Your rights during pregnancy, labour & birth

In Australia, everyone has the right to make independent decisions about their healthcare. This applies to a woman who is pregnant; even when a her decision may lead to increased risk of harm to her fetus. 

I was initially shocked to learn that there are many people who think that pregnant women should be treated differently to people who are not pregnant. Once I became aware of it I started seeing it everywhere: people touching a pregnant woman’s stomach without her permission while she waited in the checkout line at the grocery store, or strangers giving a pregnant  woman ‘advice’ about what she 'should' and 'shouldn’t' be eating or drinking when she orders at a restaurant. These are all things that you would not say or do to someone who isn’t pregnant but somehow because that woman has a fetus inside of her it’s OK to trespass her body and touch it or talk about it.

This attitude of women losing their right to autonomy (the right to act independently) is common within modern maternity care. A paper I wrote (with three other colleagues) in 2013 found that the majority of Queensland midwives and obstetricians surveyed believed that the needs of a woman should be overridden by health professionals if they believed the fetus was in danger.  This is scary stuff.

Important note:

I think it’s important to note here before we go further that I believe individual midwives and doctors should not be blamed (for lack of a better word) for such beliefs and actions. They are the product of a system that makes it extremely difficult for them to understand what women’s legal rights are and what their rights as health professionals are. Many are afraid that if they make the wrong decision they will be held legally accountable for it (e.g. be sued).  This fear is perpetuated by many factors including a lack of consistent information on the topic and a ‘fear culture’ within medicine (which is often perpetuated by the media). Given this, I can see how individual midwives and doctors may have difficulty upholding the legal rights of women during pregnancy and birth. It’s the system and society as a whole that ultimately needs to change.

You may have seen recent stories in the international media about women receiving medical intervention (e.g. caesarean section) during birth without their consent. Sometimes this intervention is forcefully performed by a midwife or doctor, or it can be ordered by a judge. In Australia, it is illegal to perform any medical intervention on any human being without their consent, including during pregnancy and birth. Despite this many women report receiving interventions during pregnancy and birth that they do not feel they gave their informed consent for; they feel like they either were not given a choice or were ‘talked into it.'

People often consider the only ‘good’ outcome of birth to be a live mother and baby. Women are often made to feel guilty or ‘wrong’ for wanting anything more such as a positive birthing experience where they felt listened to and respected. While it is a wonderful thing to have access to such a high standard of healthcare in Australia, this does not mean that women are not ‘allowed’ to want more than to be alive, and for their baby to be alive, after birth.

When I first came to be aware of this problem I was greatly concerned. However, there are many women who do not report receiving medical intervention without their consent and for whom birth is a positive experience (thanks in part to their midwife and/or doctor). There are some steps you can take to help ensure that your legal rights will be upheld during pregnancy and birth*:

• Spend some time finding a midwife or obstetrician who you ‘gel’ with – someone who has a similar opinion about what pregnancy and birth means. (This may be difficult if you live in an area with a limited amount of options and I hope that this can be improved, particularly in rural areas.) Also, note that some midwives and doctors will have different preferences about certain procedures (e.g., elective caesarean, water birth). If there is a something that is important to you for your pregnancy, labour and/or birth suss this out early on. You also have the right to find a different midwife or doctor if your current one does not meet all of your needs.
• Initiate conversations with your midwife or obstetrician (if they don’t) about your preferences for your care during pregnancy, labour and birth. For example, you may be happy to do whatever your midwife or doctor recommends, or you may want to make it clear that you will not consent to certain procedures under any circumstances or only under certain circumstances.
• Record your preferences down in writing for easy access during antenatal appointments and during labour and birth (sometimes called a ‘birth plan’). Most midwives or doctors will initiate a conversation like this, varying in depth. If they don’t offer to do so you may want to give them a written document for your hospital file.
• Inform your birth support person/people of your preferences, and ask for them to advocate (i.e. inform others about your preferences) for you during labour and birth if you're busy with other things (which you may well be!). 

You have the right to make the final decision about your healthcare. Being pregnant does not change this. We as a society have a problem with the way we view women and their bodies, and this is particularly evident when it comes to reproductive health. Individual doctors and midwives cannot be held accountable for this; we all contribute. Whether it be the language we use (e.g. “The doctor delivered the baby,” versus, “The woman birthed her baby with the assistance of her doctor”) or how we treat pregnant women in everyday life, many of us perpetuate this belief that it is somehow OK to trespass onto a woman’s body without her permission because she has a fetus inside of her. 

We—the community, medical professionals, hospitals, policy makers—must work together to ensure that all women have access to maternity care where their legal rights are upheld, their autonomy (independence) respected, and they feel safe.

Kate xx

*I would like to acknowledge that I do not believe the burden of this problem should fall on the shoulders of women alone to solve. I simply offer these suggestions in the hope that it may help some while we as a society work to resolve this problem.

Image via Death to the Stock Photo