Childbirth rights- are you pro-choice?

(94 Posts)
Feminist5 Thu 23-May-13 18:30:39

I am sure majority of the ladies who post on the women's rights forum are pro-choice, and support a woman's right to terminate a pregnancy.

My question is more about the woman's rights when she chooses to continue with the pregnancy. Should she have full control over how she gives birth?

I'm not talking about outrageous requests like demanding that a doctor perform IVF and get you pregnant with sextuplets or that a doctor perform an appendectomy or chop off a limb during pregnancy just because the woman wants it.

However, childbirth is a slightly different situation because the baby will come out somehow and I feel liken the woman should have a voice in how and where that happens. It is also quite common for doctors to be biased towards fetal rights and override what the woman feels more comfortable with.

So I am therefore referring to a woman's right to choose how she should give birth, as I happen to think this is a feminist issue.

Do you think women should be able to choose the following (as long as they are fully informed about the pros and cons)?

A home birth?

An elective cesarean?

An epidural?

An elective induction?

Or do you think that a doctor should be able to force a woman to give birth in a way that she doesn't feel comfortable?

Despite the NICE guidelines saying that it is ultimately the woman's choice if she wants an elective cesarean or a home birth, women are still having to fight for these unconventional choices.

Just as it can be disempowering to be forced to stay pregnant against your will, it can also be disempowering to give birth in a way that you don't want

Feminist5 Thu 23-May-13 20:49:49

A section at 40 weeks is riskier than a VBAC? hmm

Isn't a VBAC associated with 4 times higher perinatal mortality and a 1-2% risks of uterine rupture? I'm not saying it's a bad option, I am just saying that the risks associated are severe enough that they can't be forced on anyone.

The risks of a planned cesarean are mainly for the mother and as an adult she can decide herself if she is prepared to take them.

VivaLeBeaver Thu 23-May-13 20:50:26

bears, I agree. I see some women having inductions for reasons such as severe spd and I can totally see the need for such inductions. Glad yours worked out well.

As a midwife I always try and remember that I'm there as an advocate for women. So I will support them and fight their corner even if personally I disagree with what they want. Unless its wanting a section at 33 weeks because they want to go on holiday to Ibiza. grin

Feminist5 Thu 23-May-13 20:54:21

Oh you're a midwife! Nice smile

I wish NHS trusts would just tell women to pay the extra money for a repeat cesarean then instead of forcing them to do something with their bodies that they don't want. Denying the choice altogether is so outrageous.

VivaLeBeaver Thu 23-May-13 20:59:09

Saying vbac has a 4 times higher perinatal morality rate is slightly misleading. That figure is 4x a very small number, so the actual risk still isn't very high.

Afaik, newer research is increasingly finding vbac to be safer than first thought. Women used to have to fight for vbac and now its gone full circle. They now think risk of uterine rupture is more like 0.5%, mad that risk is the same even for two previous sections! However where I work if you've had two sections you're not "allowed" a vbac even though its as safe as a vbac after one section.

VivaLeBeaver Thu 23-May-13 21:01:59

And when the Drs are counselling women about vbac they are definitly saying that vbac is the safer option. But like you say, it's different risks and the woman may not be as bothered about some of the section risks such as infection, etc.

But the dr may well be thinking about the higher incidence of haemorrhage at a section compared to a vbac. Also they may consider possible future pregnancies more. If you have two sections and then want a third then the section can be more difficult, more risk of things like placenta accreta.

Feminist5 Thu 23-May-13 21:04:25

Well, saying that women are two times more likely to die after a cesarean is equally misleading because even that is statistically a very small risk. I know that the overall risks are small, but risks are still risks and nobody can guarantee that the woman being forced into a procedure won't be the one to have that complication.

Forcing someone to have a repeat cesarean is as unfair as forcing someone to have a VBAC. I disagree with both policies.

Feminist5 Thu 23-May-13 21:07:22

From my understanding, according to both the RCOG and the ACOG, women are less likely to have a PPH after a planned cesarean than after a vaginal birth. So I am not sure why a doctor would counsel a woman about the higher risk of PPH after a repeat cesarean, unless they were following outdated research.

Furthermore, while future pregnancies are definitely a concern, they aren't even applicable to everyone. If someone only wants two children and she has already had one by cesarean then it's a bit silly to force her into a VBAC for fear of what will happen to future pregnancies...

Salbertina Thu 23-May-13 21:15:29

@feminist- why are you so suspicious of doctors- people who have chosen to work in their demanding & competitive field and devoted years of study to that end? Quite ridiculous to presume they want the worst for their patients or just to " get out of trouble". Such reductive nonsense is the type of thing the NCT has been known to advocate in its classes (certainly in mine!) which does it a great disservice....

Far better to partner WiTH rather than against clinicians to bring about safe, sustainable change with women's interests paramount

Feminist5 Thu 23-May-13 21:31:43

Salbertina I am sorry that that is the impression you have! I have nothing against doctors or midwives. I do feel however that they shouldn't be able to override a woman's informed choice about her own birth (unless it's something ridiculous like an elective cesarean at 33 weeks because she wants to go to Ibiza).

I also happen to think that given the cost cutting measures being used by the NHS, they often don't have much of a say themselves.

AmandaPayneNeedsANap Thu 23-May-13 21:31:54

I would support all of them bar induction on demand.

Starting with the most black and white, it is barbaric that any woman be denied pain relief they request (whilst recognising that they might have to wait for anaesthetist).

Home birth/elective section/VBAC, these matters should be totally the choice of the woman. I do think that there are caveats - like ensuring that decisions on elective section are fully informed, and ensuring that the availability of that choice doesn't lead towards women being pushed that route rather than issues like counselling for birth phobia if that is what the woman would prefer.

Induction. That one is more difficult for me. On balance I think not. Just like the decision to prescribe a particular drug (for an illness) ultimately lies with the clinician, I think induction should be ultimately a clinical decision, even though I think that the views of the woman should be taken into account and added to the equation. This includes those views being given due weight.

What I struggle to articulate is why, at an intellectual level, I think induction is different from, say elective section, where the clinician's view might differ from the woman's. I think that ultimately it's about degree. Section, etc are about the fundamental mechanisms of giving birth, and in those I think a woman's views should be paramount. I'll keep thinking on that last bit.

Bunnylion Thu 23-May-13 21:32:23

feminist5 thank you.

I honestly don't think the NHS ever "forces" a VBAC or anything else on a woman. A doctor may well say that they very strongly recommend it but if the woman still says no then that is actually tantamount to assault if anyone goes against her wishes.

Pressuring is different to forcing.

Pressure obviously isn't nice but as long as the woman is informed, empowered and has a good midwife and birth partner with her then the hospital has to respect her wishes.

I do agree that procedures and protocol are followed and often consent is speedily asked and presumed throughout a labour, but a woman can clearly say no to any of them. I read a lot of women over on the pregnancy section saying they've been booked in for an induction/sweep etc and don't want it, but they don't seem to realise that they can just say no thank you and instead have the hospital monitor the baby and and wait if they have gone past due date.

The problem - as I see it - is the empowerment of women during their pregnancy and labour to actually question and speak against any standard protocol.

Salbertina Thu 23-May-13 21:36:32

Clinical risk must always be paramount and then the wants of the woman. Clinicians have to be the final arbiter on this for obvious reasons so there have to be limits to individual choice.

Feminist5 Thu 23-May-13 21:40:14

Bunnylion Viva (who is an NHS midwife) has just stated herself on this very thread that women are being forced into VBACs.

My own sister was denied an elective cesarean despite having suffered a fourth degree tear during her previous birth.

I've read quite a few threads on mumsnet about women with tokophobia being denied cesareans and/or epidurals by the NHS.

So I can assure you that it is entirely possible for women to be denied choices on the NHS.

Saying no to procedures is generally less of an issue, because patients have unlimited 'negative' rights.

"The problem - as I see it - is the empowerment of women during their pregnancy and labour to actually question and speak against any standard protocol."

Completely agree! I think the empowerment is happening. The voices are being raised, but they are not being heard.

scottishmummy Thu 23-May-13 21:41:13

you're language is v loaded and frankly anti-professional.
pragmatically clinicians manage risk and work with mums to collaborate on outcome
resources aren't limitless, nor are choices.there is no absolute wish list

AmandaPayneNeedsANap Thu 23-May-13 21:43:38

Bunny - I honestly don't know if the ever NHS 'forces' a woman to VBAC. But a VBAC is very different to all the other things you have mentioned in your post because it's the default. If the hospital does nothing, a VBAC is what will happen. That isn't the case with a sweep or an induction. I certainly do know of women who have been 'forced' to do without epidural - because if the anaesthetist simply doesn't show up, you give birth without. If all that happens is that, every time you ask, and your birth partner asks, they say she's in theatre and she'll be there soon, that's what happens.

Also, I agreed to things in labour I would never have agreed to in normal life. I hadn't slept in more than 48 hours before we even arrived at the hospital, and basically neither had my husband. We were in no position to resist 'pressure'. Pressure was almost entirely equivalent to forcing, and I suspect that's an issue for many labouring women.

Feminist5 Thu 23-May-13 21:44:25

Salbertina I disagree. It is human nature for personal bias to enter such decisions. If I am making an informed choice to have a VBAC, but my provider is against them (as many of them are) because he places maximum importance on the risks of uterine rupture then is it fair for me to be denied my choice?

My doctor may think the worst possible risk is an infection and I may think it's a fourth degree tear. I'll request a cesarean till I'm blue in the face and he'll continue to refuse because he sees things differently.

It isn't always about absolute risk, it is often about different perceptions.

I cannot condone women being forced to give birth in ways that they aren't comfortable with.

This is as bad as a doctor refusing a woman an abortion because he/she feels that it is immoral.

Feminist5 Thu 23-May-13 21:46:52

scottishmummy I am not advocating limitless choice hmm

I am advocating very basic simple decisions that women should be allowed to make on their own, such as a repeat cesarean v/s a VBAC or a home birth v/s a hospital birth. I don't think this is unreasonable at all.

Do you actually condone doctors being able to force women to have VBACs or doctors being able to deny tokophobic women cesareans?

scottishmummy Thu 23-May-13 21:49:48

your language is loaded,emotive,you're globally critical of professionals
you're trying to make me answer I question that I didn't pose
don't try to digress into a topic I wasn't addressing

Feminist5 Thu 23-May-13 21:53:02

Yes, I do understand that resources aren't limitless. If they were, we would all give birth in jacuzzis with mood lighting and champagne afterwards. wine grin

Alas! This is not the case.

The way I look at it, most women who give birth on the NHS have paid decent money into that system for a good number of years. It is highly unreasonable to deny them some form of treatment because it costs some £800 more.

Feminist5 Thu 23-May-13 21:55:11

scottishmummy I am not digressing. I am actually trying to address the topic this thread was originally about- choices in childbirth. It isn't about trusting doctors because we all have our own opinions on that based on our life experiences. This is more about women being able to have more of a say in how they give birth.

Salbertina Thu 23-May-13 21:56:38

Clinicians are held accountable and therefore cannot just follow their "personal bias" (and, btw, obstetricians are FAR more likely to be a she than a he!) They have evidenced-based protocol to follow and for a reason.

Safety -of the mother and baby/ must be paramount and therefore choice at times is secondary.

There is no way a high risk woman should have a home-birth (and i speak as someone who had a homebirth!)

Feminist5 Thu 23-May-13 22:01:31

Salbertina Gender is irrelevant. It could be a he or she, it honestly doesn't matter!

Clinicians are held accountable but many decisions are in a grey area. Such as the decision on how a woman with one prior cesarean should give birth. Or how a woman with tokophobia should give birth. There is no right or wrong answer here and even clinicians amongst themselves might disagree on these issues. Therefore, it is entirely possible for there to be a conflict of opinion between doctor and patient and it may be very difficult to say who is right and who is not.

I agree with you that ideally high risk women should not have a home birth. But would you advocate a high risk woman being forced to have a hospital birth against her will? Or would you advocate a woman being forced to have a VBAC/repeat cesarean?

Doesn't that sort of system reduce women to incubators who have no say in what happens to their bodies?

Feminist5 Thu 23-May-13 22:04:53

Also, like Viva pointed out protocol is also cost based, not just evidence based. Secondly, in many areas of childbirth we do not yet have enough evidence to be able to say with certainty what is best.

Whatever happens, good or bad, ultimately the woman has to live with it. Therefore, the decision should ultimately be hers.

badguider Thu 23-May-13 22:04:59

I support a woman's right to choose but I also support any individual hcp's right not to be involved in something they believe is very dangerous.
If I was a MW or doctor (I'm not) I would not be able to support somebody choosing a course of action I believed to be deadly - but if all hcp's refuse to support a choice then really the woman doesn't have that choice. It's a conundrum I have no answer for.

scottishmummy Thu 23-May-13 22:06:29

you quite simply have an agenda that you're sticking too irrespective of contrary pov
women as incubators might sound really right on in socialsciencetatic essay
but it's hollow quip with no substantive basis

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