Human Rights in Childbirth Conference, Introduction

I can't possibly describe in full the complex discussions at the Human Rights in Childbirth Conference. So let me share the highlights, taken from my notes and from my memory.

We arrived at the Hague University of Applied Sciences on a windy, rainy morning. If Amsterdam is old and scenic, then The Hague is IKEA on steroids. Everything is modern and geometrical, glass and stainless steel and blond wood. Close to 300 participants filled this auditorium, with another several hundred listening in via webcast. A large number of attendees were from Holland; the remaining came from all over the world. The audience was a majority female. Participant occupations ranged from midwives, OBs, pediatricians, and neonatologists; to doulas, mothers, and birth activists; to bioethicists, attorneys, and health care CEOs.

Hermine Hayes-Klein, the brainchild behind the conference, opened the conference. An American attorney who moved to Holland and had her two children under the care of Dutch midwives, Hermine was intrigued by how the care she received contrasted to her American friends' back home. After the European Court of Human Rights ruled in 2010 (Ternovszky vs. Hungary) that pregnant women have the "right of choosing the circumstances of becoming a parent." The ruling stated that EU member countries must ensure that pregnant women have access to home birth and that home birth providers should not be persecuted. This landmark ruling has wide implications for childbearing women and midwives across Europe, although the details of how this decision will be implemented in each country are still unclear.

The ECHR decision made two important points: First, that women have the right to be the chooser in how and where to give birth. Second, that women need options to choose from. The Human Rights in Childbirth Conference explored the extent that women do or do not have birth choices in various countries around the world. Presenters and participants examined how a lack of birth options might be considered a fundamental human rights violation.

Ina May Gaskin gave a brief keynote address, noting that the conference would attempt to address the following topics:
1. Pregnant women in many countries are learning that they have fewer rights than other people.
2. Strategies to address the above situation.
3. Low- and high-income countries face opposing challenges regarding childbirth (too little access to medical care versus too much medical care).
 She reviewed trends in maternity care around the world--deskilling of midwives and obstetricians, increase in cesarean rates and inductions, closure of community hospitals and centralization of maternity care in large tertiary centers, changes in infertility medicine, rise in medical malpractice suits. Ina May ended her presentation with a call for more localized, decentralized maternity care and an end to the double standard in treatment of home and hospital providers after a bad outcome.

Four panel discussions filled the rest of the two conference days: Day 1 took a global perspective on human rights and childbirth issues:

• Panel 1: Ternovszky v. Hungary: Context and Consequences of the ECHR Decision
• Panel 2: Safety, Risk, Costs and Benefits: Weighing Choices in Childbirth
• Panel 3: The Rights of the Baby: The interests of the unborn child and the power to speak for those interests
• Panel 4: Collaboration, Competition, Money and Monopoly: The legal status of doctors, midwives, and hospitals in pregnancy and obstetric care

Day 2 examined issues of human rights within the Dutch maternity care system. 

• Panel 5: Perinatal Mortality in the Netherlands: Facts, Myths, and Policy
• Panel 6: Cases on the Edge: Controversial Birth Choices in the Netherlands
• Panel 7: Financial Pressures in the Dutch Obstetric System
• Panel 8: Ternovszky in Holland: The Future of Choice in the Dutch Obstetric System

My next series of posts will summarize these panel discussions.