Human Rights in Childbirth: Panel 3

Panel 3:

The Rights of the Baby:

The interests of the unborn child and the power to speak for those interests

Panelists:

• Farah Diaz-Tello: civil/human rights lawyer, USA 
• Roanna Rosewood: mother, USA
• Barbara Harper: nurse and birth activist, USA
• Susan Bewley: obstetrician-gynecologist, UK
• Noam Zohar: professor of philosophy and ethics, Israel
• Michel Odent: obstetrician, France
• Anna Verwaal (moderator): maternal child health nurse, birth consultant, USA

Farah Diaz-Tello, an attorney for National Advocates for Pregnant Women, opened the panel by commenting on the legal implications of separating the mother & fetus. Pregnant women become second-class citizens when the fetus-mother are are separated, giving the fetus equal or greater rights than the woman. Pregnant women have been--and are continuing to be--punished for their health-care problems and addictions. She referred to a case in Norway where a pregnant woman terminated her pregnancy rather than face imprisonment for the duration of her pregnancy. She commented on the need for treating pregnant women with dignity and respect and ended with the question: "At what point in pregnancy does a woman start to lose her human rights?"

Roanna Rosewood, a mother of 3 children, told a moving story about her first two births via cesarean section. When she was pregnant with her third, her hospital had changed its policies and made VBAC practically impossible. Her doctor wanted to help, but her hands were tied. So Roanna chose to give birth to her third child at home. An excerpt from her presentation:

Women were created to give life and protect the interests of our children. We cannot separate from it. It is who we are. It's in the breadth of our hips that widen of their own volition to cradle them. It's in the curve of our breasts, heavy with milk to soothe them. Every month, our wombs ache in preparation to receive life because, as women, it is our responsibility, honor, and choice to bring new life into the world. We alone have earned the right to speak for our unborn babies' interests.

Roanna is currently working on a book Cut, Stapled and Mended: A Do-It-Yourself Birth  , forthcoming in 2013.

Barbara Harper, founder of WaterBirth International, first reviewed the UNICEF Convention on the Rights of the Child. In her presentation and in her letter to the conference, she touched on the growing field of epigenetics that examines how perinatal experiences affect a human years, even decades, later. A few comments for her conference letter worth mentioning:

Fear is omnipresent in modern birth rooms throughout the world. Fear of outcome, fear of litigation, fear of not following the rules and regulations set by the institution. When women were surveyed, they do not want to be in an environment that is unfriendly, non-supportive or not accommodating....

The place of birth is not as important as the cooperative effort and respectful attitude that is show to mother/baby....How we care for pregnant women, assist birthing mothers and what we do immediately after birth with mother/baby creates sequelae that influence the core of our existence as human beings. Instead of looking at a "right place" or a "wrong place" to care for women and their babies, we must look at a "cooperative best way," with complete honesty. 

Dr. Bewley, a UK OB/GYN, examined laws or regulations that currently limit pregnant women's freedom. She noted that pregnant women's liberty is constrained in several different ways: by laws that restrict work or exposure to occupational hazards, by airline travel rules, by incarceration in prison or mental health institutions, and by cultural or social stigma. In all of these cases, these limitations require sound justification. She next turned to examples of limiting pregnant women's autonomy in favor of avoiding harm to the fetus. She highlighted several real-life examples that might provoke medical professionals to limit a pregnant woman's autonomy in order to help the baby:

• Women who are HIV+ but decline anti-retrovirals, 
• Substance misusers
• Jehovah's witnesses who refuse in-utero blood transfusion for hydrops
• Woman with a personality disorder inserting tools into her uterus at 28 weeks gestation
• Women with severe pre-eclampsia refusing hospital admission
• Women who decline cervical cerclage in the second trimester 
• Women who refuse to consent to a CS and whose babies are stillborn or sustained brain damage
• Women who decline routine blood tests due to needle phobia

In these cases, actions to prevent "real and avoidable harm" were not universally beneficial: some babies were helped, others were harmed.

Dr. Bewley next addressed the differences between treating the mother as a patient versus the fetus as a patient. She highlighted the tools ("obstetric armamentarium") that obstetricians can use when counseling their patients:

• appealing to their training, skills, and expertise
• having a trusting relationship with the patient based on confidentiality and consent
• listening to the patient's story
• formulating a diagnosis, prognosis, and agreeing on a plan
• Advising, monitoring, prescribing, operating, negotiating, and referring
• Using friends, family, religious and community advisers
• Heavy-duty moral persuasion (she noted that while she personally doesn't like to use this one, it *does* get used by other physicians)

She suggested abandoning the the use of force, threats, or fear.

Last, Dr. Bewley examined the possible effects of proposed "fetal rights" laws and reiterated her main point--that laws limiting pregnant women's autonomy in the name of safety will never have a universally beneficial effect. Some babies will be helped, but others will be harmed. What Dr. Bewley was implying, I think, is that certainty is elusive in medical decision-making. This makes the ethics of doctor-patient interactions all the more complicated.

Noam Zohar, a philosopher of bioethics, discussed how risk is always culturally processed. Every day, parents take much more elevated risks with their existing children than they do when they choose to give birth at home. Being a parent means weighing one marginal risk against another. He commented: "Even if the there is some increase in negative outcomes due to home birth, the absolute magnitude is so small that it is absurd to base any policy on it."

Michel Odent reminded us that we need to think long-term about what is best for babies. He expressed satisfaction that science and medicine have finally (re)discovered a core truth: that newborn babies need their mothers. The challenge for the 21st century is to find the answer to another core question: can we (re)discover the basic needs of pregnant & laboring women? 

Anna Verwaal showed a short video posing questions about the impact of birth experiences on the baby. While the images were beautiful and arresting and most of the commentary was spot-on, I (and Jill Arnold, who was sitting next to me) resisted some of the more heavy-handed rhetoric that the right kind of birth has the potential to cure the ills of the human race and that we're scarred for life if our own birth was difficult or traumatic. I turned to Jill and said, "Hey, I was born while my mother was hanging upside-down by her ankles and I think I turned out just fine!" She agreed.

I don't feel like I am somehow still processing or struggling against the circumstances of my less-than-ideal birth. This doesn't negate the need for gentleness and love and respect during the birth process; however, we need to be careful about some of the inflated claims we might make in our efforts to improve the birth experiences of mothers and babies.