In a country such as Australia, where we can afford high quality maternity care and have fairly equal access to it, you would think we don’t have much to worry about when it comes to maternal health rights.
But you’d be wrong.
Since beginning my path into birth work around the time my son was born, the issue of human rights in childbirth has been a burning one for me. And of late, hearing the likes of Professor Hannah Dahlen and International Human Rights Lawyer Bashi Hazard speak about this issue has fuelled my fire even more.
Professor Hannah Dahlen believes, as do I, that human rights is the issue surrounding childbirth. Why? Because women are human. We have innate rights as humans that we are born with. And those rights are violated every day in labour wards across the country. This is not a third world problem, but very much a problem of the developed world.
Dr Neel Shah is a leading obstetrician-gynecologist in the United States. He is a vocal leader in his country about the need to lower caesarean rates and he is known to have coined the term ‘too much too soon, too little too late’, which describes the type of maternal care women receive around the world. In developing nations it’s a problem of too little maternity care, being received too late (if at all) that leads to poor outcomes.
In Australia we have too much intervention too soon. Our birth scene looks like this-
- 30% of women having inductions to start labour. Inductions increase caesarean risk by 2 to 3 times and can lead to babies being born prematurely.
- Too much, too soon in Australia leads to our caesarean rate being over twice and in some hospitals three times greater than WHO recommendations.
- Too much, too soon sees women having an episiotomy (where their perineum is cut) without their consent, sometimes when they have even said no repeatedly. This is a practice that 20% of women are still subject to, far more than evidence shows is necessary. And if performed without informed consent this is a criminal act. This is assault, pure and simple.
- Too much, too soon sees fingers being forced into women’s vaginas when they have said no. When consent has not been given to a vaginal exam this is a violation of body autonomy. This is assault. And in any other realm of life, it would be treated as such. Why in the labour ward do we accept this as inevitable, and shrug our shoulders?
Respectful care, where a woman is the very center and is treated as the ultimate expert about her body and baby, should be the goal. And the World Health Organisation agrees. Their recently released WHO Recommendations: Intrapartum care for a positive childbirth experience places human rights at the forefront of importance.
And before I tell you their top three recommendations I want to say this… a positive childbirth experience isn’t a selfish, egotistical notion by the woman. It is her right. It also does not involve merely having a baby that is born alive. That is the bare minimum we should expect in Australia. Her experience matters. How she is treated matters. How she is made to feel matters. Being listened to matters. Because it will affect her in very significant ways for the rest of her life.
From WHO’s 52 recommendations the first three are;
- Respectful maternity care – which refers to care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth
- Effective communication between maternity care providers and women in labour, using simple and culturally acceptable methods, is recommended.
- A companion of choice is recommended for all women throughout labour and childbirth.
All three refer to a woman’s human rights in childbirth.
The fourth recommendation is this;
- Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes.
Women have a right to respectful care, to good and positive communication with their care provider and a companion of the woman’s choosing throughout labour and birth. And midwife-led care is the best, medically proven way of providing optimal and respectful care for all women and babies (with doctors as backup only for high risk pregnancies).
But what we are seeing are instances in Australia where women are being forced to have procedures against their will, where women are bullied and coerced into medical interventions they do not want, where they are told they have ‘failed’ or are ‘incompetent’, where they are not given the time, space, and privacy they need, where they are denied their rights to have their chosen companion at their birth, where they are denied the right to give birth in a place of their choosing, where GPs are refusing to issue a referral to an independent midwife so a mother can have a medicare rebate for her home birth, where women are not presented with all evidence-based information about their care and funneled through a system that has the care providers wants and needs above the woman and her baby, and where women are walking away from birth wondering what the f*ck just happened to them.
Is it no wonder the leading cause of maternal mortality is suicide? That postpartum anxiety and depression is almost the norm and continues to rise?
If the above is not a human rights issue, then what is?
But a note of caution. A very dear childbirth educator and author in Melbourne Maha al Musa, recently spoke on this topic at the Doula Conference 2018 and said, ‘I worry about this constant reference to trauma that becomes the ingrained dialogue and which women believe will, by default, be a part of their experiences.’
Are women of Australia becoming socially conditioned to expect an awful, painful, traumatic birth experience? Are women scheduling their caesarean because they are afraid of having an ‘emergency’ one with the expected trauma of labour? Are women expecting to have difficulty breastfeeding but not realising a medically managed labour and birth is usually the reason why? Is postpartum depression just the expected norm?
We need to be doing better for our women and babies. But we also have to be careful not to make birth trauma and obstetric violence a socially conditioned expectation.
As consumers we can change the birth culture in our country. We have to.
I’m proud to be a Lamaze Certified Childbirth Educator, and part of a not-for-profit organisation that aims to promote the safe and healthy life event that normal, physiological birth is. Lamaze is non-biased, evidence-based education that helps women find their power and their voice to advocate for the birth they want. It gives them all the knowledge they need to form a birth preferences list that they can share with their provider and be the one in control of their baby’s birth day. It gives them acumen to find the respectful care that is their human right to have. And it provides them with the confidence they need to make fully informed choices and to say no, or ask for more time, or to ask for a second or third opinion if they know their human rights to body autonomy are being threatened.
So lets be grateful we have a very low rate of maternal and neonatal deaths in Australia. But let’s also recognise that we have very far to come to prevent the widespread morbidity and human rights violations that women are experiencing during their perinatal care across this amazing country.
Click here to watch the full replay of the discussion with Prof. Hannah Dahlen and Bashi Hazard on the topic ‘Feminism and Human Rights in Childbirth’.
Watch this free trailer to this exciting and much needed and anticipated Australian documentary ‘Birth Time’. They will be sharing the truth on birthing statistics, birth trauma, VBACs, one to one midwifery care, birth as a human rights issue, and that’s for starters.
- All birth images c/o Monet Nicole Birth Photographer
Denise Georges is a Lamaze Certified Childbirth Educator from Sydney, with a passion for guiding women into find their powerful birthing potential.