Katharine Wolfe suggests that recognizing the interdependent aspects of a mother and a child’s welfare may help to change how home birth is viewed.
When I mention to others that the freedom of a mother to give birth at home in Nova Scotia is restricted, and potentially criminally punishable, many respond with shock and surprise. The visceral effect of this information, about another way in which reproductive autonomy is curtailed in Canada, is often powerful. The moment reveals how unaware many are of such limitations as well as their troubling impact.
Section 242 of the Criminal Code of Canada stipulates that anyone who “fails to make provision for reasonable assistance” in the delivery of a child may be held criminally liable for child neglect, and imprisoned for up to five years. Yet try as one might to secure assistance for the birth of a child at home, other legal restrictions in Nova Scotia make it nearly impossible for many to succeed. Up until September 23rd 2013, provincially employed midwives were authorized to attend home births in the South Shore area only. Now, home birth is publically supported in the Halifax Regional Municipality (HRM) as well, but only for those able to obtain midwifery care – and demand greatly exceeds supply. Even for those who would be able to pay for the services of a private midwife, the option remains off the table. Since the Midwifery Act came into effect in Nova Scotia in 2009, midwives who wish to practice privately in the province must have liability insurance. The cost is reported to be prohibitively high.
These are but a few features of the current situation facing those who want to give birth at home in Nova Scotia. This situation calls for political redress. Yet effecting political change may require shifting an individualistic ethical framework informing attitudes towards home birth in the province. This underlying ethical scaffolding may partially explain why giving birth at home is currently a potentially criminal act, and why the option of home birth has been so slowly, and so very partially, introduced into the public health care system in Nova Scotia. Sue Sherwin has written of the importance of rethinking ethical frameworks here.
For example, in response to news stories (e.g., here and here) about the renewed option to have a midwife-assisted home birth in HRM, commentators have described the choice to give birth at home as “selfish” and indicative of a mother valuing her birth experience over the child’s welfare. A recent publication in Maclean’s magazine lends fuel to this view by highlighting the possibility that benefits to the mother from home birth are bought at the expense of the child. Elizabeth Bogdan-Lovis and Raymond De Vries have found similar trends elsewhere.
A careful study of the current data on the safety of home birth for both mothers and children is called for in response to these criticisms. But, so too, is some thoughtful attention to the terms in which this conversation is taking place. Why it is that the interests of mother and child are being pitted against each other, and what does this dichotomous ethical purview leave out of the story?
Both mother and child are treated here as independent beings whose welfare can be cleanly weighed and balanced on opposite ends of a scale. But are they so independent, and can their interests be so divided? While mothers can experience their own interests as differing from those of a child during pregnancy, in many instances and in multiple respects, mothers also often experience their own welfare as hinging on that of the child. In such instances, both present and prospective harms to the child are often lived as present or prospective harms to the mother. Grounding ethics in issues of individual rights and isolated welfare renders such interdependent aspects of a mother’s welfare invisible and inconsequential.
In turn, the child’s welfare is also starkly dependent on that of the mother. The child is nourished by the mother’s nourishment and affected by the medications that affect her. Further, the mother’s psychological and emotional relationship to the event of birth can influence the course of the labor, either facilitating the physiological processes of birth or inhibiting them, and, in turn, affecting the child. The kind of birth experience a mother has also often affects her ability to breastfeed afterwards, her susceptibility to post-partum depression, and her bond with her child. Given such far-reaching forms of mutual dependency, any ethical assessment of a mother’s actions at the time of birth that begins with a stark dichotomy between the mother’s interests and the child’s interests will be sorely wanting in missing some of the most profound needs of both, not only during birth but afterwards.
Katharine Wolfe is a Teaching Fellow at the University of King’s College.