Freedom for Birth

Birth as a Human Right?

On September 20th, Improving Birth National Rally for Change, ICAN of Bozeman, MT and the Montana Childbirth Collective hosted a showing of Freedom for Birth, "a new 60 minute campaigning film that re-frames Human Rights as the most pressing issue in childbirth today."  This film shows how choosing the way in which she births is a fundamental human right for all women, and how this right is routinely violated, all across the world.  The film is amazing and we highly recommend you view it, and show it to others, especially women.  We had a lively and thought-provoking discussion afterward, about birth as a human right (something many of us had not pondered before), about the violations in the film and about birth in our own community.

This got me thinking about what we are doing right - and what still needs improvement - in our own community.  One of MCC's members at the film premiere said "We are so lucky to live here - we have so many choices other women do not have."  Absolutely.  In Bozeman (and surrounding towns) you might choose a homebirth midwife - we have several with great reputations and many many years of experience.  They will attend you in your own home with kindness and compassion and a high level of care.  We have two beautiful birth centers, The Bozeman Birth Center and The Birth Place, each staffed by highly trained, experienced and well-regarded midwives.  Both offer a lovely facility as well as compassionate and safe care.  These are all excellent choices for VBAC moms, or other moms who've had traumatic previous births.  About 10% of families choose either home or center births, the highest in the state, and Montana has the highest rate of out of hospital birth in the country.

Home or center choices here give women the choice of a low to no intervention birth, a family centered birth, a birth where the mother is firmly in control of her experience.  And we know from years of research studies that these are safe choices, the most recent from the Cochrane Review, concluding "Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications."  Less interventions and fewer complications mean fewer cesareans, less separation of mother and baby, fewer problems with nursing, less tearing of the perineum, less induction, less pain medications and much happier birthing experiences for families.

What are the problems?  Some insurers still won't pay for these choices, or will pay for only some.  Women deserve for their insurance to cover all the choices.  And this makes good sense for society too, as these choices are tremendously cheaper than even natural hospital births (and since they result in so many fewer interventions and complications, they are obviously cheaper than highly interventive births).

Not enough women know that home or birth center births are safe.  Not enough women know that they probably wouldn't need pain medications (like epidurals, which are not available outside of a hospital) if they didn't birth in a hospital.  And not enough women have trust in the birth process to take total responsibility for their births, which one must do to birth out of hospital.

Finally, we have a small choice of hospitals, Bozeman Deaconess, St. Peter's Hospital in Helena (about 1 1/2 hours away), Livingston Community Hospital (1/2 hour away) and St. Vincent's or Billings Clinic, (Billings, 2 hours away).  Most women in Bozeman choose our local hospital.

What are they doing right?  Moving in the right direction - toward a gentler and more patient centered kind of birth.  Bozeman is becoming Baby Friendly, which means a huge step toward better breastfeeding rates and help for mothers who want to breastfeed.  Some mothers are now able to keep their babies with them when they have cesareans and nurse right away, rather than have the newborn and partner whisked off to the nursery for hours.  Mothers who want low intervention births are more likely to be met with encouragement and support.  Doulas are warmly welcomed.  Two nurse midwives are now on staff at Billings Clinic's Bozeman OB practice, offering a level of care more based in midwifery.  Women choosing them would have one of two midwives attend them (instead of one of very many doctors, whomever is on call).  This makes a big difference to many women.  The maternity care nurses are well-trained to help mothers who want a low intervention birth and happy to support that with compassion.  VBACs (although called TOLACs - trial of labor after cesarean) are now "allowed," at least for some mothers.  Women transported from out of hospital births are generally treated kindly and with respect.  There are a number of doctors who are patient and support natural birth and who refrain from intervention.  This is all cause for celebration.

What still needs to be done?

• All mothers who have cesareans need to keep their babies (except the very rare baby who needs intensive neonatal care) for the duration of their surgery and have help latching on right away.  Separation needs to be as close to zero as possible.
• The cesarean rate is too high - the hospital reports a rate at the national average - about 30%.  This is at least 15% too high.
• VBACs need to be openly celebrated and encouraged, not treated as train wreck waiting to happen.  The research just doesn't support this panicked mentality.  VBACs are very safe.
• Far fewer inductions.
• A doctor/patient system that puts the patient first.  Birthing women need to birth with the caregiver they've seen for 9 months, not the stranger who happens to be on call.
• A return of breech births for the majority of those cases.  Again the research supports this as a safe practice (and can help lower the cesarean rate).

Our community can continue to support women's choices about birth, as a human right.  We can all respect the value of mothers by letting them choose what they know is best for their families.  And we can encourage our community hospital to continue taking steps toward improving its care of mothers and babies.