Having read yet a few stories recently where people giving birth are being told they must lie down for monitoring, and are ‘not allowed’ to change position I am feeling so full of rage that some antenatal education cares so little about informing women of their rights in labour, when this should be something they are told through their pregnancy to hammer home their autonomy. I am so angry that as a society we have convinced women in labour (women in life generally) that they should do as they’re told without question, don’t rock the boat. That women are being treated like prisoners (and I don’t think women in prison giving birth should be treated like this either!) and being told they are not allowed to move from the bed but must lie there hooked up to monitors, despite all evidence showing that those who are able to move in birth, who use gravity and open positions, having easier and shorter labours. It makes me so angry and it makes me want to cry.
That people have to educate themselves really thoroughly about their rights (it should just be a given that when you’re in labour you have the same free rights as you do the rest of the time) and that they then have to blinking fight for those rights, at a time when we need the ocytocin flowing, not the adrenalin. And then we wonder why our intervention rates are rising year on year, and why so many women have ‘failure to progress’. It’s not the women failing to progress, it’s the institution not allowing them to progress by making them fight at every turn, by scaring them out of their wits, and by constantly telling them they need help to labour.
These points are taken from the RCM Midwifery Blue Top Guidance Midwifery care in labour guidance for all women in all settings:
“Recommendations for practice…
And yet despite this being in the guidelines for practice, this is still not considered the norm, and is ignored by some midwives (and consultants) who very often choose to make things easier for themselves rather than the person in labour.
I know hospitals where women are discouraged from using the birth pools, because the midwives don’t like filling them up. This despite the evidence showing that hydrotherapy is a very effective method of managing comfort levels in labour, and women using birth pools are less likely to need stronger pain relief such as epidurals, less likely to need intervention and less likely to tear:
“Labouring in water – there is good evidence of benefit from water immersion during the first stage of labour. Results indicate that it can reduce the likelihood of requiring an epidural and qualitative studies have illustrated that women who choose to labour in water feel a high sense of control and satisfaction…
Giving birth in water – there is some evidence that associated maternal satisfaction with maternal pushing experience in water and no added risk of sustaining obstetric anal sphincter injury, no increase in maternal or neonatal infection or requirement for resuscitation or admission to NICU...”
[RCM Midwifery Blue Top Guidance Midwifery care in labour guidance for all women in all settings]
I fully understand that midwives are under a huge amount of pressure, and that filling a birth pool takes time, but if you have a birthing person who labours quickly needing less intervention that saves time in the long run, but who needs to look at the bigger picture eh. Some seem to forget that labour should ultimately be about the person giving birth, that they should be the centre of the experience and consideration.
In the summer I supported a woman who was having a tricky pregnancy and for various reasons, we suspected would have a difficult birth. She did. It was fairly traumatic and despite us both being aware of her rights, what she was entitled to ask for and decline, when it came to giving birth she and her partner felt unable to advocate for themselves, as the power balance was too inequal. She was persuaded passively aggressively, then coerced and finally threatened. And so she gave in. After hearing her story I felt traumatised because she knew all of the stuff, she’d educated herself, she did all the right things and it still wasn’t enough. She just wasn’t allowed to use the knowledge, and when you are in a hospital with people ordering you around, the default is to fall in line. It takes a very strong person to stand up for themselves in that position, and when you are being told your baby will die if you don’t do as you’re told, most of us will do as we’re told. This is an abuse of power, it is not informed consent, and it is against our human rights.
A reminder of a couple of the key human rights applicable in childbirth:
Article 3 – No torture, inhuman or degrading treatment
This can include physical or verbal abuse, non-consented care, non-confidential care, discrimination and denial of care (including withholding pain relief).
Article 8 - Right to Private and Family Life
Which includes the right to personal autonomy and physical and psychological integrity (this right means you must not be physically or psychologically interfered with). Unconsented vaginal examinations, unagreed rupturing of membranes, or any other procedures done without full informed consent (ie you know what you are agreeing to and the benefits and risks of having or not having ‘x’ done) all breach this right. This right also includes a birthing person’s choice over where they give birth.
Not only do we have a two-tier antenatal system, with many unable to access good quality and unbiased information, but even for those that do educate themselves there is often a fight to get what they want. I hear countless tales of parents not being able to choose their own place of birth, put on to a high risk care pathway with little medical evidence to support that pathway, denied options around the type of birth they'd like or persuaded to choose a method of pain relief that the caregivers feel most suitable, whether or not the person giving birth would choose it autonomously.
And so I’m angry. I’m angry for me, and the way that I was treated. I’m angry for all the women who’ve been treated like children, like prisoners, denied their human rights . And I’m even angrier that, against the growing body of evidence showing that undisturbed births where those giving birth are able to move freely result in easier labours, healthier mums and babies and more positive experiences, interventions are on the rise and there are more and more cases of traumatic birth experiences.
This isn’t a rant against midwives in general, this is a rant against those individuals who have lost their compassion, or their understanding of who they are there to support, and against a system which is feeling so incredibly broken and is leaving a swathe of broken women in its wake.
If you’re interested in reading more about human rights in birth, Why Human Rights in Childbirth Matter by Rebecca Schiller is a great starting point. Birthrights is a UK organisation providing advice and support regarding rights in birth, and the Birth Trauma Association is helpful for those who have experienced a traumatic birth.