Policing Birth

Policing BirthRebecca Schiller and Elizabeth Prochaska

Introduction: Birthrights

•Who we are and what we do

Who we are and what we do

● Set up in 2013.

● Inform women and maternity professionals about human

rights in maternity care. Factsheets available: birthrights.org.

uk.

● Provide individual advice service to women and

professionals.

● Undertake research, e.g. Dignity Survey 2013.

● Campaign on human rights in childbirth.

● Train health professionals about their legal obligations.

Why it matters

“I fell so far down a well of sadness that first weekend and felt like there was a wall between me and the rest of the world for the next year.”

History, identity and perfection

Pregnancy and birth as the gateway to perfect motherhood, dragging behind them the historical shadow of death, can understandably weigh heavily on the mind, the policy maker and the media.

Media: oppositional views only

Don’t judge me (but I’ll judge you)

Don’t judge me (but I’ll judge you)

Policy: focused on targets

“Normal birth”: harsh criticism

Phipps (2014): “a shift...from the feminist-inspired aim of protecting women from the process of medicalization to … using ‘normal birth’ as an indicator and target and promoting ‘normalcy’ as an outcome: within this new framework there was a clear preference for particular types of birth over others.”

The reality

Impact on women

Birthrights, Dignity in Childbirth Survey, 2013

Dignity

Perhaps even more important during childbirth?

Professor Harvey Chochinov (Schiller, 2015), “if outside forces make a woman feel weak, inadequate and otherwise undermine her sense of dignity she “will feel the assault of these harsh judgements and may internalise them as being reflective of her self worth.”

Birth in 2016

● Intense pressure on women: internal and external● Media scrutiny● Presentation of birth choice as oppositional● Birth wars distract us from similar struggles faced by

women● Policy is focused in one direction● Yet services don’t match rhetoric● Impact of birth on women is significant● Dignity is key

Policing birth – common examples

Women with high BMI face…

- Sanctioned stigmatisation/discrimination in hospital

policies

- Limitations on access to services

- Non-evidence based risk assessments

- Restrictions to fundamental choices during labour

Policing birth – common examplesWomen seeking an elective c-section face:

- Assumption of mental health issues

- Risk distortion

- Official withdrawal of care

NICE guideline, Caesarean section: For women requesting a Caesarean section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned Caesarean section. An obstetrician unwilling to perform a Caesarean section should refer the woman to an obstetrician who will carry out the Caesarean section.

Policing birth – common examples

Women seeking vaginal breech birth face:

- Risk distortion

- Limitations on access to services

- Restrictions to fundamental choices during labour

- Official withdrawal of care

Policing birth – common examplesWomen with mental health issues face:

- ‘Compulsory’ referrals

- Restriction on services/choice

- Even court-ordered c-section (recent cases: Re AA, Mental

Health Trust v DD)

Policing birth – common examples

Social services referrals and investigations:

- Women making choices against medical advice face potential

referral to social services by midwife/doctor (home birth, declining

prophylactic antibiotics, early discharge from hospital)

- Social services may investigate on the basis of risk of significant

harm to the baby at birth

A human rights approach

- Founded on the principle of human dignity: treat a woman as an end in herself and not a means to an end

- Force of law: in both the English common law and under the European Convention on Human Rights

- Proactive, not reactive: promotes good decision-making and guards against harm

In April, we will be publishing a Human Rights Guide for Midwives in collaboration with the British Institute for Human Rights and the RCM.

Human Rights Guide for Midwives

We want to empower midwives, doctors and birthworkers as they provide respectful care to women during pregnancy and birth. Our training and education programme aims to directly improve care for women and families, change practice, address inequalities at the frontline and strengthen the case for the use of human rights in maternity care.

Birthrights Training and Education

birthrights.org.ukinfo@birthrights.org.uk@birthrightsorgfacebook/birthrights.org.uk

Registered charity no. 1151152