Today the Grand Chamber of the European Court of Human Rights made an important ruling on home births.
In the ECHR Grand Chamber judgement on Dubská and Krejzová v. the Czech Republic. Application nos. 28859/11 and 28473/12, the Chamber held, by twelve votes to five, that there has been no violation of Article 8 of the European Convention on Human Rights.
Essentially, the court decided that a European state can use its own "margin of appreciation" when it comes to home birth.
That means European countries don't have to fully support home births. They have "wriggle room" when it comes to allowing home birth.
Here's the details of the case:
With the Dubská and Krejzová v. the Czech Republic case, two Czech mothers appealed to the European Court of Human Rights claiming that they had no choice in their births; that if they wanted to be supported by a midwife, they had to give birth in hospital. The mothers claimed that this was a violation of Article 8 of the European Convention of Human Rights, the right to respect for private and family life.
Sounds fair to me.
However, today the Grand Chamber of the European Court of Human Rights agreed with an earlier Small Chamber ruling from 11th December 2014.
In today's ruling: No. 73. "The Chamber held that the respondent State was entitled to a wide margin of appreciation on account of the need for an assessment by the national authorities of expert and scientific data concerning the relative risks of hospital and home births, the need for strong State involvement because of newborn children's vulnerability and dependence on others, the lack of any clear common ground among the member States on the question of home births and, lastly, general social and economic policy considerations, such as the allocation of resources to set up an adequate emergency system for home births."
In other words, as there was no consensus about home births across Europe, and that home births might involve additional financial expenditure, for example in providing adequate emergency support for home births, the Chamber concluded that countries in Europe had room for manoeuvre ("wide margin of appreciation") on this issue.
One phrase really stands out from today's ruling, from point no. 183. "Moreover, contrary to the applicants' submissions, the Court finds that among the member States of the Council of Europe there is no consensus capable of narrowing the State's margin of appreciation, in favour of allowing home births".
Allowing home births.
In using this emotive patriarchal word, the case almost becomes about whether or not home births should or not be allowed in certain European countries.
I have a very difficult time with the word "allow" with respect to women's rights in childbirth. So often you hear from mothers:
"I wasn't allowed a water birth"
"I wasn't allowed to go over 41 weeks"
"I wasn't allowed a home birth"
Who decides what is allowed / not allowed? Presumably, in most cases it's doctors not allowing something based on their assessment of risk or because it is against hospital policy.
And why isn't the mother the one that decides?
As a documentary filmmaker, I've had the privilege of filming at five home births. At all these home births, there's been no unnecessary prodding, poking or forcing of women to do something they didn't want to do.
Three of the home births I've filmed have been beautiful, amazing, wonderful, empowering and life-changing to me as an observer.
Surely, every mother has the right to choose this? To choose where and how she gives birth? To have the right to choose home birth, and to be fully supported in that choice?
I know home births are not always straight forward. Sometimes mothers require additional medical assistance and sometimes an emergency transfer to hospital.
Two of the home births I've filmed did involve a transfer to hospital - one because the mum wanted more pain relief, the other because there was meconium in the baby's waters (the baby was born in the ambulance - and all was fine).
It seems obvious to me that home births need to be fully integrated into maternity systems so that adequate emergency services are available if needed. And yes, this could have cost implications.
Not every mother would choose home birth with a midwife (and with emergency services available), but surely it should be a fully supported choice. But surely, the option of home birth should be allowed.
Home birth is a fully supported choice in the UK. Under current NICE guidelines, home birth and birth at a midwifery-led birth centre are both recommended choices for mothers with healthy, uncomplicated low-risk pregnancies. So even with its very limited funds, the NHS "allows" and fully supports home births.
Round of applause to the NHS.
It's time for other countries to catch up with the UK with regards to supporting women's choices in childbirth. It's time for the majority of the Grand Chamber of the ECHR to catch up. Indeed five members of the Grand Chamber have already caught up. They voted against today's judgement - their words at the end of judgement are very powerful and fill me with hope. (Scroll down to the bottom of the judgement on this link: http://hudoc.echr.coe.int/eng?i=001-168066)
DISSENTING OPINION OF JUDGES SAJÓ, KARAKAŞ, NICOLAOU, LAFFRANQUE AND KELLER
"To our regret, we are unable to share the view of the majority of the Grand Chamber that there has been no violation of Article 8 of the Convention in the present case. In our opinion, the relevant Czech legislation renders home births de facto impossible given that it creates excessively rigid requirements regarding the equipment needed for a birth, which can only be met in hospitals. This constitutes an interference with mothers' freedom of choice that is not proportionate in a democratic society."
I agree with the five dissenting judges. It's time for all women to have fully informed choice in childbirth in every country, and this includes full support for home birth. It's time for all choices to be fully respected and fully supported by every health professional and every maternity system. In a democratic society, all mothers should have full freedom of choice. Including in the Czech Republic.
Toni Harman is the Producer / Director of the documentary FREEDOM FOR BIRTH.
For a limited time, FREEDOM FOR BIRTH is now available to buy on DVD with a free Public Screening / Education License to help spread awareness about human rights in childbirth.
DVD available to purchase from: http://www.oneworldbirth.net/project/freedom-for-birth/
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