Birth, Trauma, and Autonomy

Sylvia Burrow discusses the inadequacy of care for women during labour and childbirth.

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Health care providers are supposed to provide safe, compassionate, and ethical care for all patients. We see this idea represented in bioethical principles and values expressed in the Canadian Nursing Association Code of Ethics and the Canadian Medical Association Code of Ethics. Labouring and birthing women are noticeably vulnerable patients with intimately connected concerns for their emerging newborns. The World Health Organization (WHO) recommends that women seek medical facilities in order to receive the safe, compassionate, and ethical care that the Codes of Ethics of healthcare associations are intended to ensure. However, the reality is that women are routinely mistreated, disrespected, and neglected during labour and childbirth in hospital facilities. How are labouring and birthing women supposed to find safe and compassionate care in this environment? And what if they can’t find it?

I gave birth in a Canadian hospital that admitted a large number of high-risk labouring and birthing women. Shortly after the birth, I felt interrogated by the pediatrician. “Have you taken any drugs? What drugs did you take?” In my innocence I thought he was simply inquiring about my routine prescriptions. But in fact he was interested in getting an admission from me that I had used street drugs. This was almost incomprehensible to me. Of course I had never taken any street drugs, and I was quite willing to allow—indeed, did allow—tests to be run to prove it. In the next day or so the nursing staff barely visited the room. When I inquired about the length of my stay the nurse said, “You can’t leave. You have to stay here until the doctor lets you go.” A noticeable absence of care, coupled with a lack of respect and compassion, left a gaping hole in my recovery. I knew that nothing harmful had been in my body, not even alcohol or caffeine. My conscience was clear. In my case, I decided to stay until the drug test returned negative, then signed a waiver and left. Imagine if a teenager had instead been in my place; a woman of an ethnic or racial minority; a woman living on the street; a queer woman; or a woman who had actually taken drugs. Based on my experience, I suspected that a lack of compassion, neglect, and outright threats were not in any way unusual experiences for women during labour and birth.

Paula Modersohn-Becker "Reclining Mother and Child" (1906)

Paula Modersohn-Becker “Reclining Mother and Child” (1906)

Unfortunately, my suspicions were correct. Moreover, my experience was relatively benign compared to what happens to some women across the globe. Worldwide, women during labour and birth are commonly traumatized by experiences ranging from lack of care, dismissal, discrimination, and disrespect. A comment from a recent Huffington Post article reveals the effects of such traumatic experiences: “I had walked into that birth center in labour, happier than I’d ever been. I hobbled out of a hospital and back to another, with a sense of defeat and emptiness instead of a healthy baby. I’d failed both of us, and we were both suffering because of it.”

Disrespectful, discriminatory, and abusive treatment of women during childbirth is a worldwide issue. WHO has issued a recent statement pointing to gross invasions of privacy, failures to obtain fully informed consent, instances of humiliation and verbal abuse, refusals to give pain medication, refusals of admission to health care facilities, and outright neglect during labour and birth. These are clear cases of abuse. Even worse, labouring and birthing women report experiences frankly constituting sexual and physical assault.

Women who are unmarried, of low socioeconomic class, ethnic minorities, adolescents, migrants, and HIV-positive are most at risk for harmful treatment during labour and birth. The WHO statement calls for a worldwide recognition and response to such actions as clear violations of human rights. Over 90 organizations worldwide endorse the WHO statement. While many governments, researchers, and professional organizations have recognized the need to address the problem, WHO remarks that policies to promote respectful maternal care have simply not been adopted or have otherwise not translated into meaningful action.

Instances of disrespect, abuse, and outright detention of women and their babies within health care facilities reveal harms larger than any one woman’s traumatic experience. Birthing women suffer a systematic violation of human rights through violations of autonomy. Such violations of autonomy send the political message that birthing women are second-class citizens. Such violations of autonomy also make the moral point that respecting birthing women’s autonomy is optional – and so whatever women may desire in the best interests of themselves and their babies can be freely ignored. Such moral and political costs cannot be ignored.

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Sylvia Burrow is an Associate Professor of Philosophy at Cape Breton University.

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