Human Rights in Childbirth – What the?!

One of the 3 main Awareness Pillars of the Luxmama Club & ParentPrep asbl is Birth Rights or better expressed as Human Rights in ChildBirth.

Human Rights in Childbirth – heck, what on earth does that even mean?

Yes – we get that a lot!

And it’s perfectly understandable considering how long it took for humanity globally to even comprehend and recognise the need for basic human rights (the Universal Declaration of Human Rights was adopted by the 56 members of the United Nations in 1948). Never-mind being treated with dignity and respect, having the freedom to choose the conditions and receiving Evidence Based Care under Informed Consent during the most natural life process now treated as an illness in many civilized societies –  Pregnancy & Childbirth… 

That is having your human rights respected in childbirth. And that’s exactly the plight of a very new international organisation – Human Rights in Childbirth, (“HRiC”) recently founded in 2012 by doctors, lawyers, birth advocates and other experts realising the need for this previously ignored and not well-understood concept.

They explain that “Human rights in Childbirth are women’s rights, because women are human too. (hurray!) The last century has seen a long struggle, around the world, for legal recognition of that basic fact.” Wow! ”

“Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth.” (Source: Human Rights in Childbirth)

The human rights framework is a valuable tool for understanding the global problems in maternity care and the obligations of governments to provide care that is accessible and affordable to all citizens. It is also helpful to understand the dynamics that occur between birthing women and their healthcare providers, and problems with medical intervention and abuse including the skyrocketing cesarean section rate. The list, below, is their attempt to identify the human rights at stake around childbirth. “We do not claim that it is exhaustive. And we do not claim that these rights are protected, by law, where you live. Even if these rights are recognized under your nation’s constitution, or treaties to which it is a signatory, they may be forgotten in maternity care. That’s why HRiC came into being: “Because we believe that it is time for these rights to be recognized and implemented, in law and practice, for birthing women everywhere. For that to happen will require activism and advocacy. Work with the network in your own nation to figure out what these rights mean there, and to advocate for their more perfect realization, as necessary.”

And this is exactly why we at the Luxmama Club & ParentPrep asbl feel it is crucial to start talking openly about this. This is too important to ignore.

Consumers need to be aware so they can be empowered, because Birth Matters.

What are the Universal Human Rights of Women in Childbirth?

1. Right to Informed Consent
2. Right to Refuse Medical Treatment
3. Right to Health
4. Right to Equal Treatment
5. Right to Privacy
6. Right to Life

First of all – it is extremely important to understand that there is no doubt that technology and medical interventions have saved countless lives daily, and that we absolutely are not against medical procedures, hospitals, technology and medical staff when used responsibly and with proper consent. We are tremendously grateful, but we are also aware.

We (Birth Advocates, anthropologists, doctors, midwives, families) world-wide are becoming increasingly aware that developed countries in the Western world are experiencing a rise in medical interventions at Birth, often not based on the latest Evidence Based Practice, very often without proper informed consent from women and unfortunately for the wrong reasons…fear of litigation, time constraints inter-twisted with profit margins, routine hospital policies not based on latest evidence and simply a lack of training in what natural child-birth involves. (Documentary for further exploration: The Business of Being Born). And the funny thing is, most families are totally unaware of this, we are being conditioned that this is how it is.

Who’s fault is this?

It’s a systemic issue and not the fault of individual Care Providers. It’s profit margin pressures from hospitals (businesses) and other players. It’s the fault of the media, embedding fear into childbirth. It’s the lack of the system in allowing a Midwifery Care Model, a woman-centered model of care that has been proven to result in less medical intervention, birth trauma and more satisfaction from families with low-risk pregnancies.

Currently in Luxembourg, the role of Midwives or “Sages-Femmes” as we know them are completely under-utilised and they act mostly as assistants to doctors in hospitals or underpaid independent pre/post-natal home-visitors, whereas in many other countries, families have the freedom to choose high-quality midwifery based care from the beginning of pregnancy up until the post-natal period. But this simply is not an option in Luxembourg. The Scandinavian countries are prime examples of how successful and supportive of families this model of care can be, where families can choose that midwives follow them during pregnancy, build a relationship and then support them during birth and the postnatal period.

Michel Odent at the 2016 Heal Birth, Heal the Earth Summit in Scotland (Findhorn) said: “The Western world is currently experiencing an upward trend in medical intervention, in other words, the Domination of Nature. This can not continue without dire consequences for humanity. It is time to develop a NEW Paradigm now. A paradigm where a symbiotic revolution will bring nature and technology into a mutually beneficial relationship to co-exist.”

As you can see, the issue is very complex and not easy to understand by the average person not constantly immersed in pregnancy & birth (aka birth junkies like us!). Governments, lawyers, Courts and expecting families themselves struggle to fully comprehend the big picture. No wonder – it took so long before the world started to take notice. And that is exactly why we need to start raising the awareness at the level of the consumer, because collectively this voice is the strongest.

Professor of Complex Obstetrics Susan Bewley (quoted in Why Human Rights in Childbirth Matters by Rebecca Schiller) suggests that not significant yet, but nonetheless real increases in maternal mortality rates in some developed countries is now being seen, with a mix of factors contributing, including older mothers, IVF, language barriers, immigration and….rising caesarean section rates.

In the US, 1 in 3 women is giving birth (the same in Luxembourg) by Cesarean section and nearly a quarter are induced (30% in Luxembourg). “Is the pendulum swinging too far?” Asks Professor of Complex Obstetrics Susan Bewley (quoted in Why Human Rights in Childbirth Matters by Rebecca Schiller), “harm may be caused in pursuit of absolute safety”.

Rebecca Schiller adds that it makes sense that at some point, perhaps a point we arrived at a while ago, current obstetric practice reached a limit of what can be achieved and genuine innovation will be needed to keep mortality rates down.  Part of that innovation may be as simple as not intervening so routinely in pregnancy and birth.

What about families consciously choosing Medical Interventions

It is important to emphasise that it is most definitely NOT about validating the choices that families wanting and choosing medical intervention make. It is their human right to make those choices and they should be supported and not judged in that. Medical interventions can bring benefits and each person’s experience, philosophy and preferences surrounding birth are unique.

What is important is that families:

1. Really have the option to choose how (the conditions) and where they give birth, and

2. Receive updated, complete and enough information to enable them to make properly informed choices

3. Are not judged for their choices but rather supported.

The emergent issue is rather about those many families that receive routine, unwanted, un-consented medical interventions (with the first often snow-balling into the next and a very likely result being an eventual “Emergency” Cesarean Section). HRiC eloquently explains this as “one-size-fits-all, protocol-dictated, assembly line maternity care” that violates the right to informed consent and fails to promote health and well-being. And families unknowingly experiencing this, often believe that medical intervention actually saved their baby’s life… Professor Cecily Begley, Chair of Nursing & Midwifery at Trinity College Dublin, explains the cascade of interventions very well in this short video clip.

Also see below comparison of Routine vs Evidence Based Care commonly experienced in the US, very similar to what women experience in Luxembourg, with the exception of:

– VBAC’s:  Many doctors here do consider VBAC as a viable choice for women who had a previous Cesearan (subject of course to the women’s specific situation),

– and having a Birth Doula. The rate of Doulas “allowed” at birth if a birthing women chooses so is negligible in Luxembourg. It is clearly researched and supported by the WHO that Birth Doulas bring improved birth outcomes and satisfaction for families and therefore as part of our 1st Birth Rights Awareness Campaign, the Luxmama Club & ParentPrep asbl is campaigning for “Have a Choice 2 Have a Doula” in order to raise awareness at the consumer level.

But what if I had a Cesarean Section?

It is also important to emphasise that if you have had a Cesarean section, your birth was definitely not “less than”, that you are not less of a mother, your baby is not less of a baby and whenever Cesearean Sections are compared to Vaginal Deliveries it is never directed at you.  And if it was your conscious choice/intended outcome, it is your Human Right to make that choice and be supported.

Improving Birth explains: “Information about birth and modes of birth should be treated as what it is – important health information for personal decisions – and is not intended to shame women or make them feel bad.  At the same time, withholding information from women because we don’t want to cause hurt or guilt is a misplaced effort.  It’s a perpetuation of what is truly hurting women and babies today: known but undisclosed risks of procedures like Cesarean section, biased information from care providers, pressure because of non-health factors, and a lack of options.”

Therefore we need to speak about this topic to protect those families that are unaware of how the violation of their rights lead to unintended birth outcomes. And we would be naive to expect as humanity that our species will thrive should we completely replace surgical births with natural childbirth without consciously thinking it through properly.

The WHO warns that when C-sections aren’t medically indicated, they may be more likely to harm mothers and babies than to help them as they carry with them a host of risks to mother and baby during and after the procedure (as do many other surgeries). In addition, new emerging research is showing that compared to vaginally born babies, those born via C-section are more likely to suffer from a host of health problems later in life: asthma, allergies, eczema, type 1 diabetes, celiac disease and that they are more likely to be hospitalized for gastroenteritis. Many researches now believe this is due to the missed opportunity of baby’s interaction with the mother’s microbes in the birth canal, also referred to as the seeding of the microbiome, key to a baby’s developing immune system and responsible for a wide range of metabolic activities. (Documentary to explore: Microbirth).

So bottom line, if your baby was born via Cesarean section, he or she can still live a very healthy life, given solid and thoughtful nutrition, love and care. Also consider finding out more about optimising gut health for your child.

The “ideal rate” for caesarean sections is between 10% and 15% of births according to the WHO.  Perinatal reports worldwide compare (among other indicators) national cesarean section with the WHO recommendation to evaluate maternity care. Upon closer look at the changes we must make to decrease cesarean section rates, it becomes clear that in many cases they can be prevented (if this is is within the wishes of the family).

With all that being said, let’s take a deep breath…

2016 EU Human Rights in Childbirth Summit

In October 2016, we attended the EU Human Rights in Childbirth Summit in Strasbourg. (The 4th summit in the EU).

The purpose of the summit was:

1)  To strengthen the work of European maternity care activists to advance the human rights of all women in maternity care across Europe.
2) To report on, and document, what women are experiencing in healthcare during pregnancy and childbirth across Europe, in order to advance advocacy at the local level and to educate human rights lawyers and stakeholders from the European Court of Human Rights and elsewhere.

Wow! What an experience and eye-opener this was!

Along with the help of Initiativ Liewensufank, we gathered data and launched a survey (thanks to everybody that completed the survey!) in Luxembourg to be able to report on:

1) Access to Midwifery Care/Out of Hospital Options, and

2) How women are actually experiencing Informed Consent & Refusal.

It was clear that Luxembourg has some work to do!

Access to Midwifery Care/Out of Hospital Options:

When it comes to access to Midwifery Care/Out of Hospital Options we know that the Midwifery care Model is just not an option in Luxembourg as explained earlier.

In many countries like the UK and the Netherlands families are free to choose from viable Out of Hospital Options, like the choice to a safe and properly supported Homebirth or another alternative, a Birthing Centre.

Homebirth may sound too hippy, crazy or risky to some but  large scale studies from Birthplace in England, have demonstrated the general safety for “low-risk women” when properly managed and supported with integration to further medical support when needed.

A Birthing Centre is a home-like facility, existing within a healthcare system with a program of care designed in the wellness model of pregnancy and birth and guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness. For someone trying to avoid unneeded medical interventions but not totally up for a home-birth, this is a fabulous choice!

In Luxembourg – there ain’t no Birthing Centres as the premise for their function is a Midwifery Based Model of Care, while Home Birth carries with it a social stigma and although not against the law (as previously in some countries like Hungary), there is a lack of financial support and training of midwives and medical staff at hospitals that will enable families to really have a choice to a normalized and integrated healthcare option.

The rate of Home Birth in Luxembourg in 2015 was 0.2% while the UK was over 2% and the Netherlands 12%. Some women in Luxembourg choose to drive to Birth Centres across the border.

How women are actually experiencing Informed Consent & Refusal.

At the summit it was evident that even though the legal framework in many countries are by now supporting this aspect in theory, this does not mean that it is exercised in practice/reality (In Luxembourg, this has been part of National Law since 2014).

And just so, from our survey, a few of the outcomes in Luxembourg interesting to highlight, showed that:

• 43% of women did not feel their care providers spent an appropriate amount of time with them when explaining medical procedure(s).
• 34% felt that they didn’t have all the information about benefits and risks of the procedure(s) being suggested?
• And 30% were not satisfied with their gynecologist
• 44% rated their Cesearean Section experience bad or very bad on the psychological level and 28% for the physical experience.
• Common routine procedures performed are episiotomies, induction of labour, artificial rupture of the membranes, kristeller (pushing on the belly) and electronic fetal monitoring (EFM), with 73% of women reporting no consent given for episiotomies, 79% not consenting to the kristeller procedure and 68% not consenting to EFM (to name just a few).

Coming back to the 6 Universal Human Rights as formulated by HRiC mentioned above, let’s just see where we stand, here in the Grand Duchy.

1. Right to Informed Consent – clearly from the above survey, we see that families are undergoing routine medical procedures of which many are outdated (not based on latest Evidence Based Practice) and not medically indicated and without consent. It sounds crazy but according to Evidence Based Birth it takes up to 20 years for research findings to be translated into clinical practice. Shocking, isn’t it? But totally true.
2. Right to Refuse Medical Treatment – “This means that you don’t have a legal obligation to walk into a hospital to receive treatment, and that you can walk out at any time. It means that nobody should perform an intervention on you without asking you first.” This we can see as well from above, is not the case.
3. Right to Health – “In countries across Europe, foreign-born and immigrant women are at significantly increased risk of maternal and perinatal mortality and low birth weight babies.” In addition, almost 50% of women giving birth in Luxembourg do not carry the Luxembourg nationality and those that are not competent in French, German or Luxembourgish have difficulty communicating with some providers, which adds an additional layer of stress and confusion and definitely do not contribute to a pleasant birth experience.
4. Right to Privacy – “Recognition of the right to choose the circumstances of childbirth requires states to legitimize and support the full range of women’s birth choices, including the choice to give birth with a midwife at home or in a birth center, or with a doctor or midwife at a hospital. The state should not enforce medical monopoly and make women’s choices less safe by treating out-of-hospital birth choices as illegitimate and driving them underground. The right to choose the circumstances of childbirth has implications for women’s right to support for vaginal birth. This issue is pressing, as the cesarean rate rises. Birthing women make decisions around childbirth in accordance with their personal needs.  Women’s needs and decisions around modesty and privacy during labor and birth, pain relief, medical assistance, and surgery are different because women are different. Maternity care systems should be able to anticipate and support a diverse range of needs and choices around pregnancy and childbirth, and to support those needs with respect and non-judgment.” Clearly as explained above, Luxembourg has a long way to go here.
5. Right to Life – “An unborn baby is represented by the person who is most invested in its health and well-being. Nobody is more invested in the health and well-being of a being-born baby than the person who grew it under her heart, from her blood. The maternal-fetal dyad is best protected when the birthing mother is respected as a competent decision-maker for herself and her child. 99% of maternal deaths happen in developing countries, where poverty and lack of infrastructure can threaten survival.”  Here in Luxembourg though, we are thankful to have hospital care and infrastructure generously available to those who need it.

To conclude, we can see that the issues are complex!

Yet:

• The more consumers become aware of their rights,
• and the more they stand up for their rights,
• the more we put pressure on the systems governing maternity care,
• the more we work together as families, birth advocates, care providers and child-birth educators,

–> only then will future families, mothers, babies and generations to come, be able to benefit from the freedom of viable choices as well as respectful and nurturing maternity care.

And this my dear friends, will leave lifelong positive imprints on our society.

What Luxmama Club is doing and how you can get involved:

•  We have launched our 1st Birth Rights Awareness Campaign to raise awareness at consumer level (collectively the strongest voice) of the proven benefits of having a Doula at your birth: Have a Choice 2 have a Doula. Support our project by donating here.
• We have launched Positive Birth Meetups as part of the global movement. Anybody interested in sharing and spreading positivity about birth, come and join us!
• If you are passionate about birth rights and would like to get involved in any current or future campaigns please contact us! And join our Facebook group, Birth Advocates in Luxembourg.
• If any of this resonated with you, you can make a difference by raising awareness on these topics with your family and friends so they too are empowered.

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More about the Author

As mother of two darling babies Certified IMPI Holistic Maternity & Sleep Coach/Educator Marise Hyman provides worldwide coaching and education in planning for an empowered pregnancy, birth and parenthood journey to expecting/future/new parents through Marise Hyman Maternity Coaching – setting them up for success, so they can move from confusion to confidence!
She is also a Birth Advocate and founder of the Luxmama Club & ParentPrep asbl, an edgy non-profit organisation raising awareness for green, natural & holistic parenting alternatives, birth rights and postnatal mood disorders by offering a variety of inspiring social and educational events in Luxembourg.