A part of me, even then, could not tolerate passivity, but I identified that part with the ‘unwomanly’ and in becoming a mother I was trying to affirm myself as a ‘womanly woman’. If passivity was required, I would conform myself to the expectation.
Adrienne Rich, Of Woman Born[13]
Telling women not to try to plan birth but instead to focus on the end result carries the underlying message that a woman in labour must ultimately sacrifice herself – her hopes, needs, desires, dignity or even her life – in order to save her baby. This is interesting, because, although you might assume most women would happily give their lives for their unborn if they had to, this is not always the case. If you ask pregnant women – and their partners – this rather unpleasant question, ‘You can only save one, who do you save?’ they will almost overwhelmingly tell you, ‘the woman’. And yet, for historical, moral and religious reasons that we will explore later in this book, maternity care can often be clouded by the notion that the safety of the baby always takes precedence.
Safety first?
In some notable cases, we can gain a window (albeit one we would rather not have) into what happens when total priority is given to the life of the baby over the wishes of the mother. In April 2014 I was privileged to speak[14] – via an interpreter – to Adelir Carmen Lemos de Góes, a 29-year-old Brazilian woman who, when expecting her third baby after two caesareans, had researched VBAC and become interested in giving birth naturally, with the help of a doula. In early labour, she attended the hospital for a check-up only to be told that her baby was in the breech (bottom down rather than head down) position. Doctors demanded she stay and have her baby by caesarean, but she signed papers to discharge herself, and left, saying she would return when her contractions were five minutes apart.
Later that night, her labour intensifying, she was picking out a dress to wear to the hospital when she saw headlights outside the windows of her house. After overhearing incredulous expressions from her husband and doula, she told me, she decided to go outside herself. ‘There I was confronted by a justice officer, who stood up in front of me and said that I had to be transported to the hospital mandated by a court order that he had in his hands.’
Doctors had that afternoon obtained a court order for a compulsory caesarean.
‘The whole discussion was so surreal, everything was so unbelievable and we were just trying to understand. There were about nine policemen and they were all trying to make my husband get back … and just take me away.’ Adelir, by now experiencing strong contractions, agreed to go with them: ‘I couldn’t refuse – it was either do what the court order said or be handcuffed. And I was so scared – frightened with my whole body … having chills in my whole body.’
Adelir was driven to the nearest hospital and, although she was 9 cm dilated and nearly ready to push, her baby was born by caesarean as the court order dictated. Her husband was not allowed to be with her and she did not see him until six hours later. ‘Everything had happened so suddenly and I felt pretty much robbed and kidnapped,’ she told me.
Adelir’s story is extreme, made more shocking, perhaps, by the fact that there was no question over her ‘capacity’ – she was felt to be of sound mind, but simply judged to be ‘wrong’ in her decision to try to birth naturally. Interestingly, when I discussed Adelir’s story at the time with others, two questions repeatedly arose: ‘What were the risks of the VBAC then?’ and, ‘How about this breech thing, didn’t that make it more dangerous?’ Questions like this miss the point: by trying to judge the rightness or wrongness of her decision, we fall into the same trap as the Brazilian authorities – declaring that a grey zone exists in which a pregnant woman can be compelled to make the decision that others judge is best for her, regardless of what she would choose for herself. As human rights barrister and founder of UK charity Birthrights Elizabeth Prochaska put it to me at the time of Adelir’s story:
‘Risk might sound appealingly scientific and rational, but it is not. When it is used to compel women to receive medical interventions, it is an expression of violent patriarchy, pure and simple. Would a Brazilian court order a man to undergo an invasive kidney transplant to save his dying child? No. Only women’s bodies are treated as public objects subject to the whims of the medical profession backed by the coercive power of the state.’
Some may feel that a pregnant woman should not have the right to make a decision that puts her baby ‘at risk’, but, unfortunately, as unpleasant as it may sound, the unborn child can never and should never be considered to have any rights – and as soon as we put so much as a toe in this water, we begin to stray into a place in which a woman can be taken from her house by the police and compelled to undergo major surgery against her wishes. There is a creeping nature to such a mindset – once we begin to make provision for the occasions when doctors or the state may overrule a pregnant woman with full mental capacity, we are on a very slippery slope indeed. Instead, the point needs to be made clear, often over and over again, that we have to trust women to be the ultimate decision maker in birth, no matter what. This is enshrined in law, and in global principles of human rights, that I will outline in more detail in Chapter 7.
For now, let me simply share the words of the UK Court of Appeal in a case known as MB, in 1997, which could not put it more clearly:
‘A competent woman, who has the capacity to decide, may, for religious reasons, other reasons, for rational or irrational reasons or for no reason at all, choose not to have medical intervention, even though the consequence may be the death or serious handicap of the child she bears, or her own death.’[15]
That sounds pretty definitive – and yet more than twenty years on, women are still asking ‘Am I allowed?’ in their birth space. The reason this power imbalance continues to pervade, and indeed the roots of everything this chapter has already laid out, can be found in the fact that we live in a patriarchy.[fn3] With the hashtag #metoo snowballing on social media in late 2017, a sudden uprising of women has collectively been saying, ‘Keep your hands off us from now on, unless WE say so.’ A vital and public conversation has been started about women’s bodily autonomy, consent, and the power imbalance and patriarchal structures that, for too long, have been enabling men to behave in ways that make women feel everything on the spectrum between mildly uncomfortable and downright violated. We now need to turn the #metoo spotlight on the experience of childbirth.
#metoo: the power of no
Currently we are only just beginning to acknowledge that we have a big, ongoing problem with the way we treat women in our culture, with our collective relationship to their bodies, with our respect for their bodily autonomy, and with consent. We would be foolish to think that women’s experience of maternity care is somehow exempt from this.
Let’s look at vaginal exams (known as VEs). During labour, at regular intervals – usually around every four hours – a midwife or doctor will place fingers inside you and estimate the dilation of your cervix. In this way, the speed with which your body is opening up to allow your baby to be born can be neatly marked on a graph and your progress – or lack of it – can be readily assessed. You may be asked to lie on your back to have the VE, or get out of the birth pool. If there is any kind of ‘hold up’ with your labour, a VE can be a very helpful assessment, but standard practice is to perform VEs routinely, even if labour is patently ‘cracking on’ and there are no concerns for either woman or baby. Some women don’t mind them, some really like knowing their dilation, others find them intrusive, distracting, uncomfortable, or violating. No matter how you feel about them, they are part