Rebecca Schiller can tell you. Below is an interview with Rebecca to discuss her new book and its implications in settings like India.

Rebecca Schiller is the author of Why Human Rights in Childbirth Matters and chief executive of Birthrights in England. This is the perfect book to introduce you to framing maternity care within the lens of human rights.

To be honest, though I am studying to be a midwife and am keenly interested in the experience of childbirth, the concept of human rights in childbirth was new for me. Even at the time of starting to volunteer for this conference I wasn’t fully aware of what human rights in childbirth meant or implicated. But along came Rebecca Schiller’s book and my jaw dropped, my heart almost burst, and something shifted inside me.

So I thought it would be appropriate to interview her on Skype to further discuss the book, and it’s implications in a place like India. But, what a struggle it was for me to write this blog. No matter what I wrote, it fell short of what is conveyed in this book and by Rebecca herself. Rebecca Schiller does an unprecedented job of conveying just what the title says- why human rights in childbirth matter.

But first, a little about the book…

The book (is a whole lot better than this blog)

Schiller does a wonderful job of blending together the voices of women from across the world, the words of experts, legal cases, laws, ideologies, concepts and debates and whips it all up into a comprehensive look at human rights in childbirth. According to her, the core issue in childbirth is not what type (vaginally, natural, or c-section) or where (home, hospital or birth center) women give birth, but really women’s autonomy in birth (how was her birth experienced?). She points out that trauma suffered from a birth experience isn’t necessarily related to what type of birth a women had, but how it was conducted. A woman may have a “normal, vaginal” birth but if in the process she feels out of control, disrespected and doesn’t have enough information, she is likely to feel traumatized from her birth.

She asserts that to truly uphold human rights in childbirth, then everyone needs to recognize that when a woman is pregnant or giving birth, she is no less of a human and is entitled to the basic human rights we are all born with. These rights include the right to autonomy, dignity, choice, informed consent (and refusal) and being free from coercion. To uphold all these rights, maternity systems, healthcare practitioners, policy makers and advocates should shift their focus from pondering how to reduce intervention rates, increase rates of “normal” delivery or promote any one kind of birth, to how to implement the right models of care so that women’s authority and choice is maintained. Consequently, providing maternity models that promote individualized care, are likely to reduce c-section and interventions rates that have health officials so alarmed, without degrading a woman’s status as an autonomous human being in the process.

It may seem matter-of-fact that a pregnant/birthing woman is still human, but this fact is actually all too often dismissed, in the seemingly legitimate belief of making birth “safer” or a “healthy baby.” Women can be forced or coerced into c-sections, have episiotomies without consent, forcibly held down while unwanted interventions are performed, have police show up at their door for attempting a homebirth or even be denied elective c-sections because someone feels it is better for the baby. Women traumatized from birth beg the question, “Is it really all that matters is a healthy baby?” Schiller resolutely will answer NO! Of course it matters that we have healthy babies, but it is certainly not all that matters.

Right now, almost the whole world prioritizes getting a “healthy baby” out of the mother, at any cost- even at the cost of women losing their dignity, being treated with disrespect or abuse and without autonomy or self-determination. This translates into treating women like vessels or containers where things can be done to them, even without meaningful consent. She asserts that a true good outcome in birth is when both mother and baby turn out to be physically and psychologically healthy after birth.

One interesting point Schiller makes throughout the book is that maternity care systems shaped to maintain human rights will implicitly view mothers as the decision-makers. This can bring up a lot of questions, like, “Can a mother really be fit to make decisions, what about a ‘bad mother?’” But just like the dogma that “all that matters is a healthy baby” needs to be done away with, so does the idea the a mother is in conflict with her unborn child. She explains that mothers are typically exceedingly cautious and concerned about their pregnancies and births- rightfully so as it is their baby and their body that they will carry after the birth. So while they may not be a trained expert, they are the person with the highest stake in the outcomes of birth and with the objective input (not coercion or bullying) from healthcare providers, can know what is right for themselves individually (which can even be finding a trusted careprovider and dutifully doing everything he or she says!)

Schiller calls for all birth activists to unite forces and start fighting for human rights in childbirth so we can recognize the true potential of humanity in maternity care. I urge you to get a copy of her book to be fully convinced of why human rights in childbirth matters. But first read a little more from her in this interview…

The interview

Q. If there is one thing the Indian crowd should take away from this book, what would it be?

A. It’s quite simple: women MATTER during childbirth. If we design a system where women matter during childbirth, it will be better for women, it will be better for babies, it will be better for healthcare professionals and it will be better for the family. Actually, it shouldn’t be too hard to do.

Q. So, why isn’t that, “All that matters is a healthy baby?”

A. It’s become such a common sentence, it’s easy to let it slide. But when you look at it, what it also says is that ‘women don’t matter’ because the opposite of that sentence is that ‘nothing else matters.’ So it gets used to excuse a lot of behavior (and treatment of women), it’s used to stop women from being able to talk about their experiences and to process their experiences.

But, on a broader level, it can be part of a quite worrying desire to reduce women to reproductive vessels. There are a lot of parallels that happen in other corners of reproductive rights, particularly in the US where there is a real intersection between human rights in childbirth and rights to abortion. So if all that matters is a healthy baby, there is a discomforting and dis-topian lens to that where women don’t matter unless that are the producers of healthy babies.

Q. What’s the difference between advocating for human rights in childbirth versus advocating for “natural birth,” “homebirths” or lowering c-section rates?

A. I was a person who previously advocated for a particular kind of birth and a particular way of feeding babies but I found, when we advocate for a specific way of doing things, we can alienate some women and policy makers and health care professionals. And you risk also putting a layer of pressure on women to do things in a certain way. If all of us who are promoting different things in birth, different things in feeding, different things in reproductive rights, focused simply on ensuring that basic human dignity, autonomy, choice and non-discrimination was upheld, then things would sort of follow suite. So if a woman wants a homebirth and since we maintain that women have a choice of birth, she can. And the same with elective cesarean section. Same with infant feeding.

We don’t want to be another pressurizing force in the system, adding a layer of pressure to women. [Human rights in childbirth] brings us all together, so we are not polarized or counterbalancing our arguments by arguing amongst ourselves. We are just focusing on getting all women the respect and dignity and choice that they should have and everything else sort of follows on from there.

Q. So, can a positive birth experience be significant in woman’s life?

A. I come to this from a place where I know, from my own birth experiences, that birth can be very positive…I work with a midwife who says ‘get something out of this other than a baby.’ I think what she means is that this is an opportunity to learn about yourself, to learn about your partner, and to feel very powerful and strong. And, that doesn’t mean you won’t feel vulnerable and scared.

Birth can be very healing. I have worked with women who have had traumatising first births and go on to have very healing births. Not necessarily because it was some magical experience, but it was because she felt like she was in control, a big thing happened to them and they did it! Women can gain a sense of self that becomes stronger rather than weaker.

Birthrights did a survey where we found that women who characterized their births as negative were much more likely to have a negative view of themselves, their partners, and their babies after birth. And on the flipside, women who had positive experiences felt positively about themselves, their babies and their partners. It can be profound. A lot of women [who have had positive experiences] can take it forward into the rest of their lives, into their careers, their mothering, illness and take on a sense of strength and pass that on into the next generation.” Her mother had a very positive view of birth, so she wasn’t frightened.

Q. How could childbirth and maternity care systems change in India, worldwide, if Human Rights were held up in the process?

A. It’s hard to see that in isolation for a general respect of women’s human rights. The first caveat is that globally, there would have to be a shift towards women and girls….

But (if human rights were upheld in childbirth) we would see many more women having births they planned. And for those whose birth don’t go to plan, there will be less trauma.

I’d imagine it would have an impact on the intervention rates, because most women aren’t desperate to have loads of interventions [during childbirth]. It would also have an impact on mental health- overall perinatal outcomes.

It seems like India needs human rights in childbirth, not to just decrease the almost rampant intervention rates, including c-section, but to bring back women into birth- to remind women of India that they matter, too.

Join the conference to see how we can go about doing that!

Rebecca Schiller is the Director of the human rights in childbirth charity Birthrights, which provides legal advice, training for midwives and doctors and campaigns to improve women’s experiences of pregnancy and birth. She is a freelance writer, occasional doula and wrote the must read book Why Human Rights in Childbirth Matter.