Sunday, 23 September 2012

Reflections on Freedom for Birth

Freedom for Birth, a new documentary film about human rights in childbirth, was screened in over a thousand locations across the world last Thursday, and I was there, keen to take part in a 'Mother's Revolution' supported by leading lights from the field - Ina May Gaskin, Sheila Kitzinger, Michel Odent - all calling for women to 'take back birth'.

The film took as its focus the plight of Agnes Gereb, the Hungarian midwife currently under house arrest for attending women in illegal home births, and the related case of Ternovszky vs. Hungary, in which the European Court of Human Rights ruled that every woman has the right to choose where and how she gives birth.

Quite clearly, there are some circumstances in which the compromise of freedom and the violation of human rights are tangible, for example when imprisonment is involved, or, as in another case touched on in the film, a woman's baby was taken away on the grounds of negligence because she has refused medical intervention at birth. In such instances, outrage and revolution are needed.

In the USA, the film clearly highlights, soaring rates of intervention and poor rates of maternal morbidity are a wake-up call for change. In a land where most birthing women have very little choice about where and how they give birth, and where the majority of obstetricians have never seen an unmedicalised delivery, I felt quite excited by the prospect of an American Ternovszky, taking her case all the way to the Supreme Court, explained in the film by Hermine Hayes -Klein, a Lawyer & Research Director of Bynkershoek Institute's Centre for Reproductive Rights:

With any case, you only have to go to the next court if the lower court doesn't honour the right. Anna Ternovzsky turned to Hungary and said: "Hey, don't I have the right to choose the circumstances in which I give birth?" And they said: "No you don't!" If they had said "Yes" that would have been the end of it. She wouldn't have had to go to the European Court of Human Rights. She only had to go to Strasbourg because Hungary was failing her. Similarly, within the United States, if a birthing woman turned to the state of Indiana and said: "I have a problem with the fact that my midwife might go to jail if she supports me giving birth at home" and Indiana said, "Well sorry, the doctors of Indiana think that home birth is child endangering you and you don't have the right to endanger your child's life" then she could bring an action all the way to the Supreme Court of the United States.

Then the Supreme Court would have this question before it, a first question, just like the European Court of Human Rights faced this for the first time. This question of "Well geez, what are the rights of birthing women?"... Does a woman have the choice of how she brings a baby into the world?" And I would like to think that the United States Supreme Court would acknowledge, as Strasbourg did, that American women have the right to choose the circumstances in which they give birth.

But if it didn't, then that too I think would spark a revolution in American women because it would really bring home for them the problem with birthing in the United States. So either way, the holding has the capacity to generate a revolution whether from the top or from the bottom.

So - America is on the cusp of much needed change. But what about women in the UK, like me? The general feeling in the after film discussion was that we are 'lucky' in the UK that we do not have midwives being imprisoned, nor do we have the hugely medicalised, obstetrician led system of the US. Perhaps, then, we are alright as we are, and don't really need, or even want, a birth revolution? As a hospital midwife sitting next to me put it, "This is great, but it's preaching to the converted. The majority of women I meet aren't interested in changing the system. They're quite happy to just have their epidural and get it over with as soon as possible." 

Whether or not this is true or simply patronising to women is up for debate, but certainly, it does raise the question of whether it is equally a human right to choose to be numb for birth or even bypass it altogether with an elective section. But if a woman makes such choices simply because she's terrified and lacking accurate information - is she truly free?

At the other end of the spectrum, some women choose to 'free birth' without any midwives to attend them, because they have felt violated by a previous hospital birth experience, or decide, in spite of being higher risk, to have a home birth because they feel that in hospital they are likely to be victims of unnecessary intervention. I repeat - if a woman makes choices simply because she is terrified and lacking accurate information - is she truly free?

What all of these women have in common is that they are birthing in a climate of fear - be it fear of childbirth or fear of intervention. Freedom for Birth calls on women themselves to take responsibility for the birth revolution, to 'take back birth'. But in reality, this is not as simple as it sounds. For as much as a woman may understand the politics of birth, her human rights, and that she is giving birth in a world in which far too much unnecessary intervention is taking place, how can she be sure that the intervention she is being offered is unnecessary?

Nine months pregnant, or even nine centimetres dilated, and told that she or her baby are at risk, she is faced with an impossible choice: to stick with the books she has read telling her to trust her body, or to accept intervention being offered by experts into whose hands she has placed her safety and that of her unborn baby. You are too far past your due date, she is told, you have been in labour for too long, you are getting tired, you are not progressing, your baby is too big, your baby is too small, your waters have been broken for too long, you are too old: the risk is increasing. 

"Increased risk" is a term pregnant and birthing women hear all the time, and it is often almost impossible to get to the bottom of. Research, if you can find it, is limited, or old, or contradictory. You may feel you want to challenge the powers-that-be, but struggle to find any concrete evidence that contradicts their view. Rightly or wrongly, the impression is given that lives could be in danger, and, rightly or wrongly, most women unsurprisingly choose to forgo their hopes of a natural birth, and accept intervention.

Again, I repeat: if a woman makes choices simply because she's terrified and lacking accurate information - is she truly free? Across the board, it seems, birth choices are being made for negative instead of positive reasons, a sure sign of oppression. Birth freedom is being eroded throughout the Western world, sometimes in ways that are glaringly obvious, at other times in ways that are complex and hard to unpick. One thing seems certain: this may be a 'Mother's Revolution', but if women, midwives and obstetricians do not work together to address the climate of fear and the unavailability of truly accurate information, then there will never be true freedom for birth.

Take Action:
Free Agnes Gereb
Petition Amnesty to Support Persecuted Midwives in Europe
Petition the European Parliament to investigate human rights in childbirth
Support threatened UK Independent Midwives
The Birth I Want - campaign for continuity of care and birth choice in the UK
AIMS - write to Jeremy Hunt, Secretary of State for Health
Freedom for Birth
Human Rights in Childbirth (HRiC)

Please let me know of other resources to add to this list.

Tuesday, 18 September 2012

I Lie With You Until You Are Asleep: A Sonnet

I lie with you until you are asleep,
Ten minutes, twenty, thirty, often more,
Clocks tick, frustration builds, yet still I keep,
And stay with you on your side of the door.
Out there, my old life tempts, a voice cries, "Fail!",
And tells me there are better things to do,
Release: the world shrinks down, we both exhale,
And drift together, touching souls, we two.
In age, perhaps, you'll do the same for me,
And hold my papery hand, and stroke my hair,
You'll know the worth of love's proximity,
The gift we give by simply being there.
  A final kiss, a sigh, a comfort deep:
  I lie with you until you are asleep.

If sonnets about parenting peel your potato, see here for another: Sometimes I Pass the Place Where We Once Lived.

Tuesday, 11 September 2012

Crying It Out: What Feels Wrong, IS Wrong

Sleep training, controlled crying, and crying it out: is it ok, or isn’t it? New research has just been published in the American Journal of Pediatrics suggesting that:

“Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.”

The research is already being hailed as a victory by those who claim that sleep training is an essential parenting rite of passage and completely harmless to the child involved. The Daily Telegraph headlined: ‘Leave your baby to cry, scientists say’, whilst the good old Daily Mail claimed, ‘Letting babies cry rather than rushing to comfort them is secret to longer sleep (for infants AND parents)’.

This is not a new debate. The fight over whether or not sleep training is harmful rages constantly amidst parents, facebook groups and experts, and there have been many and various studies and scholarly articles claiming that it is damaging, and that it isn’t, before this latest one. So how do we, as parents, decide what to believe, and who is right?

The whole thing rather reminds me of a very different debate: Is smoking bad for you? It might surprise you, but if you google this question, you will find a whole raft of people who are looking for evidence that cigarettes cause harm, and doubting the evidence that exists. There are even articles that claim that cigarettes do not cause any damage, and that there is research to show that there is no link between smoking and lung cancer.

To all of these folk who are swimming along in a big fat Egyptian river known as Denial, I’ve just got one thing to say: do you remember your first ever puff on a cigarette? I do, let me tell you what happened. I lit it up, I inhaled, for a brief moment I looked and felt pretty cool, and then…I coughed like a dog, the room spun, and I felt flippin awful. Don’t worry, I persevered, and went on to be a committed smoker for a decade - nobody likes a quitter. But do you know what, from that very first moment, I knew that smoking was bad for me, really bad for me, and that it could probably kill me. And I didn’t need an expert to tell me that.

If it feels wrong, it's probably wrong. All mothers know in their heart of hearts that they should never ignore the cries of their own flesh and blood, and yet, in our culture, it’s considered pretty normal to do so. Perhaps, then, the question that should be being explored is not, ‘Should they do it?’, but ‘Why do they do it?’. Because they’re tired! I hear you cry, but is it really that simple?

‘Tiredness’ as a new mother is very real – and I’m writing as someone who hasn’t had an unbroken night’s sleep for four and a half years, so trust me, I’ve got the T-shirt (and, my partner would probably add, the personalized bullet belt). But – and if you haven’t slept in a while, please don’t shoot me – I think the tiredness can also be a metaphor for a whole host of other feelings that are much more difficult to pin down or name. As a new mother, you often have no idea what you are doing or what you are supposed to be doing; your old body, career and life have disappeared pretty much over night, and you can be isolated too.

It can feel overwhelming, like chaos unleashed. Amidst it all, you struggle to find words to describe your feelings. ‘How are you?’, they ask, ‘Oh – tired’, you reply. And suddenly, not getting enough sleep becomes like a bucket you can fill with a whole multitude of other things; all the chaotic, overwhelming, crazy struggle with your endlessly heavy responsibility, your loss of identity, your sudden and stark awareness of mortality, your fears and all the lonely darkness of this massive life changing event. You long to take back the control you have lost, and you start to believe, if only I wasn’t so tired, if only my baby would sleep through the night, then everything would go back to normal again, I would get my life back, my old life in which I was never this tired.

You feel tired, but actually this is just a metaphor for lost / lonely / overwhelmed / adrift / struggling. You say you want a good night's sleep, but what you really mean is you want to get a grip on things, you want the chaos to subside, you want normality, order, predictability, control. Sleep training, then, might seem tempting, offering the promise of the restoration of the status quo at seemingly very little cost. But as new mothers, there are some simple truths that we need to face:

  • Life is never going to be the same again, even if we get more sleep.
  • If we feel in our absolute hearts and our deepest instincts that leaving our babies to cry alone is wrong, then it is wrong, no matter what the experts say. 

Oh, and one more - smoking really is bad for you!

What feels harmful and damaging, is harmful and damaging. What feels wrong, is wrong. You know.

Sunday, 2 September 2012

Get Off Your Backs for a Birth Revolution!

If you gave birth recently, did you feel you had real freedom? Freedom to choose where you gave birth, who was present, what interventions took place and how you delivered your baby? Were you given access to all of the facts needed to make your choices truly informed? Who was the most powerful person in the room at the moment of birth? And did the experience leave you feeling exhilarated, disappointed, or downright traumatised?

These questions are currently being considered on behalf of all mothers as part of a global movement to ‘take back birth’ and reclaim women’s power in the birth place. ‘The freedom in a country can be measured by the freedom of birth’, states Agnes Gereb, the midwife currently imprisoned in Hungary and held up as ‘the epitome of the very worst of what’s happening in birth today’ by the makers of Freedom for Birth, a UK based film about human rights in childbirth to be globally screened on September 20th.

Over in the US, where caesarian rates are more than twice the WHO recommended 15%, and maternal mortality rates have doubled in the past 25 years, another organization - Improving Birth - are spearheading a ‘full scale birth revolution’ on Labor Day, leading ‘rallies for change’ in 100 major cities over 50 states, and demanding evidence-based care for all and the education and empowerment of birthing women.

For some, such protests might seem unnecessary. Surely, giving birth in a hospital with access to all the pain relief you might need is something women should be grateful for? No, say campaigners such as Alex Wakeford, co-founder of One World Birth, who describes how, “…birth has been stolen, by a powerful institutionalized system, that is born of fear, a system that inherently believes that birth is dangerous, and must be managed and controlled by modern technology”

Whilst a UK mother might assume that she is free, in fact, much of what happens to her in childbirth is determined, not by the limitations or otherwise of her body, but by the geographical place and historical time she gives birth. A woman delivering her baby in England in the 1950’s could expect a very different experience to a Scottish birther in the 1980’s, as the following graphs illustrate:

In the UK today as few as 20% of women are aware of the options for their place of birth, and in some geographical areas, options such as midwife led units are non-existent due to lack of funds. This in spite of the 2010 case of Ternovsky vs Hungary, in which the European Court of Human Rights ruled that every woman within Europe has the legal right to be supported in her choice of where and how she gives birth.

UK women are told that they are free to choose a home birth and that this is often the safest option, but in reality, the idea is less appealing when warned that they may have to transfer to hospital at the last minute due to a shortage of midwives. Continuity of care is also an issue: around one in three pregnant women never sees the same midwife twice in spite of government promises and nearly a fifth of women say they feel unsupported during labour and birth.

At the moment UK mothers can opt for an Independent Midwife: around £2500 buys you continuity of care, a guaranteed midwife if you want to birth at home, and – almost non-existent in the NHS - the reassurance that you will have met and made a relationship with the person who attends you at one of the most pivotal moments in your life. But you’d better be quick, because as of September 2013, Independent Midwives become illegal in the UK. 

Birth rights campaigners see this as yet another example of diminishing choices in childbirth and symptomatic of a global witch hunt against midwifery. In America, obstetricians lead the care of most pregnant women, only 1% of women get midwife led care outside of a hospital setting, and direct-entry midwives are illegal in several states: all of this in spite of sound evidence to show that midwife-led care produces better outcomes for mothers and babies.

In the UK care in birth is still largely midwife-led, but numbers are low, and the Royal College of Midwives is pressuring the government to recruit 5000 more midwives. This would undoubtedly inprove choice and help a system straining under rising birth rates. But some, including Toni Harman, Producer of Freedom for Birth, feel that this does not go far enough. “More midwives would help, but would not solve the problem of the routine Human Rights violations happening within the UK maternity system. There needs to be a complete culture shift within the obstetric community to make women the true informed decision-makers in their births.”

This ‘culture shift’ is at the core of what is demanded by those calling for a ‘birth revolution’. Campaigner Holly Lyne told me, “The way maternity services are commissioned is fundamentally flawed and the emphasis on risk assessment and fear of litigation are leading to massive amounts of costly, ineffective and traumatising intervention.” Independent Midwife Nicky Garrett added, “ I was trained to provide holistic woman-centred care and found that it was impossible to give that service within the NHS. The care for women was fragmented, paternalistic and pared to the bone, and the job satisfaction was zero.”

The importance of a positive, normal, low intervention or no intervention birth extends far beyond the individual. Women who demand better births can sometimes be accused of selfsishness, and organisations suggesting less epidurals have this week been declared anti-women. But how we birth has a huge impact on early bonding and attachment, breastfeeding, PND rates and more…which in turn has long term impact on the mental and physical health of both mother and child…which in turn affects the human race. There are plenty of ways to join the birth revolution, and it matters: true freedom in birth really could change the world.

You might also like Reflections on Freedom for Birth