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Freedom for Birth - Can Anyone Argue Against Respecting Women's Rights in Childbirth?

Posted: 03/12/2012 00:00

Childbirth has become a battleground of opinion. Any discussion about birth can quickly descend into a polarised debate; natural childbirth vs technological birth, home birth vs hospital birth, your view vs someone else's view on what is the safest or best way to give birth.

I believe underpinning all these issues is respect for a woman's right to make decisions about her own body. When I started making the documentary film FREEDOM FOR BIRTH with my partner Alex Wakeford, we (naively) thought how could anyone argue against a woman's fundamental Human Right to choose how and where she gives birth?

FREEDOM FOR BIRTH features academics, lawyers, doctors and midwives all calling for women's rights in childbirth to be respected and women to be afforded real choice in birth. The film highlights how, in some countries today, women who want to have a normal vaginal birth are sometimes forced by judges to have c-sections or are threatened with having their child taken away by child welfare services. In some countries, if a woman wants to have a home birth supported by a midwife, those midwives face criminal prosecution. Some midwives like Ágnes Geréb in Hungary have even been imprisoned.

2012-11-30-FFB_LOGO1.jpg

We launched the film on 20 September this year with over 1,000 screenings in 50 countries in 17 different languages. We estimate that up to 100,000 people worldwide saw the film on that day. After the screenings, we had thousands of supportive messages from people appreciative that we were raising awareness of this as an important global issue.

There were also some objections. Australian obstetrician and former Australian Medical Association President, Dr Andrew Pesce, said the film was not relevant to Australia as it was "a long bow to draw" to compare the experiences of a jailed Hungarian midwife and Australia.

Recently an article about planned home birth called 'Planned Homebirth: The Professional Responsibility Response' was published in the American Journal of Obstetrics and Gynecology. In the section addressing "respect for women's rights", the authors concluded,

"from the perspective of the professional responsibility model, insistence on implementing the unconstrained rights of pregnant women to control the birth location is an ethical error and therefore has no place in professional perinatal medicine. An editorial in Lancet succinctly summarized this point: "Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.""

The obstetrician Dr Amy Tuteur recently wrote a blog-post criticising the film (which she hasn't seen) and the Human Rights in Childbirth conference which took place at the Hague earlier this year (which she didn't attend). Dr Tuteur's main objections were that the organisers of the conference and myself are well-off white Western women holding conferences and making films for well-off white Western women. That we don't focus on abuses happening in developing nations and hence the use of the term "Human Rights" to describe violations in rich industrialized nations is "morally grotesque."

It's true, the film exposes routine Human Rights abuses happening in the developed nations. If you total up populations, that's over one billion people. This includes the 800 million citizens living within the jurisdiction of the Council of Europe who are directly affected by the European Court of Human Rights holding (Ternovszky vs Hungary, no. 67545/09, 15 December 2010) saying that a woman has the legal right to choose the circumstances of her birth.

Horrific abuse in childbirth happens every day in developing nations where women and their babies are often denied access to life-saving obstetric care. In fact, we intend to focus on this in a future film.

I believe that just because "worse" Human Rights abuses are happening elsewhere doesn't mean that a film shouldn't draw attention to what is happening now across Europe, the Americas, Australasia and beyond. With the incredible wealth and resources of industrialised nations, you might hope that these countries would get things right, that women's rights would be fully respected, that these countries would set a positive example.

Generations of women have fought for the right to equality, for the right to make decisions about your own body, for the right to have full informed choice and for the right to be respected, yet it seems when it comes to childbirth, some people believe those rights should be surrendered.

We are about to release a free-to-view 15 minute abridged version of the film. We want people to watch it and make up their own minds. We made the film not just because we wanted to reveal a difficult truth but because we wanted to start a conversation with all sides that will bring these issues into the mainstream. We want the film to spark a debate and for that debate to lead to change.

We want all women to be afforded real informed choice as to how and where they give birth, for all women's rights to be fully respected by all care providers and for Human Rights violations to end.

Can anyone argue against this?

FREEDOM FOR BIRTH will be released on youtube on 17th December. http://freedomforbirth.com

For information about Human Rights in Childbirth - http://humanrightsinchildbirth.com

Join us on Facebook: http://facebook.com/freedomforbirth

 

Follow Toni Harman on Twitter: www.twitter.com/oneworldbirth

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06:39 PM on 12/07/2012
I watched the movie, and then I went home and Googled to learn more about what happened in the case that got Agnes Gereb behind bars. A baby died from mismanaged shoulder dystocia from attempting to use the "Martius maneuver" which does not actually exist in any obstetrical literature that I've seen at all. Reports that I read regarding this case suggested that Ms. Gereb may have snapped this infant's neck while attempting to delivery him/her.

That baby's death was just thrown away by this film, a choice that I find absolutely horrifying. If Ms. Gereb botched a delivery that badly, why on earth should she be lifted up as some sort of heroine by the natural childbirth movement? Completely unacceptable.
07:56 PM on 12/07/2012
It's par for the course: doctors want to injure and kill women and babies, but how dare officials investigate midwives who presided over the deaths of infants.
09:07 PM on 12/07/2012
Well, a few dead babies is nothing compared to my own selfish needs.
03:35 PM on 12/07/2012
Does the movie blame all adverse outcomes in a hospital on doctors while simultaneously expressing outrage that homebirthers are investigated when a baby dies? Because that's what commenters here are doing.
05:32 PM on 12/04/2012
I'm all for this! But the article only emphasises the right to a HOME birth. In NL home births have been common practice for decades and it's actually the standard, resulting in the midwife & mama maffia (as I call it) that puts enormous amounts of pressure on women who want a hospital or clinic birth - let alone with an epidural! - that they're unnatural, selfish and basically not a good mother for wanting this. Some numbers: 50% of home births end up in the hospital anyway because of unforseen complications (not nice to be transported to a hospital in the middle of labour) and NL actually had a rather high infancy mortality rate which was believed to be partly caused by the home birth standard. Freedom of choice with information about the risks should be standard, on both sides women are being bullied and pressured.
04:48 PM on 12/18/2012
That 50% statistic is pretty far off. The transfer rate for (planned) home births hovers at around 12%, not 50%. And the statistics for planned home births are encouraging in other areas as well. In the US at least, the cesarean section rate for hospital births is 34%, while the rate for planned home births is usually under 4%. The rate of maternal post-partum infection is also lower for planned home births, and the neonatal mortality rate for both kinds of births are pretty much identical no matter where you choose to give birth (see the British Medical Journal for more stats). But I agree, any amount of bullying on either side is detrimental. In my experience, though, women tend to be undereducated about home birth/natural birthing.
07:39 PM on 12/18/2012
Actually it is not far off, but let me specify: 49% of home births of first time mothers is referred to a hospital because of complications in the Netherlands and 17% of mothers who have delivered before (at home) are referred to the hospital during labor. Obviously the second group are very low risk because they have done it before without complications.
Anyway, one of my points is that home birth is considered the perfect option by people in countries where hospital delivery is standard. But I can say coming from a country where home-birthing has been the standard since forever that it's not the perfect solution or necessarily "better" than hospital births. I would say leave it up to the woman giving birth what she wants to do...
08:42 PM on 12/03/2012
I have not watched the film in full, but I have watched the trailer and associated video clips on the One World Birth website, and I think one of the problems is its emphasis on just one end of the spectrum of birth choices - that is, home birth and birth with minimal medical intervention.

My personal birth choice was a planned cesarean, and I was lucky in that I found a supportive obstetrician. Too many other women are not as lucky, and either have to fight to have their birth plan preference respected and supported or are forced to have a trial of labor against their will.

Hopefully a future film will include the voices and rights of these women too because, as it stands, I'm afraid it represents a rather limited call for 'all' birth choices.
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02:25 AM on 12/04/2012
I agree - the arguments here seem to be that womwn have the right to choose home birth. How about the women who choose intervention, medication, etc.....
01:46 AM on 12/08/2012
I guess they aren't "real women"
01:47 AM on 12/08/2012
I guess they are not "real women"
06:44 PM on 12/03/2012
I hosted one of the 1000 sites during the world premier of this film on Sept. 20, in Pittsburgh, PA. Human rights in childbirth boil down to women having the right to choose their own care provider, the location of their birth and the medical interventions they have. Women have the right to informed consent and informed refusal.

When procedures are routine, birth is rushed, and babies are taken away from their mothers, the normal, physiologic birth process is disrupted. This is evident in obvious things, like breastfeeding issues, to not so obvious things, like maternal anger, disappointment and possibly emotional trauma.

Many care providers, many obstetrical practices, are not evidence-based. This is not only disheartening, but in some cases, dangerous for mother and/or baby.

This film is important. It's important for mothers to see, for care providers, for insurance companies...

Women are not second class citizens. We deserve to be treated with respect during pregnancy and birth.
05:34 PM on 12/03/2012
There is significant work to be done to include women in developing countries in this dialogue beyond fetishization, but saying that "human rights" don't apply in the west evinces a fundamental misunderstanding of the concept. Lack of access in developing nations is a human rights crisis, but it is not the whole story.

USAID's report, "Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth" (http://www.tractionproject.org/sites/default/files/upload/RFA/Respectful%20Care%20at%20Birth%209-20-101%20Final.pdf) uncovered human rights violations in over 18 countries, from beatings to coercion and shaming. These abuses drive women away from facility-based birth, and are a barrier to the Millennium Development Goal of decreasing maternal mortality by 75%. From this report, the White Ribbon Alliance for Safe Motherhood synthesized a charter, "Respectful Maternity Care: The Universal Rights of Childbearing Women." (http://www.whiteribbonalliance.org/WRA/assets/File/Final_RMC_Charter.pdf) These rights come from international human rights instruments that apply to all people.

The fact is that disrespectful care and threat of unconsented care drive women away from facility-based birth. There are women the world over who are pushed out of the system because they fear that they will be coerced or disrespected. Rather than derisively laying the blame the feet of parents making decisions in an imperfect system, we need to look critically at what can be done within systems and facilities to protect the rights to the highest attainable level of health, informed consent, liberty, and dignity.
03:47 AM on 12/03/2012
I can't actually think of any human rights violations with regards to childbirth in Australia. If anything, high risk women are free to choose a homebirth midwife, or an unassisted birth and have their baby die due to lack of adequate care. And the midwife doesn't face any consequences either other than perhaps having to give evidence in a coroner's court.
01:48 PM on 12/03/2012
I suggest to you that your understanding of this issue is lacking and while you are ignorant of the fact, I can assure you from firsthand experience that human rights violations are being routinely committed in relation to childbirth in Australia. I experienced this personally with my 1st birth in hospital which left me with PTSD and urinary and faecal incontinence. I gave birth this year at home in 6 hours to my beautiful healthy daughter despite being 'high risk' due to maternal age (41) and an overactive thyroid (medication managed).

How dare you imply that 'high risk women' are free to choose to birth at home at the expense of their child's health! No mother in her right mind would actively make a birth choice that exposes her child to unnecessary risk. Childbirth carries a small but inherent risk of injury/death to mother and/or baby and no amount of medical intervention will ever remove all of that risk.

I encourage you to investigate what actually happens to both parents and Independent Midwives when a child dies/is stillborn during a homebirth. Parents and midwives are treated appallingly in these circumstances with one mother I know whose daughter was stillborn at home being denied access to her daughter's body in hospital because her daughter was being held as 'evidence'.

I encourage you to do some research on the internet and educate yourself on the realities of human rights violations with regards to childbirth in Australia - knowledge is power.
03:31 PM on 12/07/2012
Childbirth is dangerous and painful. You are illogically assigning blame for your birth injuries the first time to the hospital, while being appalled that parents and midwives are investigated for babies deaths at homebirth. The cognitive dissonance is almost funny. You lucked out with your homebirth and you needlessly risked your baby out a need to feel comfortable.
09:15 PM on 12/07/2012
People do not get an education online, they get lied to and fed a bunch of nonsense by people who care more about their own ideology than the lives of babies.
01:25 AM on 12/04/2012
You seriously have no idea what you are talking about. Get an educated opinion, otherwise refrain from commenting. You just look ridiculous surrounded by people that know this subject inside and out.
02:37 AM on 12/03/2012
Being jailed, fined, or otherwise legally sanctioned for choosing to birth at home with a trained and licensed midwife does indeed sound like a violation of a mother's rights. So...out of all of Northern America, Europe and Australiasia (a population, as you note, of one billion), you have *how* many documented cases of this happening?
04:51 PM on 12/07/2012
Apparently, it's a violation of human rights if birth attendants are investigated after a baby's death. Unless the birth attendant is a doctor in a hospital-then it's all the doctor's fault.
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12:39 AM on 12/03/2012
I do tend to agree with the overall point of this article- HOWEVER I do agree the womans' right to choose how to give birth ends if it puts the child at risk.
04:06 PM on 12/03/2012
There is risk involved in a lot of common birth practices. Forceps or vaccuum delivery can sometimes, unfortunatly, harm the baby or even cause death. Most types of medical pain relief impacts the child, epidurals can lead to decreased oxygen supply to the baby, raspiratory depression and decreased fetal heart rate. C-sections lead to more cases of raspiratory difficulty than vaginal births, and is correlated with an increased difficulty to breastfeed. Pitocin gives strong contractions that uts a lot of stress on the baby, which can be very dangerous for it. So with your line of reasoning, women should not be allowed to give birth in hospitals. Is that correct?
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05:00 PM on 12/07/2012
You might be selling it, but I'm not buying it. C-sections save lives. They save lives.Formula saves lives. Epidurals ameliorate what is one of the most painful experiences humans can experience. For some reason, a movement has sprung up to try and make pregnant women distrust their doctors and choose danger and needless agony instead, because it is "natural". Well, I think I know the reason, actually. It's the same old misogyny that has always found virtue in making women suffer and martyr themselves, insinuating itself into feminism by using words like "choice" and "rights".
07:06 PM on 12/03/2012
What do you mean by "puts the child at risk"? Cesarean Sections performed by trained surgeons have plenty of risks for the child. Babies get cut by the scalpals. They fall into respiratory distress because their lungs don't get sqeezed, as they are designed to, during the vaginal birth process. There are some that are born too early due to C/S or inductions, so we're actually having a huge rise in premature babies, and of course that's a HUGE "child at risk" scenario.

I really do believe in these interventions, they were created for very valid reasons. However, when I mother believes that these interventions are actually MORE risky for her and her baby, she should be able to make that choice, without judgment.
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10:01 PM on 12/03/2012
By risk I mean the ultimate risk - DEATH or irreversible disability.    Not a couple of days in the NICU.  Lets make sure she signs that AMA document too.   
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MissTake1989
Equal means equal, hypocrites.
12:10 AM on 12/03/2012
If you decide to have the child in a way that the doctor opposes and it's born disabled, you shouldn't get a dime of public money.

Does that sound fair?
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01:44 AM on 12/03/2012
That makes the rather ignorant assumption the child wouldn't have been born with a disability otherwise or that the disability was connected to the act of birth itself.
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MissTake1989
Equal means equal, hypocrites.
02:52 AM on 12/03/2012
No, I made the specific hypothetical that the doctors made that diagnosis.

I find it funny everyone wants full freedom of choice, but not the "full freedom of responsibility" that comes along with it.
05:06 PM on 12/03/2012
sure - as soon as you find me a doctor so infallible that his medical malpractice insurer gives him rates as low as my car insurance!

doctors make mistakes all the time. that's why they don't, in general, have power of attorney over you as son as you become their patient.
11:46 PM on 12/02/2012
with 7 billion and counting we really should inject some sanith in reproduction....