Marie Andreoulaki, birth activist, doula & doula trainer, Greece:
- A conference organized by mothers and activists! Although I am grateful for all the amazing work of health professionals, I am convinced that the most important changes will always come from the parents and the activists; they are the most passionate ones and they will not give up; they are not afraid, they can think outside boxes and are continuously motivated to look for new ways by their children and their children’s memories.
- Networking with people, meeting similar and different cultures, putting things under new perspectives, seeing the known which gives a sense of recognition and safety, and the unexpected, which gives rise to new ideas.
- I loved the multidisciplinary approach! In the end of the conference I had to restrain myself from totally immersing myself into intensive study of philosophy, bioethics, law, midwifery, economics, sociology, music and dance, and about 10 languages, all at the same time.
- I cannot express enough my admiration to the organizational team. Apart from the professionals, I am amazed by the young students who put their time and efforts into something that is probably not yet their reality (parenthood!). Lucky you!!!
- Since I came back home from the conference, I have been working on collecting data, writing bilingual reports, speaking with people and posting about it, almost on a full-time basis. I consider it one of the most important events on the world’s social and political arena and a beginning of an era!
- It is very hard to summarize such an important event. I would suggest whoever is drawn to the subject, to get on the webinar now! I would also be happy to share my reports. I have made another document with reports written in different languages on the conference, which are also available. And I am looking forward to the publication of the three-volume book on the conference!
- THANK YOU!!!!!
I was here on a quest to learn myself. I am very much impressed by the community that is surrounding birthing women. I am very much impressed by the two brain-halves that were at stake in these two days: the data-driven brain-half and the love and emotion-driven brain half. I think that part of the solution to the quest we are on, of humanizing young people, and subsequently mothers and next generations, is to combine these two. I would like to encourage you to continue this dialogue.
When I was a midwifery student, it was obvious to me that my role as a midwife should be serving the mother, she is in control, not me. But as time went by the influence of my midwifery education, regulation, protocols, scared professionals and scared parents-to-be, made me drift off that initial path. It is painful for me to look back and see the times when I, too, have violated the rights of mothers, thinking that what I was doing was for the best of the mother or the child. Luckily, sometimes, when you grow older, you grow wiser. When you know better, you will do better. In my profession this often means: you stop doing. Still, I kept being insecure about the same questions raised during this conference. The main one being: ‘what if the rights of the mother interfere with the rights of the baby?’. It was so enlightening for me to hear Elselijn Kingsma speak about the comparison between giving blood or bone marrow to another individual. As a society we completely respect that we cannot force one human being to do that in order to save another person’s life. So why is it so hard for us to respect a mother’s bodily integrity? Especially since we know a mother would almost always make a choice for the best interest of her child, even when that choice may seem incomprehensible to the caregiver or the public. That statement made me so much more confident to really trust the mother’s decisions, even when I might still be worried about the outcome. Life or death are not in my hands, as they are in no ones hands. But as Roseanna Rosewood has said so eloquently: If there is a mistake to be made, let it be made by the one with the deepest concern and investment in the outcome of the birth: the mother.
Norma Campbell, Midwifery Advisor, New Zealand
Robbie Davis-Floyd, Anthropologist, USA
- With the exception of the few keynote speakers, each panel participant/speaker was limited to only five minutes. At first I was skeptical of this format, yet very quickly as the panelists spoke, I was simply amazed at how much people could say in such a tiny amount of time! There was no room for goofing around—every word had to count, so every panelist rose to the occasion and made sure that their words expressed their deepest messages.
- Almost every panel included a consumer representative—a mother who could describe her own experience of birth and the forces that impinged on that experience, for better or for worse. So it was not just about professionals presenting their own stuff, it was also about mothers presenting their experiences, and if we are not all about that, then we are nothing and nowhere!
- Almost every panel included a wide variety of experts—I have never heard so many different perspectives presented in one conference! Doctors, lawyers, politicians, ethicists, sociologists, midwives, doulas, mothers, fathers, students—each panel covered every possible perspective, giving us a holistic view of the panel topic.
- The panel topics were well and wisely chosen—from the unjust persecution of midwives like Agnes Gereb in Hungary, to the Ternovsky v Hungary successful lawsuit that resulted in an EU guarantee that women have the right to choose their place of birth, to the need to preserve normal physiological birth, to the current challenges to the Dutch system and what can be done about them. The insurance representatives alerted us to their concerns, the doctors to their growing fears of lawsuit and international blame for the “high perinatal mortality rate,” the midwives to their distress over recent, unfortunate changes in Dutch midwifery education that are leading midwives to abandon hands-on skills in favor of the ability to conduct research within the parameters of evidence-based medicine, which is great in many ways yet should not, ever, replace experiential ways of learning and knowing about mothers, babies, and birth.
- I was personally gratified to be able to present, for ten minutes on the morning of the second day, the Dutch system as not a premodern vestige of the past but a postmodern vanguard of the future—a viable combination of midwifery knowledge, skills and experience all geared to supporting normal, physiologic birth gained and sustained over 400 years of practice and now validated by scientific evidence that supports traditional Dutch midwifery practice and urges its continuation!
- The rapport among the national and international attendees was fantastic. We were all there to support Agnes Gereb and urge the Hungarian government to free her, and to contribute as best we could to the preservation of the Dutch maternity care system, long our best model of hope and now under threat. We hope and trust that the outcome of this conference will result in massive improvements in the Dutch system, including more support for autonomous midwives and the preservation of the small community hospitals that are rapidly being closed—it is clear that women around the world and in The Netherlands want community based care!
- The atmosphere of hope for positive change was in the air that we breathed during this conference. The desires and needs of mothers for supportive care were expressed, as were the desires and needs of midwives and student midwives to be more empowered to provide that kind of care, and the fears of obstetricians who are being forced into more technocratic models of care. The Dutch perinatal mortality rate was an issue—10/1000—touted as “the highest in Europe”—yet I did not see enough discussion of the fact that the Dutch PNMR is calculated from 22 weeks—much earlier than other countries.
- I left this marvelous conference filled with hope that we can prevail in Hungary to facilitate the government’s acceptance and legitimization of home birth and homebirth midwives and to help to free Agnes Gereb of all charges, and that the Dutch system might just be able to hold its cesarean rate at the current nationwide 16% (yet it’s 20% in Dutch hospitals and rising!) and to preserve out of hospital birth in the many birth centers, staffed by independent midwives, that are now being constructed all around The Netherlands to allow women the option of out of hospital birth even when the possibility of homebirth is being denied to them (because of the closing of so many community hospitals, due in part to a new Dutch policy against planned, midwife-attended homebirth if you live more than 30 minutes away from a hospital.
- I applaud Hermine’s decision to hold this conference again in three years!! In the meantime, let’s keep the dialogue going and let’s keep our focus on helping Hungary to legitimate homebirth and helping the Dutch to preserve the best of their maternity care system, even in the face of the current challenges to it!
The Human Rights in Childbirth conference has been, by far, the most informative and inspiring convening that I have attended. It was an incredible honor to share the room and the stage with some of the most renowned innovators, researchers, and advocates in the world of maternity care. More than that, though, it was truly humbling to share the space with brave women like Anna Ternovsky and Marie O’Connor who have stood up and challenged violations of women’s human rights. I spoke to women and advocates who described human rights violations–and successful legal responses!– that I would never have thought possible. I am grateful to have had the opportunity to learn from other attorneys from around the world, both in terms of what can be done and what remains to be done. I return to the U.S. with renewed energy, a sense of optimism, and a network of allies with whom I am proud to work to make the promise of the conference a reality.
The conference was a gathering of lawyers, midwives, doctors and other healthcare workers passionate about the right of a safe birth. There was a very open atmosphere. Everybody had the time to contribute in his own way and had the opportunity to discuss with others. I’m glad I could be part of the conference and I look forward to seeing the outcome.
Marian van Huis’ summation of the Netherlands’ unique history, published in the Conference Papers/Human Rights in Childbirth is still ringing in my mind. Those of us who have suffered because of coercive, brutal maternity care because midwifery was cut off at the knees long ago in our countries know how easy it is to convince millions of women that their bodies are inadequate for birth. It was easy enough to do this a century ago, but this kind of market-driven propaganda is much easier to purvey through modern media.
With heartfelt gratitude to all of you who made this conference possible.
Zora Javorská, Birth Activist, Czech Republic
Jennie Joseph, Midwife, USA
Stefania Kapronczay, Lawyer, Hungary
The Human Rights in Childbirth was a remarkable conference for numerous reasons. Firstly, it brought together not only professionals from all the fields concerned, but also made it possible to voice their message for those who are mostly affected: women. I particularly liked hearing about different birth stories, including a story about an elective c-section. Secondly, the structure of the conference enabled us to go into details after discussing the relevant questions in a broader term on the first day. As a lawyer it was very useful to hear how non-legal documents can affect the practice of such basic human rights as the right to self-determination. Last but not least I enjoyed attending the conference, because meeting so many people who think alike empowered me to continue our work.
I don’t know if this powerful energy managed it’s way to you through the webinar, if you could feel how everyone was standing behind you. They are standing there and supporting you with this great power that was now born here.
The first little achievement could be the right for Lithuania’s women to freely give birth at home – into the hands of their beloved midwives.
- Clearly there are many human rights violations going on through out the world regarding women’s autonomy over their bodies when making choices regarding their pregnancies. In some countries women have been forced by court order to submit to caesareans against her will and if women have decided to go against the will of medical advice, child protection laws have been evoked to take their child/children away.
- Whilst a woman carries her child in-utero, the consensus was that her rights should rank higher than the fetus, as this situation is unique. The baby cannot exist without her and sometimes the medical establishment uses their interpretation of fetal rights to manipulate and submit the woman to their will. Most women (not all) women usually have the best interest of their baby at heart when they make their decisions.
- In some countries, there have been prosecutions of midwives who attend women at home births or setting of the woman’s choice. Even if it was the woman’s desire to birth in the way she wanted and the midwife was supporting and making the birth as safe as possible. It would be better for midwifery professional bodies to handle questions about the way in which midwives practice rather than the law. There is a small irreducible maternal and fetal mortality and morbidity associated with birth which can occur in any birth setting, but the media bias which tends to highlight cases that occur outside hospital rather than hospital cases is unfair. One panelist suggested that there should be a counter-media campaign to produce more balance in the arguments. The lawyers present are forming an international legal network to support women pursue their desire for physiological birth.
- The obstetric model of childbirth, with its rational arguments to centralise medical services were culturally blind to the groundswell of opinion from mothers that this centralisation process led to a technical management of pregnancy which didn’t take into account that such a “birth factory” ideal leads to a disrespectful, frightening, traumatising, mechanical health service – especially to low risk women. This type of service does not honour the psycho-somatic, spiritual and societal importance of birth. This is perceived more by low risk women who, largely do not need medical assistance. High risk women might more readily perceive the benefit of the medical model however, there was a great deal of debate regarding mothers who have breech or twin pregnancies as many thought that their chances of safe physiological birth was better at home because of their perception of iatrogenic harm in hospitals. Radical midwives across the world were prepared to support these women in their decision for out of hospital birth.
- In a sense the obstetricians present at the conference were the one’s open to debate….perhaps “the good guys”. Guidelines from obstetricians and gynecologists were thought to be very important in arguing out legal cases, however they may be flawed. An analysis of guidelines in the USA and the UK showed that less that 30% was based on rigorous science. The majority of these guidelines were drawn from inconsistent studies and peer opinion. Understanding this gives a greater transparency to collaboration (doctor/midwife/woman) in clinical decision making.
- Both obstetricians and neonatologists, because of all the pathology they see, are not balanced in their views and continual emersion in crisis-medicine biases their views, leading them away from a position of equipoise. When looking at perinatal morbidity and mortality and the health of children, there should be an comparison regarding long term harms as well as short term harms when examining medical versus physiological birth.
- Radical midwives were averse to the integrated care concept, as they perceived that the obstetric system still held too much power and had a tendency to steam-roll over the philosophy of independent midwifery and its wish to deliver patient centred care.
- Hospitals had their harms with the increases medical interventions that happen to low risk women as compared to an out of hospital settings, but home birth also had a potential delay in accessing emergency obstetric or neonatal services. Ultimately it should be the woman’s choice as no option was risk free.
- Medical Insurance schemes are wielding huge power over choices in childbirth, through the economics of insurance premiums. Who informs the insurance companies of what makes birth safer? Do they understand the importance of continuous emotional support and that excessive time spent in documentation leaves less time to care and be compassionate for women in labour. Midwives have less time to be “with woman”. This in turn leads to greater risk of medical interventions. In these scenarios, then the value of Doulas becomes very important.
- The long term benefits of physiological birth needs to be conveyed to obstetricians, because it seems that they were not aware of this body of research – as it is not contained in standard medical education. The bio-behavioural physiology of oxytocin has not yet penetrated in to the medical model of child birth and this could be addressed by better education.
- In view of the flaws in evidence based medicine as well as a woman’s autonomy over her body, there was a great deal more to discuss in the future regarding the validity of intellectual versus an embodied wisdom about childbirth, their place in decision making and birth human rights.
Myuzhgyan Mehmedova, law student, Bulgaria
The Conference was also a daring experience. It was daring in that it talked about the heavy consequences of not having choice and support in birth. It was daring in that it uncovered unseen scenes, pictures and stories. It was daring in that it challenged the law. It was daring in that it talked about life, about death and about love. It was daring in that it also welcomed those who oppose the idea of giving birth at home. I heard many voices and many words in this Conference. I heard the voice of mothers, of midwives, of doulas, of students. But not only that. It was not a Conference presenting only one side of the story. I heard also the opinion of lawyers, of doctors, of philosophers.
As a student, going into the future of the legal world, I learned that ‘’the law’’ and ‘’ the feeling of people about what is right’’ should not be separated. Because sometimes you need to feel in order to understand. Thank you Ms. Hayes- Klein: you made me feel, understand and dare hear the stories.
That said, I felt that there was so much to take in and there was not enough time to really absorb all of it. A week ago, I attended a friend’s wedding and the topic of birthing choices came up in our conversation; I was shocked and astounded at the lack of confidence really well-educated women in my generation have in their ability to make birth choices and decisions for themselves; and I was also a little sad that I didn’t have more answers for their questions. For me, it only highlighted the need for more conferences like this and more peer-education seminars and think tanks.
Michel Odent, Obstetrician, France
Helene Oord, Founder NGO Worldview Mission, Netherlands & Suriname
Tine Oudshoorn, Midwife, the Netherlands
Abide this; I think that the conference has been quite a success. Good atmosphere, much fun and many progressive people there from my working field. Hermine, you were able, with Dutch women, the birth movement GeboorteBeweging, to establish a new direction of sight. A new wind is blowing over the dykes. How beautiful, and thanks for all the joy and energy given.
When Hermine and Nicola first contacted me about this conference, I was overjoyed that I had found some other lawyers as excited as me about women’s rights in childbirth. Little did I know then that there were so many others across the world who shared our concerns. It was inspiring to meet all those committed advocates for women’s rights at the conference. Whatever our professional backgrounds, we all shared a common goal to illuminate and advance an area of women’s rights that has been too long neglected.
It is during pregnancy and childbirth that many women encounter their first serious threat to their physical autonomy. In the twentieth century, this threat came from a paternalistic medical profession that sought to protect women from themselves. In the twenty-first century, the threat is a bureaucratic one. Women are the playthings of risk management policies that stifle both their autonomy and the clinical judgment of their caregivers. Human rights law provides one solution to this homogenisation: it demands that each women is treated as an individual and that she is an active participant in every decision about her care. This can be achieved through legal actions, such as the ground-breaking Ternovszky case, through cultural permeation of the maternity system and by representing those midwives all over the world facing punitive sanctions for facilitating women’s choice. There is no doubt that lawyers have an important part to play in changing childbirth.
Inspired by the enthusiasm and commitment of the conference participants, I am establishing a new legal advocacy organisation in the UK called Birthrights. It will launch in the Autumn providing women and caregivers with legal advice and lobbying policy-makers on childbirth rights. I am looking forward to the next Human Rights in Childbirth Conference when I hope we will be able to report progress in making rights a reality.
Rachel Verweij, Chairperson for Vereniging ‘het OuderSchap’, Dutch organization for parents (to be), Netherlands.
Roanna Rosewood, author of Cut, Stapled and Mended: A Do it Yourself Birth, and HBA2C mother , USA
Nicholas Rubashkin, Obstetrician-gynecologist, San Francisco, CA, U.S.A.
Thank you all for the energy and inspiration.
- On June 29, I represent LABOR in a workshop on the topic of Childbirth as a Human Right at the US National Organization for Women (NOW)’s Annual Conference in Baltimore.
- This fall, we will bring the message to the next generation of women’s health physicians with a workshop at the Medical Students for Choice Annual Conference.
- I will contribute to the Bynkershoek’s Post-Conference Collection on Human Rights in Childbirth.
- I am participating in the international umbrella organized network of lawyers committed to women’s human rights in childbirth. I will be pleased to help shape that into an effective platform for legal work in this area on a global scale.
First of all I have to admit that being there with you in May was an amazing experience for me. There are two sides of this.As a LAWYER working on cases, legislation and standards that refer to giving birth I always used to look at the dark side. What can go wrong, how to help women who were denied proper services etc. The same about perinatal care. We argue that women have to have a right to decide about the way of reducing the pain and all. That of course has not changed, still I think there should be proper information, education and a right to decide. But what was outside my vision was what I got from you – an idea that it can just go so far away from all these complications and that I should also be dealing with a woman’s right to choose WHERE and HOW she wants to give birth. It is not very well develooped in Poland to give birth at home or at the birth center. It is so normal to have a doctor throughout the whole pregnancy and then at your birth. Now I see what are the other rights I should be fighting for. And guess what – I found allies
Secondly but not less importantly you gave me so much in terms of me being a WOMAN! I do not have children yet. To be honest with you I am a kind of girl who no longer that in March had this conversation with one of the doctros we work with how much I want to have a ceasarian on demeand, planned in advance you can imagine his face. I thought I was so afraid of pain that there was just no other option for me! And he actually kind of talked me out of it but I was still frightened. Until I came to the Hague. You have no idea how much it empowerde me. All I know is that I want to give birth naturally in a tub with a midwife, and I want a doula I am so not afraid of it anymore. All the stories, the pictures, movies and most importantly PEOPLE who I met – it all made me sure that my labour can be beautiful and amazing. And I really want to thank you for this.
It has been a while since the conference, I still share this experience with anyone who wants to listen. You made me open my eyes to the side of story I have not seen before or treated it with less attention it deserves. In Poland the notion “natural birth” and all is still considered as some kind of new trend for celebrities. But I know it is changing and I am really happy about that.
So thank you for this amazing experience. It will stay with me forever. And I really hope for some cooperation with wonderful lawyers I met in the Hague. And am looking forward to the next conference.