Birth a Human Rights Issue in New Zealand?
Initial audience responses at 2 Auckland screenings of the new documentary ‘Freedom For Birth’ , were thankfulness that the maternity system in New Zealand unlike Hungary, the USA and many other nations, offers a full range of birth options; a choice of Lead Maternity Carer and support of midwifery autonomy. Or does it?
NZ Care Contrary to NZ Law.
During the film, many audience members’ heads were nodding in acknowledgement of accounts about fear-mongering and other coercive means to gain women’s consent such as a health professional standing over an exhausted woman presenting a cesarean section as a means to end her turmoil ‘now rather than later’. Several women in one audience group spoke of being separated from their babies for observation ‘just in case’ or the baby going to another hospital where it was given formula, both with-out the mother’s consent. None of these incidents are consistent with the New Zealand legal requirements of the Health and Disabilities Commission’s (HDC) Code Of Consumer Rights which all hospitals need to meet to maintain their Ministry Of Health (MOH) funding. The HDC Consumer Rights include;
Right 1: the right to be treated with respect
Right 2: the right to freedom from discrimination, coercion, harassment, and exploitation
Right 3: the right to dignity and independence
Right 4: the right to services of an appropriate standard
Right 5: the right to effective communication
Right 6: the right to be fully informed
Right 7: the right to make an informed choice and give informed consent.
A guide to determining what is adequate information to support an informed decision is to check if the information given answers the following BRAINS questions about the treatment (or test) being offered;
1) What are the Benefits of the treatment.
2) What are the Risks of the treatment.
3) What are the Alternatives to the test.
4) What does my Intuition say about the treatment (ie How do you feel about it?).
5) What if I/we do Nothing?
6) What are the Subsequent actions (consequences) of the test.
Too many New Zealand women, recount tales of not being told the risks of a procedure as part of their consent process. Such tales are often told when they learn about the possible connections between risks and subsequent events, sometimes months or years after their experience. Often the procedure happens so often in hospitals it has become a widely accepted event or ritual, joining the other myths and misinformation about birth which are repeated by the masses.
For example women have been told, and many practitioners still believe as they were taught, that rupturing the membranes in labour speeds up a labour. International evidence rejected this assumption in 2009, catching up with the knowledge and respect many home birth midwives have long had for the membranes and their physiological protection of both mother and baby. Similarly, many doctor dramas talk of how a cesarean delivery has saved a baby from strangulation by their cords in the womb, but this is not consistent with the anatomy and physiology of birth. However this (alternative) information is not part of the consent process for a caesarean section as a treatment for foetal distress, if it were one might also expect to hear suggestions that women get off the bed (unless the cord is in the cervix) as a possible alternative measure.
Thus many NZ maternity consumer groups have created information resources such as brochures to address deficiencies in MOH maternity information sources, explaining for example the known risks to healthy women and babies of ‘treatments’ offered such as epidurals. Such misinformation is one reason why for example many healthy NZ women birth where evidence says they are most at risk of complications from these interventions.
NZ Care Contrary to International Best Evidence.
Not only do the vast majority of NZ women birth in hospitals (84% in 2007) but hospital is also where all the doctors and most midwives in New Zealand (and across the world) have learnt about birth and how they should practice. Thus today there are many NZ midwives who are only comfortable to look after labouring women in a hospital, regardless of the increasing evidence that home is as safe, or safer for healthy women as they have fewer complications following home birth. However only supporting labour and birth care in hospitals is contrary to the profession’s statement, endorsed by maternity consumer groups which says: “Women who are experiencing normal pregnancies should be offered the option and encouraged to give birth in primary maternity facilities or at home. The evidence clearly demonstrates that women who receive effective antenatal care and are assessed to be at low risk for complications, will give birth to healthy babies and need fewer interventions if they are supported to give birth in a primary maternity unit or at home.”
Today more than ever ‘Women need midwives’, midwives who are true to their roots, who understand the basis of the aforementioned statement. Similarly ‘midwives need women’ to demand that more birth centres are created and home birth promoted for the education of midwives who will promote, protect and support natural birth in the best possible environments which facilitate a woman’s responses to the needs of their bodies and babies.
Both midwives and women need evidence based information to be a feature of MOH maternity information, policy and funding directives as outlined in the Maternity Manifesto rather than women and midwives having to demand evidence-based care options or to protest inappropriate policies such as DHB closure of primary birthing facilities.
As previously mentioned the lack of evidence driven maternity provision and policy in New Zealand contrasts with UK countries where the Royal College of Obstetricians is calling for more birth centre and home births, along with care by a known midwife and a Campaign for Normal Birth which is supported by a cross-party parliamentary committee.
Reputable evidence also needs to inform reporting about maternity care in NZ, not sensationalist media diatribes about sad but rare fatalities and woeful stories fed by a minority anti-midwife group. Either the MOH, its Minister or parliament needs to redress the low standard of ‘journalism’ around maternity care reporting to promote public health and safety.
So in New Zealand as ever “Midwives Need Women, Women Need Midwives” as birth is a (Human) rights issue!