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.

PeoniesPlease Thu 20-Dec-12 09:57:36

I also think this discussion is getting a bit derailed. Both imposing interventions on birthing women that they do not want and have not consented to, AND refusing ELCS at maternal request are human rights violations. They both involve refusing the woman in question agency over her own body. There is no point in playing women off against each other because their ideal births look different.

Thankfully, it seems that the ECHR is waking up to this, and I hope that we will see more cases which will clarify and strengthen the position.

Also Shagmundfreud, re my use of language - surely if fewer than 50% of women are doing it, then it is no longer the norm? Perhaps you should consider your own language too.

Shagmundfreud Thu 20-Dec-12 11:43:28

Re: norm - what is meant by 'normal' in regard to medical matters is the physiological norm.

Rain - I haven't implied that women wanting ELCS aren't being thwarted in their choice in the NHS. Just that it's hard to know exactly how often requests are being made and how often they are being denied.

Would like to add - I think it's really important in relation to this issue to acknowledge the likelihood that choices are and will have to continue to be made about how to allocate maternity spending. IMO higher rates of elective surgical birth and wider availability of epidural shouldn't be prioritised over increasing midwife numbers. Just saying - if choices have to be made, and I think they do......

PeoniesPlease Thu 20-Dec-12 12:26:51

But that is prioritising the rights of only one group of women - those who want a midwife-led vaginal delivery, at the expense of another - those who want a consultant-led vaginal or ELCS delivery. It is exactly what I think we should be avoiding. Playing one set of women off against another because they make different choices about how best to bring their baby into the world.

It is no less of a human rights violation to be denied ELCS/epidural than it is to have CFM/induction/episiotomy without consent. Both involve denying women choice over what happens to their own bodies.

Shagmundfreud Thu 20-Dec-12 13:07:42

"But that is prioritising the rights of only one group of women"

No - it's about optimising health outcomes.

At the moment many women are being left on their own for long periods in labour in some hospitals because of the shortage of midwives.

This is leading to higher rates of emergency c/s, birth trauma and ill-health.

It's also not safe for babies.

Safety has to come first in any system of health care surely?

Shagmundfreud Thu 20-Dec-12 13:12:55

"It is no less of a human rights violation to be denied ELCS/epidural than it is to have CFM/induction/episiotomy without consent. Both involve denying women choice over what happens to their own bodies."

I don't agree with you.

If you inflict medical treatments on a woman without her consent then it's classed as an assault.

There are many, many, many people in the UK who are not getting the treatment options they would prefer under NHS care in a huge range of areas outside of obstetrics.

Including children like my son who has waiting nearly a whole year for an assessment for autism.

It's very distressing not to get treatment on the NHS you feel you want and need, due to a lack of resources, and it's wrong that people's quality of life in these situations isn't seen as a priority. But it's not an infringement of your human rights.

rainrainandmorerain Thu 20-Dec-12 14:18:32

I think many people feel that leaving a woman in childbirth in extreme and traumatising pain by denying her an epidural is not a humane way to treat people.

You diminish experiences like that by talking about them as 'treatment options" we might 'prefer'.

And if you want to talk about funding outside obstetrics - at my local a&E, over 70 percent of the people treated there, for free, across the weekend, are seen for alcohol related injuries. Over 70 percent - using ambulances, triage staff, surgical staff, nurses, taking up beds.

So I don't buy this argument of 'you can't have better access to epidurals because it costs too much." If the NHS can afford to stitch up a self inflicted wound on an aggressive drunk, it can afford to give labouring women in intense pain pain relief.

The sad thing here is that (perhaps naively, I don't know) I think that women are capable of supporting others' birth choices, and their right to choose, even if it is emphatically not their own choice. I think that way it would be possible to get enough momentum going to change things. Like peonies said upthread.

But people like you, Shagmund, alienate some of the women who might be happy to come on board a campaign on the shared grounds of rights over our own bodies, because actually, at heart - it's not all mothers and babies you care about. It's the mothers who share your particular beliefs. Not the rest of us.

Shagmundfreud Thu 20-Dec-12 14:57:03

I don't think anyone would agree that it is fair or ethical to deny a woman an epidural if the services of an anaesthetist are available.

The question is whether we should be spending more money on employing anaesthetists or more money on employing midwives.

Ideally the money would be there to have both. But things are very far from ideal in relation to maternity funding. At the moment there simply isn't the money for EITHER and if more funding becomes available choices will have to be made as to how it'll be spent.

If you want to widen the debate to include NHS spending on self inflicted conditions (smoking, obesity, drinking) then that is another issue. I can see a lot of people would appreciate the idea of removing free healthcare from these people and diverting it into other aspects of patient care. Not sure the general public would rather see any money thus saved being used for non-essential surgery or higher rates of epidural use, but who knows.

And I do support other women's right to have an epidural. Christ - I've had one myself and very grateful I was too! Just because I'm making a case for any additional funding going to provide safer care for women and babies rather than elective surgery and more access to epidurals it doesn't mean I'm fundamentally anti-choice. Of course I could always just court popularity by writing washy washy posts arguing that we must have epidurals and c/s on demand, plus a first rate home birth service, case loading midwifery care for all women, water birth services for all who want them, etc etc but really, it's all cloud cuckoo land, because at the moment there isn't even the money to provide adequate midwifery cover on many labour wards.

Xenia Thu 20-Dec-12 15:34:57

i have not see the film but I was very comforted when expecting my twins by the fact that under English law I could decide what I liked,. Eg I chose and my private midwives agreed to let them stay in to 40 weeks. NHS doctors like to whip twins out 2 weeks early although the science is not that decided on the topic and I think mine hugely benefited from my not following what many NHS doctors recommend for twins for example. Instead they came when they were ready - that is just one example of mother's choice even if it might hurt the unborn child. We are lucky to have these rights.

There was another case just before the twins were born where the English court held a mother in labour did have enough mental capacity despite contractions to determine what was done to her. Very comforting.

The issue though of whether you can force the state to provide expensive intervention at tax payer expense when not medically necessary is totally different and not one I would equate with "choice" really.

Ushy Thu 20-Dec-12 16:13:46

Xenia You wrote The issue though of whether you can force the state to provide expensive intervention at tax payer expense when not medically necessary is totally different and not one I would equate with "choice" really.

Two things - a caesarean being 'not medically necessary' - is your personal opinion but another woman may fear hypoxia or perineal trauma much more than surgery so it may be medically necessary for her. How we perceive safety and risk is not absolute - it depends on our previous experience, personality and a host of other factors.

Secondly, there is actually hardly any difference between the cost of caesareans and planned natural birth if you take long and short term costs into account. (Only about £84.00 as estimated by NICE).

Planned natural births result in lower short term cost but more need for perineal trauma operations so have higher long term costs. However, the £84.00 extra cost of caesareans excludes the significantly higher litigation costs of natural birth - overall both modes of birth are probably about the same.

Personally, I think we should ALL be arguing for women's choices to be respected whatever they choose.

elizaregina Thu 20-Dec-12 16:35:20

http://www.bbc.co.uk/programmes/b01nbryp

I dont belive there should be a choice one way or another - is that how they decide things on the NHS? Is that how they allocate funds?

Before anyone does allocate funds in that manner they should watch this program.

It encompasses the various ways our government ( S) have let people who do not pay NI abuse our health system and how surprisingly easy it is.

Once someone has been refered by a GP - the hospital has no system in place to actually check if that person is entitled to free care - which can run into the thousands.....its assumed that because the person has come via a doctor that they are bonefide....

It also shows how the most money we loose is by not claiming back from Europeans visiting us - the documentary shows how If brits abroad use another countries healthcare - they vigoursly chase us for the money - but the UK doesnt chase other countries for the money spent on thier nationals.

As well as all the other ways the NHS heomrages money - I personally think before a debate starts on the nitty gritty details of who should have what care - I say - all women should have the right to choose the best care for themselves - and if cost is a problem - address all the other issues first, including drunks in A&E etc etc etc.

All the women on here - should be lobbying for all womens choice - not to bear the brunt of cuts and cut backs - instead of splitting hairs over personal preferences at the detriment of general rights and choices...

elizaregina Thu 20-Dec-12 16:36:33

http://www.bbc.co.uk/programmes/b01nbryp

elizaregina Thu 20-Dec-12 16:37:16

Declan Lawn reports on how 'health tourists' are obtaining free NHS treatment they should be paying for - at a cost of millions to our health service. Panorama goes undercover inside a black market where NHS access is being bought and sold, and finds an NHS practice manager taking money to register health tourists. Declan also discovers how easy it is for foreign nationals to get free treatment - with many hospitals across the country not making the required checks.

rainrainandmorerain Thu 20-Dec-12 16:41:17

Good post, Ushy.

Odd and a bit sad somehow that often, those of us who do support epidurals on demand, and elcs as an informed and valid birth choice can be supportive of those who choose to go down a very different birth choice route.

But they don't support us in return.

Shagmund - you were the one who broadened the debate to funding and provision outside maternity and obstetrics by discussing your son. I simply continued the discussion about resources.

rainrainandmorerain Thu 20-Dec-12 16:45:54

Yes, good posts too eliza.

I think the 'debate' over costs in maternity care is often a smoke screen for ideological hostility, tbh.

Shagmundfreud Thu 20-Dec-12 17:15:26

"Secondly, there is actually hardly any difference between the cost of caesareans and planned natural birth if you take long and short term costs into account. (Only about £84.00 as estimated by NICE)."

But that's because a planned vaginal delivery now has a high chance of ending in a planned c/s or assisted delivery, which is where the costs accrue.

And the reason the emergency c/s rate is so high is because the vast majority of low risk women are giving birth in obstetric units, which have almost double the rate of emergency c/s than midwife led units.

High emergency c/s rates are also linked to staffing issues, namely a lack of one to one care, and a lack of consultant input after a labour starts to become complicated.

So surely it should be a priority for the NHS to spend whatever money they do have on bringing down emergency c/s rates (which would also significantly reduce maternal and neonatal mortality and morbidity) by:

a) increasing midwife numbers
b) improving access to birth centres and out of hospital birth
c) improving consultant cover in obstetric units

The average rate of unplanned c/s nationally is 14%. Some hospitals are as high as 20%, while others are as low as 13%. If rates were reduced (by spending money on doing the things I suggest above) to bring most hospitals in line with the national average, then planned c/s would begin to look like a very expensive option in comparison. In other words, it's only comparable because women planning vaginal births are so often getting suboptimal care which is resulting in high rates of complications. sad

As for lobbying for increases in NHS funding for maternity services - well, yes! But if we are having to make decisions about how CURRENT funds are used, then I still hold that safety has to be prioritised, and that means increasing midwife numbers, even if it's at the cost of reducing access to c/s on maternal request and in the absence of a diagnosis of tokophobia.

Shagmundfreud Thu 20-Dec-12 17:16:06

sorry, that should read: planned vaginal delivery now has a high chance of ending in an unplanned c/s or assisted delivery

PeoniesPlease Thu 20-Dec-12 17:19:44

"No - it's about optimising health outcomes."

But health outcomes are optimised when women's choices are respected and they are able to take an active role in deciding what their birth is going to look like. (Whether that is a homebirth or an ELCS).

"Safety has to come first in any system of health care surely?"

Safety is important, yes. But this is a discussion about human rights violations in birth. I think respecting women's human rights is equally as important. (Even when a labouring woman chooses a path of action which may endanger her baby - I would still support her right to do that.)

Shagmundfreud Thu 20-Dec-12 17:22:29

Oh for goodness sake rain - do you have to engage in character assassination in order to make your point?

I have no 'ideological' objection to epidurals or to planned c/s.

elizaregina Thu 20-Dec-12 17:25:02

Two women are in hospital, the same hospital in different areas a few corridors away from each other.

One is UK national giving birth - she wanted an ELC but was denied one due to lack of funds....she also cant get an epidural due to shortage of staff, and pruning back of services....her other choice - a HB was also ruled out - due to lack of MW's....so she gives birth - traumatised - etc etc...and the NHS people are looking at ways to prune back her care and others like her - even further.

SECOND lady - has brought her way into our system, she has no entiltement at all - to any of our services and yet - she is going to run up a bill in the thousands for treatment to her stomach. The NHS people dont care one jot....and this abuse will happen over and over and over again. There isnt even any one in the hospital to check her credentials - even if someone was suspicous there is no body to check!!!!

THAT is the current allocation of funds - that is what we should all be asking to be addressed!

Shagmundfreud Thu 20-Dec-12 17:26:37

"But health outcomes are optimised when women's choices are respected and they are able to take an active role in deciding what their birth is going to look like. (Whether that is a homebirth or an ELCS)."

Health outcomes are optimised when you have the greatest number of women and babies coming through labour in optimal physical and mental health. If we increase access to c/s on demand and widening access to epidurals instead of increasing midwife numbers (which is what most people involved in delivering maternity care are desperate for) we will continue to see very high rates of birth trauma and emergency c/s rates linked to inadequate care of women planning vaginal births.

At the moment women who have a planned c/s are getting optimal care on the NHS.

Women planning vaginal births are often getting suboptimal care, which is leading to high rates of emergency surgery. This isn't acceptable and any increase in funding needs to be used to address this problem FIRST.

LaVolcan Thu 20-Dec-12 17:27:41

even if it's at the cost of reducing access to c/s on maternal request and in the absence of a diagnosis of tokophobia.

Rather than that shagmund I would like to see a good hard look taken at why the EMCSs are happening, and some serious attempts to reduce this rate. And no, that's not by telling the woman who had an EMCS the first time that she has to try for a VBAC. We could probably start by questioning the rate of inductions, in particular those which happen because of a date on the calendar - I am sick of reading about women who 'had' to have an induction because they were 40 +10/12/14/choose your hospital's date overdue, which then failed and led to an EMCS. Who knows whether they would have had a straightforward delivery if the baby had been allowed to come in its own good time?

Shagmundfreud Thu 20-Dec-12 17:34:50

"SECOND lady - has brought her way into our system, she has no entiltement at all - to any of our services and yet - she is going to run up a bill in the thousands for treatment to her stomach."

Yes - lets just stop treating refugees and illegal immigrants who pitch up at our hospitals. They can die on the streets. sad

Eliza - a mum who has serious mental health issues in relation to labour and birth in our current system should be offered a) counselling and b) a planned c/s if she is unwilling to have a vaginal birth following counselling. If this isn't happening then obviously it needs to be addressed nationally as well as at a local level.

But that's not really what we're discussing here is it? There are already systems in place to accommodate women with tokophobia (which are working imperfectly at the moment - this needs addressing). The issue is whether ANY and ALL women should be able to request elective surgery on the NHS.

PeoniesPlease Thu 20-Dec-12 17:38:07

Firstly, I don't know what evidence you have to suggest that women who have an ELCS get optimal care. Secondly, there are frequently women on these boards in a terrible state because they have requested ELCS and been refused. That is hardly optimal is it?

This comes back to the same point though. ALL women should be respected before, during, and after birth, whatever that birth looks like. We shouldn't be playing different groups off against each other when actually, what we all want (and need) are improved maternity services.

Shagmundfreud Thu 20-Dec-12 17:38:13

Yes - look at the ridiculous disparity in induction rates between hospitals.

But also I think it's a national scandal that healthy women giving birth in obstetric led units are having DOUBLE the rates of unplanned surgery when compared to women in midwife led units. I mean - HELLO! - this is completely insane!

LaVolcan Thu 20-Dec-12 17:44:11

I doubt whether health tourists are really the cause of the problem. There are loads of parts of the country where this just doesn't apply and yet still services are poor.

Those parts of the country where it does apply (near Heathrow?) probably should provide some clerical staff to bill the defaulters. It is not the job of the health care staff to question her credentials. Their job is to offer appropriate care.

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