I don’t know what disturbed me most about Genevieve Tait’s opening argument.

Was it that it was written by a woman? Or a student doctor who would one day care for women? Or was it that these thoughts were not just the naive reflections of youth and inexperience but attitudes I see commonly expressed in society and by medical professionals with years of experience?

Ms Tait and I agree on this much, “Every woman should have the right to make a choice about her birthing strategy and her body. This right is inalienable.” But with her following sentence, she loses my support, “But sometimes I worry that women get so concerned about how they are going to deliver the baby that they forget about the actual welfare of the baby.”

If an expecting mother defies an obstetrician’s advice against a vaginal birth, we need to assume and respect her decision is motivated by reasons other than “competitiveness and entitlement”. And if we don’t – if we coerce a woman already under duress – we may trigger a toxic postnatal experience.

Women have told us there is something worse than death. It is in being alive but feeling dead inside.

It is in being so traumatised by pressurised interventions in their birth plan that they can’t care for their newborn or have a relationship with their partner. Ms Tait’s comment that “whether a baby first glimpses the light of day via the stomach, in a pair of forceps, or via the vagina, what matters is that the baby arrives alive and the mother stays alive” is clearly naïve. We need women and babies to be more than simply alive; we need them to be well physically, emotionally and culturally.

We need women and babies to be more than simply alive; we need them to be well physically, emotionally and culturally.

A pregnant Jehovah’s Witness and her nearly 27-week foetus died after she refused a blood transfusion for acute leukaemia in a Sydney hospital. This has been raised in the media this week and led to significant public debate. We might find this hard to comprehend, but the law is clear – the woman was an adult with the mental capacity to refuse treatment and the foetus is not a legal person in his or her own right until it is born.

We inevitably see the backlash and the comments that laws should be introduced to force pregnant women to consider the interests of their baby first. The innocent baby becomes the justification of our outrage. But we cannot force someone who is not pregnant to have a medical procedure for the good of another. When a man refused to donate his bone marrow to save his cousin’s life and his cousin then tried to sue him for neglect, the court found that to compel a person to submit to intrusion of his body for the good of another “would change every concept and principle upon which our society is founded” (McFall v. Shimp).

The USA demonstrates the ramifications of perching on such a slippery slope when it comes to foetal rights. The expansion of foetal rights in the USA and the recent debates over similar law reform in Australia, such as Zoe’s Law, are a warning sign to us. Do we really want to go the way of the USA where women have been charged with eating junk food, taking drugs or even having sex that could or did harm their baby? In Western Australia in 2012 when there was discussion of possible foetal homicide laws being introduced, the WA Australian Medical Association called for the laws to be extended to include women who chose a home birth or drank alcohol or took drugs. Shortly after this we saw the Right to Life Association calling for the laws to be extended to include abortion.

And so, the ease with which we can slide down the slippery slope of women’s rights becomes clear. So too why a woman’s right to determine what happens to her body is and always should be enshrined in law.

The World Health Organisation and the White Ribbon Alliance have recently produced statements warning against violations of the human rights of childbearing women to determine what happens to their bodies and to receive respectful care from health care providers.

Now to the real questions. How often do women actually refuse medical advice and why do they? The answer to the first question is rarely; the answer to the second question is more complicated. In the last five years I have worked on several research studies with my PhD students investigating the question of why some women say ‘no’ to our recommendations and services. We have found the main reasons for this choice is a distrust of mainstream services due to trauma during a past birth experience. This is often due to unnecessary or forced intervention and disrespectful, at times downright abusive treatment, from health care providers.

Unnecessary intervention in the private sector in Australia is leading to increased morbidity for mothers and babies. It is not saving lives.

Australia has one of the highest rates of intervention in birth in the world and this is traumatising for many women. Unnecessary intervention in the private sector in Australia is leading to increased morbidity for mothers and babies. It is not saving lives. Giving birth is not just physical. It is intensely emotional, social, and psychological. With suicide now the leading cause of maternal death in the developed world and post traumatic stress disorder (PTSD) affecting up to one in ten women following birth, this is clearly not safe.

Women are not stupid. They read and research their birth options and know the evidence, sometimes even better than health professionals who consider themselves the final authority. Expecting mothers talk on blogs, they tweet, and they post on Facebook – something which our research has found is more than “peer-pressure for grownups”, it can be very constructive. So why are we so insulted when women become active, informed participants in their own welfare?

There is more and more scientific evidence showing that vaginal birth not only primes the immune system, impacting positively on the future health of the child, but may impact the wiring of the human brain and in epigenetic changes. So, are women so misled in “being proud of their vagina’s capacity to deliver children”? Or is vaginal birth much more important than we ever realised?

The answer is not to reject medical intervention but to get the balance right and to ensure that mothers don’t feel like a failure if they need intervention.

Vaginal birth is still the best option for most mothers and babies, but not all. I’ll grant the benefit of the doubt that this is a point Ms. Tait and I largely agree on. However, in situations where vaginal birth is not the best course of action, her argument that women should always defer to the obstetrician’s advice, is where I disagree.

The answer is not to reject medical intervention but to get the balance right and ensure that mothers don’t feel like a failure if they need intervention. Countries with low caesarean section rates and excellent maternal and perinatal outcomes show us that living ‘as nature intended’ for the most part is what is optimal. Iceland, with half our caesarean section rate, loses fewer mothers and babies than we do. Finland, Sweden, Norway, and Iceland are consistently rated as the best places in the world to be a mother. In all of these places midwives are the main providers of care.

In 2005, the World Health Organisation challenged health practitioners not to ask, “Why don’t women accept the service that we offer?” but to question, “Why don’t we offer a service that women will accept?” Let’s stop trying to criminalise women’s choices or bully them into submission and let’s start trying to understand why those choices are made. We need to put in place responsive, sensitive maternity care systems that cater for the individual. And we need to remember and respect that birth for a mother is more than the everyday medical event that is for an obstetrician.

Read Genevieve Tait’s counter-argument here.

This is the first of a two-part debate by different members of the medical community on the topic of what is natural and what is reasonable when it comes to birth and a mother’s right to choose her delivery method.

Genevieve Tait worries that many mothers who insist on vaginal birth against medical advice are competing for a fraught badge of womanhood at the risk of their life and the life of their baby:

I recently spent some time working with an obstetrics team at a Melbourne hospital.

I just might have witnessed a new and unexpected Vagina Liberation movement – where women are so proud of their vagina’s capacity to deliver children that the organ has taken on an identity status all of its own.

I frequently saw women wax lyrical, and sometimes even territorial, about their vaginas and vaginal birth.

It would seem that vaginal birth has gone from a functional use of anatomy to a source of competitiveness and entitlement that can be life threatening for expecting mothers and their unborn babies. And birth has become some kind of holy experience, rather than the mechanism by which another life enters the world.

“Vaginal birth has gone from a functional use of anatomy to a source of competitiveness and entitlement that can be life threatening for expecting mothers and their unborn babies.”

I saw many expecting women assert their desire for vaginal birth, even when that birthing method posed particular risks for themselves and their baby. Some women refused to allow for any blood tests or examination in case the result triggered the doctor to recommend induction, early epidural, or C-section.

Every woman should have the right to make a choice about her birthing strategy and her body. This right is inalienable. But sometimes I worry that women get so concerned about how they are going to deliver the baby that they forget about the actual welfare of the baby.

I worry they forget that the obstetrician is trying to manage the health of two people, and so any recommendation coming from that doctor is intended to benefit two lives. Whether a baby first glimpses the light of day via the stomach, in a pair of forceps, or via the vagina, what matters is that the baby arrives alive and the mother stays alive.

If I had a dollar for every time I heard that “vaginal birth is the most natural thing you can do” I wouldn’t be suffering such crippling debt from my medical degree.

I hear it in the hospital, I hear it on the bus, I hear it from my clucky friends.

To me, this statement is absurd.

Vaginal birth is the best option for some mothers. If we were all to live only as nature intended it, we need only look as far as those less privileged parts of the world where medical intervention isn’t available – nature kills mothers and babies. If these women are so opposed to medical advice (a specialized body of knowledge that is naturally evolving over time), then when they next get pneumonia they should just cross their fingers and hope to get better, or press their palms together and pray.

The capacity of the female pelvis and vaginal canal to accommodate the passage of an enormous fetal head leaves only millimetres to spare – if you try to add 1cm of width by inserting a pair of forceps, you more often than not end up with a tear.

Attention base jumpers and other thrill seekers: try giving birth.

“Every woman is different – so it doesn’t follow that every birth should be the same.”

Every woman is different – so it doesn’t follow that every birth should be the same. And yet, somewhere along the line, these women seem to have internalised the pervasive and pernicious notion that without a vaginal birth they are less of a mother and less of a woman.

Where did they swallow this misinformation?

I point the finger in a few directions but I poke it at parenting blogs and forums. Not all of them. Some of them are great. But so many of them spew up little else than gossip mongering, anti-intellectual, fad-driven peer pressure for grownups.

And don’t get me started about the current trend for home births and all the YouTube videos they inspire. Here are women so desperate for low-intervention, non-clinical deliveries in settings where incense burning won’t set off the fire alarm, that they are willing to flout the fact that home birth doubles the neonatal death rate.[1]

Women are demanding natural births but often those women have bodies and health issues that are a long way from the idealised body type discussed in natural birth forums. Pregnant women today are often very physically different to the pregnant women of a few decades ago. Today’s expecting mothers are more likely to suffer from: high blood pressure, obesity, gestational diabetes resulting in very large babies, mental illness, drug addiction, age complications, and domestic violence. All of these factors complicate birth.

For a number of women I saw, their insistence on vaginal birth had very serious consequences that could have been avoided by way of an alternative birthing method.

I attended the prenatal visits of a severely obese forty-one year old woman who refused any prenatal care other than ultrasound as she clearly saw the obstetrician as some evil agent seeking to suck her baby out of her navel with a vacuum cleaner.

The obstetrician suffered this hostility with dignity and followed through with this worryingly well-rehearsed advice: it has been found that more than 50% of mothers who die giving birth are obese, and 30% of stillbirths or neonatal deaths were born to obese mothers[2]. She didn’t budge.

Another woman had been sent to the ICU after suffering eclampsia – she refused any tests that may have identified such a complication because she was adamantly opposed to undergoing C-section or induction.

Another woman’s baby suffered brain injury and renal failure due to the delivery delay attributed to her violent defense of her right to vaginal birth – despite her baby having a dangerously low heart rate in-utero.

These were not the only examples I encountered. And I worry this particular Melbourne hospital is not the only one where the Vaginal Liberation movement is gathering pace.

Ladies. Some of you will choose to push a baby out of it. Some of you will choose to smuggle cocaine in it. There’s no need to get lyrical about it. Good mothering in the lead up to and during the birthing process should be measured by the judiciousness of decision-making based on professional advice – not the diameter of your vagina.

This article is part of a debate on the right to defy doctor’s orders. Read the other side here.