
Women must uphold the right to defy their doctor’s orders
ArticleLifestyle + Health
BY Hannah Dahlen 9 APR 2015
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.
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BY Hannah Dahlen
Hannah Dahlen is a professor of Midwifery at Western Sydney University and a practising midwife.
1 Comment
It is reasonable to accept the advice of the midwives and doctors who actually have spent their adult live’s learning how to avoid the terrible situation of maternal and/or child injury/death during childbirth. Not that far back in history – 100 years- my great grandmothers generation- the maternal and child death rates were quite high. The efficiency and safety of moderrn childbirth has spoiled us so much that we no longer think of childbirth as the dangerous environment it truly is. This leads the patient away from the appreciation of the safer birthing experience and towards the idea that this is an experience that they can control- even though they often have no (or very limited) personal experience nor any relevant academic knowledge (possibly read one book as compared to the years of accumulated and disseminated of the midwives and doctors). In essence, the patients are not aware of what they don’t know (unconscious incompetence). My wife’s and my personal birthing strategy was to go as natural as possible as long as it was safe- from the midwive’s and doctor’s viewpoint. We were fortunate that she was able to go drugless and had a very strong personal birth experience- yet at any moment had the professional opinions suggested aggressive interventions to allow for the safety of mother and child- we would have accepted those recommendations.
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