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.