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A couple of weeks ago we hosted a premier showing of the movie Freedom for Birth and it was awesome!!! We had a nice turn-out and it was a very powerful movie with a powerful message. Afterwards we had a panel of midwives speak about what it’s like to attend home births in both legal and illegal states.
The movie began by talking about fear. Fear about childbirth is pervasive in our society and has been for quite some time. The media perpetuates and plays on our fears through “reality” shows like A Baby Story and I Didn’t Know I Was Pregnant as well as through sitcoms and movies. Our fears about childbirth also have a basis in history. As doctors and hospitals became more plentiful, home and midwife-attended births were portrayed as less safe for *all* women than hospital or physician-attended births were. Midwives were portrayed as ignorant women and there were often negative racial undertones to those portrayals as immigrant and black “granny” midwives were common in those days.
Nowadays, generations removed from seeing our mothers, sisters, and nieces give birth before having our own babies, women in general don’t tend to be very informed about birth and about how their bodies can usually give birth without any problems. Most modern American women don’t ever get to see any other women have babies unless they are lucky enough to be asked to come to a friend or family member’s birth as a support person.
I can understand this type of fear coming from the unknown because – even having been to quite a few births myself – every single time it seems miraculous to me that those big beautiful babies can come out of a woman’s vagina – and it is miraculous! Birth is a miracle every single time and it’s incredibly important for women to understand that our bodies were made to give birth. Barring unforeseen complications, women can birth babies.
Back to the movie – we learn that Agnes Gereb is a midwife in Hungary who was jailed and is now under house arrest for attending home births when they were illegal in Hungary (they have recently been legalized although Hungary is still not actually licensing home birth midwives, from what I can find). Agnes has reportedly attended over 9,000 births in 32 years and about 3,000 of those were home births.
In her interview, Agnes states that she believes in helping, caring for, and instilling confidence in her clients. She wants to give her clients a choice without compromising their safety and she understands that not all women should birth at home. Agnes started off as an OB/GYN and was shunned by the other doctors when she started encouraging midwives to work independently.
When she was arrested, it was not even for a planned home birth. The mother had a precipitous labor during a childbirth education class and Agnes, very wisely, called for medical assistance. With the medical assistance, however, came the police, as well, who placed her under arrest.
During the trial Agnes was not allowed to present her defense, it was very one-sided in the media as well, and throughout her years of attending home births she had tried to become licensed, but the country would not allow it. A representative from the media told one man who was interviewed for the movie that they painted Agnes as a villain because they could not fathom painting her as a heroine.
Agnes poses a very good question at one point – Babies die in hospitals too so why aren’t those attending doctors not jailed? Indeed! Why not? Why the double standard?
Currently laws all over the world are suppressing midwives’ ability to provide quality care as well as women’s choices about their own bodies and about how they give birth. Women are often coerced into making decisions by threats of child services and court orders. Women are also being given incorrect information and therefore are not being allowed to make informed choices.
Now, some women do not mind the way things are. Some women are perfectly happy to have their babies in a modern medical way, and that’s fine, but many other women do mind and can be traumatized by the way their birth actually ends up being compared to how they had hoped it would be. For the women who want choices, those choices need to be made available.
Licensure of home birth midwives alone doesn’t solve all the problems with modern maternity care either. Licensure doesn’t always ensure that women have choices and often can even limit women’s choices and the types of care that midwives can provide their clients: suturing, attending VBACs, and administering vitamin K are just a few of the things midwives can be denied the ability to do legally even though they are licensed by their state.
Midwives are still being prosecuted in both legal and illegal states and countries. Mothers, American citizens, are still sometimes being threatened with CPS or police action in states where home birth midwives are legal and licensed.
In the Netherlands it’s not illegal to have twins vaginally or at home, but at least one woman who chose to do that has been accused of child abuse, even though her babies are fine and so is she. In Florida, which licenses home birth midwives and has no law against VBACs, the authorities took custody of a baby in utero and forced the mother into a repeat c-section while denying her a chance to even try for a vaginal birth after a cesarean.
There is a pervasive and erroneous idea in our society today that women who make choices in opposition to their care provider are a danger to their babies. Nobody loves babies more than their mothers do. Usually women have very good reasons for making the choices they make regarding childbirth.
I have yet to meet someone who chose an unconventional birth believing that their baby would’ve been safer in the hospital with medical management. Most home birth mothers do the research and make informed decisions that they believe are in the best interest of both themselves and their babies.
No mother wants to lose her baby, so why is that idea so common?
Ternovsky vs. Hungary
Thankfully for us, Anna Ternovsky got involved in this issue. Anna was a client of Agnes’ who thinks very highly of Agnes and she took a stand and brought a case against Hungary for denying her the right to choose to have a home birth.
This case went all the way up to the European Court of Human Rights and they agreed that Anna has the right to give birth wherever she would like to. The European Court of Human Rights agreed that birthing women are the decision makers in childbirth and legally upholds women’s rights to choose the circumstances in which they give birth in all of the European Union.
This case does not set a binding precedent in the United States, however, it can help set the tone in the US. Hopefully someday soon we will recognize the full set of human rights here and perhaps someday soon American women will take the question of their right to choose where and with whom to give birth all the way up to the Supreme Court.
One woman can make a difference!
Ina May mentions that countries without strong midwifery professions have worse birth outcomes. We certainly see that on the CIA list (2010) where the United States is tied with Iran and Hungary for spot 45 from the bottom (the list goes from worse to better from the top). That’s extremely concerning for a developed country – especially one that spends as much on health care as we do.
Well, there we have it. Our maternity care system is in a sorry state and our society as a whole does not recognize birth as a human rights issue that needs to be talked about and reformed. During the Rally for Change most of the people who passed by thought that we were protesting abortion or that we were pro-abortion. Many people seemed to think that we had to have been there about abortion although they admittedly couldn’t tell which side we might be on. Most people we talked to did not realize that many women are dissatisfied with the available birth choices or why anyone would be!
What Can We Do?
So, what to do? Midwives can only fight so much before their money runs out and so consumers NEED to let their care providers know that they’d like them to support women’s right to choose to birth where and with whom they choose. Consumers need to contact their representatives and work towards raising awareness of these issues!
Often women don’t even know they have these choices or a right to informed consent and a right to decline – even a lifesaving surgery, like a cesarean. Women may not know that they also have the right to know about the benefits and risks of any proposed treatments and that they can almost always fire their care provider or work with their care provider to come to a compromise in a situation where the care provider is getting nervous.
Knowing your reasons for wanting your compromise or for making non-mainstream choices can make a huge difference in how you are treated by care providers and even by child services. If you can tell your care provider or the authorities something like, “I’m making this decision because of this, that, and the other study which had these results.” they will be more likely to take you seriously and less likely to give you a hard time about your choices.
Consumers can also be careful when interviewing care providers by asking questions like, “How many of your clients have intact perineums?” or “How many of your clients deliver their babies in a position other than on their backs?”
Asking questions like those not only helps to weed out care providers who would be unwilling to compromise, but also lets more care providers know that their clients want choices and that potential clients are willing to ask difficult questions and even switch to a different care provider if this care provider is unwilling to try something new.
As clients express their preferences for unconventional births more often, care providers should be more willing to try allowing unconventional methods and will then, as a result, become more familiar with them, which will hopefully start a positive cycle of allowing women more choices in childbirth, which will increase the care providers’ comfort levels with those choices, etc. Maybe someday women will even be encouraged to have more choices in childbirth!
Every woman should be the decision maker in her own childbirth. Women should have the right to give birth wherever and with whomever they choose. Women should be given complete information about their choices so that they can make an informed decision that is in the best interest of themselves and their babies.
Every woman should have legal access to a well-trained attendant in the birthplace of their informed choice and no woman should be left to bleed to death after her birth.
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