Opinion Articles

‘Something should be done’: campaigns for choice and human rights in childbirth

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Two recently published reports have again put the spotlight on Britain's overstretched maternity services. The National Federation of Women's Institutes (NFWI) and National Childbirth Trust (NCT) researched the experiences of 5,500 women, concluding that choice of place of birth remained 'an aspiration, not a reality' and painting a picture of 'fragmented' antenatal care and lack of postnatal support. While a report from the Royal College of Obstetricians and Gynaecologists revealed wide variations in practice and outcomes across maternity units. Meanwhile, a range of recently-founded groups are campaigning for women's rights and choices in childbirth, including Choose your Midwife, Choose your Birth; The Birth I Want and Birthrights. Birthrights' founder, human-rights lawyer Elizabeth Prochaska, said, 'It's very common to hear of women being bullied, emotionally blackmailed or pressured into things in childbirth', adding that, 'The rise of post-traumatic stress disorder and post-natal depression are problems, too.'

These calls to respect women's rights and choices in childbirth have a long historical pedigree. For decades there has been a struggle between those arguing for maternity services to prioritise mothers' wishes, and those who believe that a healthy baby is the only way to measure a successful outcome. Current NHS budgetary pressures have added an economic dimension to this contested arena, with debates over how to deliver choice and safety as cheaply as possible.

These tensions have come to the fore during current and previous baby booms. In April 1960 Sally Willington published a letter in The Observer after a distressing ten-week stay in St Albans hospital in 1958, recalling that she 'lay there miserably waiting and observing what went on.' She invited readers who thought that 'something should be done' to write to her. Letters - and donations - flooded in from women around the country who had had similar experiences. Willington was inspired to found a radical, new, voluntary organisation - the Society for the Prevention of Cruelty to pregnant Women, which became the Association for Improvements in the Maternity Services (AIMS) in 1960. Anticipating Birthrights' use of the language of rights, AIMS' called upon women to 'know your rights'. Women I interviewed who gave birth in Oxford in the early 1960s recalled similar experiences to those of Willington and her supporters. Jackie felt she was 'just one in a sort of sausage machine', while Georgie described uncaring medical staff who, after a long and difficult labour, would not allow her a cup of tea.

From the mid-1970s -1980s there was a vigorous public debate about obstetric practices, encouraged by the groups such as AIMS and the NCT, and second-wave feminism. The most dramatic moment came in April 1985 when obstetrician Wendy Savage was suspended from her post at London Hospital Medical College for alleged incompetence. In February 1986 she was exonerated by a public inquiry and five months later reinstated. Savage believed in minimum surgical intervention during labour and birth, arguing that all pregnancies should be treated as normal unless there were clear indications that something is wrong. Savage's court case helped to bring women's reproductive rights to the fore. I interviewed Carol, whose first baby was born in 1979, whose experience included many of the features criticised by campaigners at the time: giving birth on her back with legs raised and a routine episiotomy. She explained it, 'felt like a pair of shears, just cutting into you. It was the only time out of all five children that I let out a scream. Coz that was just really painful. And shocking as well, coz they didn't tell you.'

We are now living through another boom in the birth rate and still trying to reconcile the needs of mothers and babies for both choice and safety, with stretched NHS resources. Some clinicians argue that women should temper their expectations of birth, focusing on a live, healthy baby, rather than their own satisfaction. Obstetrician Dr Gedis Grudzinskas recently argued: 'The fact is, because of budget issues, there's much less flexibility and likelihood of a happy outcome to an agreed birth plan.' He continued with an assertion of professional, medical expertise over women's knowledge and wishes: 'The advice that professionals give is based on many years of experience. In the old days, women referred to doctors as experts. Now, many women think they're well-read because they've done research on the internet'. Similar arguments were being made in the 1960s, when the obstetrician John Stallworthy stated: 'The patient has the right to express her choice, but it may be unwise or impossible to implement it.'

However history shows that traumatic birth experiences do matter for women, even if their babies are born safely. My interviews with women who gave birth between the 1940s and 1990s revealed that poor interpersonal relationships with doctors, midwives and nurses defined women's recollections of their births and determined their satisfaction with their care. Good communication and durable relationships left women feeling better equipped, physically and emotionally, to deal with new motherhood, resulting in improved outcomes for them and their babies. As Professor Christine MacArthur has demonstrated, medical interventions in birth can lead to emotionally and financially costly long-term health problems for women, such as urinary and faecal incontinence and depression.

Despite over 50 years of campaigning for improvements in maternity services it is striking that the call to respect women's human rights in childbirth is still needed. In the current climate of maternity unit closures and failed government promises about choice in place of birth and continuity of care, this need is likely to intensify. Those responsible for maternity policies seem yet to realise that proper investment in maternity services, with resources directed towards providing continuous, personalised care will be both cost and health effective, promoting the physical and emotional wellbeing of mothers and their babies.

Please note: Views expressed are those of the author.


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