Giving birth is a basic human right that shouldn't be violated - opinion

The process of giving birth belongs to the woman and should be controlled by her, not the doctors.

 Giving birth (photo credit: PEXELS)
Giving birth
(photo credit: PEXELS)

On Mother’s Day in 1985, I became a mother.

I was a 23-year-old, fresh-off-the-boat Israeli in Los Angeles and 36 weeks pregnant. It was, of course, a Sunday – so we spent the morning strolling up and down Venice Beach, then going home to hang with our friends and that was when my water broke. Just four hours later, my baby girl was born.

Back then, women were still allowed to give birth at 36 weeks, without it being considered abnormally early. My daughter was born perfect, beautiful and tiny, but she was not a preemie.

I have given birth to four children: two in the hospital and two at home. During my hospital births:

  • I had two unnecessary (but routinely performed) episiotomies (a cutting of the perineum).
  • I had doctors and nurses perform numerous, unnecessary vaginal exams, without asking for my permission.
  • I had a doctor say “Mazal tov” to my husband, shake his hand warmly and leave the room without even a glance in my direction.
 Illustrative image of a pregnant belly.  (credit: PIXABAY) Illustrative image of a pregnant belly. (credit: PIXABAY)

When I went to see my home birth midwife for the first time, early during my third pregnancy, I asked her how many support people will I be allowed to invite for the birth. Her answer shocked me and changed the trajectory of my professional life: “Hayuta, this is your birth. You decide how it’s going to be and who is going to be there with you.”

Birth belongs to the woman giving birth. Period. What a shocking truth to realize after two births.

The question that follows is this: 37 years later, has it changed much? The short answer is not really and definitely not sufficiently.

At the Birth Freedom Israel movement, we have recently collected some disturbing data. Here is a small, but telling sample from a 2022 survey conducted among 1,700 women in Israel who gave birth in the last five years:

One in every five mothers reported their birth experience as either “terrible” or “traumatic.” About 32% noted that they experienced hurtful speech, disrespectful treatment or neglect. About 58% felt that someone else was making decisions regarding their birth. Only 51% felt that they were able to intervene in decisions without fear of it negatively affecting the quality of their care.

The vast majority, 68%, reported the hospital personnel did not respect their privacy. And in the case of episiotomies, only 13% were informed of the risks, only 48% of them were asked for their permission beforehand and 90% were not educated or given the choice of alternate solutions, as is the rule in the Patient’s Rights Law.

These are facts that should keep awake anyone for whom human rights and women’s freedom of choice, dignity and well-being are important – but they do not.

Birthing horror stories are plentiful

I CAN share so many disturbing stories, ranging from disrespectful, to horrible and even illegal conduct. Stories of women being scolded for moving too much or screaming too loudly; of procedures, such as stripping of membranes or rapturing the amniotic water sack, being performed without the consent or even despite a woman’s clear refusal; of telling a woman that she must agree or else; of yelling at her; of manipulating her to be fearful and therefore agreeable; of ignoring her requests to be treated respectfully; of lying to her about the need to induce labor because “there might be something wrong with the baby,” even though the real goal is to make room for the next delivery... and on and on.

In 2020, 177,307 babies were born in Israel, the highest average among OECD countries. This is a very large amount of women giving birth, whose voices are hardly heard. Why is that?

The medicalization of childbirth, a process by which birth became a medical issue, has been taking place for over 100 years. It is not specific to Israel but affects Israeli women in many ways.

In the medical view, birth is seen as a medical event that requires control and management according to a very specific paradigm, called the Medical Model of Care. In comparison, the midwifery model of care views birth as a physiological process that does not routinely necessitate medical interventions and other interferences.

In countries such as England, New Zealand, and the Netherlands, women are given the freedom to choose between the medical and midwifery models of care. This choice was one of the revolutionary recommendations brought forth by the Israeli National Council of Bioethics in their 2018 opinion paper. Thus far, all of their recommendations have been ignored.

In the medical paradigm, the end – a live baby – justifies the means, and so the woman becomes but a vessel, otherwise irrelevant. Another aspect of this model is the concept of risk management, with its view of childbirth as a ticking time bomb of risks, and therefore requiring continual and defensive birth management.

But birth belongs exclusively to the mother, and freedom of choice in childbirth is an absolute value that does not depend on the level of risk assigned to the pregnancy or the beliefs of the medical establishment. This does not mean that there is no value in medical care, advice and/or intervention – of course there is; but not as a routine, comprehensive, exclusive approach, and not without the informed consent (or refusal) received from each and every birthing woman to each and every procedure.

Human rights in childbirth are quite simple, self-explanatory, and anchored in laws and ethics that are widely accepted in Israel and around the world. It includes freedom of choice, autonomy, quality and evidence-based care, pleasant/respectful/attentive/equal treatment, informed consent or refusal, freedom to conduct oneself as one wishes, et cetera.

These rights are far from being fully observed and respected. Here are some reasons why:

Lack of awareness among medical care providers, women themselves, and society as a whole.

The doctor doesn't always know best

THE DOGMATIC belief that doctors know best. That if the doctor says so, they must be right and that, therefore, it is always safer to obey.

Fear dominating the medical establishment’s decision-making process (of something going wrong, of lawsuits and their consequences, of taking responsibility, of angering superiors, of being fired... any deviation from the strict protocols is perceived as a threat).

Furthermore, the midwifery profession in Israel suffers from medicalization. Midwives, who are supposed to be women’s first line of advocacy and defense, are a part of the medical system in Israel, and so their hands are all too often tied.

Midwifery training courses only teach the medical model of care. They are taught to believe in and provide care according to the system’s philosophy, rules, and protocols. On top of that, they work under extreme conditions of one midwife per three women (sometimes more).

Hospitals get paid over NIS 15,000 per (regular) birth from Bituach Leumi. In fact, birthing women are an unmatched financial resource, but the money they bring in is used for the benefit of the entire hospital, rather than for them (i.e. reducing the midwife-to-mother ratio to 1:1).

Part of what keeps this situation unchanged is a governmental and public lack of interest. There is blatant indifference toward the fact that so many mothers come out of their births traumatized and wounded in body and mind. Expressions like “you have a living baby and that’s the most important thing” are diminishing, silencing, paralyzing and absolving all of the involved policymakers and care providers, of their responsibility.

So we are here on behalf of all Israeli birthing people to fix it once and for all. A task that all too often feels like a Sisyphean one, but we keep at it and are making a difference, slowly but surely. The Birth Freedom Israel movement has projects in place, in various phases of planning, addressing the following primary needs:

To raise awareness of women’s rights and all other related issues.

To create and change laws in order to protect rights and prevent acts of obstetric violence.

To support women who have been wronged and/or hurt in the process of pregnancy and birth, through mistreatment of any kind.

Kav Layoledet, a helpline for birthing women, is our flagship project, offering a one-of-a-kind type of support. Our Kav Layoledet volunteers give unconditional and non-judgmental assistance to those who contact us. They listen compassionately and provide validation to the woman’s sense of something not being right.

Among other things, they often provide help writing letters, figuring out what to do next, and even accompanying women to relevant meetings. Our volunteers also may refer the woman to one of the lawyers that work with us for some initial legal counseling, as well as to our extensive network of therapists.

Please give some thought to this truth: how society treats birthing women attests to its value and affects it. I am asking you to care.

Visit our website for further information, read about our other projects, browse through articles, podcasts and more: http://birthfreedomisrael.org

The writer is the director of Birth Freedom Israel, a registered nurse, doula, hypnotherapist, birth educator and expert, mother and grandmother.