Thursday, November 05, 2009

A Parent's Rights vs a Woman's Rights

I was reading a great pregnancy resource book called 'Pushed' the other day and I just had to comment on something that was brought up in the book. The author (who has a website here: ) is clearly on the 'liberal' side of women's rights. Thankfully she didn't really go off on any long winded tangents during the book, but, multiple times, it was mentioned, sometimes naturally in passing sometimes somewhat forced into the conversation, that pro-lifers are hurting a woman's right to labor and deliver as they want since they are trying to give the baby individual rights. So the hospitals/doctors/states are using the baby having rights to force the woman to have c-sections, birth in hospitals, or otherwise be forced into unwanted intervention that the doctor thinks is 'better' for the baby. She references cases where court orders were obtained where the woman was forced to have a c-section against her will. One in particular stands out where the judge (while the woman was in late labor) told her 'the state has taken custody of your unborn child, and we are delivering the baby safely. You are having a c-section, now.' In that case the woman was attempting VBAC (vaginal birth after Cesarean) and, after having been told by doctors that her scar was 'sure to rupture' and refused the right to even try vaginal labor at the local hospital, had decided to try to have the baby at home.
Now, I will state on the outset that I am one of 'those' people who think the hospital is NOT the proper place for labor and delivery of a normal low risk pregnancy (which over 90% of pregnancies are). My reasons are varied but mostly come down to one point. Study after study since the 70s (and as recently as this year) show that home birth with a midwife is safer than hospital birth with a physician. The main reason is because physicians consider labor and delivery a medical problem that has to be fixed and midwives consider labor and delivery a normal course of life that should be allowed to take its natural course unless something goes wrong. For a physician in a hospital that 'something goes wrong' happens when the first contraction hits. Because of this the average c-section rate in America today is around 40%. Midwives have around a 4% c-section rate. A c-section is a major operation where is is 'expected' a woman will loose twice the blood as during a normal vaginal delivery, where the mother and baby will be separated for hours afterwards, and where a woman is 4 times as likely to die as during a vaginal delivery. It is also more dangerous for the baby. C-section babies are more likely to need help breathing, including tubing and resuscitation, more likely to have a low 1 and 5 minute apgar score, and more likely to require time in the NICU. Even assuming everything goes correctly, you still have a mother who has to take care of a newborn (not to mention any other children) healing from a serious abdominal surgery.
Now I could spend the next several pages going over research the has proved midwives/homebirth is safe, but the information is pretty easy to find, and that isn't want this blog is supposed to be about. I will offer two good books on the subject for anyone who is interested. The first was the one that was previously mentioned, "Pushed" by Jennifer Block and "The Thinking Woman's Guide to a Better Birth" by Henci Goer.
That being said I'm going to get back on point. I can understand that, from a pro-abortion standpoint, the issue of a woman's right to kill her baby in utero could seem similar to a woman's right to choose how to bring that baby into the world. But, as usual, they have missed the point entirely. Just like abortion isn't about a woman's right to privacy or authority over her own body, neither, in the most important aspects, is where/how to give birth.
As I've said previously choice always comes before action. A woman's right to choose to have a child happens BEFORE she has one, not after. The moment of conception is a moment of life. When two separate entities, nothing more than parts of individual people, join and create a new, distinct individual, with a new, unique, and separate DNA, the ability to grow, consume, respond, and produce (the four biological requirements for life). The woman is now a mother, the man is now a father. Their choice to enter into the mother/father relationship has already been made. Unfortunately the current law allows that mother/father to then choose to kill that baby. To become parents of a dead child, instead of a live child. Thankfully (for now) the law does not allow parents of older children to make that choice. Once a child can be easily seen by the society (the only real difference between a baby in the womb and a baby out of the womb) they are protected, by society, from extremely bad parenting choices. And I say 'extremely bad' because, under most situations, it takes more than a lapse in judgement or even what most people would consider bad parenting. As well it should. Parents should be free to raise their children as they wish, only expecting the society to step in and save the child if their actions pose a persistent and real danger to the child, like extreme or long standing abuse or neglect. This allows people who differ wildly in parenting styles to co-exist within a society.
I think you'd be hard pressed to find someone who takes the stance that to kill, maim, or starve their child is covered under their 'right to privacy' or their right to do as they wish with their own body. Its absurd. It is a parent's right, as the parent and guardian of an underage person, to use appropriate physical, social, or monetary punishment or reward. It is the parents choice where and how to educate, care for, dress, and monitor their children.
A woman's right to have a baby at home, in a birth center, in a hospital, to accept/refuse any/all intervention during the labor is not really a right to HER body, its her right, as a parent, to choose what is best for her child, taking into account, as parents do everyday, her own person as well. For instance, lets discuss VBAC for a moment. VBAC is 'vaginal birth after c-section', and many doctors refuse to even attempt them. Why? The stated medical reason is because there is a slightly higher risk for uterine rupture, which is dangerous to both mother and child. The real reason, however, is insurance. Insurance companies (remember all doctors are supposed to practice only with malpractice insurance) have declared an injury to baby after VBAC is 'indefensible'. So doctors who will perform VBAC will not be covered by their insurance carriers. The insurance company's position isn't due to any medical facts or even proven case law, instead it is their assumption that, since VBACs are rare, anyone who decides to sue for an injury during VBAC will be able to find a doctor to state it isn't 'standard medical practice' to perform one. "Standard medical practice" is the gold standard for medical malpractice suits. In order to conceivably win a medical malpractice suit the injured party must have been injured during a procedure or by an action that stands outside 'standard medical practice'. (this is meant to protect the doctor from frivolous lawsuits where the person was injured during the normal course of medical practice, there are side effects after all and no everyone who is injured during surgery is injured due to medical malpractice. In reality it just as often protects the doctor from legitimate lawsuits since not all medicine as it is commonly practiced is GOOD medicine. No where is this more evident than in the abortion industry. Since standards of practice are so low even woman who were injured or killed by what the average person would consider gross malpractice has no recourse in the courts since that 'gross malpractice' is actually common enough to be considered 'standard medical practice'. The case that jumps immediately to mind is the woman who suffered serious injury, including an emergency hysterectomy, because the doctor left fetal parts inside her and then refused to return her calls or reexamine her. Read the book 'Lime 5' for more specific examples of this) We've all heard of those absolutely ridiculous lawsuits, and, somewhere in there we can probably remember one of two against doctors. But, unfortunately, most of the time when someone brings a ridiculous lawsuit against a doctor we never hear about it, because the insurance companies just settle. Ultimately its usually cheaper to settle, even cases without any basis, than it is to go to trial. Since doctors must follow the mandates of these companies who are too removed from real life to understand that settling bad cases sets bad precedence, the doctor's patients end up suffering. Taking a step backwards lets look at the so called 'medical' reason for refusing VBAC. The standard statistic given is that 2% of VBAC births will end with a ruptured uterus. A ruptured uterus is deadly to the baby about 10% of the time. We are going to accept those statistics even though studies actually done on VBAC birth points to lower percentages. Now, a standard vaginal birth has around a 1% rupture rate. So, that means that a VBAC baby has approximately a .1% greater chance of death than does a standard vaginal birth baby. Now, I admit when we are talking life and death even .1% is something to be considered. But, since a baby is around twice as likely to die during a c-section delivery (its a little under 50%, numbers vary depending upon study and which pregnancies/births are counted and which are excluded) than a low risk vaginal birth, and the mother is 4 times are likely to die, how is that .1% somehow a reason to force a c-section? It isn't, at least not logically or medically. And certainly, given those odds for mother and baby both, it should be within a parents rights to choose which situation is better for their family. After all, you are 37 time more likely to die riding a motorcycle than you are while driving a car, but we allow parents to ride with their children as passengers in either a car or a motorcycle. It is, after all, the parents right, on behalf of the child, to make that choice and take those odds if they so choose. So go the so called 'medical' reasons for denying a woman the right to birth outside of a hospital, without intervention in a hospital, or any combination thereof. For instance it is a medically sound choice for a mother to refuse continuous electronic fetal monitoring (called EFM) because it has been shown in repeated studies to have no benefit over frequent manual monitoring with a Doppler or fetoscope. Hospitals, however, usually require this continuous EFM because 1) it frees up nurses, allowing a 2:1 or 3:1 patient:nurse ratio instead of the previous standard of 1:1 2) it is required by their insurance coverage as a 'paper trail' to be used in case of lawsuit and 3) its considered 'easier' than charting manual readings. EFM, however, isn't just not superior to manual monitoring, its actually worse for both mother and baby. If the baby or mother shifts the EFM can lose the heartbeat or signal a false decrease in heart tones for the infant, this can lead to intervention that is unnecessary and dangerous. EFM requires the mother to remain still and on her back, both of which are unnatural during labor and tend to slow or stall labor progress. The back lying position also can put stress on the baby. (all through pregnancy woman are told not to lay on their back as the weight of the baby can depress the blood flow thus potentially lowering the oxygen to the baby then, when we are trying to deliver, hospitals put us...on our backs)
So why can't a mother choose? Partially its because many doctors, in the role of making more money and running the hospital are more interested in seeing as many patients as possible than they are in giving quality care to the patients they see. It isn't hard to find a story of a momma overhearing the doctor who just coerced or scared her into a c-section to say something like 'great, I can make it home by dinner' or 'I'll be out of here in time for my tee time' (I'm NOT joking, I've read the quotes, they are NOT hard to find in you read pro-birth sites/books, but I will be happy to help you if you are curious and can't find them yourself). Partially its because doctors are legitimately afraid of lawsuits if something happens. But they are mostly to blame for this. They agree to settling ridiculous lawsuits when they happen at the advise and pressure of their insurance companies, and they set a women's expectation that since the birth is taking place in a hospital with the 'best medical' technology and access available, they can expect a perfect outcome. They don't want to admit they aren't perfect, that no one can guarantee a perfect baby, birth, or mother. Partially its the insurance companies fault, who are so out of touch with the real world that they pressure those doctors to 'admit' fault (even if only passively) by forcing them to agree to settlements when they are not at fault for an injury or death during a labor/delivery. Partially its the parent's fault, who don't do the research, put their complete trust in a broken system that treats a normal act of life as a medical emergency, and comply, even if its only under stress, to interventions they know they don't need, don't want, have already said no to, and know it is not evidence based medicine. I know its somewhat harsh to put any blame on the parents, they are made to have so little choice, frequently the nurses or doctors preform interventions against their will and/or without their knowledge. But every patient that puts up with it, who doesn't transfer care, birth elsewhere, complain to the medical authorities, or yes, even sue for non evidence based medicine regardless of if it is 'standard medical practice' (insurance companies get enough threats of legal action against a practice evidence proves is medically poor, they will start to treat them the same way they treat those 'frivolous' lawsuits now, and they might stop putting so much pressure on doctors to practice bad medicine.) who even goes so far as to contact the police for assault (regardless of if they listen or prosecute) when a doctor does something against their will or without their consent, only perpetuates the situation, only makes it seem like the behavior is agreeable and encourages it to continue. Men can even be more to blame for this than the women, after all, the father isn't in the middle of labor. He should be advocating for his wife/mother of his child. So should every other member of the birth team the mother chooses. So moms, if you are pregnant and considering birth in a hospital, first, consider again. Find the info, look into the facts, read the material, make an informed choice. And, if you still feel most comfortable in the hospital after you've been fully informed (which, certainly is both your choice and a valid choice for you to make as a parent), choose your birth party carefully, expect them to warn you if the nurse/doctor is about to do something you haven't consented with, expect them to advocate for you. Consider a doula, who is more familiar with the situation than you or your family may be. Mostly, be adamant, YOU are the parent, it is YOUR choice how your dependant child is treated, even in birth. Don't let yourself be bullied, coerced, or terrified into something you know is wrong. Write it down, try to stay calm, avoid even the little unnecessary intervention that will lead to larger ones which will be more difficult to decline. It will take time, doctors and nurses are accustomed to running roughshod over women in labor, they are accustomed to being god in the delivery rooms and doing whatever they want, bullying women 'arrogant' enough to disagree with them, frequently forcing them when it doesn't work. But every shift in policy needs its head runners. Every civil rights issue needs its forerunners, even its martyrs at times. Stand and be counted, not just so that you can have a better birth next time, but so that our daughters and granddaughters can as well.

Some good websites to check out for more info: