Birthing Outside the System : The Canary in the Coal Mine (Routledge Research in Nursing and Midwifery)

"This book investigates why women choose 'birth outside the system' and makes connections between women's right to choose where they birth and violations of human rights within maternity care systems. Choosing to birth at home can force women out of mainstream maternity care, despite research supporting the safety of this option for low risk women attended by midwives. When homebirth is not supported as a birthplace option, women will defy mainstream medical advice, and if a midwife is not available choose either an unregulated careprovider or birth without assistance. This book examines the circumstances and drivers behind why women nevertheless choose homebirth by bringing legal and ethical perspectives together with the latest research on high risk homebirth (breech and twin births), freebirth, birth with unregulated careproviders and the oppression of midwives who support unorthodox choices. Stories from women who have pursued alternatives in Australia, Europe, Russia, the UK, the US, Canada, the Middle East and India are woven through the research. Insight and practical strategies are shared by doctors, midwives, lawyers, anthropologists, sociologists and psychologists on how to manage the tension between professional obligations and women's right to bodily autonomy. This book, the first of its kind, is an important contribution to considerations of place of birth and human rights in childbirth"-- Provided by publisher Cover Half Title Series Information Title Page Copyright Page Table of contents Acknowledgements # ENOUGH Figures Tables Notes on contributors Foreword Part 1 Understanding the problem Introduction Introduction The state of childbirth in the world Recent world reports Birth trauma and mental health Obstetric violence Racism in maternity care The genesis of this book Perched on a slippery slope An international effort for an international problem This book is not a manifesto The history of the canary and the coal mine About the Editors Hannah Dahlen Birthing the canary in the coal mine Bashi Kumar-Hazard Virginia Schmied A book in two parts Part 1 – Listening to the canary Part 2 – Fixing the system Conclusion References 1 Freebirth in the United States About the authors Rixa Laura Introduction Genealogy of freebirth in the US A midwife for every woman, or every woman her own midwife? Genital love gifts Midwifery as inherently interventive Coming full circle: from Pat Carter to Laura Shanley Entering academia Why do women freebirth in the USA? Policies and regulations that restrict options (push-O) Vaginal birth after caesarean (VBAC) Breech and multiple births Racial bias and racialised outcomes History of negative birth experiences (push-T) Birth trauma and obstetric violence Birth rape and obstetric violence PTSD and mental health Freebirth for well-being (pull) Autonomy Competence Relatedness The way forward Notes References 2 Giving birth outside the system in Australia: Freebirth and high-risk homebirth About the author Introduction From home to hospital in Australia The Australian maternity care system Perceptions of hospital-based maternity care options – the hospital cannot provide the best or safest Not enough resources to cope with demand It’s not like home It’s like a cattle yard Care providers are bound by hospital policies They intervene They (the maternity system) fear birth Tension about the woman’s autonomy Emotionally unsafe A place for giving birth in hospital Making Australian maternity care options more acceptable Humanise maternity care Midwifery continuity of care models One-to-one midwifery care during labour and birth Woman-centred care Reduction in routine interventions Expand birth options Publicly funded homebirth Birth in standalone or alongside midwifery units Midwifery care for high-risk women Enhanced support for private practice midwifery and private homebirth Conclusion The way forward References 3 Understanding women’s motivations to, and experiences of, freebirthing in the UK About the authors Introduction Birth and maternity care in the UK Birth choices: rhetoric versus reality Understanding women’s motivations Diverging paths of decision-making The converging path of decision-making Tensions and conflicts in choice Experiences of freebirthing Discussion/implications Conclusion The way forward References 4 Birthing ‘outside the system’ in the Netherlands About the author: an obstetrician with the heart of a midwife Setting the scene of birth in the Netherlands The road to enlightenment: you can never go back What do partners say about birthing outside the system? What do the midwives who support high-risk women to birth at home say? What do midwives and obstetricians say about women who birth outside the system? Looking at the impact of birth trauma on the choice to birth outside the system The trials and tribulations of a dedicated clinic Where do we go from here? The way forward References 5 The rise of the unregulated birth worker in Australia: The canary flees the coal mine About the author The rise of UBWs The drivers in the Australian maternity system Exposing the issue of UBWs through coronial enquiries A proposal to protect midwifery practice in SA Why do women choose UBWs? What do UBWs do? Characteristics of the work of UBWs Categories of services Education of UBWs What UBWs believe Services UBWs provide Paradigm of care Equipment and consumables What motivates women to choose a UBW-supported homebirth Women’s views of UBW care When things go wrong it is devastating Conclusion The way forward Notes References 6 Identifying the poisonous gases seeping into the coal mine: What women seek to avoid in choosing to give birth at home About the authors Introduction What women seek to avoid by choosing a homebirth Caesarean section Medication for pain relief Induction and augmentation of labour Foetal monitoring and vaginal examinations The National Homebirth Survey (NHBS) Discussion Conclusion The way forward References 7 The journey of homebirth after caesarean (HBAC): Fighting the system or birthing in peace About the authors Vaginal birth after caesarean (VBAC) The VBAC journey Introducing Sarah’s story The first step in the VBAC journey is information gathering Fight the fight, give up the fight or leave the fight Homebirth after caesarean (HBAC) The four factors that influence how women feel about their birth after a previous caesarean Control Confidence Relationship Staying active in labour Conclusion The way forward Note References 8 Seeking control over birth in the Middle East About the authors Introduction Change in birth place over time Shaping birth expectations What we know about birth in Jordan and the Middle East today My first birth was traumatic Taking control: ‘a redemptive birth’ Negotiating birth options in a private Jordanian Hospital Twilight Sleep in the Middle East ‘But at the end they knocked me out’ What options are possible for women to achieve a positive birth experience in Jordan? Seeking an alternative to hospital birth in Jordan Health professionals rocking the boat Taking small steps What will I tell my daughters? Conclusion The way forward Note References 9 Why South Asian women make extreme choices in childbirth About the authors Introduction On becoming a midwife Kaveri Mayra Mistreatment from the perspective of midwives Mistreated midwives Why accessing facility-based maternity healthcare is the extreme choice in childbirth On becoming a mother Bashi Kumar-Hazard Extreme choices – from whose perspective? Conclusion Interview with Indian obstetrician Evita Fernandez Seeing birth in a new light Listen to women The more honest we are the more women will trust us What is the key thing in the next 10 years that we need in India? Traditional birth attendants (TBAs) Do you get any attack on yourself, for what you do? How do we engage doctors? The challenges to rolling out midwifery in India Do you have excitement and hope for the future? The way forward References 10 Birth choices in Eastern Europe and Russia About the authors Four births in four languages: one woman’s international journey to vaginal birth after caesarean section A story of four births My first pregnancy and birth Safety and health during caesarean sections Having another go The politics around VBAC Pregnant again Third (fourth) time’s a charm? Opening up the possibility for others Conclusion An obstetrician’s perspective on human rights and childbirth in Central and Eastern Europe About the author Moving back to my Eastern European roots Ágnes Geréb Ternovszky v. Hungary (before the European Court of Human Rights) Gratuity payments to obstetricians for better care On risk and choice A postcard on birth from Russia The birth of a new paradigm in Russia Tamara’s experience of running away from the system Implementation difficulties in post-Soviet Russia – inspiration, naivety, risks Assimilation into the system A way forward Daniela Nick Tamara and Svetlana Note References 11 The modern-day witch hunt About the authors Introduction The history of witch hunts from the Middle Ages to today The trials of Hanna Porn in the 1800s The modern-day witch hunt Norway Case 1 Case 2 The United States of America Ireland Australia The experiences of privately practising midwives who have been reported to the regulator in Australia Homebirth midwives are ‘doubly tainted’ The reporting of PPMs in Australia ‘Caught between women and the system’ The suppression of midwifery A flawed system Lack of support Devastation on so many levels Making changes in the aftermath Conclusion A way forward References 12 Birth trauma: The noxious by-product of a failing system About the authors Introduction What is birth trauma? Agy’s story What makes birth traumatic? What is life like after a traumatic birth experience? PTSD: the extreme end of the birth trauma continuum Potential healing and protective factors against birth trauma The way forward References Part 2 Working towards a solution 13 What are women’s legal rights when it comes to choice in pregnancy and childbirth? About the authors Introduction Extending state jurisdiction into the womb Foetal protection and pregnancy prosecution Convicted for refusing a caesarean section Criminally prosecuted for induction of labour Criminally prosecuted for an unassisted birth Conviction for concealing a birth Birthing rights without remedies? Civil rights Tort and breach of contract Forced caesarean section occasioning assault and battery Forced episiotomy occasioning assault and battery Forcing treatment by threatening child removal False advertising and non-consented care occasioning assault and battery Human rights: privacy and dignity in childbirth Looking forward The way forward References 14 The role of the coroner in Australia: Listen to the canary or ignore it? About the author Introduction Controlling the provision of Australian maternity healthcare services (‘the coal mine’) Collaboration following the MSR (‘closing the gates’) When women become the casualties of a fractured system (‘when the canary sings’) Before the Coroners’ Courts (‘an opportunity to open the gates’) Coronial interdependence on the medico-legal framework Guilt by association Listen to the canary or ignore it? Dismissing the mistreatment of mothers as irrelevant Dismissing the views of mothers as misinformed or misled Elevation of hospital protocols over autonomy, choice and quality of care A recalibration of risk through the dehumanisation of women Conclusion The way forward References 15 Keeping the canary singing: Maternity care plans and respectful homebirth transfer About the authors Supporting women’s autonomy in maternity care The master’s tools Reappropriating clinical documentation and communication for woman-centred ends Including the woman’s voice Widely promoted Scaffolded Flexible initiation A shared, living document A failsafe Conclusion The way forward Principles for handover in the homebirth transfer context Transferring out of the comfort zone The power of the midwife–woman partnership Encountering ‘us and them’ Understanding the social process driving problematic interactions between midwives in the homebirth transfer context Ameliorating ‘us and them’ dynamics in the transfer context Why is homebirth transfer unique? The way forward Notes References 16 Why Aboriginal women want to avoid the biomedical system: Aboriginal and Torres Strait Islander women’s stories About the authors Introduction Stories of resilience Taking Control Awakening Betrayed Community culture, resilience and power Minga Goodjaga (Mother and Child) maternity services – cultural continuity Reflection A way forward Notes References 17 Midwifing women who make ‘off-menu’ choices About the authors The birth of Serenity Birth Centre Vaginal birth after caesarean section (VBAC) in a birth centre Flora’s VBAC at the Serenity Birth Centre Taking on breech birth Asma’s breech birth at Serenity Birth Centre Alexa’s birth with twins at the Serenity Birth Centre Reflecting on women who choose care ‘off the menu’ Dancing in the grey zone Two stories where ‘off the menu’ choices were dismissed Case one: Katherine’s story Case two: Steffanie’s story Practise within your scope as midwives and continue to advocate for women regardless of scope Scaling up the advice You could do either or as the evidence is equivocal ... There is evidence that this increases the risk for you and/or your baby and so we would recommend ... The risk for the baby is significantly increased and so I would strongly recommend ... When it goes terribly wrong, we are all scarred The way forward References 18 Anthropologist, midwife, researcher: A perspective on birth outside the system About the author Introduction Why women birth outside the system Working towards harmonious solutions Gentle caesarean sections as part of the solution Collaboration is key Homebirth after caesarean (HBAC) Unlicensed birth providers How midwives get labelled as good or bad Interprofessional training is key Culturally and socially matched Continuity of midwifery care is key Increasing the midwifery workforce and looking at funding systems Midwives need to take responsibility Looking at birth as an anthropologist The way forward References 19 A conversation with the ‘breech whisperer’ About the author The way forward Note References 20 Obstetricians discuss the coal mine and the canary About the authors Iatrogenesis in the coal mine We need to stop the ‘my way or the highway’ approach About the author Thinking differently about risk and how to talk to women Health providers are part of the problem Informed consent and refusal: midwives’ and obstetricians’ approaches to ‘recommending’ expose their vulnerabilities An example of counselling about risk with VBAC What if a woman is five hours from the nearest operating theatre and wants a VBAC? Wrapping up with Andrew The way forward The way forward References 21 Conclusion: Keeping the canary singing into the future Maternal rights are human rights The world is speaking up and so must we The way forward Some advice from our leaders on the way forward Fran McConville – Midwifery Expert at the World Health Organisation in Geneva WHO is important Engage women from the beginning We need to strengthen leadership in midwifery, and we need to respect midwives Don’t ignore reproductive rights issues or the biological impact of kindness We must unite as health workers for women – our time is now Franka Cadée – President of the International Confederation of Midwives Be brave and be political It should always be a woman’s choice Freebirth is also a woman’s right We need to build relationships with women and each other Don’t put so much emphasis on the place Engage midwives in the system just like we need to engage women Hospitals represent power and this affects midwives as it does women When you hold the power you don’t see it Our obsession with risk is a massive problem We need a ‘Me Too movement’ for birth Michael Klein’s birth dystopia – ‘The Dissident Doctor’ Has neoliberal feminist ideology impacted the surveillance and management of pregnancy and childbirth? Human rights in childbirth have been neglected We can’t be divided over the politics The canary is still highly regarded ... by some Conclusion References Glossary of terms Index