Today, International Women’s Day, impassioned women, their partners, midwives and doulas are marching to demand birth rights.
They are marching because on International Women’s Day — which for so many years has championed the international women’s rights agenda — and in the social and cultural moment encompassed by #MeToo, it is time to unleash the many silenced voices of women on issues of assault and “power over” violence in the Australian birth system. Time to highlight birth rights, the scourge of obstetric violence and the distressing prevalence of birth trauma.
Obstetric violence was described by UK obstetrician Dr Amali Lokugamage at the Royal College of Obstetricians and Gynecologists 2014 World Congress. She defined it as the act of disregarding the authority and autonomy that women have over their own sexuality, their bodies, their babies and in their birth experiences. It is also the act of disregarding the spontaneity, the positions, the rhythm and the time the labour requires in order to progress normally when there is no need for intervention. It is also the act of disregarding the emotional needs of mother and baby throughout the whole childbearing process. Sadly, this description of obstetric violence is what passes as standard care in far too many birth settings.
University of Queensland PhD candidate Bec Jenkinson published research in 2017 on the experience of women, midwives and obstetricians when birthing women decline recommended maternity care. She found that once a birthing woman crossed the clinician’s “line in the sand” in declining recommended care (her human right to bodily autonomy), she was subjected to “escalating intrusion”, beginning with “manipulation”, escalating to “punishment and judgement”, then onto “badgering” and possibly ending in “assault”.
Birth has its dangers, of course, and we are lucky to live in a time and place that gives us access to life-saving medical procedures. But access to these procedures on the rare occasions that they are medically necessary is not a privilege to be paid for by forgoing other rights to dignity, autonomy and choice.
I hear too many stories like Emily’s, whose experience of birthing her baby can only be called out as obstetric violence: “I was greeted by the on-call consultant obstetrician. She was more than rude, she was aggressive — pressuring me to consent to both an epidural and a drip despite having regular contractions and my birth plan stating not to even offer me pain relief,” Emily told me. “My body was touched and prodded without warning, so aggressive was one unconsented vaginal exam, the student midwife asked the obstetrician to stop (but she didn’t). I now know that what happened to me is called ‘obstetric violence’.”
It might seem counter-intuitive that in an activity experienced only by women, women are nonetheless pushed to the bottom of the power hierarchy and treated so appallingly, but this is the case.
Applying a human rights framework to childbirth, we see that birthing women do not hold the power. Rebecca Schiller, from charity BirthRights, in her book Why Human Rights in Childbirth Matter, states that birth rights are: the right to receive safe and appropriate care; the right to care that respects the birthing woman’s fundamental human dignity; the right to privacy and confidentiality; the right to equality and freedom from discrimination; and the right to make choices about her own pregnancy and childbirth even if her caregivers do not agree.
Yet it does not appear that birthing women hold the power when we note the rising rates of unnecessary birth interventions. Restrictive timing protocols are just one example of the way our medical system lags on implementing current research — and the way the system results in unnecessary intervention in birth. In the US in 2017, the American College of Obstetricians and Gynecologists (ACOG) recommended restricting the use of many routine labour and birth interventions because they are not the safest care for women and babies, and are definitely known to initiate a “cascade of interventions”. These routine procedures include screening for GBS; routine continuous electronic fetal monitoring; restrictive timing protocols for stages of labour and for going past supposed due date; restriction on mobility with suggestions to remain on the bed; the use of epidurals and managed third stage — all standard practice in Australia.
Fired by movements like #MeToo, women’s silenced voices about “power over” structures and individuals are being heard. In the birth arena, when we listen to women’s voices, what birthing women want, as well as dignity and autonomy, is choice. And the choice so many want to make is for midwifery “continuity of care” programs — the evidence-based “gold standard” for maternity care. Presently, only 8% of women in Australia can access such care.
Definitely a long way to go then — come join the march.
*Rhea Dempsey is a childbirth educator, counsellor and the author of Birth with Confidence: savvy choices for normal birth, published by Boat House Press