Rights and Responsibilities: Where did they Go?

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Feminism is a dirty word, especially if you are a pro-establishment columnist. Recently, the mass media have spurned the safety of homebirth. Doctors were outraged at the death of four babies, without revealing any case facts ... Not one mainstream piece has explored why a number of women feel the need to give birth without any health professional, nor have they explored simple tested legal concepts of informed consent and right of refusal. It would seem far more sensible to herd all women into hospitals where they can be controlled. Women cannot be trusted, especially those who challenge the fierce medical domination of childbirth.

As an owner of a female body I have taken it for a test run seven times. I have chosen to use limited medical technologies ... I took ultimate control of my body and became responsible for the life growing within me ... I paid a price however. My decision to give birth at home with a registered midwife was not respected or funded. At the same time my taxes paid for a system controlled by medicine—a system with virtually no accountability, that allegedly enabled gross sexual assault under Dr Graeme Reeves. These assaults were extreme but lower level violence continues in maternity wards every day ...

With this environment how could a woman previously damaged by the system feel safe? We have a maternity health system that leaves one in four women experiencing birth as a ‘battlefield’ and suffering debilitating post natal depression or even post-traumatic stress disorder, usually reserved for soldiers and victims of crime. Whilst women cry out for a mainstream midwifery option that puts their needs first, the medical establishment remains largely unaccountable.

Federal Health Minister, Nicola Roxon put her toe in the water, by announcing the Maternity Services Review last September. As expected the women who have been denied their rights and are funding others ...

While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time.

The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.

As a woman and lawyer, Nicola Roxon is well placed to oversee the design of a maternity system with the established principles of informed consent and right of refusal at the centre. Arguments of safety and wellbeing are thin guises of tightly held power and control by medical lobby groups ...

I attended a roundtable meeting of key stakeholders as part of the Maternity Service Review last year. The topic discussed was ‘high-risk pregnancy’. ... many women and babies are classified as ‘high-risk’ by an obstetric community that is largely dogged by fear and distrusts women and women’s bodies.

My conclusion was sadly confirmed at the roundtable meeting, when a senior obstetrician said without hesitation that he ‘would be loathed to think a woman would have the final say in her care.’ ... As a consumer, passionate about the rights of women to make informed choices, I believe the paternalism that pervades obstetrics and the widespread midwifery practice of maintaining the status quo pose a major threat to reform.

This view is in direct contradiction to common law in Australia. Kim Forrester, a member of the Queensland Bar states, ‘all adults who are of sound mind and considered legally competent have an absolute right to consent, or refuse to consent, to medical intervention and/or treatment. This is the case regardless of the opinion of health professionals as to what is in the “best interests” of the patient or client.’

... A US appeal case heard in 1914 made a landmark decision still quoted today: Schloendorff v Society of New York Hospital, clearly articulates, ‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent, commits an assault.’

The culture of fear and control in obstetrics has enabled these legal principles to be ignored. Women are consistently misled about procedures performed on them. Ironically most women are grateful and believe that either their own or their baby’s life was saved, often after an unnecessary intervention.

Obstetric dominance pervades midwifery. Virtually all models operate with exclusion criteria that are not based on evidence. A woman with a previous caesarean section is unable to give birth in a bath in a birth centre with a midwife sometimes only seconds from operating theatres. Her safety can only be assured in a ‘labour ward’ sometimes only metres away from the birth centre. The capacity for a healthy woman to deliver her placenta without oxytocics is doubted and feared ...

The birth reform process is likely to bring with it guiding principles. The Australian College of Midwives developed guidelines for establishing midwifery models. The recent second edition was mindful of the need to enshrine informed consent and right of refusal. They state:

Ethical principles underlying health care and health law emphasize the importance of respecting the autonomy of those receiving health care and the rights of individuals to choose among alternative approaches, weighing risks and benefits according to their needs and values. Midwives, like all health professionals, are responsible for being clear about their scope of practice and limitations, giving recommendations for care if appropriate and for informing women about risks, benefits and alternative approaches.

Should a situation arise in which the woman chooses care outside the recommendations in the Guidelines the midwife must engage with the woman and her family and with hospital staff through identified channels where applicable, in a thorough discussion of the request, looking for options

The Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG) do not accept these guidelines ... they have released their own guidelines ...

It would seem that unless a woman conforms to obstetric dominance she is not informed. If this wasn’t so serious it would be funny.

For too long we have chanted that birth needs to come back to women. Now is the time to empower women with rights too often denied. How can we have a maternity system that largely treats women as incubators where emotional wellbeing is dissected from her uterine cavity; and yet come post-natal discharge the same woman walks out into the world to make major life decisions for her child for the next 16-18 years? As with maternity reform, empowering women will take time, but if the reform process respects the rights of midwives to practice a full scope of practice and that of women that determine how and by whom their bodies are handled (if at all) a true woman-centred approach is possible.

Neither the church nor the state has the right to control a woman’s body. Maternity reform must be based on the three R’s - rights, responsibilities and respect. Consumers have the right to a funded registered health professional in any setting, and the responsibility to demonstrate they have made informed decisions. They deserve these decisions be respected ...

Melissa Maimann, Essential Birth Consulting 0400 418 448