Childbirth rights- are you pro-choice?

[Feminist5]

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]

I forgot to include a VBAC!

[JedwardScissorhands]

There is very little I agree with on the feminism boards, but choice in pregnancy is fundamental to equality for me. Choice whether to continue to be pregnant, at any stage and for any reason, and choice when and how to give birth. The only caveat would be that resources. Maternity obviously needs adequate funding but that doesn't mean facilitating every precise choice. So you may have to wait for the epidural, and you may nit get an attended homebirth if the midwife isn't free.

[Bunnylion]

I'm pregnant and haven't come across any pressure as to where and how I can give birth.

Everything I've come across with the NHS has been put to me with the aim of providing information with the full understanding that all of the options are 100% my choice. Hearing from friends who have very recently given birth have had the same experience right through to beyond birth.

In answer to your original question, yes - all women should have 100% control on making an informed choice how they birth their babies.

[VivaLeBeaver]

I think all women should be able to choose a home birth.

Elective induction I'm not so sure about. Induction is expensive for the nhs and if there's no medical need I don't see the point.....just because someone's a bit fed up with been pregnant, etc. research shows that induction is often the start o a cascade of intervention. And where do you draw the line? If a woman wants an induction at 33 weeks pregnant (which I've seen been asked for) do the doctors agree because its her choice/her body?

I think everyone should be able to have an epidural......but the problem again is lack of resources. Most women can have one if the anaesthetist is available, they may have to wait for the anaesthetist to be available. But apart from waiting for a dr I don't think women should be put off an epidural if its what they want. In an ideal world there would be 2 or 3 Drs per labour ward but its not going to happen.

Elective ceaserean, yes I do think women should be able to make an informed choice over this. If they understand risks, etc and still want one then yes. Though again there is an increased cost to the nhs but like its been said before. If someone ends up with a vaginal birth against their wish then there is more chance of pnd, etc which has its own cost implications.

[Feminist5]

I think resources are critical to the discussion, but then that isn't limited to just maternity. That would be true for abortions and any other medical treatment.

Abortions cost the NHS money as well, yet we don't oppose it on those grounds.

The lack of resources can also lead to a different feminist debate on why is it that maternity wards seem to most understaffed and underfunded? Why is it that it's so easy to have pain relief for even the most minor procedures in hospital but not during labour?

VivaLeBeaver I battle with the questions you've asked as well. I have heard so many women state that abortion should be allowed up until 39 weeks. Then the same ones turn around and say that elective inductions and cesareans shouldn't be allowed and that is what doesn't make sense to me. It just sounds hypocritical to say that it's OK to compel a doctor to give a fatal injection to a 39 week old fetus, but it is not OK to request a cesarean or induction.

Personally, I don't think anyone should have an induction at 33 weeks. However IME maternal rights are given far, far less importance than fetal rights and this seriously disempowers women. I think we need a system where a woman is considered the final word on what happens to her body even if she is pregnant.

[Feminist5]

Bunnylion Congratulations on your pregnancy :)
I know that there are women who have very positive experiences and I am always glad to hear them. Unfortunately, not everyone has an experience similar to the one you have had so far. The women I know for instance have had completely different experiences where their wishes weren't respected at all.

[Feminist5]

Viva Don't you think the resource argument can be used against home births as well then? In most hospitals there should be two midwives per labouring woman. Yet in reality there is often one midwife taking care of three women at the same time. Is it then always fair to send two midwives to attend someone's home birth?

I think that the argument about resources can be used against almost any birth choice from a VBAC to a home birth to an elective cesarean.

I think a good feminist cause might be to work towards a way of ensuring that women can choose whatever way of giving birth they prefer without resources being a hindrance.

[VivaLeBeaver]

Home births actually work out cheaper than the majority of hospital births as they're more likely to be straight forward. Therefore no dr involvement, no paed, no overnight stay.

[Feminist5]

Women can give birth in hospital without a doctor being involved and can be discharged 6 hours later (no overnight stay required). A straightforward birth will be cheaper no matter where it happens.

In any case, I don't think money should be the deciding factor here at all. I think the decision needs to be based on what is best for the lady in question both physically and emotionally.

[VivaLeBeaver]

Hence why the only thing I'd argue against is induction on demand. There are definite benefits to being able to choose a csection, epidural or home birth. What's the benefit of early induction? It's the same method of delivery, with greater risks just because someone is impatient?

A straightforward birth will be cheaper no matter where it is but a woman has more chance of a straightforward birth at home where there can't be interference from a dr. Once they're on a labour ward the Drs start prowling. If a woman has only gone from 3cm to 4 cm in 4 hours they're telling the midwife to break the waters and put synto up. The midwife tries arguing that the woman wasn't in established labour for the first of those two hours but Dr wins. Wouldn't happen at a home birth.

I agree that money shouldn't be an issue but in reality it is, it totally is. Accountants make the overall decisions. Not the individual ones but the ones like some trusts now won't offer repeat sections for previous section. You have to have a vbac whether you want one or not. That blanket ruling was down to money.

You talk about what's best for the woman both physically and emotionally - but who says what's best. A lot of Drs might say a section isn't best for a woman physically so therefore refuse her one.

[Feminist5]

But Viva that is the point. I am arguing that it isn't for anyone else to decide what is best for the woman. She is the only one who can determine what might be suitable for her.

For example, I concede that a cesarean is risky. But if I prefer the risk of infection to that of a third degree tear, then those are my preferences which the doctor may or may not identify with. But since it is my birth experience and my body and I have to live with the consequences of decision, shouldn't it be my choice and no one else's?

[Feminist5]

I find it appalling that some trusts are forcing women to VBAC How can they force someone to take the associated risks???

This is what I mean when I say that pregnancy disempowers women. There are plenty of other areas where the government can cut costs. I find it disgusting that they choose to take away a pregnant woman's right over her body.

[Feminist5]

If the woman they have forced to VBAC turns out to be one of the unlucky ones to have a uterine rupture will they take responsibility?

[Salbertina]

Clinical risk must be a factor too. Not only did i not have to fight for a home birth, I was persuaded towards one by an NHS consultant and midwife. Much yhknking around this is far too black and white and simplistic.

[Feminist5]

Like Viva said, home birth is cheaper. That may have been why you were persuaded into one?

Women who want repeat cesareans or epidurals DO have to fight for it. Some even have to fight for a home birth.

[VivaLeBeaver]

Yes, totally agree. It should be the woman's choice and its very condescending and probably patriarchal for Drs to be of the "silly woman doesn't understand the risks, I know best" opinion.

But if it comes down to the woman wanting an option which costs 3k more then should she have a choice? Nhs trusts are fast running out of money which is what's behind the vbac only decision at a trust I know.

You can argue that higher rates of pnd, etc will cost the nhs as much but the hospital doesn't give a toss as they won't pay out the obstetric budget for pnd treatment. They likely won't pay for it at all as it will come out the GPs budget.

I suppose if a man had a condition that could be treated two ways and one was more expensive the nhs may well tell him he has to have the cheaper one no matter what his preference is.

[VivaLeBeaver]

If the woman has a uterine rupture Maybe she has a good case. Maybe the trust though would argue the risk is very small and the risk of section complications is actually higher.

If a dr/hospital can back their treatment/care up as evidence based then I think the woman may struggle claiming. The dr says he chose the best of both options, both had risks, the woman was unlucky.

[TeiTetua]

You can imagine a doctor saying "silly woman doesn't understand the risks, I know best" and of course that's wrong. But then what if it's a case of "patient who has no medical qualifications wants to do something which imposes a risk on her or her baby"? I think we must accept that at some point medical ethics require a doctor to say "No, I won't do this because I feel it would be wrong". And then there's the issue that when resources are scarce, the doctors have to consider the cost of whatever treatment the patient wants as part of the decision.

The doctor should always respect the patient. But I can see there might be times when the patient's wishes can't be followed.

[Feminist5]

I am not fully convinced. Firstly, a cesarean costs £800 more, not 3k.

Secondly, maternity is a women's rights issue. Men do not have to give birth, nor do they have to go through any such major life event which can change their body and impact their health for the rest of their lives.

If this was a dental treatment or a stomach bug and they wanted to use the cheaper option, I wouldn't care. Pregnancy and childbirth is not a trivial matter and treating it as though it was, is misogynistic.

If the NHS want to cut costs then there are plenty of other areas they should look at first instead of making maternity their favourite choice for cost cutting.

The VBAC only decision is so unfair that it has me shaking with anger. It is also illogical- even one VBAC gone wrong can end up costing the NHS trust millions in damage control.

Do you mind telling me which trust this is? (You can PM me if you don't want to reveal it on here).

[VivaLeBeaver]

To some extent, yes. Which is why I said that been able to demand an induction or section at 33 weeks would be very silly and should never happen.

But if its something fairly straightforward such as vbac vs section at 40 weeks.....then the Dr could argue that the section is slightly riskier. But the mum would be right in saying there's a small risk of uterine rupture which perhaps she isn't prepared to take.

[VivaLeBeaver]

Sorry, last message was in rely to teitura.

[BearsInMotion]

Even inductions aren't black and white. I was fed up of being pregnant. I'm disabled and pregnancy exacerbated my condition. Also no-one knew whether I'd be able to manage labour, and one suggestion was an induction alongside epidural was the best chance of a vaginal delivery. So we discussed the options, and that was what I decided. Worked out perfectly :)

[Feminist5]

Viva I have no doubt that the doctor will find a way out of trouble even if the VBAC ends up with disastrous results. They usually always have an excuse.

I'd advise all women to insist (prior to consenting to this forced VBAC) that the hospital sign on a piece of paper which states that she will not suffer a uterine rupture and that if she did, they would take responsibility for the risks involved. It should also go on record that the woman did not consent to the VBAC and was concerned about a uterine rupture.

There will always be a debate about which childbirth option is safer, even amongst obstetricians. Two doctors might have a different opinion on the same case. That is why it has to be the woman who ultimately says what is best for her.

You can argue that a section is riskier based on your perception of risks, but I may find a VBAC worse. Since either way I will be the one to ultimately bear the brunt of whatever happens, shouldn't I get to decide?

[VivaLeBeaver]

Feminist, I've sent a pm.

[Feminist5]

A section at 40 weeks is riskier than a VBAC?

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.