Feeling safe and Being Safe during Labour and Birth

Human beings, like all mammals, need to feel safe in order to give birth.  Childbirth as a physiological process is powered by hormones, and those hormones are strongly affected by the birthing women’s emotions, which are in turn affected by her perception of whether she is giving birth in a safe environment.  What women need to feel safe will vary from individual to individual, and across cultures as well. Some women will need to feel safe laboring naked; some need to be covered to feel safe. Some feel safe in a space where they can be very quiet and peaceful, some need to be able to move, dance, sing or scream.  Some women will need their mother with them to feel safe, some will need their man. There is no reason why maternity care cannot be constructed in a way that meets each woman’s needs to feel safe during birth. And yet, in many systems around the world, women must sacrifice feeling safe, and even being safe, in order to access the safety that medical backup provides.  Widespread reports of disrespect and abuse, dehumanized, traumatizing treatment, and violations of women’s rights to privacy and dignity show that women are giving birth in environments in which they cannot feel safe, because in fact, they are not safe.

The recognition of preventable maternal mortality as a human rights issue was a huge step for women’s sexual and reproductive health and rights.   But when we only recognize the right to survive as important for childbirth, the violation of women’s other human rights is rendered invisible. Women in both the developing and developed world are organizing to speak out about systems of care that dehumanize and traumatize them at their moment of greatest vulnerability. They are demanding recognition of their rights—not only to access healthcare and to survive childbirth, but their rights to autonomy as informed consent and refusal, to privacy, to dignity, to non-violent and non-discriminatory treatment in labor and birth.  The human rights framework takes women beyond asking providers to please give them individualized, non-violent care, but requires the state to enforce women’s human rights as legal rights that must be respected in policy and practice. In some nations, women’s groups have passed laws naming the abuse of women in childbirth as obstetric violence, and brought legal actions that described their experiences in those terms. It is notable that the systems of care in which women are passing laws against obstetric violence are those with some of the world’s highest cesarean section rates, like Central and South America.

The global cesarean section pandemic is, in itself, a form of obstetric violence.  In many cities and nations in both the developed and developing world, women who can access care are churned through cesarean section assembly lines, while women from marginalized communities in the same nation are left to die preventable deaths.  Is this equity? Media reports on the cesarean pandemic often claim that women want all these surgeries. Studies show, that’s not true. Women want a healthy birth, and they want to know that the medical system will meet them at their need, and have surgery available if they need it, but support them in a vaginal birth if they don’t.  Economic studies all over the world connect providers’ financial and time-convenience incentives to the massive increase in surgical deliveries. The money that healthcare systems are wasting on the surgical delivery of healthy babies from healthy women could be directed toward underserved women and closing gaps in women’s reproductive health.

The disrespect and abuse of women in childbirth, and the generation of children being born by surgery, are not soft human rights issues.  The right to respectful, non-violent support in childbirth is not the request for a “positive birth experience.” Framing these issues in terms of “birth experience” runs the risk of trivializing them, and creating a false dichotomy between the “experience” of care, versus health and safety.  The issues that we are talking about here are, in fact, about health and safety, and are a matter of life and death.

As the cesarean section rate passes 50% and approaches 100% in many facilities around the world, the global movement for women’s health and rights needs to ask, when are we going to stand up and say, no more?  Why are we letting this happen to ourselves and our babies? Why are we letting this happen to each other? What would maternity care look like if it recognized not only women’s right to survive childbirth, but the full spectrum of human rights that every woman has, and that she carries into labor and birth?  What would it look like if every woman could feel safe, and be safe, while she brought her baby into the world?

Human Rights in Childbirth founder and executive director Hermine Hayes-Klein gave this speech at Women Deliver 2016, on a panel session titled “Compassionate and People-Centered Care: Why We Need It.”  The session’s subtitle: “Respectful maternity care is a woman’s right, not a luxury. Ensuring that women are not only satisfied with their care but have a positive birth experience can be the catalyst to ensuring they survive and thrive.”