On September 20, 2012, the groundbreaking documentary, Freedom For Birth, by film makers Toni Harman and Alex Wakeford, was shown in over 1000 screenings and over 50 countries around the world. I hosted a screening in Raleigh, NC, and while we only had six people attend, I cannot adequately express my excitement at being part of this larger movement to benefit birthing mothers and their attendants. But under the excitement is a call to action based on the tragic state of birth in our world. Given all we know about physiological birth and the overall desire in our society to uphold the rights of the oppressed, it is unfathomable that mothers, infants, and birthing professionals are literally battling for what is arguably the most basic human rights to be free to give birth where, when, and with whom they choose. This is not a simple issue or a case of some minority complaining over a preference. It is a matter of a grave violation of human rights, human mothers and human infants, in perhaps the most vulnerable time of any human's life. I've seen a lot of blogs and articles speaking out for mothers' rights following the Freedom For Birth screening, but I feel like we've yet to really go far enough. I get the sense that women are afraid to be angry, as if we will be criticized (as we often are) for overreacting to the issue of how mothers and babies are disrespected and abused in birth. If there is one message coming through loud and clear through the work of the One World Birth team and their supporters, it's this: You are right to be angry! Procedures done to your body without your informed consent are abuse, no less real than someone punching you in the face! It's a violation of your rights as a human being! Just in case this seems too extreme, let's take a step back and examine the issue, based on facts, and you can draw your own conclusions. And that, my friends, is what we call an informed decision.
First, let's consider the phrase “human rights violations”. This might bring to mind Nazi Germany, Democratic Republic of Congo, and our own history of human slavery followed by the Jim Crow era. Now consider the phrase “I'm a doctor”. You might envision a plane crash or other emergency setting, a heroic individual rushing forward to lend assistance in the midst of panic and chaos. Our culture teaches us to categorize these two concepts very differently. Those who violate human rights are monsters, untrustworthy, cruel, serving a personal agenda at the expense of others. Those who serve as doctors are life-saving, quick-thinking under pressure, making difficult decisions while keeping their patient's health, well being, and best interests in mind. If you were to suggest combining these concepts, imply that a doctor might be capable of violating human rights, people start to shift in their seats, grumble, look away, or even become aggressively defensive. A doctor would never violate human rights. A doctor has sworn an oath to “first do no harm”. A doctor can be trusted. To imagine otherwise is frightening because there are times in life when we must hand ourselves, our lives, or the lives of loved ones over to doctors. There are times when the law requires us to involve a doctor, our families pressure us to seek assistance from a doctor, or we fear the outcome of not having a doctor present. What happens in these circumstances if the doctor can't be trusted?
This scenario is playing out all over the world for women in childbirth. I don't mean to demonize all doctors; there are some truly revolutionary, brave, amazing doctors in our world on the front lines for women's rights in childbirth. But... there are many more, some working out of ignorance, some out of malice, who have taken part in a global effort to control birth for their own convenience or out of fear. While it is human nature to fear things we don't understand, it is human failure to not try to understand the things we fear. And in this, our doctors have failed us.
To be fair, it isn't just doctors who are fault. Our culture supports an ideology of fear, ignorance, and lack of faith in female physiology, all tied into a history of misogyny. If we're honest, women's rights have been violated for time immemorial. We have struggled for equality, for representation, for education, for security, for safety. We have sought to balance our feminine nature and instincts with a need to be free of social/cultural pigeonholing. We've come to expect a fight by virtue of being female, and society delivers. When you put this in the context of birth and becoming a mother, it becomes clear why the freedom of informed choice in birth is really about human rights and in particular women's rights. We've been numb to the rights of birthing mothers for far too long. It's time we call it like it is, acknowledge the human rights violations that have become normalized in our society and around the world, and then... do something to change the status quo and take back birth!
Just how bad are the violations I'm talking about? Let's look at some basic facts. Currently, the national average for c-section delivery is 32.9%.1 When you look at the rates by individual state, you get an idea of just how influential one's location alone can be on the chances of having a c-section. Did you catch that? Location! Not health, not emergency need, not because it's the best thing for the mother or baby. Just by virtue of where you live and what the trends are in your area. Who decides these rates? What criteria are used to determine these rates? Are women in one state that much less capable or less healthy in giving birth vaginally than in another state? If you can't answer these questions for where you live, call your local hospitals and OB-Gyn offices and see if they can.
C-sections are so normalized in our society that a lot of people don't find the current rates that problematic. Maybe they see these numbers as an indication of a real need. So let's look at some other troubling facts, such as vaginal exams being performed without consent while a patient is under anesthesia, rates of interventions in labor, maternal and infant mortality rates, and of course there are barbaric practices like the husband's knot2 (still in use!), which as its name implies is definitely NOT for the benefit of the woman. When you consider the prevalence of these procedures and statistics in a society so proud of its medical advances, you might begin to question the necessity and safety of a lot of our common medical practices, particularly in obstetrics.
So if a mother does question certain common procedures, if she decides that birth is not a disease in need of curing, if she chooses to follow her instincts and engage birth as a process her body inherently knows and her baby actively participates in with her, how is she received? What are her options? What are her rights? Sadly, a woman's right to give birth as she chooses, where she chooses, and with whom she chooses is extremely limited, especially in the US. This has not always been the case, and in fact the history of modern gynecology/obstetrics and how birth was stolen from women warrants its own article (in the mean time, check out pretty much anything by Sheila Kitzinger).
One of the options women have exercised for millennia is home birth, an option that is currently under attack around the world. Part of the focus of Freedom For Birth was the case of Agnes Gereb, a midwife who is currently under house arrest in Hungary for attending women giving birth at home. This hits especially close to home for me. In my state of North Carolina, while it is technically not illegal to give birth at home, women have a hard time finding adequate support to do so. Our CNMs (certified nurse midwives) are required to work with an OB and deliver at the hospital. Our CPMs (certified professional midwives) have gone underground or stopped practicing following recent events. Providing licensure for CPMs in NC would offer them a legal way to practice their calling and offer mothers the assurance that their birth professionals really know what they are doing and have some level of legal accountability. Instead, our state has chosen to attack home birth as dangerous in general and apply the threat of legal action for those assisting women at home. This does make home birth dangerous. Desperate mothers will either try to birth at home without professional support, or they will seek the help of someone with questionable credentials.
Luckily, the argument against the safety of home birth is being negated by study after study in recent years (here's a very recent one). More importantly, women are waking up and demanding the option to birth at home, not just because they prefer it or are crunchy granola hippies (nothing against crunchy granola hippies; I'm fairly crunchy myself), but because they've done their homework, understand what their bodies are capable of and don't fear birth, and because they are tired of having this decision taken away from them. This is obvious by recent events such as Where's My Midwife rallies, The National Rally for Change put on by ImprovingBirth.org, and the Freedom for Birth screenings. These are all positive steps in the right direction that generate media attention and start conversations to bring about real change and education. But there are still too many women in the world suffering trauma, abuse, and even death (themselves, their babies, or both) to drop our guard and proclaim victory.
I'm so proud and grateful to have had the opportunity to participate in the Freedom For Birth screening event. I'm honored to know Toni and Alex personally (see my article about their visit to Raleigh in November 2011). I'm humbled by the passion and energy I'm witnessing in the birthing community, among moms, and growing within the medical profession as more OBs partner with midwives, push for the rights of their patients, and just listen to the cry for support and freedom that is growing louder as we connect human to human. Again, this is a fantastic beginning, but we have a long way to go. You can be a part of this movement for change and help reclaim birth for women all over the world. You can help create a world where women can birth safely where they feel safest, whether that is at home or in the hospital, where interventions occur to save lives and not to get a doctor home in time for dinner, where c-sections are performed in times of real need, hand in hand with a genuine respect for the female body, and trust in the process that affects every single human on this planet. You can help educate women and doctors alike to stop fearing birth. You can help create freedom for birth!
2In her book, Essential Exercises for the Childbearing Year, Elizabeth Noble has this to say about this procedure: “This 'knot,' which is actually an extra stitch or two, does not restore any PF [pelvic floor] function for the woman; it merely makes the vaginal entrance a little tighter. The name is significant since it reveals not only a sexist bias but implies that the female vagina is quite passive and therefore improvements need to be structural instead of functional. The women's needs, as the name indicates, are totally secondary! Sometimes an actual tuck is taken as the birth canal outlet is sewn up 'as tight as a virgin' after an episiotomy...This can cause pain to the woman during sexual penetration.”
You will have a visit from your provider 24 hours after the birth and then 72 hours after the birth, and then once a week thereafter typically anywhere from 6 to 12 weeks postpartum. If you are having any issues make sure you are candid with your care provider. See if you can have friends or family set up a meal and cleaning train for you. The more you can rest the faster you will recover. If you are having breast feeding difficulties your provider may recommend seeing a Lactation Consultant and never forget there is the La Leche League which is a free breastfeeding support group available worldwide.
Go back to: Step #11: Birthing Day
Go to: Birthing Methods Main Menu
Call your care provider, by this point you will have a great relationship with them and they will help you through it over the phone, putting your mind at ease until they arrive. Have your partner call whoever you were wanting to attend your birth (doula, friends, family, photographer) and if you changed your mind on having people there that is completely okay! Have your partner start filling up your birthing tub (if you are a fast birther, start this early as it takes awhile) or wait until your care provider comes and they will help with that. Keep in mind you can always top up the tub later on with hot water, if the water sits for awhile. This is a way better option than not having time to set it up. In fact if you have an inflatable pool, having it inflated and waiting in those last couple weeks is a good idea.
Make sure that if you are going to have your placenta encapsulated you contact that person so they know to be ready to do that. And remind your care provider that you want your placenta encapsulated so they can make sure that it gets bagged up and placed in your fridge or freezer appropriately.
Go back to: Step #10: Making Your Birthing Space
Go ahead to: Step #12: Postpartum Care
Go to: Birthing Methods Main Menu
Birth support? Isn’t that what my care provider is for? Well yes, however in some instances they are there to make sure nothing bad happens and recognize when a labor is not going right. Additional birth support can be helpful; they can remind you of things you wanted and make sure that you understand what is going in. What is the name of this support person? A Doula.
Go ahead to: Step #10: Making Your Birthing Space
Go to: Birthing Methods Main Menu
Now that you have scheduled your appointments, it is important to find out how they do tests, what tests, and when.
If there is informed consent then you should receive a form that states why it is recommended, whether statistically speaking it is worth while and any possible side effects or contra-indications to the procedure or test. Not all tests are mandatory, and some are, whether it is dictated by local government, care provider policy or hospital policy. If you are not sure, ask. They will tell you if it is mandatory, recommended or simply voluntary/encouraged. Ensure you know your options and are comfortable with everything going on in your body.
The Pelvic Exam looks for:
Go back to: Step #4: Appointments
Go ahead to: Step #6: Creating a Birth Plan
Go to: Birthing Methods Main Menu
This is a hard question to answer. You are going to need to have open dialogue and find out why your partner or family has reservations. There are tons of home birth videos on Youtube that you can watch to see the what a homebirth looks and sounds like. There are also documentaries out there like The Business of Being Born, More Business of Being Born, and Pregnant in America which go through many of the common misconceptions of homebirth and the risks of delivering in a hospital. Some answers may come from looking at statistics of risks. Those can be harder to find but they are available. Reading books written by Ina May Gaskin or Jennifer Block’s Pushed are a good place to start. Spiritual Midwifery by Ina May is one of the first recommended titles to mothers to be who want home births and Pushed looks at the history of birthing in America and where it currently is.
In the USA the CDC has a list of the statistics of home birth from 2009 and according to it, preterm home births was 6% compared to 12% at hospitals, low birth weight is at 8% for hospitals and 4% for home birthers. Here is the link for this data and also to see what some of the other statistics are. These are American statistics and the data is much different in other countries. Europe has a much higher concentration of midwives to OB/GYN’s and has a much higher home birth rate.
When it comes to family it can be difficult for them to understand your needs and to remove their own fears from your particular situation. Having open conversation is again the most important thing to do. You need to stick to your guns and hopefully they will respect your decision regardless of their personal feelings.
Go back to: Step #2: Whether to Find a Care Provider or Not
Go ahead to: Step #4: Appointments
Go to: Birthing Methods Main Menu
Keep up to date with changes and updates with newsletter via email . Contests, new articles and much more!