EU law on woman's rights during birth

(152 Posts)
cantreachmytoes Mon 17-Dec-12 12:25:49

One World Birth

A film has been made about women's rights to choose the type of birth they want - hospital, home, midwife centre, whatever(!) - and their right to privacy during it, based on an EU law passed following a case brought by a Hungarian woman.

It features the UK, US, Chinese, Aussie presidents of their respective colleges of midwives, as well as human rights lawyers and others.

This is the abridged version (15 mins), the original is 1 hr.

RedToothbrush Mon 17-Dec-12 14:23:27

Given who some of the people who are in the introduction to this piece of work, and their own ideological and vested interest in promoting 'natural' birth over birth choice and some of the things they have said publicly, I've very torn over this. There is a distinct whiff of hypocrisy and opportunism from some, which I find extremely distasteful.

That said the films core does seem to be very positive and the implications of Ternovszky v. Hungary in the court of European Court Human Rights which I hadn't heard of before are brilliant and I'd go as far as saying every woman should know about it, especially if they are facing problems getting a homebirth or indeed getting an ELCS if thats what they choose.

To give people an idea of what the film is about - the ruling of the EUCHR:
^ "is a fundamental principle underlying the interpretation of the guarantees of Article 8 (cf. Pretty, loc. cit.). Therefore the right concerning the decision to become a parent includes the right of choosing the circumstances of becoming a parent. The Court is satisfied that the circumstances of giving birth incontestably form part of one's private life for the purposes of this provision [...]".^

Thats not the entire story as having a bit of a read around the subject, it does seem that actually the situation is a little more complex and there are other rulings which mean that a woman doesn't have a 'right' to choose how she gives birth:

The European Court has ruled a number of times that “the Convention does not guarantee as such a right to free medical care or to specific medical services” (RR v Poland (App No 27617/04)). It has also said that the state’s margin of appreciation is greater when assessing priorities in the allocation of scarce public resources (Sentges v Netherlands (App No 27677/02)).

But given that theres been recent studies in the UK that have put the cost of homebirths as being cheaper than MLU and CLU and that NICE stated in their recent guidelines on CSection that the cost of ELCS were exceptionally difficult to assess and when factoring the long term effects of incontinence alone - and not exploring other issues or factors - stated that the difference was negligible and should not be used as an argument against an ELCS, I'd have to say that theres really a case to be made here, in the event someone had the unfortunate need to or simply the balls to challenge it legally.

Interesting and thought provoking despite some of the individuals who did contribute to the film.

Shagmundfreud Wed 19-Dec-12 10:27:41

"and their own ideological and vested interest in promoting 'natural' birth over birth choice"

What - you mean people like Ina May Gaskin and Michel Odent make it difficult for women to choose a hospital birth?

What rubbish! Do you have any evidence at all that the natural birth advocates in this film have campaigned or argued for a restriction of the right to a hospital birth?

Shagmundfreud Wed 19-Dec-12 10:33:34

Should add - when the normal birth rate has dipped nationally to under half of all births, and where there are HUGE variations in intervention rates between hospitals that can't be explained away by demographics, it's an absolute distortion of the situation to suggest that those who are seeking change in maternity care which they believe would result in an increase the rate of normal physiological birth, are somehow behaving unethically in bringing this sorry state of affairs to public attention.

PeoniesPlease Wed 19-Dec-12 15:04:14

But no reference was made to maternal request ELCS as a valid birth choice was it?

It seems to me that the people involved in the making of that film have just as much of a vested interest in making women have a particular type of birth - a "natural" vaginal birth, as they claim that obstetricians do. After all, if all women decided that they wanted to have an ELCS, then they would be out of a job wouldn't they?

I would love to see more choice for birthing women. But I think that needs to encompass ALL types of birth - from unmedicated homebirth, through hospital birth with any pain relief requests made by the mother immediately responded to, to ELCS, and anything else I haven't thought of!

Wasn't it the RCM who brought out that ridiculous publication recently, about trying to arbitrarily reduce the number of epidurals by 20% in the absence of all evidence? That is why I don't trust the individuals involved in that film. They are only interested in one very specific type of birth.

Hopefully though, people will be able to widen the scope of this movement, and challenge the law if necessary in the way that RedToothbrush suggested, so that this could actually be really useful for women.

RedToothbrush Wed 19-Dec-12 15:19:28

The comments of many involved were and have consistently been against medicalised births. That puts pressure on women, and the way they phrase things frames the argument that medicalised birth = bad, natural birth = good. It means that choice is not free.

If at any point some of these ideologists said "yes if woman want a CS or are happy with one under the guidance of a doctor" AS WELL AS supporting the right to a natural birth then thats fine. But the argument is constantly framed as doctors being the bad guy and interfering and midwives being saintly and doing things in the best interests of woman at all times.

The trouble is, that caught in the middle of this and their evangelical beliefs they actually fail to listen and instead just end up telling us all whats best.

But they don't. Its biased. And they don't represent choice. They represent the natural birth lobby and its agenda which in some cases is extremely damaging to the interests of women as many, many threads in this section and elsewhere on Mum's net will testify to.

Shagmundfreud Wed 19-Dec-12 17:03:10

"It seems to me that the people involved in the making of that film have just as much of a vested interest in making women have a particular type of birth - a "natural" vaginal birth, as they claim that obstetricians do."

You have utterly missed the point of the film and the campaign.

And the language you use says everything about the way you see birth, and the role of health professionals in labour.

They have no interest in making women have any particular type of birth. They simply want a maternity system which enables women who want a physiologically normal birth which doesn't involve emergency surgery or the use of instruments (the type of birth the vast majority of women want) to have one. Our current system simply doesn't optimise women's chance of a healthy, normal birth, which is what it should be doing. In fact it ruins many women's chance of having a straightforward labour. It actively obstructs normal birth.

As far as women's right to have a planned c-section goes where there are no medical indication (including tokophobia) - I agree that this is a problem in our current system in the UK and we need to resolve it. But first we need to resolve the problems that are making our system unsafe and leading to very high rates of emergency surgery, as this is the cause of the greatest amount of emotional trauma and ill health in new mums. And this will only be resolved by increasing the number of midwives and improving access to case-loading midwifery care. If the government decide to increase funding to the point that we can guarantee all women instant access to epidural, and c-section on demand, while ALSO vastly increasing midwife numbers so that women who want a normal birth have a reasonable chance of getting one, then brilliant. But I suspect this isn't going to happen any time soon, and if we have to choose, we need to prioritise safety. Which means that increasing midwife numbers needs to be prioritised ahead of widening access to surgical birth for low risk women.

"I would love to see more choice for birthing women. But I think that needs to encompass ALL types of birth - from unmedicated homebirth, through hospital birth with any pain relief requests made by the mother immediately responded to, to ELCS, and anything else I haven't thought of!"

According to the current evidence (Care Quality Commission (CQC) in 2010) nationally more than 9 out of 10 women 'definitely' (68.9%) or 'to some extent' 27.9%) got the pain relief they wanted. I'm assuming that women who requested an epidural and didn't get one wouldn't answer tick a box that said they 'definitely' or 'to some extent' got the pain relief they wanted. I'm suspect that large number of the women who ticked the 'to some extent' box had pethidine or opioids which didn't work well for them, so perhaps not a situation where they were denied access to pain relief.

And nearly all women in the UK have access to obstetric led births. In fact 9 out of 10 births take place in obstetric led units. It's birth centres which are being shut down, and home birth services (like the one attached to the Homerton) which are being cut. If you want an epidural in a large teaching hospital in the UK you are very likely to get one. On the other hand if you want a birth without the use of instruments, episiotomy or surgery in an environment which supports active birth and water birth - well, bloody tough luck, you're probably not likely to get one!

In other words, the power isn't in the hands of midwives and natural birth advocates. Our current system, even the UK where we have a midwife led system of maternity care, is vastly biased towards medicalised birth, and this is reflected in the ridiculously high rates of emergency surgery that mothers are experiencing in labour.

"medicalised birth = bad, natural birth = good"

Can you explain to me how a birth involving forceps, ventouse, episiotomy and emergency c/s is preferable to a vaginal birth involving none of these things which still ends with a healthy mum and baby? Surgery, augmentation and instrumental birth (which is what we mean by a medicalised birth) ARE bad if they are avoidable!

Shagmundfreud Wed 19-Dec-12 17:06:47

Redtoothbrush - what do you mean by a 'medicalised birth'?

RedToothbrush Wed 19-Dec-12 17:07:30

I didn't understand the point of the film. Ok...

Shagmundfreud Wed 19-Dec-12 17:13:12

"They are only interested in one very specific type of birth."

I think you'll find that the type of birth they are interested in is what ever birth it is that women feel the current system of maternity care (particularly in the US) is denying them.

I honestly don't believe for one minute that women in the USA or across Europe outside of the UK are being denied access to medicalised birth including emergency surgery, induction, augmentation or c/s on demand.

Do you?

But there is clear and unequivocal evidence that women in these countries are not being offered an alternative.

Shagmundfreud Wed 19-Dec-12 17:14:35

What do you mean by a 'medicalised' birth?

RedToothbrush Wed 19-Dec-12 17:15:34

I honestly don't believe for one minute that women in the USA or across Europe outside of the UK are being denied access to medicalised birth including emergency surgery, induction, augmentation or c/s on demand.

Do you?

In a word. Yes.

And they are also being made to feel guilty by not having a natural birth.

Shagmundfreud Wed 19-Dec-12 17:21:46

"In a word. Yes."

There aren't enough emergency c/s being done? Or inductions?

Where are women being denied inductions or emergency surgery? Do you have proof that women are being denied access to these things.

"And they are also being made to feel guilty by not having a natural birth"

By whom? And how?

Two of my three births involved interventions (forceps/augmentation/epidural). Why do I not feel guilty about needing this type of help in labour when I'm a strong advocate for normal birth?

Shagmundfreud Wed 19-Dec-12 17:25:31

And what do you mean by 'medicalised births'?

You clearly feel that women are unfairly denied access to a 'medicalised birth', but that's not what the evidence says. It says that more than half of women in the UK are having interventions and medical input in birth, despite pretty much all doctors and midwives believing that normal birth rates could be much higher.

So the evidence doesn't suggest that women are being denied access to medicalised birth. It suggests that many women who could have uncomplicated births are ending up needing surgery to deliver their babies, because of substandard care.

RedToothbrush Wed 19-Dec-12 17:36:04

Shag, this debate is pointless with someone I consider to be one of the very people who be part of the problem rather than the solution, due to the strength of their feeling about natural birth. You are pro-natural birth, not pro-choice. And I do feel there is a massive and fundamental difference.

I've seen you on MANY occasions upset people on this forum with the language you use and the way you frame your arguments. You have some valid points, but I'm damned if I'm going to get into yet another debate with you on the subject for that reason. You don't get the problems that are a direct result of the preachings of the pro-natural lobby, which can be as damaging as over zealous and pushy and defensive obstetricians. Thats not about choice or the best interests of women. Its about ideological belief. Its a massive missing part of the debate you actively choose to ignore.

Anyway carry on... I know you will.

Phineyj Wed 19-Dec-12 17:41:31

At the same time, I understand that EU legislation on insurance requirements for healthcare practitioners means that independent midwives can't legally deliver babies after September next year, in the UK at least. So that takes that choice away, even for those who can afford it.

Rainbowbabyhope Wed 19-Dec-12 17:58:20

Red I am confused - why would anyone not be pro-natural birth in the first place? Of course there are many situations where medicalisation is necessary, including elective sections and other interventions. But pro-choice means being pro-all choices including natural birth. We can't ignore the fact that the introduction of any intervention, including all forms of pain relief, has side effects and risks which is why you need to consent to them. Why wouldn't we support those trying to make sure we all have access to at least the chance of a natural birth? The whole point is that many of us don't even have that opportunity to be supported in trying for a natural birth which is undeniably the best for our bodies (excluding those who have specific medical issues). For example, if we can eliminate the need for some women to require opiate based pain relief (with the risk factors it comes with for mum and baby), simply by providing access to a pool during labour to encourage the most natural birth possible, why on earth wouldn't we do that?

Shagmundfreud Wed 19-Dec-12 18:00:47

"Shag, this debate is pointless with someone I consider to be one of the very people who be part of the problem rather than the solution, due to the strength of their feeling about natural birth. You are pro-natural birth, not pro-choice."

What makes you think I'm not 'pro-choice'?

True, I do believe that in our current situation of very limited funding in the NHS we need to focus on improving safety first. This might mean not widening access to epidurals and c/s on demand within a context when we can't even guarantee adequate midwifery care in labour or safe postnatal care in the community because of short staffing. But the funding crisis aside, what have I said that makes you think I believe hospital birth, epidurals or c/s on demand should be rationed, even if all the resources were there to widen access while also providing safe care to all mothers across all birth settings? I have no fundamental problem with women having pain relief or c/s on demand and nothing I've said here suggests I do.

I think the problem is RedTooth that the evidence supports my argument, and not yours. It's hard to engage in an adult and reasoned argument when you have so few facts at your disposal.

Which perhaps is why you feel the need to resort to unsupported assertions about my beliefs, and character assassination.

That's a shame.

I'd also like to point out that you need to get your head around the distinction between 'normal' birth and 'natural' birth. The midwives and advocates on this film are making the case that our system of maternity care is denying choice to mothers, and putting their health at risk by exposing them to unnecessary surgery during birth. They are not advocating that women 'should' go without pain relief or that they 'should' give birth in any environment other than the one they feel safest in. They are not advocating that women who need the help of doctors should be denied it. If you are hearing another message it's coming from your own assumptions and beliefs about birth, not from what this film, or the individuals in it are saying.

It's a shame you can't engage like an adult on this topic. We should be able to have a sensible discussion , because it's a damn important subject!

Shagmundfreud Wed 19-Dec-12 18:05:53

"that many of us don't even have that opportunity to be supported in trying for a natural birth which is undeniably the best for our bodies (excluding those who have specific medical issues)"

Actually a natural birth is undeniably best for ALL women who want it and can achieve it safely, including women like myself who are categorised as 'high risk'. In fact you might argue that there are many high risk women who are even more likely to suffer ill effects from surgery than healthy women (diabetics, and morbidly obese women for starters) who have a great deal to gain from having a straightforward delivery.

Rainbowbabyhope Wed 19-Dec-12 18:21:30

Shag yes I agree with you about encouraging natural birth for anyone who can achieve it safely.

The main point is providing allowing everyone to have access to an environment where the normal processes of birth are encouraged rather than hindered, which unfortunately just isn't the case. I understand this is what is being supported here.

I too am in the position where in my current pregnancy I am classed as high risk - totally unnncessarily from a medical perspective. Unfortunately in my local hospital high risk translates to being encouraged to stay on my back in bed like a good girl being monitored constantly (without medical indication). No choice for me - except that thankfully I can afford independent midwives.

Shagmundfreud Wed 19-Dec-12 18:28:48

I hired an IM too because of a lack of support for normal birth for high risk women at my local CLU.

I really think that in about 20 years time they'll have cottoned on to the fact that birth is safest when technology and medicine is incorporated into the care of women in a way which doesn't obstruct the normal physiology of labour.

I honestly think one day it'll be everyone, and not just the natural birth lobby, who'll look back on the way many labours are managed now and feel a sense of disbelief at the sheer dunder-headedness and wastefulness of certain aspects of our system of maternity care.

Ushy Wed 19-Dec-12 21:40:00

shag You said "According to the current evidence (Care Quality Commission (CQC) in 2010) nationally more than 9 out of 10 women 'definitely' (68.9%) or 'to some extent' 27.9%) got the pain relief they wanted. I'm assuming that women who requested an epidural and didn't get one wouldn't answer tick a box that said they 'definitely' or 'to some extent' got the pain relief they wanted."

Actually they would because of the issue of women being told they are 'too early' or the anaesthetist is unavailable. So they are delayed and delayed, end up with a much riskier procedure because they can't keep still and a much higher risk of the epidural not working (late placed epidurals are much more likely to fail).

So basically 8% say they definitely did not get the pain relief they wanted at all and 27.9% only got it to some extent - that's over a third of the 700,000 or so women who give birth every year.

Given that labour pain is one of the severeist you can experience, I'd say that is a flagrant breach of human rights. hmm

Shagmundfreud Wed 19-Dec-12 23:12:01

Have you got access to any evidence regarding women requesting epidurals - the average wait?

Worth considering: 1 in 8 epidurals don't give complete relief of pain.

And many of those who opted for pethidine would have found it ineffectual. This might account for a large proportion of those saying they did not get adequate pain relief in labour.

But yes you are right Ushy - women should have access to the services of an anaesthetist if they want an epidural. They should also have access to one to one care, a midwife they know, access to a pool, access to a birth centre, access to a good home birth service. On current form I very much doubt these things will materialise though, do you? And access to epidurals is no more important than access to one to one care, or a home birth service, or waterbirth is it?

Shagmundfreud Thu 20-Dec-12 08:03:37

Meant to add that women won't usually be admitted to hospital unless they're in active labour and therefore epidurals at 2cm aren't going to happen. I'm not aware of women in active labour being told it's 'too early' for an epidural. And of course some delay is down not to the anaesthetist being unavailable, but to the woman not requesting an epidural until they are in transition or in late first stage.

Of course a lot of this discussion is speculation as we don't have figures - we don't know what percentage of women don't get epidurals following a request for one, or who experience a significant delay in getting one.

rainrainandmorerain Thu 20-Dec-12 09:37:15

shagmund - there have been threads on this board about women requesting cs and being refused. Whether or not you don't 'believe' it is irrelevant (although presumably you think these women are lying, which is a bit repulsive). It happens. This is women who have had traumatic births previously as well as those who are requesting them for other reasons. If you believe you can just get cs 'on demand' in this country you are very badly informed - or perhaps being wilfully ignorant, because the actual facts don't suit your views or argument.

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