Women’s rights in childbirth have occupied a dusty corner of the feminist movement for too long. As CEO of the human rights in childbirth charity, Birthrights, I’m working with a small team of staff and an expert board of midwives, obstetricians, lawyers and maternity service users to change that.
We believe that all women matter in childbirth and that we need to be treated as the same, reasonably rational human adults we were before pregnancy at this transformational time in our lives. We’re using the human rights framework (with its focus on dignity, respect, choice and autonomy) to push for a system, services and practice that protects women during birth, offers them safe, equal and compassionate care and listens to their feedback. To do that we provide advice, training for NHS staff, conduct research and feed the resulting knowledge in to maternity policy - always with a focus on vulnerable groups.
Women contact us for free advice on a range of issues. From accessing their chosen place of birth and help with making a complaint about care to dealing with issues around informed consent or entitlement to maternity care in the UK.
Over the past two years a worrying third of our advice service enquiries have come from women trying to access a maternal request caesarean and finding themselves battling, jumping through endless hoops and waiting for months for answers. Some women whose reasons are not deemed compelling enough have even had their care withdrawn completely in the last weeks of their pregnancy. These enquiries have been some of the most distressing we have handled and we’re determined to do something about it.
Whether they are choosing a caesarean, a homebirth or any other birth option women have very compelling, thoughtful and sometimes private reasons for making their decision. From the 83 women hoping to have elective caesareans we advised in an 18 month period 33% had experienced a previously traumatic birth. 28% wanted a caesarean birth because of an underlying medical condition such as symphysis pubis dysfunction (SPD), vaginismus or fibroids. 16% of women simply believed it was the right option for them (often after extensive research into the evidence), 8% cited primary tokophobia as their motivation while 6% explained their request was based on other trauma in their lives such as sexual assault (6%). 10% did not give their reason for making this request. Nor should they have to given our growing realisation that many more women have experienced trauma and violation in their pasts than we’ve previously assumed.
Through a series of Freedom of Information request we have created this map of Trusts showing the 26% who offer a respectful pathway for women to request a caesarean (in line with best practice guidance) Trusts whose policy effectively bans maternal request caesareans (15%) and the many in the messy middle ground that women are expected to muddle through. We’re now working closely with national policy makers, the Royal College of Obstetricians and Gynaecologist and the Royal College of Midwives to push for clear national recommendations on this issue and to encourage Trusts to abide by them. And we are considering legal action if Trusts’ policies are shown to be unlawful.
Women make decisions on what kind of birth is right for them based on a range of medical, social, cultural and experiential factors. For me a safe birth meant being at home, for others it requires access to an epidural or the presence of a trusted midwife. And for a small percentage of women electing a caesarean is an important decision in a positive journey to motherhood. We must come together to support women’s decisions and insist on a system that makes safe, respectful care a reality for all.
If you need information on anything concerning your rights in pregnancy and birth head to our website and this series of Mumsnetters FAQs, such as “Can I be refused admission to a midwife-led unit” and “Do I have the right to access my maternity notes?”
I’ve used this radical idea that pregnant women are human beings as the basis for my new book, Your No Guilt Pregnancy Plan: a revolutionary guide to pregnancy, birth and the weeks that follow. I’ve focused less on the ‘you shoulds’ and ‘you shouldn’ts’ and more on the concerns that came up for me when I was first pregnant a decade ago and asked for support on a Mumsnet due date thread. So there aren’t endless comparisons of your baby to the size of a vegetable but I do cover the huge shifts happening in our relationships, bodies, work, sex and emotional lives as we become mothers. And of course a firm focus on rights and mental health.
birthrights.org.uk
rebeccaschiller.co.uk