EL PARTO ES NUESTRO AT THE EUROPE SUMMIT 2016 OF CHILDBIRHT ASSOCIATIONS IN STRASBOURG
Texto de presentación de El Parto Es Nuestro e informe sobre Consentimiento Informado y situación de las matronas en España elaborado para la Cumbre Europea de la organización Human Rigths in Childbirth, escrito por Francisca Fernández Guillén, socia y encargada del área legal de nuestra asociación. (La traducción se puede ver aquí)
I work as a volunteer lawyer for the Spanish NGO El Parto es Nuestro, which can be translated as “Childbirth is ours”. It was founded in 2002 to provide emotional and group support, and advice, to women who had gone through traumatic childbirths. Now we have active groups in Ecuador and Argentina.
Most of us had become mothers in our late thirties. We had well established careers and economic security, but, also the mistaken belief that feminism had won all the fights for women's rights, such as access to work and education, the right to abortion and legal equality. We didn't think there was anything left to fight for. That was until we gave birth to our own children.
Our experiences of childbirth and our interactions with health professionals and even our own families and couples left us feeling humiliated, infantilized, used and brutally divested of our pride and any fantasy that true equality had been achieved.
When we started El Parto es Nuestro we began by collecting women's stories of their births and we published them on our webpage.
In these stories we found an incredibly degree of shared experience. Women talked about feeling isolated and ignored during childbirth, and, of being treated as irrational and nonsensical by health providers. The main complaints that emerged from these testimonies are:
• An absence of prior information on the medical procedures that are going to be performed on the woman or her baby.
• The failure of health providers to obtain women's informed consent before performing medical procedures and techniques.
• The procurement of consent by way of threat or coercion, such as stressing the risk of death to the child, when a woman objects to the use of a procedure or technique.
• Having to endure the presence of students during childbirth and being touched by them endlessly as they learn and become familiar with the techniques being practiced.
• They complained about the lack of privacy.
• They also spoke of the humiliating impact of the contempt and lack of respect they received when being spoken to as infants rather that adult women who supposedly had full rights and equality.
• Unnecessary c-sections, forceps deliveries, inductions and episiotomies.
• Being separated from their children immediately after birth, sometimes for hours, and their children being isolated in neonatal rooms.
So we began to look at the evidence. We collected, translated and published studies about the risks of c-sections and episiotomies and their impact on women's lives, the benefits of skin-to-skin contact, and the proportion of women who suffer from Posttraumatic Stress Disorder after childbirth.
We set about raising awareness of these problems among society, in the media and with politicians.
All of these problems and complaints happen despite the fact that the Spanish legislation on informed consent is as modern as it could be, and of course the European law is fully enforceable in the country. This law calls for the woman’s express and informed consent before any medical procedure is performed. But even when doing inductions or cesareans, interventions where the need for informed written consent is best known, health professionals often don't acquire it or forget to get it.
A high percentage of women were never told the real reason why a cesarean had been performed, and many suspects that it had more to do with the convenience for health professionals than any genuine medical reasons.
None of women's testimonies mentioned being asked for permission to carry out procedures such as episiotomy, bursting the amniotic membrane, or monitoring the baby internally, a practice which involves pricking the fetus’s cranial membrane.
The narratives reveal that, generally speaking, the health professionals seem not to even consider the relevance of the woman's preferences. They didn't ask questions or offer alternatives.
In the words of Stella Villarmea, a philosopher and member of EPEN:
Pregnant women are set in the “natural world”, along with the animals and plants, as far away as they can be from the rational world, the world of decision making, the world of informed consent.
Mothers are told that their Birth plans are “preferences” that can or cannot be respected by the health providers, when, of course, according to our legal system they are informed decisions, not just “preferences” and consequently it is not up to doctors or midwifes to respect them or not.
Doctors often tell women that they will respect their will provided it is not contrary to the ‘Protocol’ or evidence-based medicine. But, protocols cannot be imposed on patients, that is not what they are made for. Their goal is to improve medical practice by making better proposals to patients. And I have never seen in my whole life as a lawyer a Birth Plan that was contrary in any aspect to evidence-based medicine. Well on the contrary, they were kind of a summary of good practice in childbirth. Most of the interventions performed on women or their children during childbirth were in fact contrary to the written protocols.
Women are also told that Birth Plans are not legally valid. But our law is not formalist, if a patient decision is informed and autonomous, it is compulsory for the health practitioner, no matter on whether it was oral or written or whether the paper that expressed it was titled “Informed consent” or “Birth Plan”.
We have had to sue state hospitals for all of the reasons I have described. However, it seems that some judges make an exception to Human Rights and Patient’s rights when the human being and patient in question is a pregnant woman.
So 4 cases are currently being taken to the European Court of Human Rights.
Childbirth is ours and midwifery
Since the very beginning, we realized that midwives are our natural allies.
In Spain, midwives are independent professionals that can work both in hospitals and at home. Homebirth is legal but is not financed by the State Healthcare System. Only 0,3% of childbirths are homebirths in my country.
When an intrapartum transfer from homebirth to hospital is necessary, the woman and her assistants can be criticized and condemned by the attending health professionals. Sometimes, the woman and her baby subjected to more interventions than usually as a means of revenge, but little by little society is normalizing the phenomenon of homebirth.
In hospitals, despite the official recognition that midwives are the best option in normal birth, doctors manage the organization and development of the obstetric services and can interfere in a midwife assisted childbirth at any time.
Part of our work consist in empowering midwives, co-operating with midwives associations and letting pregnant women know the benefits of being assisted by them.
Childbirth is ours … give it back to us!