Wednesday, April 01, 2009

more about choice

My thoughts have returned again to the issue of choice, and what are the limits or boundaries around the whole notion of choice for women giving birth.

A young mum-2-B told me she was shocked when the midwife at a suburban public hospital told the group of expectant parents that they were not to argue if the doctor wanted to put forceps on their baby's head to deliver it. Preparing for birth, in this situation, included an attempt by someone who is called a midwife to ensure submission by the woman to those who are in positions of authority.

I would like to work with this young woman so that she understands the broader context of consent; so that when the time comes for her to labour and give birth to her child she will be confident in her own decision-making; so that if indeed she needs to face the question of forceps or any other intervention, her acceptance or refusal will be based on a principle of her knowledge of her own body, and making the best choice she can make at the time; not on the bullying of someone who wants to ensure compliance with the dominant authority structures in the hospital.

I would like to work with this young woman so that she understands her own ability in birthing. The physiological processes that our bodies expect to engage in are profound and extremely sensitive. The physical and hormonal changes in labour and birth can be disturbed by seemingly small interruptions that may not be considered interferences or interventions. It's about being able to access that innate power to do whatever it is that women do in birthing. How can a woman actively *choose* to work in harmony with her body's natural processes, and *choose* to avoid situations that will interrupt those natural processes. That is the essence of choice in childbirth.

Another aspect of choice:
A midwife attending a planned homebirth was distressed when the labouring woman refused her requests to listen to the baby's heart beat. The labouring woman was exercising her autonomous right to refuse - her choice.

But it doesn't end there. The midwife's duty of care includes attending to the baby's wellbeing as well as the woman's. Listening to the baby's heart sounds from time to time in labour is a non-invasive and usually acceptable way midwives use to ascertain how the baby is responding to events (uterine activity and subsequent progress). The midwife is responsible not only to her client, the woman and baby, but to the society that gives her the right to practise midwifery. Midwives are required to answer to peer review of our practices from time to time; and particularly when there is an adverse outcome. Reviewers in this case would, I believe, encourage the midwife to reflect on how she might act if this situation happened again.

A reader of this blog recently wrote to me, in the context of discussion about women's choices "It really disappoints me to hear a midwife disrespecting womens choices in birth. Surely it should be for no-one but the woman to decide."
This is a good question. Should women expect to have absolute freedom to choose what happens when they give birth? Are there no boundaries?

There is no other 'freedom' that we exercise that is absolute, even in a free society. Think about travel. We can choose when we leave home and where we go for whatever reason, but we are required to act within certain limits. The way we drive our cars, or ride our bicycles, is regulated by law.

Once a child comes into our lives, our freedoms are further limited, as we have a responsibility towards that child. The midwife's duty to protect the child in its transition from the womb to the outside world is not in opposition to the mother's freedom or ability to choose. The partnership between a midwife and the woman should be harmonious, working together to achieve the very best outcomes for both.

Those who are thinking about the choice of unassisted childbirth, I would like to recommend that you read

1 comment:

Stitch Sista said...

As much as unique situations may arise 'in the moment', I would hope that mother/midwife pairs hash out this stuff well before the baby is birthed.

Discussion about what both parties are happy with, boundaries and what have you are important.

I know in the past I have defended someone who chose not to attend someone...I think if I was a midwife it would be my prerogative and infact my right to only work within my own ethical and safety boundaries.

Just as much as it is a mother's right to choose to work with someone more aligned with her desires.

Having said all that I can see where there could be times of conflict and it's a tough issue you raise.