Slides from Policing Pregnancy: A one-day conference on maternal autonomy, risk and responsibility. April 2016.

1. Policing Birth
Rebecca Schiller and Elizabeth Prochaska

2. Introduction: Birthrights
•Who we are and what we do
Who we are and what we do
● Set up in 2013.
● Inform women and maternity professionals about human
rights in maternity care. Factsheets available: birthrights.org.
uk.
● Provide individual advice service to women and
professionals.
● Undertake research, e.g. Dignity Survey 2013.
● Campaign on human rights in childbirth.
● Train health professionals about their legal obligations.

4. Why it matters
“I fell so far down a well of sadness that first weekend and
felt like there was a wall between me and the rest of the
world for the next year.”

5. History, identity and perfection
Pregnancy and birth as the gateway to perfect
motherhood, dragging behind them the historical shadow
of death, can understandably weigh heavily on the mind,
the policy maker and the media.

6. Media: oppositional views only

9. Don’t judge me (but I’ll judge you)

10. Don’t judge me (but I’ll judge you)

12. Policy: focused on targets

14. “Normal birth”: harsh criticism
Phipps (2014): “a shift...from the feminist-inspired aim of protecting women
from the process of medicalization to … using ‘normal birth’ as an indicator
and target and promoting ‘normalcy’ as an outcome: within this new
framework there was a clear preference for particular types of birth over
others.”

15. The reality

16. Impact on women
Birthrights, Dignity in
Childbirth Survey,
2013

17. Dignity
Perhaps even more important during childbirth?
Professor Harvey Chochinov (Schiller, 2015), “if outside
forces make a woman feel weak, inadequate and otherwise
undermine her sense of dignity she “will feel the assault of
these harsh judgements and may internalise them as being
reflective of her self worth.”

18. Birth in 2016
● Intense pressure on women: internal and external
● Media scrutiny
● Presentation of birth choice as oppositional
● Birth wars distract us from similar struggles faced by
women
● Policy is focused in one direction
● Yet services don’t match rhetoric
● Impact of birth on women is significant
● Dignity is key

20. Policing birth – common
examples
Women with high BMI face…
- Sanctioned stigmatisation/discrimination in hospital
policies
- Limitations on access to services
- Non-evidence based risk assessments
- Restrictions to fundamental choices during labour

21. Policing birth – common examples
Women seeking an elective c-section face:
- Assumption of mental health issues
- Risk distortion
- Official withdrawal of care
NICE guideline, Caesarean section: For women requesting a Caesarean
section, if after discussion and offer of support (including perinatal mental
health support for women with anxiety about childbirth), a vaginal birth is still
not an acceptable option, offer a planned Caesarean section. An obstetrician
unwilling to perform a Caesarean section should refer the woman to an
obstetrician who will carry out the Caesarean section.

22. Policing birth – common
examples
Women seeking vaginal breech birth face:
- Risk distortion
- Limitations on access to services
- Restrictions to fundamental choices during labour
- Official withdrawal of care

23. Policing birth – common examples
Women with mental health issues face:
- ‘Compulsory’ referrals
- Restriction on services/choice
- Even court-ordered c-section (recent cases: Re AA, Mental
Health Trust v DD)

24. Policing birth – common examples
Social services referrals and investigations:
- Women making choices against medical advice face potential
referral to social services by midwife/doctor (home birth, declining
prophylactic antibiotics, early discharge from hospital)
- Social services may investigate on the basis of risk of significant
harm to the baby at birth

25. A human rights approach
- Founded on the principle of human dignity: treat a woman
as an end in herself and not a means to an end
- Force of law: in both the English common law and under the
European Convention on Human Rights
- Proactive, not reactive: promotes good decision-making and
guards against harm

26. In April, we will be publishing a Human Rights Guide for
Midwives in collaboration with the British Institute for
Human Rights and the RCM.
Human Rights Guide for Midwives

27. We want to empower midwives, doctors and birthworkers
as they provide respectful care to women during pregnancy
and birth. Our training and education programme aims to
directly improve care for women and families, change
practice, address inequalities at the frontline and
strengthen the case for the use of human rights in maternity
care.
Birthrights Training and Education

28. birthrights.org.uk
info@birthrights.org.uk
@birthrightsorg
facebook/birthrights.org.uk
Registered charity no. 1151152