The "A-Word": A Birth Activist Speaks Out

This post orginally appeared on Change.org in the Women's Rights blog

Recently, I spoke at Perinatal: A Symposium on Birth Practices and Reproductive Rights at George Mason University. The task for the featured round table panelists was to determine legal and political strategies to advance reproductive rights in childbirth. My contribution included noting that childbirth rights advocates need to involve our work into the more mainstream causes of human rights and reproductive rights, including abortion rights.

The audience, fellow childbirth advocates, ignored my comments on abortion. Apparently, the "a-word" is not acceptable language among childbirth reformers. I discussed the abortion debate from a mother's perspective in a prior post, and understand that women who devote their lives to improving birth outcomes and lowering infant mortality rates are invested in the life of the fetus. However, my comments never took a side on the abortion debate. I merely observed an unfortunate consequence on childbirth rights from this debate.

I observed that one unexpected effect of the abortion debate was to give more importance to the choices and beliefs of third parties regarding the medical care of pregnant and laboring women than to the choices of the women themselves. Doctors and hospitals have relied upon Roe v. Wade and subsequent law to impose medical treatment on pregnant women in utter disregard of their legal rights to informed consent and informed refusal. Pregnant women's rights are ignored while the fetus receives legal representation after the 26-week gestation period. The justification has consistently been that the government's interest in the life of the fetus found in Roe overrides a woman's decision in her own healthcare and medical treatments.

A 2003 University of Chicago study of the directors of 42 U.S. maternal-fetal medicine programs around the country found: 1) 14% reported that their hospital used court orders to compel unwilling women to have operating room (c-section) deliveries; and 2) 21% considered coerced c-sections ‘ethically justified' to spare a fetus possible harm - even over the woman's physical resistance!

One example of forcing medical treatment against a woman's will is court-ordered c-sections. To impose medical treatment on a pregnant woman is unethical as it does not necessarily even save the fetus and often endangers the mother.

In Pemberton v. Tallahassee Memorial Regional Medical Center, a woman named Laura Pemberton took her forced c-section case to court. The U.S. District Court found that "the state's interest outweighed the mother's interest" under Roe, because she was in her third trimester. Her labor was progressing well and the baby was not in distress, but the court found that her decision to give birth naturally was less important than the medical professionals' opinions that there was up to a 5% risk in natural birth. (Note that there was also a measurable risk in surgical birth, but presumably, it was somewhat less. According to Childbirth Connection, the additional risk of a vaginal birth after c-section (VBAC) is only 0.14% in comparison to a repeat c-section.) After the forced c-section, the plaintiff went on to give birth naturally to three additional children, which demonstrates that the forced c-section was unlikely to have been medically necessary.

It is detrimental for childbirth advocates to continue to censor themselves from even mentioning the a-word, let alone any overlap between these two major reproductive rights issues. Women must combine forces to discourage these infringements on our reproductive rights by maturely finding common ground on the abortion debate. Otherwise, our own divisiveness on abortion restrictions will only favor third parties who use these controversial restrictions to further encroach on women's reproductive rights. Just as the vast majority of society believes in exceptions to abortion restrictions for the health and life of the mother, let us educate society about the need for ensuring that these restrictions do not infringe on a pregnant woman's right to make her own medical decisions during labor.

As a young birth advocate, I am truly standing on the shoulders of the leaders of this movement, as it only seriously began in the generation before me. Lamaze, one of the first philosophies of natural childbirth, was invented in France in 1951, and childbirth education courses were made widely available in the 1970s. Thus, the men and women who revolutionized childbirth are the same men and women who are guiding it today. I am filled with admiration and gratitude to these reformers, who often put in time and energy to mentor the next generation. They are ground-breaking leaders in a unique combination that few other fields encounter today. Therefore, the younger generation of this movement holds them in higher esteem than otherwise. Young childbirth advocates feel pressure to respect the established preference to separate from other reproductive rights proponents, especially abortion activists.

However, I also detect that the climate is changing within this movement as it reaches a tipping point. Childbirth rights groups are gaining momentum and mainstream acceptance; we are an "emerging market" in the fields of law and policy, especially in health reform, reproductive justice, and human rights. Today's young birth activists will have the opportunity to have a larger-scale impact on birth reform as political leaders become more receptive to these ideas.

Childbirth issues are receiving increased media attention. On October 15th, CNN ran a story about Joy Szabo whose local hospital refuses to grant her wish to have another VBAC. This refusal goes against medical evidence, because Ms. Szabo has had a previous VBAC. Medical wisdom teaches us that another c-section after a VBAC is actually more dangerous for mother and baby than a repeat VBAC. In a prior post on this issue, I noted that the International Cesarean Awareness Network (ICAN) found that many hospitals were banning VBACs. Since that post, ICAN has done an additional survey and found the bans to be much more prevalent; 1434 hospitals out of the 3000 hospitals surveyed either have explicit or de facto VBAC bans.

Today's young leaders are also more comfortable discussing abortion laws and how they are affecting childbirth rights, and acknowledging that abortion restrictions are being misused to disrespect pregnant and laboring women's decisions on childbirth. While a diplomatic approach to the abortion debate will be helpful to making our cause a bipartisan issue, a self-imposed segregation from even tangential issues will prevent it from reaching its potential significance to women and reproductive justice. The current strategy, in other words, will eventually be ineffective in ensuring that childbirth rights are respected and valued, because there will always be the a-word loop-hole for opponents to capitalize upon. When we start to find common ground with fellow reproductive rights advocates, we will be as widespread and well-known as every other major women's rights cause, including breast cancer, workplace discrimination, and yes, the a-word.

After all, it is not a bad word; the term is abortion.