Safe Birth is a Human Rights Issue
“While women in developed countries as a whole have a 1 in 2,800 chance of dying in childbirth—with some countries as low as 1 in 8,700—women in Africa have a 1 in 20 chance, and in several countries the lifetime risk exceeds 1 in 10.”[1]
No wonder the theme of next Fall’s Midwifery Today conference is “Birth is a Human Rights Issue.”
What topics would you expect to form the main focus of such a conference?
"UNFPA Provides Child Delivery Equipment in Timor-Leste" by United Nations Photo/CC-by-nc-nd via Flickr
- Ensuring access to effective birth control and family planning methods?
- Enhancing access to adequate pre-natal, intra-partum and post-natal health care?
- Improving maternal and neonatal outcomes?
- Improving access to effective pain relief for women in labor?
Guess again.
According to Jan Tritten, the organizer of this conference and editor of Midwifery Today, the primary human rights issue affecting women in their child-bearing years is abuse by medical professionals.
In her introduction on the conference web page, she writes:
“We will bring Birth Rights into the human rights arena. Women and babies are suffering abuses at the hands of medical professionals. Many of these abuses are similar to the travesties done to women in Africa and the Middle East. It is also similar to domestic violence.”
Actually, according to United Nations (UN) General Assembly Human Rights Council Resolution 11/8—the draft of which Ms. Tritten quotes in her “Birth is a Human Rights Issue” editorial in Midwifery Today—the primary issue is preventable maternal mortality and morbidity.[2]
The UN Millennium Goals task force report on child and maternal health upon which the Human Rights Council resolution was based notes the main causes of preventable maternal morbidity and mortality as hemorrhage, infection, unsafe abortion, and obstructed labor.[3]
What does Ms. Tritten plan to focus on in the welcoming session of the conference, entitled “Birth is a Human Rights Issue”?
“Every mother and baby has the right to be treated with reverence and respect during the birth process including pregnancy and beyond. We welcome you to this conference as we seek solutions to the problem of overmedicalization of normal birth. Safe and humane birth is a basic human right.” [Emphasis mine.]
This is in direct contradiction to the determination of the UN task force on maternal and child health, which states that:
“…if all women had access to the interventions for addressing complications of pregnancy and childbirth, especially emergency obstetric care, 74 percent of maternal deaths could be averted.”[4]
In other words, the most significant reason women and babies around the world are denied the right to safe and humane birth is the undermedicalization of birth.
In fact, little of the Midwifery Today conference program is actually about the human rights of mothers and babies as defined by the UN. Most of it seems to address the specific interests and preferences of the relatively small group of women fortunate enough to be able to take things like access to family planning and emergency obstetrical care for granted. For example there are several sessions on waterbirth, various presentations on birth stories and photos, and my personal favorite “human rights” issue, “Orgasmic Birth: Myth or Reality?”
Even sessions that purport to address human rights directly are, when one read the descriptions, really about reinforcing the particular anxieties of the group of “natural birth advocates” that presumably make up the audience for Midwifery Today:
Right to a Physiological Birth
We will talk about how women must be the most important part of their birth by facilitating body and psycho-emotional confidence and independence…Right to a Relationship with Parents
…Sensorial Perinatal Gymnastics (SPG) uses the latest scientific research on fetal awareness to help parents integrate the newborn into their lives, building skills for a lifelong relationship.Breastfeeding is a Human Right
Midwives sometimes put the woman’s right not to choose to breastfeed, [sic] over the child’s human right to obtain the optional nutrition as a baby…Homebirth is a Human Rights Issue
Explore the human rights aspect of homebirth as well as the many benefits for mother and child…International Issues
Denying women their choice in birth is a basic human rights violation; one of the many forms of oppression women experience in the world today. Women are sometimes coerced into undergoing unneeded medical procedures against their will and then being left to deal with the resulting pain and trauma.
These issues have little, if anything, to do with any of the issues identified by the UN Human Rights Council as central to the rights of women and infants.
Far from being “coerced” into “unneeded medical procedures,” millions of women are too often prevented from accessing basic lifesaving procedures—such as pharmacological interventions or cesarean section– that the sponsors of the Midwifery Today conference are fixated on helping the relatively small group of women who share their personal preferences avoid.
If you are interested in helping women around the world have safe, humane births, please consider contributing to one of these organizations:
CARE’s Mothers Matter campaign ~ Improve access to safe pregnancy and delivery services for 30 million women in Africa, Asia and Latin America by 2015.
The United Nations Population Fund (UNFPA) ~ Takes a multi-faceted approach to support the UN’s Milennium Goals for improving maternal survival rates, including improving access to medical care, reducing violence against women, and improving access to family planning methods. Also has a campaign to help women affected by obstetric fistula.
Women Deliver has a list of additional organizations promoting maternal health and reproductive rights.
I also recommend reading Kate Mitchell’s blog, Maternal Mortality Daily.
References
- 1. United Nations Milennium Project, Task Force on Child Health and Maternal Health, Who’s got the power? Transforming health systems for women and children, 2005, 99.
- 2. United Nations, Human Rights Council, Preventable maternal mortality and morbidity and human rights, Resolution 11/8, 2009.
- 3. United Nations Milennium Project, Task Force on Child Health and Maternal Health, Who’s got the power? Transforming health systems for women and children, 2005, 107.
- 4. Ibid., 26.
I do think improving low tech prenatal and birth care can have positive global ramifications. The WHO provides an excellent framework for this, and would love to see collaboration with homebirth midwives who work with a healthy, low-risk (in every sense of the word) population. Lisa Barrett, for example, does some amazing work with breeches in AU — if her techniques are getting to places where vaginal birth is not optional, then she is doing more than simply sparing a few privileged mothers unwanted surgery. I hope it is.
A wonderful post. It does open up my perspective in a very necessary way, and it does seem that ‘birth plans’ are indeed a privilege of those with access to advanced medical care and, well, basic human rights. A misdirection of energy, maybe?
At the same time, though, I have to wonder at, putting aside the medicolegal bits for a moment, how much energy is put into preventing women from attempting VBAC in this country, for example, when the worst possible catastrophe still gives a mother and child better odds than in parts of Africa.
NCB and midwifery advocates may very well have an undetected overwhelming sense of entitlement, but it was not created in a cultural vacuum.
Nor does childbirth cease to be a human rights issue in correlation with a nation’s per capita spending. I think it’s completely fair to remind US mothers that mothers in other countries don’t have any peas, but making US mothers eat peas they don’t like doesn’t feed those other mothers.
I’m in Baltimore, and I realized (from one of your links) that I just missed a public forum on global maternity care in DC by a couple of days. I definitely think I need to open my eyes more, and I do appreciate this post.
Thank you for your thoughtful comments.
I think “misdirected energy” is a good summation of my feelings about a specific branch, if you will, of NCB advocacy, and you’re right–safe, humane childbirth is indeed a human rights issue in every country, regardless of economic standing.
I have no quarrel with advocates who want more, better,and safer choices for women in wealthy countries (access to VBAC in the U.S. being an excellent example, and access to epidural in the Netherlands another.) I believe people like Jan Tritten and those like her actually damage those efforts because they operate from a position of emotion and hyperbole that allows others to dismiss more earnest and realistic efforts to improve care options for women.
This conference is a perfect example: it purports to be about human rights, but the many of the sessions seem to be about minutiae that are of limited interest even to women in wealthy areas. It’s self-aggrandization and, I think, insulting to advocates who are attempting to address real issues like VBAC access and increased access to midwives.
As you’ll see if you read my other posts on the topic, I have a particular beef with Ms. Tritten because she is among the worst of the worst of NCB evangelists-she attempts to elevate her personal preferences to a universal ideal for all women.
Thanks for responding. ^_^
Yeah — I read your summation of her 10 Commandments (I hadn’t run across them, before this) and …. wow. There’s really no other conclusion than that she is doing ‘natural childbirth’ absolutely no favors. She’s pretty much a whackjob, and it’s incredibly offensive, given the title of her conference, that she’s included a panel on orgasmic birth.
I think a fair case could be made that childbirth is probably the closest that wealthy nations (without domestic warfare) actually come to real human rights issues, and I absolutely agree with your comparison of epidural to VBAC. Neither should be restricted where there are the means to provide.
I hope to read more.
I’d say that access to healthcare in general is one of the most pressing human rights issues in the U.S., certainly.
Access to quality care (not to mention defining quality) and respect for the individual are issues that plague healthcare across the board.
I am also interested in end-of-life care issues–and it strikes me that maternity and end-of-life care share some challenges for patients and providers. Both carry the extra challenges that come with the heightened emotions and significance families experience at those times, and both have a significant subjective aspect to how “quality care” may be defined.
“I am also interested in end-of-life care issues–and it strikes me that maternity and end-of-life care share some challenges for patients and providers. Both carry the extra challenges that come with the heightened emotions and significance families experience at those times, and both have a significant subjective aspect to how “quality care” may be defined.”
And they are both unavoidable parts of the human experience — for the baby anyway. Birth and death are never going anywhere.
But I definitely agree that access to healthcare in general is of serious concern — it should never be a commodity, IMO. There’s no excuse. Not that socialized medicine is lovely and perfect, but…
I’ve just been sent this to read and felt I had to comment – to say thank you for an excellent post. I blog on the subject of cesarean delivery, and am constantly frustrated by very large and powerful maternity organizations that view ‘normal physiological birth’ as the number one goal for every pregnant woman (it isn’t), and many of whom constantly criticize and disparage whole groups of medical professionals involved with childbirth.
In my blog, cesareandebate.blogspot.com, I talk about women who would rather choose a planned cesarean delivery in favor of a trial of labor; this legitimate birth plan has been shown in many studies to be the safest delivery method for babies (at 39 weeks) when compared to the various outcomes that can result in a trial of labor such as instrumental delivery or an emergency cesarean.
Women in the developing world don’t have the luxury of turning their backs on medical advancements that save lives – they’re experiencing TRUE natural birth with no medical intervention, and dying as a result. Women who desire a vaginal delivery in the developed world may want to have their cake and eat it (trial of labor with back-up emergency intervention if Mother Nature lets them down on the day), and this is their prerogative. But until vaginal delivery advocates can come up with some real solutions to the challenges facing obstetrics today (e.g. obesity, older mothers, bigger babies, litigation pressures, expectations of the perfect birth and baby), it’s unhelpful to label medical intervention as the enemy. I think we should focus on what’s most important to women: positive physical and psychological birth outcomes.
Pauline,
Thanks for your comment.
Indeed, the hand-wringing over the escalating c-section rate in the U.S. and other developed nations is unhelpful when it doesn’t include realistic suggestions for reducing it. The oft-cited WHO ideal of 15% seems to me to ignore a host of issues, including differing risk profiles of different regions, liability concerns (at least in the U.S.), and, of course, the actual preferences of women.
If we are to listen to the (valid) concerns of women fortunate enough to have access to c/s who feel they are being deprived of their human right to choose how to give birth, we must be equally concerned with both those who prefer vaginal birth and those who prefer c/s.
Thanks, pinky & stork.
Stork, I think the topics covered by this conference explain it–these women aren’t focused on things like maternal or perinatal mortality precisely because OBs, science-based midwives and other scientists and clinicians have ensured they don’t have to be. It’s a lot like vaccines (which many of these folks also disdain)–obstetrics has been almost too successful. You became the “bad guys” because it’s now so easy to ignore the fact that birth isn’t especially “safe.” Even when a woman eschews the very interventions that have helped make it safer (not to mention less painful–but that’s a whole different screed!) she has a remarkably good chance of surviving and having her baby survive because the interventions are fairly readily available–if she’s lucky enough to have been born in a wealthy country–even if things go tits up.
I understand the complaint that there’s now too much intervention done on a routine basis, and I’m sure there’s truth to that, but we need to look at the reasons. As Amy has pointed out, some of it is based on the fact that we have come to expect perfect, healthy babies and moms every time, because it happens most of the time. Even in countries that aren’t as lawsuit-happy as the U.S., nobody wants a dead or injured mother or baby, so we do stuff “just in case” that may not always be evidence-based (witness the recent reversals on eating in labor) to try to ensure it.
Thing is, I don’t think there are any “bad guys”–even the folks with whom I vehemently disagree. We all want essentially the same things you mentioned: safe AND good experience. Where I think Ms. Tritten and some of her like-minded colleagues err is to assume we all do–or should–define “good experience” the same way, and are willing to downplay or even ignore the role interventions have in safety in order to achieve the prescribed “good experience.” Moreover, they ignore the fact that there is “safe enough” but that it, too, is subjective. “Safe enough” may mean one thing to a client/patient or a midwife, whose responsibilities and experiences are often quite different from an OB’s. Those responsibilities and experiences are what prompt most OBs to intervene–sometimes even contrary to the evidence–but it’s a better soundbite and easier to grasp to say they just want to exert their “power” or even “get home for dinner.”
A more fitting topic for the conference might very well be the fallacies existing in obstetrical medicine as they pertain to the “evidence” of evidence-based practices. Whether those evidence-based practices are used or are not used, out of luxury or out of necessity, the scientific error engendering many of them is daunting to even the most casual observer.
Excellent job, Squillo! It’s hard for me to fathom how we turned into the “bad guys” when we want a safe AND good experience for a pregnant woman. I’m posting this on FB.
you have really put it into perspective Squillo