I am really well organized, ask any of my practice partners: I keep a detailed calendar & refer to it regularly. I do not miss appointments, there's just no procrastination in my world! So when I discovered that I'd missed a deadline for Midwifery Today, I was devastated. Turns out that the Editor had changed the order of upcoming topics. So the print edition said one thing, but the online list had been altered. Of course I'd already calendared everything and so did not discover the discrepancy until it was way too late...
After giving the matter some thought, I decided I'd keep the article as a blog post to publish when I received my copy of MT. It makes sense thematically: we're getting the "Birth is a Human Right" issue and that's what my article is about. But that's not all this blog post is about. It's really about what we do when we hit a roadblock with one of our projects. I'll be honest, I had some feelings for a minute or two. I had worked hard on the piece and believed I had something unique to contribute to the conversation. I was surprised by what I discovered- let me know your thoughts.
Between Belief and Birth: Where Are Our Human Rights? Birth rights advocates are buzzing over two recent court cases. The first being that of Kimberly Turbin, whose OB did a horrid multiple-cut episiotomy, while she loudly and repeatedly declined permission. Although the OB involved surrendered his license, a judge has ruled that the case may proceed to civil court. The second case involves Caroline Maletesta and a hospital in Birmingham, AL. Brookwood Med. which advertised as providing personalized births, did exactly the opposite. The Mother in questions was "restrained by nurses during labor to the point of suffering intense physical and emotional injuries, including being forced onto her back by nurses who held her son’s crowning head inside her for six minutes as they waited for a doctor to arrive". The Court held the hospital accountable to the tune of $16million dollars! All of which begs the question: if birth is a human right, why are we having to go to court to sue for it?
When beginning this article, I thought it would be fun to find all the national and international documents that included affirmations regarding our human right to birth as autonomous individuals. Five minutes in, I realize this was not going to be fun at all. I began in what I thought was the most obvious place, the United Nations Universal Declaration of Human Rights, I was sure there'd be specifics regarding gender violence, rights of bodily integrity (whether or not directly identifying FGM), and childbirth. Out of 30 articles of intent, only one, Article 25.2, gives the smallest nod to the childbearing cycle, and even that felt paternalistic and patronizing: "Motherhood and childhood are entitled to special care and assistance...".
I checked out the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. Also known as the Patient's Bill of Rights, it contains nothing about the special circumstances of birth, although article 4 deals with treatment decisions in general "You have the right to know your treatment options and take part in decisions about your care..." I notice this wording "take part in" feels fuzzy, not specifically granting autonomy, or authority for the final decision.
In the American Cancer Society's section on patient rights, I came across this note: "The American Hospital Association (AHA) has a document called The Patient Care Partnership that replaced the AHA’s Patients’ Bill of Rights. This brochure can help a person be a more active partner in his or her health care when in the hospital." So it appears that the right to take decisions regarding one's healthcare has been downgraded to participation as one of the players, not that of the major stakeholder.
I was sure I'd find rights-based language in everything coming from the World Health Organization (WHO) relating to birth. Google's first choice was "Care in Normal Birth, a Practical Guide". Not once in that entire document were there any phrases containing the word rights, nor any affirmation around the birthing person's right to consent or decline recommended treatments.
I've been at this for an hour and am feeling rather disillusioned.
In my next search I came across the National Partnership for Women and Families and their adjunct site Childbirth Connection. Under the header Maternity Care, there it is: Ten Tips for Taking Charge of Your Maternity Care. At last, language affirming our rights to own our process! One of the first things I see is a link to something called The Rights of Childbearing Women; I am now cautiously optimistic. This document contains twenty points, all of which readers of this publication will agree, are affirming of our human rights as autonomous individuals during the childbearing cycle. There are the words I've been searching for: "know your maternity care rights", and "You are the one who should decide which benefits and harms matter most to you.". Finally, a document I'd want every pregnant person to see.
Those of us who instinctively understand birth as a human right, will find it difficult to comprehend how it can be viewed as anything else. And yet it appears that the major players have gone out of their way to keep from speaking these truths in plain language. Documents that ought to have included references to body specific issues such as birth, FGM and rape, are conspicuously missing specifics in favor of neutral language or worse, complete absence of any mention whatsoever. The language within the patient's rights papers I viewed, seems to be intentionally skewed in favor of the institution and providers, and what feels like permissions to participate, rather than rights to claim for one's self. We have an incredible lot of work to do in order to narrow the gap between claiming our human rights in birth and the belief systems of the dominant paradigm in which we currently live.