The birth industry makes pregnant women passive and powerless

WHY the silence?

It’s 12 days since Waterford Regional Hospital went to the High Court in an attempt to compel a woman to give birth by caesarean section and there has been hardly any further comment from the mainstream media in Ireland.

Take five seconds to think about what that would mean if the woman had resisted. How would she be restrained while her middle was cut open to extract the baby?

The woman consented to the caesarean before the judgement. I voiced my severe misgivings about the application to the High Court on this page last week. There was a frenzy of activity on blogs and on Facebook and Twitter, and Improving Birth — the US group advocating evidence-based maternity care — has gone on red alert, but the official media here mostly met the news with silence.

I am appalled. Why do we do think this woman’s bodily integrity is unimportant? We, who have entertained the world with our shenanigans over abortion for three decades?

Why has the women’s movement not concerned itself publicly with this woman’s case? There hasn’t been a squeak out of the National Women’s Council. They’ve been busy with the apology to the Magdalenes and the lack of women in politics and the taxing of maternity benefit. Oh, and abortion, of course — an expression of a woman’s autonomy over her body which leaves her without a baby.

An expression of a woman’s autonomy over her body which gains her a baby is of little interest. Even though more than 70,000 women gave birth in Ireland last year while about 4,000 had abortions. Even though it is the same Eighth Amendment to the Constitution regarding the unborn child which threatens women with the force of law if they do not follow their doctors’ instructions regarding birth. And a leak from the HSE has established that new guidelines for patient consent will explicitly deny to pregnant women the autonomy which other patients enjoy because of the constitutional protection of the unborn.

Only the repeal of the Eighth Amendment measures up for women. There is no way any feminist organisation should be looking for legislation for the X Case, which creates a body of law from this flawed amendment.

We could get to the point that a pregnant woman is had up for smoking a cigarette — as happened in Tallahassee, Florida, in 2009 when Samantha Burton was required by court order to stop smoking and stay in bed — but an appeals court later overturned the order. But the US does not give the unborn constitutional protection as we do. Here we are also governed by the European Court of Human Rights, which ruled in 2010 that it is a woman’s human right to choose the circumstances and the location in which she gives birth. The judgement in the Ternovsky v Hungary case — in which a pregnant woman appealed for the right to have a home, rather than a hospital, birth — states that “the right concerning the decision to become a parent includes the right of choosing the circumstances of becoming a parent”.

Did Waterford Regional Hospital know about this judgement when they sought a court order to compel that woman to have a caesarean last week? Will some Irish woman be beaten into taking a case to the European court to have her right to give birth as she wishes vindicated?

You’re asking why doctors and pregnant women should have an adversarial relationship when they both want a healthy baby? The reason is that, throughout the western world, the birth industry has internalised attitudes to women from the 18th century.

Ireland is in the vanguard of that tradition. The system of ‘active management’ pioneered in our National Maternity Hospital has been exported all over the world. Its aim is to take away the woman’s autonomy and replace it with “a modern, efficient, intensive care delivery unit”. Labour is allowed to last for 12 hours and is then cut short by intervention. Pre-printed charts do not allow for a longer labour.

Far from respecting women, this system reduces her to a passive spectator of the “active” hospital staff. The 1993 manual cautions: “the disruptive effect of one disorganised and frightened woman in a delivery unit extends far beyond her individual comfort and safety.”

The traditions within midwifery are often not based on evidence, but on culture. Hospital practices common in the western world such as artificial breaking of waters, constant electronic monitoring, refusing a woman food and drink, and keeping her in bed and on her back, are unsupported by evidence. Artificial induction of labour is practised in about 30% of Irish births, though the WHO recommends a maximum of 10%. It results in the increased use of epidurals because it causes unnatural levels of pain. In turn, this increases the risk of instrumental delivery and hugely increases a woman’s risk of having a caesarean section.

Babies do know how to be born and, in most cases, the use of a drip of artificial hormone is unnecessary. The claim that the woman in the Waterford case was 13 days overdue and the placenta was “ageing” must be put in the context that due dates are hard to calculate and the evidence for increased risk to babies born after 42 weeks refers to a miniscule increase. There is also an indication that this evidence, garnered in Thailand and India more than 20 years ago, will soon be challenged.

Oh well, you have a healthy baby, don’t you? As Improving Birth says, that’s not enough to justify depriving a woman basic respect. Nor is it ideal for a baby to enter the world with artificial oxytocin racing through its veins or with a forceps or ventouse at its head, while a caesarean section has many effects on babies, including a five-fold increase in the risk of allergic reactions.

As for the woman, her experience of giving birth will stay with her psychologically, and sometimes physically, her whole life. In Aug 1996 a young midwife was five days overdue with her second baby in Our Lady of Lourdes Hospital, Drogheda when she asked for an epidural. She was given one, and then Michael Neary suggested an oxytocin drip to speed up delivery. She had not delivered by morning and consented to a caesarean section, but Dr Neary cut out her womb as well while she begged: “Don’t do a hysterectomy on me.”

Dr Neary has been struck off and I am not suggesting that many doctors have a thing for cutting out wombs. But the truth is that that young midwife probably needed none of the interventions which led up to her mutilation. Our birth industry allowed Dr Neary the opportunity to ply his gruesome trade for a quarter of a century.

Under our constitutional protection of the unborn child, and HSE guidelines based on it, Dr Neary, like all other doctors, would have the law on his side if he insisted on intervention for the sake of the baby. There is not even equality between the life of the mother and that of the baby here. The labouring woman is utterly powerless. And she will stay that way until we break our silence.