This week, The Diane Rehm Show planned to air a piece comparing the applicability of the new U.K. NICE guidelines recommending midwifery-led homebirth for low-risk women, to midwifery care in the U.S. (The show has since been rescheduled for January 15.) For the thousands of women who choose homebirth in the U.S. every year, and the thousands more who wish to see more integrative, respectful, evidence-based care that honors pregnant folk’s rights to choose the circumstances of their birth, this was an exciting topic.
Leading the discussion about women’s bodies and choices were the President of American Congress of Obstetrics and Gynecology (ACOG), a professor of OB-Gyn’s, a director of American College of Nurse Midwives (ACNM), and a reporter.
Curiously missing? The women. The consumers.
The new National Institute for Health and Care Excellence (NICE) guidelines state that homebirth is the best option for low-risk women in the U.K. The topic of out-of-hospital midwifery-led-care in the U.S. is an important one and it needs to be discussed – especially in light of disparate midwifery laws, regulations, and accessibility when compared to the U.K. Considering the U.S.’s sky-rocketing maternal and infant mortality rates, the U.S. would be remiss not to look at how other countries are making maternity care safer for women. Namely, how creating an integrative system for midwifery and obstetric care, like that in the U.K., could benefit pregnant folks in the U.S.
But instead of a thoughtful, explorative dialogue, this subject has remained unnecessarily polarizing.
Two years ago the American Journal of Obstetrics an Gynecology (AJOG) published a scathing and patronizing opinion piece by Frank Chervenak and four of his cohorts, titled, “Planned home birth: a professional responsibility response.” In it he detailed the reasons physicians should not support their patients who choose homebirth. Most of the arguments revolved around concerns for safety. But, as most of us who work in reproductive justice advocacy know, safety is often a simple guise for a medical, political and societal paternalism that presumes doctor-knows-best and that women should lay back, shut up, and do as they’re told.
A number of consumer advocacy organizations have bubbled up, globally, in recent years in response to the lack of respect and outright abuses that women face in the maternity care system. The U.S.-based organization, Improving Birth, advocates for pregnant folks by espousing evidence-based care and humanity in childbirth as basic human rights to which all pregnant people are entitled.
But lucky few actually find those rights honored.
According to Improving Birth, most women who receive maternity care in the U.S. do not receive care that is based on evidence, but rather, standards and routines that are motivated by profit, liability concerns, and convenience. On top of that, women are not offered the full right to informed consent and refusal. Women, routinely, report feeling coerced and forced into interventions, procedures and surgeries that they feel they did not want or need. A number of cases in recent years have made headlines where pregnant women were threatened with, or forced by court order to undergo, major surgery against their will. In fact, the very real fear of protective service intervention for disobeying doctor’s orders is usually enough to make most women comply.
It’s not just consumer-run organizations that are hearing women’s stories and speaking out about these routine abuses, either. Earlier this year, the World Health Organization issued a statement on the prevalence of disrespect and abuse in childbirth. In it, they said,
“Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination.”
Circumstances that disallow women control over their healthcare choices, and which are not based on evidence place women at risk.
The U.S. spends the most money on maternity care in the world. This fact often leads people to believe that we have the safest maternity care system in the world. But we don’t. The U.S. leads the charts in maternal mortality. Our mortality rates have increased by 50% in the past 20 years, and we are only 1 of 8 countries with increasing mortality rates, and the only developed nation, at that. It’s worth noting that our maternal mortality rate is triple that of the U.K.. When it comes to infant mortality, we we don’t fare much better, losing more babies in their first year than 27 developed countries. When we look at those rates broken down by race, we really start to see some alarming statistics. Black women and babies die at more than twice the rate of white women and infants – in some communities the disparate rate is as much as 4 times greater.
Clearly, our maternity care system deserves a scrutinizing look.
So, if a dialogue is to be had about women’s bodies and choices, shouldn’t the women, themselves, be represented in that conversation? The Diane Rehm show interviewed consumer advocates for the show, examined their options and made a calculated decision about which voices were important. And guess what? The women’s voices just weren’t.
What message is sent when a show deems that there is no room for a consumer advocate’s voice, but there is more than enough room for not just one, but two, high-ranking OB-Gyn’s?
Diane Rehm’s choice to exclude women in of a panel of experts on the issue of women’s bodies, choices, and birth circumstances is no isolated situation, but I’m calling her out, nonetheless, because of her complicity in this societal norm. Women are routinely left aside as a backdrop or decorative prop in conversations about their own bodies. Women’s rights and abilities to access abortion and birth control are debated on senate floors, dominated by men; and in the Supreme Court, where the rights of corporations are stacked against a woman’s rights to reproductive healthcare.
Women have held their place as an inhuman conceptual idea – one that is clothed in the dirty rags of one’s imagination so as to maintain a believable discourse. Society, at large, feels the need to leave it that way because as soon as we begin to actually listen to women’s stories and experiences it becomes complicated. We can no longer maintain our pretend image of what kinds of women make certain choices. We have to begin to acknowledge that choices are personal, that women are best positioned to know what is best for themselves and their families, and that women, alone, should be held with the responsibility and right of making their own healthcare decisions.
The Diane Rehm Show’s unwillingness to include women’s voices and perspectives reveals a universal, societal belief that women’s voices don’t matter.
It demonstrates the idea that, in conversations about our bodies and lives, an Authority knows better than we do and he deserves the loudest voice and the final say. It reveals a willingness to make broad assumptions about women’s choices – why we make them, what circumstances fuel them – and the undercurrent of it all reflects a deep gender-based bias that maintains pregnant folks as unintelligible children who need authoritative guidance.
When are the folks who physically experience a pregnancy and a birth going to get a seat at the table? When are we going to stop shielding these conversations from women, as though we just can’t handle worrying our little heads over it?
Women are exhausted of listening to the experts, alone, discuss issues about our bodies and our rights. Women’s voices should not only be included in these conversations, but they should dominate them. What a revolutionary and radical idea that women should be included in, and steer discussions about, their lives and their needs.