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Wednesday, 22 August 2012

Human Rights in Childbirth

By Lynn Morrison and Olga Mecking

I would like to thank Lynn Morrison for her invitation to co-author this article. 

We are two expat women living in the Netherlands. We each have two daughters, gave birth around the same time, and had our first child outside of the Netherlands and our second one here. We have both met women who told us stories how their wishes and needs were ignored because the midwives expected them to have a more natural birth experience. This inspired us to co-write this article to present a slightly different perspective on the human rights in childbirth debate.

This past summer the Netherlands hosted the Human Rights in Childbirth Annual Congress. Thought leaders, researchers and political figures from around the world gathered in The Hague to discuss the rights of women to determine when, how and where their childbirth will take place. 

We were only somewhat surprised to see that most of the presentations that got wide coverage were about women who wanted to give birth at home at all costs. We started asking ourselves these questions: what about those of us who want to give birth in the hospital with every pain relief option? Are our own rights to the birth of our choice worth less than the rights of women who want to give birth at home? 

I gave birth to my first child in the United States. I attended childbirth classes well in advance and was educated on all of the different types of pain relief available and the risks and side effects (both for myself and my child) for each one. I approached the birth with an open attitude – I would listen to my body and use exactly what I needed to get through the birth. However, after 8 hours of laboring at home, I arrived at the hospital and asked for mild pain relief. I was provided with an IV-drip that helped to take the edge off of the contractions but still allowed me the freedom to move. After two hours later I realized that my early plans to walk through the labor pains were not realistic. If I wanted to get through the next hours (I was only at 5cm at this point), I needed stronger pain relief. I was then given an epidural, and this full-strength relief took away all labor pains but still let me feel enough to push out my child with no problems. I left the delivery room feeling pleased with my whole experience. My pregnancy in the Netherlands was a complete contrast. Knowing the national opinion on epidurals (“bad and unnecessary”), I vocalized my desire for one at every single appointment during my pregnancy. Every time I was told that it was noted but they could not guarantee that such relief would be available. In the end, I was able to get one for my delivery, but I felt rushed into the decision due to the imminent departure of the staff anesthesiologist. 

I am confident that had I not been both resolute in my desire for pain relief for my second pregnancy I would not have received the care and treatment I wanted. I don’t think a woman should be vilified because she doesn’t want to feel every single pain associated with labor and delivery. If anything, the relief that the epidural gave me allowed me to be more relaxed and focused on the arrival of my child and not on the side effects. I would like to see more doctors in the Netherlands support a woman’s right to choose pain relief during delivery, instead of vilifying the epidural.

My experiences are very different from Lynn’s. The first time, I gave birth in Germany, had a very hard, long, exhausting labor (38 hours and almost 3 hours of pushing), and took ages to recover. Obviously, I wasn’t very thrilled with how the birth went, but I had a healthy, beautiful baby girl. I didn’t have pain relief, since the pain was manageable, but the exhaustion wasn’t and I can’t help but think that maybe an epidural would allow me to sleep a while during labor, and maybe I would feel better after the birth. 

I became pregnant very fast after that, and looked into other opportunities for having a better birth experience. I decided that I would have a homebirth, and felt that this choice was respected in the Netherlands. I liked the idea of having my own midwife. The second time, my labor was 6 hours. I was transferred to the hospital for a minor complication, and a midwife I didn’t know took over. In the end, it didn’t bother me. I was monitored in labor, but could move around. I didn’t have pain relief, but I didn’t feel it was necessary. We went back home the next day. Even though I didn’t have the homebirth I wanted, I was very happy with the midwifery model of care. 

I believe in respect in childbirth, and that women should have the right to choose. But just as in many countries women feel that they can only go the medicalized route, and possibly end up with a C-section they don’t want, in the Netherlands many women (especially expat women) feel that they are denied their right for pain relief. Just like the doctors in other countries, in the Netherlands it’s the midwives who are in a position of power: often, they try to push their opinion on women because they can’t provide certain services, such as pain relief. There is no shame in needing help in labor-whether it is pain relief, a C-section, or a doula and natural remedies. 

I think that “human rights” and “dignity” should have to do with respecting all kinds of choices without compromising safety. It should have to do with giving and receiving the help that is needed. And even though I support homebirths and midwives, I would argue for more choices in the Dutch healthcare system- and I don’t mean more midwives, I mean more doctors, and an easier access to them.

What are your thoughts on this subject? 

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  1. I agree that in the Netherlands "midwives expect women to have a more natural birth experience". I think in the US, pain relief is likely within arms reach at all points during labor. I would say that as the prenatal checkups progress, if it doesn't seem like personal preferences/requests are being taken seriously enough - it's time to shop around for a more supportive, more aligned midwife/doctor/hospital. My preferences matched well with the Dutch approach, and I had good experiences here. Aside from receiving the wrong baby to breastfeed in the hospital (story for another day, not relevant to the discussion of the cultural approach to birth in NL), my birth experiences in NL will be one of the cherished memories of my life.

  2. Dear Sarah, thank you for your comment. My experiences are similar to yours- I was very happy with the care I received. And I agree, one should definitely shop around for a better midwife/doctor/hospital if the care is not satisfying enough. However, if a pregnant woman wants to go to the doctor, she will have to go out of her way- as the midwives are "doorkeepers", and will only transfer care if something wrong happens. I think everybody should get a choice whether to go to a doctor or midwife. I mean, I got the care and help I needed, why wouldn't anybody?

  3. I started writing a response to your post but the comment got far, far too long. So I have moved it to the Amsterdam Mamas site. You can find it here: http://www.amsterdam-mamas.nl/stories/parenting/pregnancy/human-rights-in-childbirth-moving-the-discussion-forward. Its a topic that I feel very strongly about, due both to personal experience and to hearing the stories of the women in our community who have given birth in the Netherlands. I applaud anything which continues to shed light on this topic and keeps the discussions moving forward.

    As one of the media organisations publishing articles from the Human Rights in Childbirth Conference I would like to add that there is still more to come from this conference. Whilst some of the initial published articles shared a theme of non-medicalised birth they should not be taken as representative of the conference as a whole but of sections of it. At the beginning of your post you asked of the conference "what about those of us who want to give birth in the hospital with every pain relief option? Are our own rights to the birth of our choice worth less than the rights of women who want to give birth at home? " Based on the panels at the conference and the dialogue which has been ongoing since then I would say that all rights and birth options were equally represented. I would be happy to put you in touch with people directly involved in the conference, if you would like to explore your questions further with them.

    Once again, thank you for keeping the discussions going. These are questions we need to ask, and conversations we need to be having if we are to improve what we currently have.

    1. Hi Emmy, I've just read your response, and left a comment on your post. Thank you for taking the time to comment! I believe that the topic of childbirth is one everybody feels very strongly about- just as you do.

    2. Hi Olga, unfortunately your comment hasn't appeared on our website. We can't find it on the site or in the pending comments. I wanted to let you know. Please feel free to post it again.

    3. Hello Emmy, thanks for letting me know about my missing comment. I will re-post later today!

    4. Hi Emmy, it's done! I can see my comment now.


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