All of this debate, all of these headlines, all of these obstetric authorities are ignoring one astoundingly obvious factor: maternal autonomy. Photo: Stocksy
A West Australian coronial inquest has found that two infant deaths following homebirth may have been prevented in hospital. In response, the president of the WA Australian Medical Association has called women who choose homebirth despite medical advice to the contrary 'selfish'.
AMA president Michael Gannon told ABC News, 'When women with risk factors … choose to have their babies at home … They are risking their babies lives, it really is a very selfish decision.'
The language of Dr Gannon's statement is problematic for two reasons. Firstly, it perpetuates the myth that women choosing to homebirth don't care about their babies' lives, and further alienates women from accessing medical care. Secondly, and most insidiously, Dr Gannon's statement exists on a spectrum of anti-woman sentiment that has, for a very long time, subordinated women to the purpose of reproduction.
The AMA certainly aren't the first to suggest some women don't consider their baby's wellbeing—one needn't Google for long to find headlines labeling certain pregnancy or birth choices reckless, irresponsible or self-centered. Late last year, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) stated, 'For the woman whose highest priority is the welfare of the baby, a hospital birth may be preferred'.
By statements like these, what is reinforced is a broad cultural message: that a woman not doing as she's told is a bad mother. And ours is a society that reserves a special kind of hatred for women who don't display as selflessly maternal.
The Australian College of Midwives (ACM) respond that a lack of evidence-based, women-centred care in hospitals for women with 'risk factors' means women are sometimes 'forced outside the usual health system.' ACM call for a more flexible hospital system that provides greater natural birth options, as well as women being able to take their known, privately practicing midwife to hospital.
In Australia, discussion currently rages over access to a scope of birth choice. There's talk of registration, regulation, insurance, policy, collaborative agreements and more. Obstetric authorities argue one line of evidence while midwifery authorities argue another. Arbitrary categories are drawn up of 'low risk' or 'high risk', all the while discounting the fact that bodily risk assessment is individually subjective.
As ACM go on to say, 'Homebirth is safe for the right women (low risk women who are healthy and informed), with the right midwives (those who are registered, regulated and networked in to the larger hospital network) and in the right systems (with effective consultation and referral systems with obstetricians and other providers, in a respectful collaborative model).'
With this caveat-laden statement, in practice, the entire issue of women's autonomy dissolves. 'Risk' becomes the defining authority, reducing women to a series of medically-authored check boxes. Pregnant women regularly cite coercion, paternalism, being 'risked-out' of certain choices or care options.
So with all this birth bureaucracy—who is profoundly invisible?
Women. Women are the key stakeholders in birth but no one seems to be asking, What do women actually want? And how can we honour and accommodate all women's unique and varying needs?
Terrific medical advancements have led to improved childbirth outcomes, but that doesn't mean complications don't still happen. In birth, as in life, heartbreaking tragedies occur—at homebirths, and in hospital. Almost 3,000 baby deaths, as well as several direct maternal deaths, occur in Australia each year. The only factor we can control in every case is to respect women's autonomy.
All women (or men with biologically female bodies) are different—each have their own unique family and support systems, beliefs, fears, life circumstances, class or economic or racial privilege. While medical staff may have policy, preferences and insurers with which to adhere, it is the woman who has to give birth. It is the woman who has to live bodily with the consequences of that birth, for the rest of her life.
It's human to use hindsight to question, analyse, regret and learn. This is how society progresses, how positive change comes about. Yet there is a difference between considered analysis and ceaseless demonisation. And it is the latter that birthing women—in particular those who dare to make choices outside cultural norms—are facing.
Very old misogyny drives the erroneous assumption that a woman making her own choices is flouting her baby's health. It is the exact same misogyny that lingers today in the criminalisation of abortion in almost all Australian states and territories. It is this same misogyny that drives foetal personhood laws, and sees women like Purvi Patel sentenced to 30 years jail following a miscarriage.
A woman needn't be an expert to give birth, she simply needs to be respected. The presence of a foetus should not negate a human being's right to as much or as little medical treatment as they choose. Regardless of whether or not birth goes to plan, or whether or not emergencies arise, or whether or not we agree with her choices, a woman's right to autonomy should remain unequivocally.
Public conversation about childbirth is rife and divisive. It evokes a collective sense of entitlement to dissect, spread and judge the personal lives of others. Yet all of this debate, all of these headlines, all of these maternity care authorities are ignoring one astoundingly obvious factor: maternal autonomy.
So I urge anyone calling a pregnant woman 'selfish' to please stop, and unpack your thoughts. What inner beliefs about women, about motherhood, are causing your disdain?
To function as a woman in a patriarchy—at any stage of life, let alone when pregnant—requires a level of self-preservation. So if refusing to be self-sacrificial gets a woman through life with some semblance of intact mental, emotional or physical health, then selfish is brilliant.
Kim Lock is a writer, mother, and author. Twitter: @KimRLock