Is Birth A Political Issue?

Newborn Sleeping

Sparked by some comments on my previous post (which I am still formulating replies to, so bear with me) I have been wondering when childbirth stops becoming just another set of choices, and when it transforms into a political issue.

A commenter very insightfully pointed out that putting the safety of the unborn baby over the safety and autonomy of the mother during birth – specifically home birth – is edging close to arguments over abortion rights. This really made me think about the balance between the baby’s ultimate safety versus the emotional and physical safety of the mother.

It is pretty standard thinking that the #1 most important goal of a birth is the delivery of a live and healthy baby. That’s not to say that the experience of the birth is not important – my God, it’s so important – but the ultimate ‘prize’, if you will, is the soft, warm bundle at the end. For the vast majority of mothers, nothing else is as important as that and I for one will gladly, gladly give up my perfect birth experience in order to ensure that my baby makes a safe entrance to the world. If a caesarean is the only way to get my baby here in one piece, grab the scalpel and go nuts. If an induction is going to save my baby’s life, crank up the Pit. Do whatever the hell you need to do to ensure my baby is safe – that is my choice. My choice – this is the key phrase here – Don’t you dare do any of those things without informing me truthfully as to why they are necessary, and without giving me the final say in my care.

The question I want to ask is this – In obstetrics, why is the mother’s autonomy often overruled by the safety of the baby?

Imagine this situation, if you will – one of your children is very ill in hospital. It could go either way. The doctors give you a range of options for treatment, and you also have the option to forego all treatment for your child and simply let nature take its course. You would be given information on the risks and benefits of each treatment, possibly counselling to help you come to a decision, and when you made your choice – even if that choice was to forego treatment and allow your child’s life to end naturally – nobody would try to browbeat you into changing your mind.

Your right to choose the prenatal and birthing care that you see fit is absolutely as important and valid as your right to choose whether or not you take antibiotics for an infection, whether you or your child receives vaccinations, or whether you choose to get checked over after a knock to the head.

Now, I am aware that birth is a different kettle of wombats. Often, the life-and-death decisions need to be made very quickly in order to ensure everybody’s safety. If an unexpected complication crops up during labour, you won’t have the time to agonise over it, discuss it at length with your OB or midwife, or go online to ask Dr Google what he thinks. The point I am trying to make is that with every other facet of healthcare, we are given full autonomy over decisions pertaining to the health of ourselves and the health of our children. So why is obstetrics so different? Why are some women browbeaten into choosing something they don’t want? If Modern Medicine is so intent on viewing labour and birth like a disease, with the death of the baby likely or even imminent, why aren’t labouring mothers afforded the same basic respect that the mother of a dying child would have?

Now, I’ve strayed away a little haven’t I? Allow me to get back on track.  Lets use unassisted childbirth as an example.

Before I continue, I want to be honest about my personal opinion on unassisted childbirth (UC). I personally feel that it is a risky decision to make. I understand WHY women choose to birth unassisted – I even considered it myself for a time when I fell pregnant with Squishy – so please don’t all jump down my throat and accuse me of judging anybody. Even if I don’t agree with a woman’s choice, I will fight, tooth and nail, to defend her right to that choice. Just because I don’t agree with unassisted childbirth does not mean for a second that I think it shouldn’t be an option, or that it is not indeed right for some women and their families. I will post about this another time, in more depth.

What bothers me is that it is so flippin’ hard to access the right information in order to make these decisions safely. Statistics on complications of birth are easy to twist to fit an agenda, and finding unbiased information is very difficult. For this reason, we know it’s important to seek a care provider that you can trust. Even most UC’ing mamas I know opt to have prenatal care either with an OB or midwife, so that they can feel more secure in their safety of birthing at home.

A woman’s right to birth how and where she pleases absolutely cannot and should not be taken away. Your right to choose the prenatal and birthing care that you see fit is absolutely as important and valid as your right to choose whether or not you take antibiotics for an infection, whether you or your child receives vaccinations, or whether you choose to get checked over after a knock to the head. You have the right to correct, current and unbiased information in order to make an educated decision. We should be able to trust our doctors and midwives to assist us in making those choices.

What I haven’t quite figured out yet is exactly how this relates to the arguments over abortion rights. Does putting a woman’s right to autonomy above her baby’s right to be born safely mean that the baby is more important?

I have to say I take issue with this comparison.

The question I want to ask is this – In obstetrics, why is the mother’s autonomy often overruled by the safety of the baby?

The current law on informed consent states that if a patient is unable to make a choice that could mean life or death, that the doctor in charge is legally permitted to make that choice for them. An example – a woman in labour is in trouble. She’s bleeding heavily, her baby is in distress and she is slipping in and out of consciousness. She is not physically able to give consent to the lifesaving treatment that she needs. In that situation, where both the baby and the mother are in physical danger, it is legally required of the doctor to put the mother’s safety first (I may be wrong here, please feel free to correct me if this is the case). I don’t think anybody would blame the doctor here for taking action when he could have simply let them die.

So what of this situation? – a woman in labour at home becomes hysterical (this can happen thanks to all of those hormones, physical and mental exhaustion, possibly drugs, lack of sleep etc) and refuses the transfer to hospital that is needed in order to save the life of her baby. It is explained to her over and over that her baby is in severe distress and needs to be born right away or the risk of them dying is very high. She continually refuses to transfer because, in her altered mental state, she doesn’t fully understand the implications of her choice. The midwife makes the uncomfortable decision to call for an ambulance regardless of her wishes and she is taken kicking and screaming to hospital, where she is sectioned against her will and her baby’s life saved.

Although I’m sure this situation is incredibly rare, I’ll bet it has happened. Is that an infringement of her rights? Or is it thoughtful and responsible, albeit forced, care?

What I am really asking is – are there some specific situations in which the mother’s autonomy SHOULD be overruled by the safety of the unborn?

Please share your opinions and insights in the comments below!

Comments

  1. Becky says

    Interesting question, I’m looking forward to following the discussion. I will point out that there are times, at least in the United States, where the courts will step in and demand that a child get medical care, even against the wishes of his parents. Generally this is not in a case that “could go either way” as you describe above, but when a clear standard of care is being refused, such as providing insulin for a type 1 diabetic. Of course, this doesn’t affect the bodily autonomy of the woman in the way that an intervention at birth does.

    • says

      That’s an interesting point, and you’re right… I imagine the same would be applicable here. It would likely be considered neglect if a parent refused treatment for their child for something like diabetes or asthma.

      Thanks for commenting! I, too, am looking forward to reading what people have to say on this one. I really don’t think there’s a clear cut answer.

  2. April says

    This line is the what the whole issue is about. We cannot come to a consensus about when to save the mothers’s life vs. the life of the baby. In my opinion, there needs to be another person, a partner or a doula (not a doctor or a midwife) that knows the wishes of the mother and can act in her behalf if she cannot. Then, if the woman chooses an unassisted birth without even a partner or doula or if she chooses to override her partner/doula, then she is knowingly choosing the uncertainity that may come up during her labor. It is still her choice. We, as parents, should have the choice. We mush take our own responsiblity that our choices may affect the life or death of our baby during labor. In our current society, we have handed over the responsibity for our baby’s life to the medical system and will sue if the outcome isn’t favorable. Either, we need to be responsible or we need to allow the doctors to be responsible. We need to accept that sometimes mothers or babies die, both at home and in the hospital, regardless of what we do. We need to accept responsibility for our choices and make decisions that we each individually feel is best for us.

    • says

      I feel what you said about responsibility is bang on the money. That’s why we need easy access to the right information so that if we make a choice that turns out to not be a good one, we can put our hands in the air and accept that it was always going to be a possibility. It’s just difficult when that bad outcome might include the death of another human being – the baby.

      Yes, mothers and babies unfortunately do die – it’s a part of the life cycle, albeit a tragic one. I think the issue arises when a death occurs that could have easily been prevented, had they been in a different place. Which then of course brings us back to responsibility for the death, and back to the question of whether the mother’s choice is more important than the life of the baby. This pertains not just to home and unassisted birth, but could pertain to a mother choosing to pay for a private elective caesarean because she doesn’t want to go through labour.

  3. says

    This reminds me of how, once a person has a child, the public seems to have an interest in it. Telling the parent how to raise the child (unsolicited advice) all the way to actually having the right to report them for not being a good parent and possibly taking the child away (doctors, teachers, etc. all have this as their duty, for example.)

    I personally appreciate that people care about a child that is not theirs. We complain that it takes a village to raise a child and that it’s hard to do on our own, but then brush away any outsider’s involvement as an unnecessary interference. Their advice may not always be good, but the intention is there and I think that’s something to be valued.

    In the specific case you cite, that of a labouring mother, no I don’t think it should be entirely up to her. I think she has a right to decide the nuances, but when it comes to medical care, it is up to the professionals to decide the best course. Of course, in an ideal world, medical professionals would always be very wise and know the right course. . .so all we can do as patients, I think, is choose the best caregivers and place a lot of trust in them. Once a person is in labour for many hours or days, it becomes very hard to think clearly. For those whom labour only lasts a day or less, well, that is probably a different story but nonetheless, reading a few books and websites even over the course of years, such as I have, is no substitute for years of real world experience and specialized degrees (such as those midwives, OBs and L&D nurses have.)

    That said, we could choose caregivers that seem incredibly supportive and knowledgeable yet change completely once we are in labour, as was the case for me my second time around. I knew something was wrong and begged to go to the hospital for a couple hours before they took me, not for the reason I wanted, but because they thought I wasn’t pushing enough and wanted to get me some pitocin (I had been in active labour for 13 hrs and pushing for over 2 at 10cm dilation.) My midwives even tried to override me at the hospital, telling the OB to give me pit as I screamed no, and tried to explain what was going on even as I was in the most dire agony and my son was going into distress. Fortunately the OB listened to me, not them, checked me out carefully, and realized I knew what was going on better than them (my son was posterior and transverse, with his head flexed in a way that the OB could not even move him without endangering his life, plus he was in such distress there wasn’t even time if he hadn’t had his head flexed in that way.)

    All that to say that sometimes that it’s a very complex subject without any clear answers. The patient knows better than anyone how they feel and what is going on, most of the time. It is then up to the medical professional to be skilled enough to make the right assessments and call for the right course of action. It really is a matter of both sides working together. If one is really out of it or incompetent, then yes, I think the other side needs to make the call to take over, that is the patient requesting a second opinion or new caregiver, or the doctor doing what they have to to save both baby and mother.

    • says

      Thanks so much for sharing your story here. I think it’s an important one. I’ve said it before and I’ll say it again – I’m so sorry you went through that. It’s such a shame that your “midwives” didn’t listen to you, the woman, the birthing mother.

      I agree with you in that both sides need to work together. For me, in a perfect world, caregivers would always be very hands-off, allowing the mother to make the decisions with regards to her care, and then if they *did* suggest interventions the mother could fully trust that it was necessary.

      Going beyond all of this, though, I feel the ultimate choice still should rest squarely on the patient’s shoulders, assuming that they are mentally and physically fit to make that choice. One of the big problems is that, according to the law on informed consent, being in active labour (above 3 or 4 cm dilated, I think) constitutes being unable to consent. THAT really concerns me.

      Thanks so much for your thoughtful and insightful comment :)

  4. Courtney says

    I always have trouble when people bring up the mother’s autonomy during childbirth and compare it to an abortion. The trouble is that I often here people say, “Women choose homebirth because they believe it to be healthier and safer for their baby.” I often hear that women who choose to homebirth are not intentionally endangering their baby.

    How do we reconcile the right to refuse potentially life saving/injury preventing treatment for a baby at the time of birth with choosing homebirth as a safe and loving choice for the child’s entry into the world.

    I wouldn’t agree or feel that same way – but I could accept it if a woman openly said they knew their choices were more dangerous to their baby but they were okay with loosing that child to a preventable death. I know for some women, particularly in some religions, a large family is of high value and importance. If concerns about repeated pregnancies after a c-section mean that a woman prefer to let the current baby go it is certainly her right. However, it is not her right to claim that ‘the baby would have died in the hospital too.’

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Notify me of followup comments via e-mail. You can also subscribe without commenting.