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.

“Who here tonight has used online dating?” asked panel moderator Jackie Dent. Almost half the hands in the room, accurate for wider Australian demographics, shot up.

“Rather than the last resort, it’s become the logical first step. But it isn’t an even split between the sexes: it’s a buyer’s market for men”, said cyberhate researcher Emma Jane.

But even if half of us are doing it, most things digital tend to get tagged as ‘inauthentic’ and there’s still a stigma around online dating (less so with apps). So when it comes to creating a profile, what constitutes an ‘authentic’ representation of who we are? What we think is import to know about us is not always what other people think is important to know. Is it important to disclose the colour of your eyes? That you’re married? That you have HIV?
HIV activist Nic Holas generally recommends disclosing your HIV status up front so you don’t set yourself up for rejection, even though some people don’t want to disclose because it doesn’t give them a chance to fully explain their situation. “It’s only reasonable to disclose your status when sex is a sure thing”, said Holas. “In NSW, if you are HIV positive, you’re legally obliged to tell anyone who you intend to have sex with. But that’s not the case all over Australia.”

Does online dating make us racist?

The online space is a wonder world for niche interests and narrow preferences. If your thing is getting it on in a coffin, there’s “Vampire Passions” or if you just want to spoon-feed your lover quinoa salad, there’s “Gluten Free Singles”. But what if your thing is just ‘white guys’?

“No one would walk into a bar wearing a T-shirt that said ‘No Asians!’. But there’s no end to Grindr profiles with stupid lines like, ‘No rice, no spice, but black guys to the front of the line ;-)’”, said Holas.

“If you were approached in a bar by someone who is Asian, even if you don’t intend to sleep with him, there are plenty of ways to let him down without making explicit reference to his race – or for that matter, his height, weight, or HIV status.”

“You can’t feel empathy unless you’re in some way vulnerable. We’re still at an awkward early stage of a digital era that doesn’t really compensate for physical embodiment,”, added philosopher Matthew Beard. Which is kind of what Louis C.K. reckons when it comes to letting kids use text messaging: if you call someone fat but you’re not there to see how it hurts them, you don’t learn not to call people fat.

Which begs the question, is it fair to call it online dating when our ultimate judgments will always be made in person? Well, there are plenty of people using the likes of Tinder and Grindr to meet friends or just to chat. While there are sites like “Girlfriend Circles” that are designed especially for finding friends, the app market is still in waiting.

Can an algorithm know us better than we know ourselves?

But not everyone’s brutally honest about what they want. We might not want to admit to ourselves or to a computer that we have a racial preference, but the algorithm works it out pretty quickly. “After you’ve interacted with three people, that’s enough data for the algorithm to ignore what you said you want”, said algorithm scientist Luiz Pizzato.

“It’s like Clippy the paperclip popping up to say, ‘Hey, it looks like you’re being a bit racist. Let me help you with that”, added Beard. Only, everyone hated that overly enthusiastic paperclip so the algorithm uses stealth.

The most conventionally attractive people don’t necessarily get the most messages. “Most users assume that ridiculously good looking people will get flooded with messages, so they don’t message. Those people with looks that polarize, people who would get 10s and 3s in a hot or not challenge, are the ones who get the most messages”, said Pizzato.

Does online dating make us more likely to lie?

Both men and women add about five centimetres to their height and about 20% to their income when they fill out an online profile. And when you’re instant messaging on a device with a camera, quick verification snaps of “those extra inches in other departments”, added Holas, is standard practice for gay guys.

But not being 100 percent honest online isn’t an indictment of online daters’ morality, thinks Beard. “Online dating doesn’t inspire lying, it just exposes it. It holds a magnifying glass to the human experience of meeting people.” Who can honestly say they haven’t told a few lies or sweetened the truth on a first date?

Cheating

What do you do when you see a friend’s partner on a dating platform? And if you’re partnered, is talking to people online the same as flirting in a bar? “I think the best gauge of what counts as cheating is to ask yourself, ‘Am I comfortable telling my partner about this?’” said Holas.

While studies show that men are more likely to cheat in general, there isn’t much reliable research to conclude whether online platforms make cheating easier. “In any case”, said Jane, “something like five to 15 percent of children are not fathered by their biological father. So the idea that men are the only ones who cheat is clearly inaccurate.”

Scamming

The sharks are still lurking, but since the online waters have deepened and sites have more safety nets, they’re less of a threat. “Scammers often masquerade as religious people. They do this because they tend to then attract genuinely religious people who are often trusting and caring and then the scammer abuses that trust for money or a visa or whatever else,” said Pizzato.

What’s Next?

When there are too many online offerings, we tend to see a throwback. But it tends to be token, suggests Beard. “The resurgence of speed dating in hipster bars says more about their love of irony than anything else.” The shift to online dating is only going to gather pace as more and more services come onto the market.

What might those new services look like? “The gay community is always an early adopter market”, said Holas, “so you should expect to see heteros opening up to the idea of meeting new people in new ways soon enough.”