If you gave birth recently, did you feel you had real freedom? Freedom to choose where you gave birth, who was present, what interventions took place and how you delivered your baby? Were you given access to all of the facts needed to make your choices truly informed? Who was the most powerful person in the room at the moment of birth? And did the experience leave you feeling exhilarated, disappointed, or downright traumatised?
These questions are currently being considered on behalf of all mothers as part of a global movement to 'take back birth' and reclaim women's power in the birth place. 'The freedom in a country can be measured by the freedom of birth', states Agnes Gereb, the midwife currently imprisoned in Hungary and held up as 'the epitome of the very worst of what's happening in birth today' by the makers of Freedom for Birth, a UK based film about human rights in childbirth to be globally screened on September 20th.
Over in the US, where caesarian rates are more than twice the WHO recommended 15%, and maternal mortality rates have doubled in the past 25 years, another organization - Improving Birth - are spearheading a 'full scale birth revolution' on Labor Day, leading 'rallies for change' in 100 major cities over 50 states, and demanding evidence-based care for all and the education and empowerment of birthing women.
For some, such protests might seem unnecessary. Surely, giving birth in a hospital with access to all the pain relief you might need is something women should be grateful for? No, say campaigners such as Alex Wakeford, co-founder of One World Birth, who describes how, "...birth has been stolen, by a powerful institutionalized system, that is born of fear, a system that inherently believes that birth is dangerous, and must be managed and controlled by modern technology"
Whilst a UK mother might assume that she is free, in fact, much of what happens to her in childbirth is determined, not by the limitations or otherwise of her body, but by the geographical place and historical time she gives birth. A woman delivering her baby in England in the 1950's could expect a very different experience to a Scottish birther in the 1980's, as the following graphs illustrate:
In the UK today as few as 20% of women are aware of the options for their place of birth, and in some geographical areas, options such as midwife led units are non-existent due to lack of funds. This in spite of the 2010 case of Ternovsky vs Hungary, in which the European Court of Human Rights ruled that every woman within Europe has the legal right to be supported in her choice of where and how she gives birth.
UK women are told that they are free to choose a home birth and that this is often the safest option, but in reality, the idea is less appealing when warned that they may have to transfer to hospital at the last minute due to a shortage of midwives. Continuity of care is also an issue: around one in three pregnant women never sees the same midwife twice in spite of government promises and nearly a fifth of women say they feel unsupported during labour and birth.
At the moment UK mothers can opt for an Independent Midwife: around £2500 buys you continuity of care, a guaranteed midwife if you want to birth at home, and - almost non-existent in the NHS - the reassurance that you will have met and made a relationship with the person who attends you at one of the most pivotal moments in your life. But you'd better be quick, because as of September 2013, Independent Midwives become illegal in the UK.
Birth rights campaigners see this as yet another example of diminishing choices in childbirth and symptomatic of a 'global witch hunt' against midwifery. In America, obstetricians lead the care of most pregnant women, only 1% of women get midwife led care outside of a hospital setting, and direct-entry midwives are illegal in several states: all of this in spite of sound evidence to show that midwife-led care produces better outcomes for mothers and babies.
In the UK care in birth is still largely midwife-led, but numbers are low, and the Royal College of Midwives is pressuring the government to recruit 5000 more midwives. This would undoubtedly inprove choice and help a system straining under rising birth rates. But some, including Toni Harman, Producer of Freedom for Birth, feel that this does not go far enough. "More midwives would help, but would not solve the problem of the routine Human Rights violations happening within the UK maternity system. There needs to be a complete culture shift within the obstetric community to make women the true informed decision-makers in their births."
This 'culture shift' is at the core of what is demanded by those calling for a 'birth revolution'. Campaigner Holly Lyne told me, "The way maternity services are commissioned is fundamentally flawed and the emphasis on risk assessment and fear of litigation are leading to massive amounts of costly, ineffective and traumatising intervention." Independent Midwife Nicky Garrett added, " I was trained to provide holistic woman-centred care and found that it was impossible to give that service within the NHS. The care for women was fragmented, paternalistic and pared to the bone, and the job satisfaction was zero."
The importance of a positive, normal, low intervention or no intervention birth extends far beyond the individual. Women who demand better births can sometimes be accused of selfsishness, and organisations suggesting less epidurals have this week been declared anti-women. But how we birth has a huge impact on early bonding and attachment, breastfeeding, PND rates and more...which in turn has long term impact on the mental and physical health of both mother and child...which in turn affects the human race. There are plenty of ways to join the birth revolution, and it matters: true freedom in birth really could change the world.