Hague Conference – Conference Experiences

The Human Rights in Childbirth Inagural Conference in the Hague brought together stakeholders from throughout maternity care for the first time. Some participants provided their impressions from the conference below.

Maria Andreoulaki, doula and doula trainer, Greece

Attending the Conference was a blessing for me. I am very grateful to European Network of Childbirth Associations (ENCA) for sponsoring my trip. The subjects discussed were exactly the ones that have troubled me for the last 16 years, when I first became a mother, and I was so thrilled to meet other people that had similar concerns and ideas and to see it all organized in such an official setting!

Highlights:

A conference organized by mothers and activists! Although I am grateful for all the amazing work of health professionals, I am convinced that the most important changes will always come from the parents and the activists; they are the most passionate ones and they will not give up; they are not afraid, they can think outside boxes and are continuously motivated to look for new ways by their children and their children’s memories.
Networking with people, meeting similar and different cultures, putting things under new perspectives, seeing the known which gives a sense of recognition and safety, and the unexpected, which gives rise to new ideas.

I loved the multidisciplinary approach! In the end of the conference I had to restrain myself from totally immersing myself into intensive study of philosophy, bioethics, law, midwifery, economics, sociology, music and dance, and about 10 languages, all at the same time.
I cannot express enough my admiration to the organizational team. Apart from the professionals, I am amazed by the young students who put their time and efforts into something that is probably not yet their reality (parenthood!). Lucky you!!!

Since I came back home from the conference, I have been working on collecting data, writing bilingual reports, speaking with people and posting about it, almost on a full-time basis. I consider it one of the most important events on the world’s social and political arena and a beginning of an era!
It is very hard to summarize such an important event. I would suggest whoever is drawn to the subject, to get on the webinar now! I would also be happy to share my reports. I have made another document with reports written in different languages on the conference, which are also available. And I am looking forward to the publication of the three-volume book on the conference!
THANK YOU!!!!!

Ernst van Bemmelen van Gent, Lawyer, The Netherlands

I was here on a quest to learn myself. I am very much impressed by the community that is surrounding birthing women. I am very much impressed by the two brain-halves that were at stake in these two days: the data-driven brain-half and the love and emotion-driven brain half. I think that part of the solution to the quest we are on, of humanizing young people, and subsequently mothers and next generations, is to combine these two. I would like to encourage you to continue this dialogue.

Michelle ten Berge, Midwife, The Netherlands

For me this conference was very special on many levels.

First, as a midwife, there were so many pieces of the puzzle that finally fell in the right place. Before, during and even after the conference.

When I was a midwifery student, it was obvious to me that my role as a midwife should be serving the mother, she is in control, not me. But as time went by the influence of my midwifery education, regulation, protocols, scared professionals and scared parents-to-be, made me drift off that initial path. It is painful for me to look back and see the times when I, too, have violated the rights of mothers, thinking that what I was doing was for the best of the mother or the child. Luckily, sometimes, when you grow older, you grow wiser. When you know better, you will do better. In my profession this often means: you stop doing. Still, I kept being insecure about the same questions raised during this conference. The main one being: ‘what if the rights of the mother interfere with the rights of the baby?’. It was so enlightening for me to hear Elselijn Kingsma speak about the comparison between giving blood or bone marrow to another individual. As a society we completely respect that we cannot force one human being to do that in order to save another person’s life. So why is it so hard for us to respect a mother’s bodily integrity? Especially since we know a mother would almost always make a choice for the best interest of her child, even when that choice may seem incomprehensible to the caregiver or the public. That statement made me so much more confident to really trust the mother’s decisions, even when I might still be worried about the outcome. Life or death are not in my hands, as they are in no one’s hands. But as Roseanna Rosewood has said so eloquently: If there is a mistake to be made, let it be made by the one with the deepest concern and investment in the outcome of the birth: the mother.

As a co-organizer of the conference, I have had such a wonderful time working together with so many outstanding people. They taught me so much about life and death and the questions at stake. Every discussion we had, every thought we shared, has broadened my perspective, both as a midwife, a mother and, most important, as a human being. Even though I finally couldn’t keep up with the amazing amount of work that was done (due to my own progressing pregnancy), I have loved every minute of being part of this group.

Finally, as a mother pregnant with her second child, the questions raised at some point also came very close to my personal life. As if to challenge my thinking and feeling, my baby chose till late in pregnancy to keep away from a simple head first position, varying between breech and transverse. This made me look at the options in my own country, the Netherlands. I suddenly experienced how it feels when you can not truly have a meaningful choice where it comes to childbirth. Do I feel safe enough to have a breech delivery in the hospital? Current medical breech protocols are not so favourable for a good outcome, in my opinion. Would I ask my colleagues to assist me with a breech birth at home, knowing that the current climate isn’t safe for them to do so without ramifications? Do I personally feel safe enough to ‘try this at home’? Questions that were familiar to me because of the conference, but became so different when applied to my own body and decision making. Finally my baby turned head down, letting me off the hook to answer them. Nevertheless leaving me with a valuable experience of knowing how it feels to face these universal questions on a personal level. Knowing how hard it is to make these choices, my dream for the future holds that every mother will be giving the respect and the support to honour her final choices when it comes to the pregnancy and birth of her children.

Norma Campbell, Midwifery Advisor, New Zealand

The conference gave me much to think about when I was there, but more since I have been back in New Zealand. I guess from over on this side of the world, we think of human rights issues around childbirth as being a developing country issue. The conference starkly reminded me of what women have to put up with in developed countries. It also reinforced for me how fortunate we are here in New Zealand but also how women and midwives take so much of the wonderful system we have here for granted. The day we spent looking at the Netherlands system, which we have always held in such high regard, really brought home how fragile it can all be when there are bigger powers at work.

Thank you so much for organizing those great two days. It is a long way to travel for us, but hopefully somehow New Zealand will be able to contribute in another three years time.

Robbie Davis-Floyd, Anthropologist, United States of America

The conference on Human Rights in Childbirth that took place in The Hague in May 2012 was by far the best, most exciting, and most informative conference I have ever attended—and that’s saying a lot, because I have attended and spoken at over 500 conferences in the last 10 years!

Why was this one so special? For many reasons:

With the exception of the few keynote speakers, each panel participant/speaker was limited to only five minutes. At first I was skeptical of this format, yet very quickly as the panelists spoke, I was simply amazed at how much people could say in such a tiny amount of time! There was no room for goofing around—every word had to count, so every panelist rose to the occasion and made sure that their words expressed their deepest messages.
Almost every panel included a consumer representative—a mother who could describe her own experience of birth and the forces that impinged on that experience, for better or for worse. So it was not just about professionals presenting their own stuff, it was also about mothers presenting their experiences, and if we are not all about that, then we are nothing and nowhere!

Almost every panel included a wide variety of experts—I have never heard so many different perspectives presented in one conference! Doctors, lawyers, politicians, ethicists, sociologists, midwives, doulas, mothers, fathers, students—each panel covered every possible perspective, giving us a holistic view of the panel topic.

The panel topics were well and wisely chosen—from the unjust persecution of midwives like Agnes Gereb in Hungary, to the Ternovsky v Hungary successful lawsuit that resulted in an EU guarantee that women have the right to choose their place of birth, to the need to preserve normal physiological birth, to the current challenges to the Dutch system and what can be done about them. The insurance representatives alerted us to their concerns, the doctors to their growing fears of lawsuit and international blame for the “high perinatal mortality rate,” the midwives to their distress over recent, unfortunate changes in Dutch midwifery education that are leading midwives to abandon hands-on skills in favor of the ability to conduct research within the parameters of evidence-based medicine, which is great in many ways yet should not, ever, replace experiential ways of learning and knowing about mothers, babies, and birth.

I was personally gratified to be able to present, for ten minutes on the morning of the second day, the Dutch system as not a premodern vestige of the past but a postmodern vanguard of the future—a viable combination of midwifery knowledge, skills and experience all geared to supporting normal, physiologic birth gained and sustained over 400 years of practice and now validated by scientific evidence that supports traditional Dutch midwifery practice and urges its continuation!

The rapport among the national and international attendees was fantastic. We were all there to support Agnes Gereb and urge the Hungarian government to free her, and to contribute as best we could to the preservation of the Dutch maternity care system, long our best model of hope and now under threat. We hope and trust that the outcome of this conference will result in massive improvements in the Dutch system, including more support for autonomous midwives and the preservation of the small community hospitals that are rapidly being closed—it is clear that women around the world and in The Netherlands want community based care!

The atmosphere of hope for positive change was in the air that we breathed during this conference. The desires and needs of mothers for supportive care were expressed, as were the desires and needs of midwives and student midwives to be more empowered to provide that kind of care, and the fears of obstetricians who are being forced into more technocratic models of care. The Dutch perinatal mortality rate was an issue—10/1000—touted as “the highest in Europe”—yet I did not see enough discussion of the fact that the Dutch PNMR is calculated from 22 weeks—much earlier than other countries.

I left this marvelous conference filled with hope that we can prevail in Hungary to facilitate the government’s acceptance and legitimization of home birth and homebirth midwives and to help to free Agnes Gereb of all charges, and that the Dutch system might just be able to hold its cesarean rate at the current nationwide 16% (yet it’s 20% in Dutch hospitals and rising!) and to preserve out of hospital birth in the many birth centers, staffed by independent midwives, that are now being constructed all around The Netherlands to allow women the option of out of hospital birth even when the possibility of homebirth is being denied to them (because of the closing of so many community hospitals, due in part to a new Dutch policy against planned, midwife-attended homebirth if you live more than 30 minutes away from a hospital.

I applaud Hermine’s decision to hold this conference again in three years!! In the meantime, let’s keep the dialogue going and let’s keep our focus on helping Hungary to legitimate homebirth and helping the Dutch to preserve the best of their maternity care system, even in the face of the current challenges to it!

Farah Diaz-Tello, Lawyer, National Advocates for Pregnant Women, United States of America 

The Human Rights in Childbirth conference has been, by far, the most informative and inspiring convening that I have attended. It was an incredible honor to share the room and the stage with some of the most renowned innovators, researchers, and advocates in the world of maternity care. More than that, though, it was truly humbling to share the space with brave women like Anna Ternovsky and Marie O’Connor who have stood up and challenged violations of women’s human rights. I spoke to women and advocates who described human rights violations–and successful legal responses!– that I would never have thought possible. I am grateful to have had the opportunity to learn from other attorneys from around the world, both in terms of what can be done and what remains to be done. I return to the U.S. with renewed energy, a sense of optimism, and a network of allies with whom I am proud to work to make the promise of the conference a reality.

Marlies Eggermont, Lawyer and Midwife, Belgium

The conference was a gathering of lawyers, midwives, doctors and other healthcare workers passionate about the right of a safe birth. There was a very open atmosphere. Everybody had the time to contribute in his own way and had the opportunity to discuss with others. I’m glad I could be part of the conference and I look forward to seeing the outcome.

Ina May Gaskin, Midwife, United States of America

Nearly a month after returning home from The Hague, I am still digesting dishes from the rich banquet of information and thought-provoking discussion that was served to us over the two days of the Human Rights in Childbirth Conference. I think that the organizers did an admirable job of setting up a structure for the conference that allowed for a wide variety of speakers from varying backgrounds from several countries to contribute their perspectives on the important theme of human rights in childbirth. I’ve been waiting for something like this to happen for decades.

The debate format allowed for a freedom of expression that was valuable. I loved it that we had lawyers, midwives, obstetricians, neonatologists, anthropologists, sociologists, mothers, doulas, epidemiologists, nurses, journalists, a blogger, an ex-member of the Dutch Parliament-turned-doula, and a philosopher. My only frustration is that there wasn’t enough time for me to talk to a long list of people who presented fascinating information.

Basically, I’m thrilled that this group of several hundred people, including however many participated via the webinar was able to learn a great deal in a short time. It was important that the conference began with the persecution and imprisonment of Agnes Gereb, the lawsuit against the state of Hungary made by Anna Ternovzsky, and the decision in her favor from the European Court of Human Rights. My meeting with women from several Eastern European countries showed me how important it is for the Netherlands to maintain a model of maternity care that recognizes that birth in healthy women should not be regarded as a medical event. Talking to those women made it very clear to me why we must act quickly to get this debate going world-wide, for the suffering that is currently taking place is enormous. With cesarean rates already 50% or more in China and approaching that in an increasingly long list of other countries, we should waste no time in spreading the word that maternity care systems can be designed that protect childbearing women from being exploited by the forces of fear, ignorance, and greed.

It was appalling to me to learn that many countries may have women trained to be midwives but that these midwives are not allowed to take any part in prenatal care because of the dominance taken by obstetricians who want midwives to work only as their handmaidens.

We simply must reverse the trend that has turned birth into a commodity, as it already has been in so many parts of the world—to the detriment of mothers and babies. Seen from this perspective, it is obvious who benefits from any limitation in women’s right to choose the model of birth care. It’s factory-model birth “care”, the one-size-fits-all formulation that was pioneered in my country during the 20th century. It has been very distressing to watch one of the worst maternity care models in the world be imitated by countries whose maternal-fetal-infant outcomes are far superior to that which still predominates in the US (which itself is imitating Brazilian maternity care).

At last now, I see us taking a first step towards reversing the damage that has been done to the image of the current Dutch maternity care system. I find myself wondering if a Dutch sculptor made a statue yet of Catharina Schrader? If not, this is just one project that might be undertaken to begin to build some national pride that would be well justified. I’d like to see plenty of ideas of how to put the anti-midwifery propagandists on the defensive instead of continuing to endure the current situation in which the midwives are finding themselves in a position of having to defend their profession.

I’m so excited by the conference that I am studying Dutch (as I have time), with the idea that someday I may be able to read Catharina Schrader’s full Memory-book of Women: Diary of deliveries in Dokkum, 1693-1745. I would also like to read Hendrik van Deventer’s work. These are exactly the texts that people today need to be aware of, given the amount of superstition and ignorance that has been generated since the Middle Ages regarding the place of midwifery in every society.

Marian van Huis’ summation of the Netherlands’ unique history, published in the Conference Papers/Human Rights in Childbirth is still ringing in my mind. Those of us who have suffered because of coercive, brutal maternity care because midwifery was cut off at the knees long ago in our countries know how easy it is to convince millions of women that their bodies are inadequate for birth. It was easy enough to do this a century ago, but this kind of market-driven propaganda is much easier to purvey through modern media.

Toni Harman, Filmmaker, One World Birth, United Kingdom

The Human Rights in Childbirth conference at The Hague was a game-changing, world-changing event. In bringing together the world’s greatest birth experts and focusing global attention on arguably the most important issue in birth today, the conference has already changed the world.

The conference started a conversation about human rights in birth that involved midwives, doulas, obstetricians, lawyers, educators, academics, parents and us as filmmakers.

What is really exciting to me is that conversation will now continue and will spread wider until it reaches the mainstream – until every single expectant mother around the world is aware of her birthing rights. What’s more, in that knowledge comes the power to decide where and how she gives birth. That’s the dream. That’s what gives me goose-bumps. That’s why I am incredibly proud to say “I was there!”

Elke Heckel, Independent Midwife, United Kingdom

You asked me to feed back on my impressions of the conference. This is easier said than done – such intensity and richness. 
Not sure if you remember that I congratulated you on your ‘can do attitude’. This is the main message I have taken back to the UK with me.

Sadly it is quite difficult to convey this to my independent midwife colleagues who couldn’t attend the conference.I have put a few excerpts of the webinar on a disk to inspire the general meeting of IMUK (independent midwives UK) and this was received with interest, it was so hard to be selective though! I believe parts of the webinar could be a brilliant source for local groups to discuss what Ternovsky vs Hungary could mean in the UK and if it can help us in our plight to keep Independent Midwifery and women’s choice alive in the UK. It is great to know that the webinar will be available for longer.

I am not sure what is happening in the Netherlands but I also think it would be brilliant if Midwifery Colleges could make this webinar accessible to their students. Human Rights in Childbirth never featured in my midwifery training and I think this could be a powerful tool for questioning the the politics of childbirth.

The speakers I particularly enjoyed were Anna Ternovsky – what a woman, what courage – whilst women need midwives, midwives need women like her, especially when they find themselves persecuted. According to Jane Evans ‘midwives can only be as courageous as the women they care for’.

Ina May Gaskin: ‘Don’t talk to people who depress you!’

It was fascinating to hear two obstetrician with very differing views: Amali Lokugamage pointed out that only 1/3 of recommendations by the ACOG (American College of Obstetricians and Gynaecologists)is based on Class A evidence, while according to Arie Franx, ‘doctors aren’t led by emotions, their decisions are based on science’.

I was surprised and shocked to hear [the opinion of Rotterdam law professor Robert Kottenhagen] that a fetus in the Netherlands has got a legal right that could override the right of his/her mother in late pregnancy. My image of the Netherlands has always been of a land that trusts its citizens to make decisions for themselves and is more liberal than the rest of Europe. What I heard at the conference made me question those assumptions.

It was good to see that this conference provided a forum for the start of a dialogue, and that it was initiated by a women’s group called GeboorteBeweging. Whilst it is important to be aware and proud of achievements it is important to also be honest about weaknesses in the system. It is often the women who are instrumental in change! The conference showed that on so many levels.

I wonder if both listening and talking gets easier in a more multidisciplinary setting. In my professional life as an independent midwife in the UK I often feel the absence of a common language between those inside and outside ‘the system’. Maybe it is easier to listen when concepts from other disciplines get introduced.

I keep wondering about the role of the law and the lawyers in childbirth. I think it was Ina May Gaskin who pointed out that childbirth professionals are often scared of lawyers, doctors more than midwives? Could there be another role. Can the law support women and professionals that want to provide truly informed choice? Should we need to resort to the law, why hasn’t feminism been enough? Maybe the next wave of feminism comes propelled by human rights law.

Apart from the actual conference the networking opportunities were amazing and this has led to ongoing practical support and cooperation.

Yes and last but not least I am thrilled by the plan to make India a future focus for Human Rights in Childbirth. I sincerely hope to see you there – but hopefully before!

With heartfelt gratitude to all of you who made this conference possible.

Paola Hidalgo Noboa, Social Anthropologist and Community Doula, Belgium and Ecuador

I am a mother, childbirth and women’s rights activist. I’m also a social anthropologist and a community doula. I live in Belgium and I was born in Ecuador. I am a multiple person. I have many passions… so, there are not so many opportunities for me to feel “integrated”.

The Human Rights in Childbirth Conference in The Hague was one of the most stimulating moments in my life. I could finally meet authors, researchers, activists, childbirth attendants… some of them were world famous pioneers of the respectful childbirth movement, and some of them were (less famous) activists and professionals, passionate, like me, about childbirth. Most of them I’ve only known from books, internet forums and blogs. Being able to talk to them was very empowering.

It was also the very first time for me to discuss with other professionals and activists about women’s rights and childbirth as one same thing and that’s very important: a new approach of women’s reproductive rights was brought to life there! The authority on childbirth is the woman, the mother-to-be! A health-care system that respects Human Rights must be based on the woman’s capacity to make the best choices for her. And the best choice for her is the best choice for the baby.

We felt again that the private is political!

We might believe that childbirth is not a big issue in Western Europe. In countries like The Netherlands and Belgium women have many choices: homebirths, skilled independent midwifes hospitals that provide evidence-based care… Unfortunately, for immigrant and illegal women in Europe, those choices are not really available. Minorities and lower income groups are not as free to choose a satisfying birth experience.

Let’s keep working together on this new approach, remembering always that the Millennium Development Goals 3, 4 and 5 cannot be achieved without allowing women to give birth with dignity, freedom and respect. We must remember that Human Rights are Universal.

Zora Javorska, Birth Activist, Czech Republic

I am an Czech home birth activist, working in the small local NGO in Brno, Czech Republic. Since April this year, the new law dealing with midwives rights was applied in Czech Republic. The interpretation of this law by the health authority in Czech is leading to forbid midwives to assist in the birth out of hospital. At the same time, I am coordinating the project Systemic Change in the Czech midwifery and trying my best to cooperate with all birth and parent organisations and activists to lobby and make change in the system. We already make it to the level to have participants in the working group on the Ministry of Health, which is trying to solve this situation. The negotiations are very difficult.

In this mood I got the opportunity to come to the conference Human Rights in Childbirth in Hague. I was surprised by the amount of information and different opinions which were presented in such a polite way. I feel that people in that conference were open minded and tolerant to different opinions. This was the most new point of view for me, that it is possible to discuss this topic in such a polite atmosphere. I was also very happy to see and talk to Ina May, Michael Odent and also to Ms. Ternovszky. And the atmosphere of support and trust to natural birth was just great. Thank you very much to Hermine Hayes-Klein to gave me the opportunity to be a part of such event.

Jennie Joseph, Midwife, United States of America

For me, attending the Birth and Human Rights conference at The Hague was a pivotal moment in my life as a midwife turned activist. It was the very moment when I stepped across that threshold, that fine line, that has kept me in the space of “…but I am just a midwife”. A million thanks to the organizers, especially Hermine Hayes-Klein for without their vision so many of us would perhaps not have had the opportunity to truly reframe our work and make the connections that were the result of this powerful conference. YES, birth is indeed a human rights issue! I was able to come and speak on a topic that has troubled me (and many others) greatly over the last twenty years: namely that in America today women and babies are at serious risk and jeopardy during pregnancy and birth simply because of the color of their skin. That on top of the issues that are already impacting perinatal health across the nation, the additional effects of racism, classism and sexism are apparent in the consistently poor birth outcomes experienced by African American, Native American and Hispanic women in the USA. I am grateful that I was afforded the time to express my concerns, warmed by the reception and response to my comments and encouraged that the international movement to address human rights in birth is officially underway. I am ready now…

Stefania Kapronczay, Lawyer, Hungary

The Human Rights in Childbirth was a remarkable conference for numerous reasons. Firstly, it brought together not only professionals from all the fields concerned, but also made it possible to voice their message for those who are mostly affected: women. I particularly liked hearing about different birth stories, including a story about an elective c-section. Secondly, the structure of the conference enabled us to go into details after discussing the relevant questions in a broader term on the first day. As a lawyer it was very useful to hear how non-legal documents can affect the practice of such basic human rights as the right to self-determination. Last but not least I enjoyed attending the conference, because meeting so many people who think alike empowered me to continue our work.

Julia Karadi, Psychologist, Netherlands and Hungary

[written in a letter to Agnes Gereb:]

Dear Ági,

I can’t tell you how wonderful it was. I’ve never took part in such a conference, nor in the organization, nor as participant, so I could hardly imagine what to expect. But what actually happened, surpasses all my imagination.

It had an unbelievable strength that hundreds of people are coming together from all over the world for something that is the most important for them: to let birth, this amazing miracle of nature happen, to let it be free, and to let it belong to the mother again, because to whom else could it possibly belong?!

I don’t know if this powerful energy managed it’s way to you through the webinar, if you could feel how everyone was standing behind you. They are standing there and supporting you with this great power that was now born here.

Everyone is so lonely and isolated in his/her own country, being left alone. The Lithuanian midwife, the British, the Czech, the Australian, the Dutch, and so on, that are all being persecuted for serving women. And what happened now, is that we took each other’s hands, all of us. This was like an explosion with an effect and sound that will be heard in great distances.

And now I do understand what you meant when you wrote in your letter to the conference how much you wished to be here and hug Ina May and Michel Odent, and all the others with whom you’ve been paddling in the same boat. The miracle is that you have actually been here with us the whole time.

Anna [Ternovszky] was being torn apart. She was hugged, and kissed in tears with love and grace by the participants, for being the mother who finally stepped out, for the women and for the persecuted midwives. Hermine said that you and Anna are the microkosmos of what’s happening in the world on a bigger scale: the unbreakable unity of mother and midwife. As Karen Guilliland said on Panel 1: “women need midwives need women.”

With lots of love and hugs,
Julcsi

Elena Kosaite-Cypiene, Law Professor and Advocate, Lithuania

One of the most important, impressive and precious memories of my life is Lithuania’s fight for independence 25-22 years ago, when I was a teenager. Month after month, people used to gather for meetings and talk in all possible spaces – there was almost no other means of fighting, except expressing out loud our point of view, ideas, wishes, ideals, and beliefs.

During the conference Human Rights in Childbirth in the Hague I suddenly felt as if time was turned back: all those emotions, intensity, raising of questions and problems, faith, hope, expectations, tears, laugh, and community of thoughts and feelings reminded me of Lithuania’s struggle for freedom, which resulted in the collapse of the Soviet Union.

Ironically enough, the prohibition for professionals to render help at home childbirth in Lithuania would be the remnant of the Soviet regime.

During the freedom fight, our only weapon was people. This spring in The Hague, I met 300 strong, brave, believing, donating their time and attention women and men. I cannot help believing in great results of this gathering and uniting of minds and hearts.

The first little achievement could be the right for Lithuania’s women to freely give birth at home – into the hands of their beloved midwives.

Amali Lokugamage, Obstetrician-Gynaecologist, United Kingdom

It was an amazing conference and an opportunity to hear the many views of stakeholders in the field of birth. I thoroughly enjoyed writing my paper entitled “In Pursuit of the Benefits of Physiological Birth” for the conference book. I will try to condense some of the more core messages that I took away from the event. Forgive me if there is a topic that I missed out…as I am still processing the large amount of information gained from the event, as well as its enormous significance to the birth world.

Clearly there are many human rights violations going on through out the world regarding women’s autonomy over their bodies when making choices regarding their pregnancies. In some countries women have been forced by court order to submit to caesareans against her will and if women have decided to go against thewill of medical advice, child protection laws have been evoked to take their child/children away.

Whilst a woman carries her child in-utero, the consensus was that her rights should rank higher than the fetus, as this situation is unique. The baby cannot exist without her and sometimes the medical establishment uses their interpretation of fetal rights to manipulate and submit the woman to their will. Most women (not all) women usually have the best interest of their baby at heart when they make their decisions.

In some countries, there have been prosecutions of midwives who attend women at home births or setting of the woman’s choice. Even if it was the woman’s desire to birth in the way she wanted and the midwife was supporting and making the birth as safe as possible. It would be better for midwifery professional bodies to handle questions about the way in which midwives practice rather than the law. There is a small irreducible maternal and fetal mortality and morbidity associated with birth which can occur in any birth setting, but the media bias which tends to highlight cases that occur outside hospital rather than hospital cases is unfair. One panelist suggested that there should be a counter-media campaign to produce more balance in the arguments. The lawyers present are forming an international legal network to support women pursue their desire for physiological birth.

The obstetric model of childbirth, with its rational arguments to centralise medical services were culturally blind to the groundswell of opinion from mothers that this centralisation process led to a technical management of pregnancy which didn’t take into account that such a “birth factory” ideal leads to a disrespectful, frightening, traumatising, mechanical health service – especially to low risk women. This type of service does not honour the psycho-somatic, spiritual and societal importance of birth. This is perceived more by low risk women who, largely do not need medical assistance. High risk women might more readily perceive the benefit of the medical model however, there was a great deal of debate regarding mothers who have breech or twin pregnancies as many thought that their chances of safe physiological birth was better at home because of their perception of iatrogenic harm in hospitals. Radical midwives across the world were prepared to support these women in their decision for out of hospital birth.

In a sense the obstetricians present at the conference were the one’s open to debate….perhaps “the good guys”. Guidelines from obstetricians and gynecologists were thought to be very important in arguing out legal cases, however they may be flawed. An analysis of guidelines in the USA and the UK showed that less that 30% was based on rigorous science. The majority of these guidelines were drawn from inconsistent studies and peer opinion. Understanding this gives a greater transparency to collaboration (doctor/midwife/woman) in clinical decision making.

Both obstetricians and neonatologists, because of all the pathology they see, are not balanced in their views and continual emersion in crisis-medicine biases their views, leading them away from a position of equipoise. When looking at perinatal morbidity and mortality and the health of children, there should be an comparison regarding long term harms as well as short term harms when examining medical versus physiological birth.
Radical midwives were averse to the integrated care concept, as they perceived that the obstetric system still held too much power and had a tendency to steam-roll over the philosophy of independent midwifery and its wish to deliver patient centred care.

Hospitals had their harms with the increases medical interventions that happen to low risk women as compared to an out of hospital settings, but home birth also had a potential delay in accessing emergency obstetric or neonatal services. Ultimately it should be the woman’s choice as no option was risk free.

Medical Insurance schemes are wielding huge power over choices in childbirth, through the economics of insurance premiums. Who informs the insurance companies of what makes birth safer? Do they understand the importance of continuous emotional support and that excessive time spent in documentation leaves less time to care and be compassionate for women in labour. Midwives have less time to be “with woman”. This in turn leads to greater risk of medical interventions. In these scenarios, then the value of Doulas becomes very important.

The long term benefits of physiological birth needs to be conveyed to obstetricians, because it seems that they were not aware of this body of research – as it is not contained in standard medical education. The bio-behavioural physiology of oxytocin has not yet penetrated in to the medical model of child birth and this could be addressed by better education.

In view of the flaws in evidence based medicine as well as a woman’s autonomy over her body, there was a great deal more to discuss in the future regarding the validity of intellectual versus an embodied wisdom about childbirth, their place in decision making and birth human rights.

Alec Malmberg, Obstetrician-Gynaecologist, Netherlands

I was unaware of the fact that in Hungary a midwife can be prosecuted as a criminal when she attends an outside the hospital delivery. Caregivers can be frightened to help those women who wishes to deliver at their own home. Thus it diminishes the freedom of choice of the women.

Mother-to-be Anna Ternovszky brought this up to European Court of Human Rights in Strasbourg, known as the Ternovszky v Hungary case. The court stated that article 8 according to the European Convention on Human Rights was violated. Respect for private life and choice for place of birth was confined.

Mothers, doulas, lawyers, sociologists, midwives, gynecologists and students from a variety of countries came together to discuss this topic on the human rights of women in pregnancy and childbirth. I would like to share, in my opinion, the repeatedly underlying, essential topics. I think these are the essentials of general care and especially in childbirth.

Respect
First of all, respect for the woman, the mother to be. We need to be aware of her dignity and we should not judge on her. A woman wants what is best for her child. Every woman chooses her caregiver for her delivery and place which fits her. Some women choose to deliver at home, some choose an elective ceasarean section; respect among the women for these different choices.

Of course there is respect between caregivers like midwives, gynecologists and doulas, who assists deliveries. And also respect between caregivers from the different groups themselves. In all the above mentioned, there should be no judging. Unfortunately this is not comprehensible.

Trust and self-confidence
Assisting childbirth is focused on enforcement of trust and self-confidence of the women. Preparation is very important and half of the job. To give birth is like performing top sport, and for excellent performance a thorough preparation is mandatory. The caregiver needs a lot of experience and skills in medical technical fields as well as in psychological fields.

Listen and inform
A truly dedicated caregiver listens, listens, listens, hears and understands what the woman wants. One is truly open for her thoughts and background. As I said before: she really wants what is best for her and her child.

When carefully has been listened, information can be given. Well informed she can take her decision. Thus the woman can give informed consent or give informed refusal. It is the health care professional who has to deal in the proper way, with respect for own skills, ethics and borders. In this way there is individualized care for the women. And the human rights of the women during delivery are fulfilled.

Myuzhgyan Mehmedova, Law Student, Bulgaria

As someone who has been to the Conference Human Rights in Childbirth, perhaps I can use three words to describe this event: daring; passionate; unique.

The Conference was passionate in that it amplified the voice of a Hungarian mother, brave enough to challenge the law in her country, denying her the choice of giving birth at home. I had the opportunity to hear her story. And by telling her story, she changed the law. I saw her passion. I heard it. But more importantly, I felt her passion. It is important that I could feel her passion, because sometimes you need to feel in order to understand. I felt and understood: the society should care about the circumstances in which a baby is born and about the right of the mother to chose them.

The Conference was also a daring experience. It was daring in that it talked about the heavy consequences of not having choice and support in birth. It was daring in that it uncovered unseen scenes, pictures and stories. It was daring in that it challenged the law. It was daring in that it talked about life, about death and about love. It was daring in that it also welcomed those who oppose the idea of giving birth at home. I heard many voices and many words in this Conference. I heard the voice of mothers, of midwives, of doulas, of students. But not only that. It was not a Conference presenting only one side of the story. I heard also the opinion of lawyers, of doctors, of philosophers.

All these, make the Conference a unique experience for me. After all, is it not unique to learn ‘’lifelong lessons’’? It definitely is. And what I learned is definitely a lifelong lesson.

As a woman I learned that I should care about the circumstances in which my baby is to be born. I should have the choice to decide. I should fight for all women to have the choice to decide.

As a student, going into the future of the legal world, I learned that ‘’the law’’ and ‘’ the feeling of people about what is right’’ should not be separated. Because sometimes you need to feel in order to understand. Thank you Ms. Hayes- Klein: you made me feel, understand and dare hear the stories.

Gloria Mkushi, Law Student, Zimbabwe and Netherlands

I found the conference to be such an eye-opener, and it was a phenomenal privilege to have attended. I thought that the caliber of the speakers was incredibly high. I was really impressed that all the speakers were exceptionally knowledgeable in their fields of expertise, as well as that they were representing women of every age and socio-economic demographic. I also liked that the conference did not take a single disciplinary approach to the subject, and offered holistic and broad solutions to a lot of the problems surrounding human rights and childbirth.

That said, I felt that there was so much to take in and there was not enough time to really absorb all of it. A week ago, I attended a friend’s wedding and the topic of birthing choices came up in our conversation; I was shocked and astounded at the lack of confidence really well-educated women in my generation have in their ability to make birth choices and decisions for themselves; and I was also a little sad that I didn’t have more answers for their questions. For me, it only highlighted the need for more conferences like this and more peer-education seminars and think tanks.

Zahra Mousavi, Lecturer in International Law, Iran and Netherlands

It was a great pleasure for me to participate in the ‘human rights in child birth’ conference. The ‘Ternovszky v. Hungary’ case review as well as analysis of Dutch birth system were very educative. I found it very interesting to listen to the multi-disciplinary experts who discussed the child birth from different aspects, while audience could have their inputs. I enjoyed the variety of combination of the panelists and audience consisting of lawyers, medical professionals, midwives, duals, NGOs, insurance expert, journalists, students, etc, from different parts of the world. It was a unique atmosphere. I would like to mention that the conference was very well organized, and impressively efficient.

Michel Odent, Obstetrician, France

The Hague conference should not be looked at in isolation. It should be remembered in the framework of a new generation of conferences. Such conferences provide opportunities to consider childbirth from a great diversity of unusual perspectives. In The Hague (May 2012) childbirth was explored from a human rights perspective. In Rio+20 (June 2012) it was explored from a “changing planet” perspective. In Honolulu, at the Mid-Pacific Conference on Birth and Primal Health Research (October 2012), it will be considered from the perspective of a transformation/evolution of Homo sapiens. In terms of timing, The Hague conference may be classified as historical. From now on, childbirth is not just a topic for midwives, health professionals, and pregnant women.

Helene Oord, Founder of WorldView Mission, Netherlands and Suriname

I attended the conference and atmosphere was great. For the first time after years, I had the opportunity to talk about my own birth experience with others. It was great to share, and I learned a lot.

Being part of the conference, it felt like also being there for those who could not be present, especially those from developing countries. The issues of the conference are also their issues. They struggle with maternal mortality, and when women receive medical care, it is with disrespect and abuse. Many women have never heard about having their own rights around pregnancy and birth.

I spoke with the representatives of human rights groups from developing countries. Money and power are big issues in their healthcare systems, and the people are not heard by their own governments.

It was inspired to see how many people were focused on the outcome of the conference regards the epidemic global problems in birth care. Midwives, doctors and others are seeking solutions.

I am supportive to the plan of organizing similar conferences Worldwide, to meet the needs in developing countries, for the voices of all women to be heard, for the betterment in the world to achieve the United Nations Millennium development Goals 3, 4 and 5 by 2015.

Tine Oudshoorn, Midwife, Netherlands

I am very happy with the achievements of the GeboorteBeweging and your conference. It reassures me, gives me faith to give way to the younger generation women and midwives. My work is done; I was very worried for years and did start up all kind of actions and campaigns to keep the spirit up. I am 65 now and did my share. The younger Dutch midwives can take over; they have the keys in hands for a brilliant future.

One of my friends attending the conference told me two week afterwards, that she did find the conference quite heavy, rather a confrontation. Probably she is not the only one. The conference itself, the items discussed and the openness to give way to women and all focus on the physiology of birth is quite new. We are medicalised midwives in the Netherlands, and we are the ‘polder’ people. Always working towards consensus, and please no fuss or confrontation. Special by midwives is pro active behavior not common. We make ourselves small, not important, as the message is ‘we will cut you small’. You can explain this as repression, a well-known illness in midwifery. Horizontal violence is not uncommon in Dutch midwifery. Part of our medical upbringing.

During the second conference day, I spoke to several international experts knowing Dutch midwifery, asking them, “Are we going to achieve change in the Netherlands this way?”

“Yes, you are. Be however alert and always clear about your objectives!”

“Keep focus on women in your midwifery care, arrange a model of integrated care = women centred care, ‘care arranged around women’ as stipulated in ‘the midwifery theory.’ Focus on women and their particular individual needs and interests, in care and education. This focus will guide you, because it will suit in creative ways individual women’s needs and interests. Midwifery care is individual care by individual professionals. The workers follow individual women and families. It is not a ‘one fits all’ model.”

Abide this; I think that the conference has been quite a success. Good atmosphere, much fun and many progressive people there from my working field. Hermine, you were able, with Dutch women, the birth movement GeboorteBeweging, to establish a new direction of sight. A new wind is blowing over the dykes. How beautiful, and thanks for all the joy and energy given.

Elizabeth Prochaska, Human Rights Barrister, Founder of BirthRights, United Kingdom

When Hermine and Nicola first contacted me about this conference, I was overjoyed that I had found some other lawyers as excited as me about women’s rights in childbirth. Little did I know then that there were so many others across the world who shared our concerns. It was inspiring to meet all those committed advocates for women’s rights at the conference. Whatever our professional backgrounds, we all shared a common goal to illuminate and advance an area of women’s rights that has been too long neglected.

It is during pregnancy and childbirth that many women encounter their first serious threat to their physical autonomy. In the twentieth century, this threat came from a paternalistic medical profession that sought to protect women from themselves. In the twenty-first century, the threat is a bureaucratic one. Women are the playthings of risk management policies that stifle both their autonomy and the clinical judgment of their caregivers. Human rights law provides one solution to this homogenisation: it demands that each women is treated as an individual and that she is an active participant in every decision about her care. This can be achieved through legal actions, such as the ground-breaking Ternovszky case, through cultural permeation of the maternity system and by representing those midwives all over the world facing punitive sanctions for facilitating women’s choice. There is no doubt that lawyers have an important part to play in changing childbirth.

Inspired by the enthusiasm and commitment of the conference participants, I am establishing a new legal advocacy organisation in the UK called Birthrights. It will launch in the Autumn providing women and caregivers with legal advice and lobbying policy-makers on childbirth rights. I am looking forward to the next Human Rights in Childbirth Conference when I hope we will be able to report progress in making rights a reality.

Rachel Verweij, Chairperson of Verening Het ouderschap, Netherlands

The conference was a wonderful opportunity to meet with people from all over the world and hear their stories – some very famous people too! From our Dutch perspective, it is awful to hear and hard to believe some of the stories of births in other countries. We have taken them as a warning that we need to stand for our system and for the (relatively) free choice that women have in our country. We have learned a lot about the rights of the baby and of the parents in the Dutch and European situation. Also a lot of inspiration comes from the beautiful initiatives in other parts of the world such as New Zealand and the UK, and from new research on the importance of birth for the development of the baby and the bonding in the new family.

What we missed in the conference, was a broad dialogue between the complete spectrum of Dutch perspectives, especially the perspective of the gynaecologist. There were very few of them present. For a possible follow up, I would like to call upon the gynaecologists and their organisation to come to the conference in large numbers to share their perspective and to listen to the perspective of the parents (to be).

Roanna Rosewood, Author and HBA2C Mother, United States of America

I’m asked to provide “just a paragraph or two about the conference.” And I stall. I stall for days because it’s an impossible task. Who am I to squeeze hundreds of people from around the world, all passionately and competently tackling one of the most important crises we face, into a paragraph? Where do hope and fear, happiness and tears, fragility and power converge? They converge in birth, and at the Human Rights in Childbirth Conference. Something was born. I cannot see what it will become. I know only that if we nourish and support it, it will be grand; and that when the time comes for our daughters and granddaughters to give birth, they will do so safely and with joy.

Nicholas Rubashkin, Obstetrician-Gynaecologist, United States of America

As an obstetrician who studied anthropology and is also part Hungarian, I went to the conference mainly to learn more about the Ternovszky case and to meet with Hungarian experts in the area of birth and human rights. I accomplished both of these goals easily; due to the small size and format of the conference, I was pleasantly surprised how easy it was to engage panelists. With the energy and knowledge gained at the conference, I hope to conduct a research project in Hungary exploring how the government decree regulating home birth has influenced the options available to birthing women.

Upon returning home and back to my practice in a small, urban community hospital, I felt a big “click”. The conference has re-focused my energy on what I always knew was important to me in the field of Obstetrics: options for women and reproductive justice. Through connections at the conference, I learned about the efforts to train providers in breech deliveries–I plan to attend Betty Ann-Daviss’ conference in Washington D.C. this November. I also connected with like-minded-Americans in the audience, and will attend a Medical Students for Choice conference with them this fall. At my hospital, as director of the quality committee, I am engaging our nurse-midwives to develop their own quality agenda, and exploring ways with the physicians to perform fewer inductions. Our Ob group is motivated to become a provider of breech deliveries in San Francisco.

I feel my career reforming in exciting ways. Who wants to organize a North American conference on birth and human rights???? Ultimately, I see myself taking on a greater role in training Ob/Gyn residents and performing research in the area of human rights and childbirth.

Thank you all for the energy and inspiration.

Rebecca Spence, Lawyer and Founder of Legal Advocates for Birth Options and Rights, United States of America

My goal in attending the conference was to learn, share strategies, and make connections with lawyers globally. I was thrilled that these goals were met and exceeded.

The Human Rights in Childbirth Conference was a groundbreaking gathering of advocates, attorneys, ethicists, philosophers, care providers, parents, and change makers. Together, the seeds of an international network committed to realizing women’s human rights in childbirth through legal advocacy were planted, including our US-based Legal Advocates for Birth Options & Rights.

From around the world, including Hungary, Lithuania, the Netherlands, the UK, United States, Poland, Belgium, Switzerland, Czech Republic, and Ireland, lawyers discussed strategies and challenges for integrating a rights based approach to childbirth. In each jurisdiction, similar challenges were echoed: how do we create sustainable change over time in an ever drastically changing health care environment? How do we ensure that all women receive high quality, safe, and dignified care they are entitled to under the laws of their nation and the demands of human rights? How can we meet the legal challenges of liability, health system structure, the rights and interests of concerned parties, and how do we develop policy based on these considerations?

The Conference’s crucial questions included: What are the rights and responsibilities of birthing women? Are women the final decision makers when choosing the location and circumstances in which they give birth? If so, how can this right be upheld? How can we ensure meaningful options from which women can choose, while promoting the best outcome for all concerned? Of course, there were no easy answers.

Among my own next steps to carry work in human rights in childbirth forward are:

On June 29, I represent LABOR in a workshop on the topic of Childbirth as a Human Right at the US National Organization for Women (NOW)’s Annual Conference in Baltimore.
This fall, we will bring the message to the next generation of women’s health physicians with a workshop at the Medical Students for Choice Annual Conference.
I will contribute to the Bynkershoek’s Post-Conference Collection on Human Rights in Childbirth.
I am participating in the international umbrella organized network of lawyers committed to women’s human rights in childbirth. I will be pleased to help shape that into an effective platform for legal work in this area on a global scale.

Simone Valk, Midwife, Netherlands

Still after 3 weeks images pop up in my head. Different images. Of different people. After all these months of intense hard work to prepare, it was really hard to believe that it was really happening. To meet all these panellists whom I have often just read books from, meeting all these visitors from the Netherlands and abroad. And once more it makes me realise how much we can learn from foreign colleagues.

One of the great outcomes for me of the HRiC is that many painful subjects at stake in birth care were exposed. The idea was not to solve problems, but to create a space where people with different opinions could share and discuss. This way, we could help make people aware of different ways of thinking about childbirth. For example, aware of the value of interpretation of scientific research. Aware that issues that have not been researched can have an important value, but a different one for different people.

I cannot help but admire many of the panellists, some of whom must have felt uncomfortable, because they presented points of view that were met with strong disagreement by some others. Some doctors were painfully confronted with women whose best interest they have at heart , but who are angry and or dissatisfied with their experience of medical care. By showing up and staying, by participating in an open and honest dialogue, these individuals showed their integrity, their willingness to listen to others, to learn from others, to take matters home for discussions within their professional peer groups. They came away from the conference understanding better the pain, the frustration and anger of so many mothers and professionals alike.

All the energy and love flowing these days, all the discussions, the sharing, the emotions were very valuable. It mattered deeply to all present, and it struck a chord that will hopefully vibrate for many years to come.

Homebirth in itself should not be our goal. Homebirth is a state of mind, rather than tied to an actual place. It has to do with how one views pregnancy and birth. Normal life event, or life threatening disease called pregnancy that ends with a medical emergency called birth. And who owns this process?

I think it is wonderful that there is a law that clearly states that a woman should be supported in her choices. Not taking away the power and responsibility that is hers by rights. Finding ways and means to reconstruct the Dutch system to that will be a wonderful challenge for the next decade.

Karolina Wieckiewicz, Lawyer, Poland

First of all I have to admit that being there with you in May was an amazing experience for me. There are two sides of this. As a LAWYER working on cases, legislation and standards that refer to giving birth I always used to look at the dark side. What can go wrong, how to help women who were denied proper services etc. The same about perinatal care. We argue that women have to have a right to decide about the way of reducing the pain and all. That of course has not changed, still I think there should be proper information, education and a right to decide. But what was outside my vision was what I got from you – an idea that it can just go so far away from all these complications and that I should also be dealing with a woman’s right to choose WHERE and HOW she wants to give birth. It is not very well develooped in Poland to give birth at home or at the birth center. It is so normal to have a doctor throughout the whole pregnancy and then at your birth. Now I see what are the other rights I should be fighting for. And guess what – I found allies

Secondly but not less importantly you gave me so much in terms of me being a WOMAN! I do not have children yet. To be honest with you I am a kind of girl who no longer that in March had this conversation with one of the doctros we work with how much I want to have a ceasarian on demeand, planned in advance you can imagine his face. I thought I was so afraid of pain that there was just no other option for me! And he actually kind of talked me out of it but I was still frightened. Until I came to the Hague. You have no idea how much it empowerde me. All I know is that I want to give birth naturally in a tub with a midwife, and I want a doula I am so not afraid of it anymore. All the stories, the pictures, movies and most importantly PEOPLE who I met – it all made me sure that my labour can be beautiful and amazing. And I really want to thank you for this.

It has been a while since the conference, I still share this experience with anyone who wants to listen. You made me open my eyes to the side of story I have not seen before or treated it with less attention it deserves. In Poland the notion “natural birth” and all is still considered as some kind of new trend for celebrities. But I know it is changing and I am really happy about that.

So thank you for this amazing experience. It will stay with me forever. And I really hope for some cooperation with wonderful lawyers I met in the Hague. And am looking forward to the next conference.