulating body has overstepped its bounds. We, as women, DO NOT NEED a paternalist in any form looking over our shoulders to make sure that we make “good choices.”
You know, this reminds me of my recent escapades in looking at childcare provider websites. There was this one that repeatedly talked about their desire to help toddlers “make good choices.” It made me puke in my mouth because “make good choices” is really code for “behavior modification.” In other words, turning them into little programmed robots who do what WE want when WE want them to.
It’s not about “good” choices, it’s about “their” choices.
It is time for consumers everywhere to wake up to this kind of language and legislation that seeks to regulate not only a profession, but also (and especially) the women that they serve.
Want your voice to be heard? You can write a letter to the director of Arizona’s Health Services Department expressing your concerns over the proposed legislation (be respectful – take some cues from the HRiC and Improving Birth letters):
Office of the Director
150 N. 18th Ave.
Phoenix, AZ 85007