Childbirth rights globally

[PeaceAndHope]

I've spoken about this earlier on mumsnet. I think that the rights of women while giving birth are an integral part of the feminist movement, and I know that a lot of you agree. Until even a few years back, these rights were thought to be limited to women being able to choose a home birth, a natural birth or a VBAC. I've always believed that it is equally a woman's right to choose an elective caesarian or an epidural, as long as it is an informed choice.

In the UK, I am seeing a more balanced debate about this now. Most of my feminist friends here agree that it is wrong to deny women the right to choose how they want to give birth, even if what they choose is artificial pain relief or a surgery. Her body and her choice.

Unfortunately, I haven't noticed a similar trend in other countries, particularly the USA. I have relatives there and so I visit the USA quite frequently and the attitude of the self-proclaimed "feminists" there really surprises me. A lot of them think that women should be denied epidurals and caesarians. They even think that women should be denied repeat caesarians and be forced to VBAC.
In fact, I was told by a friend that the American pregnancy forums will delete any post that speaks positively of an epidural and/or caesarian.

Americans IMO have always been more ignorant , but isn't this a bit extreme even for them?

I fully support a woman's right to have a hands-off, non-medical birth if she prefers that and I find it horrifying that women are being forced into caesarians or forceps without consent. But how will we solve this problem by denying other women their choices? The answer is to enforce an adult, sane woman's right to both refuse and request reasonable treatment while giving birth.

Some women want a medicalised birth and others want a natural birth. Why oh why can't we just leave all of them alone to make their own choices as adults?? And why does the American feminist movement align itself only to an all-natural birth? Doesn't that actually put pressure on women to do things in a certain way and maybe even set them up for disappointment if that does't happen?

For a movement with a motto like "her body and her choice" sometimes we sure like to tell women what to do with their bodies!

[PeaceAndHope]

TheDoctrine

I don't really know what argument you have tried to make overall in this thread.

Are you simply sharing trivia or are you saying that it's actually OK to get women to pay for abortions personally?

The point that I was making is that American feminists have argued for the right of women to have abortions free of cost. They have argued for the right of women to have their home births and VBACs (which can cost quite a bit, especially if things go wrong) to be paid for by insurance.

Given the above, I don't see why an argument to get insurance to pay for elective caesarian sections would be so undoable and unreasonable.

I keep coming back to the same point- there isn't a single influential, prominent feminist (especially in the USA) who is arguing for the rights of women to have elective caesarian sections or a more medicalised childbirth experience if that is what they want.

Recently, the Mayor of NYC announced that women wouldn't be able to formula feed their newborns in New York hospitals without there being a medical reason for it. Instead of being outraged that the rights of women to not breastfeed were being attacked, feminists celebrated this as some sort of breastfeeding victory.

(Mayor Bloomberg of New York had announced that women who want to formula feed for non-medical reasons will no longer be given formula by the hospital. If they still refused to breastfeed, then whether they would be given formula or not would depend on the discretion of the hospital staff who have to account for every bottle of formula given out in their facility. Since US health and safety laws don't allow women to bring in their own formula into the hospital, this does put formula feeding moms in quite a pickle)

[TheDoctrineOfJetlag]

I was trying to enlarge on my point about elective procedures in different healthcare systems, but was also trying to pack up for a day out, so was a bit disjointed.

I'm coming from a feminist perspective and a health economics perspective, I suppose. It's hard to comment knowledgeably, OP, because healthcare systems are so different in different countries. So I can only speak with any depth of knowledge about the UK.

In a perfect world, every woman would access all the child-related choices freely (including free, unlimited IVF, free birth control, free abortions, free elective caesareans, free sterilisation etc).

But I know that free unlimited IVF, say, would leave less money available for some other treatment and that some other person would be in pain (physical or mental) because of that.

So I can understand if a particular country (or other payer) looks at the costs and the medical outcomes of elective caesareans and places caveats on them. The same kind of framework is applied to eg new drugs being introduced.

Reading the NICE guidelines, it seems the plan in the UK is, to paraphrase, to talk women out of ELCS where possible but not to deny if that's not possible.
NICE

It looks like a sensible policy to me. But looking at the list of influencers - medical professionals, birth/parenting associations and mothers - I don't think that high profile feminists influenced it, though I could be wrong.

I assume that ACOG's opinion in the US is taken seriously, is that right? Their current guidance doesn't recommend but also doesn't preclude ELCS, how does that interact with what insurance companies do?
ACOG 2013

Turning back to your OP, I agree with you that women negatively judging women who choose epidurals or elective caesareans isn't a feminist act. But I'm not sure that feminists are better placed than, say, doctors, to lead any campaign on this issue, as it is so much about the balance of physical risks and possible trauma.

(UK hospitals don't give out formula either but you can bring your own in. That sounds unworkable if you can't )

[AmandaPandtheTantrumofDoom]

Do you have a link on the NYC thing Peace? I am interested to read, but when I have just Googled I am finding articles from last year which said that formula would have to kept locked up like medication and all other medical equipment and signed out at the mother's specific request. I don't agree with the bit I've found about a mandatory lecture, but that's not the same as discretion and denying mothers an option to formula feed their baby, so I'm interested to see if it has changed in the last year?

US hospitals have a very formula based culture where newborns are often kept away from parents, given formula in the night as routine unless you've stressed not, freebies are given out, etc. I can understand trying to balance that, though of course maternal choice should and must be the final governing point.

[PeaceAndHope]

Amanda

What you've read is absolutely right. Formula will be locked up and there will be a mandatory lecture if women ask for it- even then it will be up to the HCP to decide whether to give it to her or not.

Do you want further links to the same story? Because it seems like you've read the right one.

The reason that this is equivalent to denying mothers formula is because in most USA hospitals, the health and safety guidelines state that outside food (including formula) is not allowed.

So if hospitals are restricting formula and keeping it under lock and key and women can't bring their own either- isn't it essentially denying them formula? Or at the very least making it rather difficult for them to be able to formula feed their newborn.

And shouldn't feminists be concerned about this?

I didn't even see them protesting the mandatory lecture.

[PeaceAndHope]

Finally.

Evidence that mainstream American feminists do not support caesarian on request.

Here we are then : a blog post from ourbodiesourselves.com which states "We must clearly understand that real autonomy does not mean cesarean on request"

www.ourbodiesourblog.org/blog/2009/04/an-essay-on-the-factory-model-of-childbirth/comment-page-1#comment-8094

[PeaceAndHope]

Doctrine

Yes, ACOG is taken quite seriously there. Unfortunately, their current guidelines are quite ambivalent when it comes to caesarians on request.

OTOH, their guidelines about VBACs are quite explicit. They state that it should be encouraged and allowed, even in case of unknown scars on the uterus (which might be vertical).

[AmandaPandtheTantrumofDoom]

Well, I strongly disagree with the idea of a lecture. That bit sounds awful. I didn't see anything in the stories I found about discretion in giving it out after the talk, so I'll leave that bit on one side for now.

But the keeping formula locked up and getting it signed out, no I'm not sure I do disagree with that. I'd have to know a lot more about how it was implemented and whether it was causing distress to mothers and babies. The US has a long and sad history of 'formula pushing' in hospitals, so I can see the need to redress the balance. I fully support every single woman's right to ff. But I also support every woman's right to bf and not to have efforts to establish bf-ing undermined by commercial enterprises (which is what has sadly happened a lot in the US) so it is a very difficult balance. I'd need to know a lot more about the implementation.

As I said, the lecture bit is horrid though.

[PeaceAndHope]

Amanda

If formula is locked up and handed out at the discretion of HCPs, they will try to stop mothers from accessing it. A woman should simply be able to say that she wants to ff, and have that decision accepted without needing permission or having to have an HCP sign off on it.

I also fail to see how this will help mothers who want to breastfeed. If you want to breastfeed, then do it. How will it help you to have access blocked to women who don't want to breastfeed?

Most importantly, the low breastfeeding rates in the USA is largely a media created myth. Around 75- 80% of first time moms leave the hospital exclusively breastfeeding their babies. That wouldn't happen if nurses were sneaking formula to them without anyone's knowledge.

www.sciencenews.org/view/generic/id/348259/description/US_breast-feeding_rates_up


Especially in New York, most mothers breastfeed their babies already. I fail to see the point of this exercise.

www.health.ny.gov/statistics/facilities/hospital/maternity/

[TheDoctrineOfJetlag]

Peace, I read that post withtheextracts from the article as being concerned about the medical profession "gearing up" for more c-sections which would then be likely to lead to pressure on women to have c-sections. I read the phrase you highlighted as equivalent to "autonomy doesn't mean you have one choice promoted to you which is a c-section"

I didn't read any of it as anti-c-section, more as anti hospitals pushing sections for their own purposes.

[AmandaPandtheTantrumofDoom]

Formula needing to be signed out doesn't automatically mean that HCPs will try to stop mothers accessing it. That is an assumptive leap.

I have said before that I don't think it's necessarily constructive for Uk feminists to have a detailed debate on US policies. Not because, as you've tried to characterise me, I only care about my country, but because we do not have as much access to the background information to inform our judgement. I've also said that I would need to understand implementation.

It was very clear that something needed to be done to support Bf-ing in US hospitals. It really isn't as simple as saying that availability and promotion of formula do not affect women who bf. That's like the old argument that formula adverts shoudl be allowed because they don't directly make someone decide to ff.

Even very recently women leaving private hospitals in many parts of the US were sent home with 'goodie bags' promoting certain brands of formula. Bf-ing rates in many parts of the US fall dramatically within 1-2 months. Part of this is short maternity leave, but another part is the undermining of bf-ing that routinely happens in the early days and the delayed effect of that.

You think formula should be freely available without any monitoring. That's your right. I do not. It doesn't make me a worse feminist. And it doesn't mean that I don't support a woman's right to choose what to do with her body. It just means that I think that those women who choose to bf should be supported and given a fair crack of the whip. So many women choose and want to bf but are undermined and find themselves feeding their baby in a way that they didn't choose. Sometimes that is inevitable. Often it isn't.

[PeaceAndHope]

Amanda

Formula needing to be signed off means that unless the HCP agrees, the woman cannot have access to formula. Which means that the power lies with the HCP and not the woman. Maybe some HCPs will agree, while others won't. I'm not making an assumptive leap, I am simply stating a fact. Many HCPs are breastfeeding zealots and can keep women from accessing formula if they are given this level of control.

I agree that women who breastfeed should be supported. But the way to do that is by making lactation consultants and further support available for breastfeeding moms, not by restricting access to formula for those who don't even want to breastfeed in the first place.

Currently, I only see campaigns to support breastfeeding- baby friendly hospital initiatives, initiatives to make public spaces friendly for breastfeeding mums, etc. And they seem to be working very well! Breastfeeding rates are increasing and most hospitals have lactation consultants now.
How about some initiatives to ensure that women who want to formula feed are not restricted or shamed?

I formula fed. I had strange people come up to me and say things like"breast is best, you know" or give me disapproving looks.

I was forced to breastfeed my first child in hospital (even though I did not want to) because the midwife didn't agree with formula feeding and I was too tired and too much in pain to argue. That's how easy it is for them to deny access to women who have just given birth and are tired and vulnerable.

I don't see how it would have affected any other woman if I had just been given the space to feed my baby formula like I had wanted to.

I am not asking for free formula samples to be handed out to everyone. I am simply saying that if I ask for formula I should either be given some without question or at the very least be allowed to bring my own. Unfortunately, the new rules in NYC don't leave room for this to happen.

doctrine

You and I must have read different articles, because that isn't how I interpreted it all. I think most people will be against c-sections being forced on women, but what has that got to do with women who choose them?? I take great offence to the fact that this woman who calls herself a feminist just insulted the choice of so many women by saying that it wasn't real autonomy.

The feminist debate needs to widen it's perspective when it comes to childbirth and include the rights of women like myself who choose options other than a natural birth or breastfeeding for 2 years.

Women who want to have epidurals, caesarians or women who want to formula feed are being as restricted as women who prefer a more natural approach. Yet, it is the rights of only one group of women that get discussed and supported. I am simply questioning this disparity.

I am not attacking feminism or feminists (I am one myself), so there is no need to make excuses for them or become defensive.

[AmandaPandtheTantrumofDoom]

I think we are going round in circles here, so there probably isn't much point continuing, though it is has been an interesting discussion.

I don't agree that signing out will mean 'zealots' deny woman. I am sorry for your bad experience. But women have (sadly) bad experiences in all directions. Just as many are pressured in the other direction.

I simply don't accept your premise that this initiative isn't a support for bf, though it has been a long time since I read all the stats on this type of thing (though I am sure people on bf/ff would have them)

I hear people say again and again that ff mums are shamed or subject to negative comments. Then I see again and again comments from bf mums saying the same about their choice. The reality is that ff is the normal way to feed your baby in this country and in the US (initiation rates are high, but continuation plummets) and I think both groups sadly have negative comments, just like any choice you make as a mother. The right to judge mothering is a whole other issue an done which sadly applies across the board.

I think that supporting any mother to make her own choices is a feminist issue. I don't think that that means making formula arrangement the way you would prefer.

[TheDoctrineOfJetlag]

I am sorry that midwife acted that way and that people came up and questioned your feeding choices. That is crap.

I think we must interpret things differently as I interpreted your OP with its mention of self proclaimed "feminists" as far more attack-like than the blog post just discussed.

HCPs will always put together guidelines based on health outcomes. If, statistically (which I think is the case), vaginal birth has fewer "side effects" on a population level than c-sections, then it would be unHippocratic not to "recommend" that as the first line of treatment. As the outcomes are not hugely different and patient autonomy has an impact on those outcomes, patient choice should be a much bigger consideration in birth than in, say, prescribing antibiotics, but the two options will never be completely equal to a HCP.

[PeaceAndHope]

Amanda

The reality is that formula is the normal way to feed a baby in this country (or in the US)

Absolutely untrue. 75-80% of new mothers breastfeed their babies in UK and USA. Every ante-natal class and every HCP drills it into every pregnant woman that breast is best. Formula is far from being viewed as "normal".

Yes, it is viewed as an option and I see nothing wrong with that at all.It doesn't mean that women who prefer breastfeeding are being harmed in any way at all.

I don't agree that signing out will mean 'zealots' deny woman.

REALLY? You don't agree that some people have a pro-breastfeeding bias? And if the decision is left up to them, you don't think that they will make it hard for women to access formula? They're already doing that! There is so much pressure on hospitals to become 'baby friendly' that they are trying by hook or by crook to make sure that every new mother breastfeeds whether she wants to or not.

I think that supporting any mother to make her own choices is a feminist issue. I don't think that that means making formula arrangement the way you would prefer.

That makes absolutely no sense because it's a self-contradictory statement. If you restrict access to formula, then it will mean that women who want to formula feed are not supported in their choice. Why is that so hard for you to comprehend?

As a formula feeding mum, I didn't want to have to explain my decision to every HCP and wait with insecurity while they decided whether or not they wanted to sign some off for me. That is outrageous. How is that supporting a choice, please explain this to me??


I simply don't accept your premise that this initiative isn't a support for bf, though it has been a long time since I read all the stats on this type of thing

Please explain to me how it will help breastfeeding moms to have formula restricted for women who don't want to breastfeed in the first place. I am most curious to know your reasoning behind this.

[PeaceAndHope]

Doctrine

Firstly, I have no issue with a VB being recommended. I never really said that it was wrong to do that. I am not even suggesting that HCP be the ones to offer caesarians randomly. I simply want them to respect the informed choice of a woman who asks for it and so far they aren't doing that across the board in any country.

Secondly, which mode of delivery has more side effects often depends on the person. There are women who had staph infections in caesarian incisions and then there are also women who had incontinence and colostomies following a vaginal birth. The issue is that the risks of a caesarian are discussed much more openly than those of a VB.

And yes, my OP was an attack. I don't deny it. I am sick of the bias that feminism has against the choices I made as a mother.

[AmandaPandtheTantrumofDoom]

Those rates are early days rates of bf. The fact is that long term, most babies are ff.

As for the rest, I think we are going round in circles, so although I disagree I am not sure it helps to keep discussing it.

[5madthings]

sorry but most mothers dont bfeed in the uk. yes a lot of them start to but within a week the number declines hugely and by six weeks the vast majority of babies are bottlefed. as far as i know that is similar in the us.

m.bbc.co.uk/news/health-20406743

yes women should have the right to c sections on request but thete is a huge issue of childbiryh becoming ovet medicalised and at the moment campaigns are focusing on that.

of course you are welcome to set up a campaign for c sections on request but i guess its slightly trickier in the us with insurance etc and they have othet isdues like some if the worst rates for maternal and infant death in developed countries. and the fact that the right to abortion is being steadily eroded in many states in america.

[PeaceAndHope]

Amanda

The fact that you have not answered even one of my questions directly is making me think that you may well be a closet lactivist who agrees with the idea of formula being restricted.

We are not going around in circles, you are simply evading the topic. What don't you agree with?

[PeaceAndHope]

5madthings

What happens to breastfeeding rates after mothers are discharged from the hospital is really down to the support that women get post-natally and from their families.

The solution is to encourage better post-natal care (instead of the token 6 weeks check) and to educate families in ways to support breastfeeding mums. Making work-places friendly for breastfeeding mums is another issue that requires attention.

I don't see what we are accomplishing by restricting formula. The vast majority of women want to breastfeed (as evidenced by the high initiation rates) and the focus should be on supporting them, not on restricting access for the minority of women who don't even want to breastfeed. That's all I'm trying to say.

My sister couldn't breastfeed because she didn't have enough post-natal support. When I was denied my choice to formula feed in the hospital, guess what? It didn't help her in the slightest. Why? Because the two are unrelated.

And there are women who have started small scale campaigns for c-sections and epidurals on request, but for such campaigns to be successful they need the attention of people with more influence. The mainstream and prominent activists choose to focus only on the right to a natural birth.


I personally didn't feel that childbirth was overmedicalized where I gave birth. They tried their best not to induce me until I got to 42 weeks, even though the baby was measuring very big for dates and I had excruciating SPD. Then they did all they could to stop me from getting an epidural. Then they did everything possible to force me to breastfeed. I didn't even have fetal monitoring even though I would have actually wanted it.

Maybe in the USA childbirth is not really 'natural' (although we all have our definitions of natural) but in the UK at least, I feel that natural birth and breastfeeding are being preferred and encouraged quite a lot.

[AmandaPandtheTantrumofDoom]

I haven't answered your questions because you are not listening to anything anyone on this thread says, so I see no point. It's not a discussion, it's you lecturing people.

And you are often (either intentionally due to the passion of your argument or unintentionally) misquoting statistics and information - like NW and bf-ing stats.

I also think, quite frankly, that you have tipped the balance to just being rude and passive aggressive towards me. So I really don't see much benefit. If I were talking to you in RL, I'd reserve the right to excuse myself now, so it's what I'm doing here.

[PeaceAndHope]

Amanda

Which stats have I misquoted? I said that 75-80% of women now leave the hospital breastfeeding and I provided several links to prove the same.

You are claiming to support choice and then in the same breath you say that it is OK to restrict formula. How is that supporting choice?

I am very interested in a discussion, but you made it awfully difficult for me by nit-picking little details and focusing on the most irrelevant parts of the debate. You can therefore hardly blame me for being a bit put off.

When someone excuses themselves from a debate despite claiming to have the right answers,it usually means that they don't have the right answers. The fact that you haven't clarified your position and the fact that you haven't answered how restricting choice for formula feeding moms will help breastfeeding moms makes me think that you are caught out and you have nothing to say in support of your opinion.

[GoshAnneGorilla]

O.P - I actually agree with a lot of your points, particularly any dubious attempts to dissuade mothers from formula feeding, especially as discouraging formula feeding doesn't equal improved bf support, it's just leaving mothers to flounder.

However, I don't think you're doing yourself any massive favours with how your coming across here.

[AmandaPandtheTantrumofDoom]

You obviously have the right to think what you like. I remain of the view that continuing this discussion is not constructive.

[PeaceAndHope]

GoshAnn

I don't think I am coming across any better or worse than a lot of other posters who have been defensive and accusatory since the beginning.

I am appalled that there are "feminists" on mumsnet who agree with measures to restrict formula, epidurals and c-sections.

[PeaceAndHope]

Amanda

Continuing this discussion is not constructive for you because you are of the opinion that women should have choices as long as you agree with them. You clearly support the idea of restricting formula and childbirth choices. Since you know that it a terrible opinion to hold, you are simply avoiding the discussion. Not once have you denied my accusations. You've simply stated you don't want to continue the discussion.

Fine by me. I suspect I am a happier person not knowing your real opinions anyway.