It's a woman's right to choose how she births by Monica Dux

It's a woman's right to choose how she births
by Monica Dux
The Age, July 16, 2009

Changes that will effectively outlaw supported home births are paternalistic.

IN FIVE months' time, if my pregnancy progresses without complication, I will birth my second child at home, attended by two registered private midwives. If I'd become pregnant a mere six months later, this carefully researched, intensely personal decision would have been far more tenuous.

From the middle of next year, if the draft legislation establishing a new national registration scheme for health professionals becomes law, midwives will be required to hold indemnity insurance and midwives in private practice — those who typically attend home births — will be unable to access this insurance. This means that, with the exception a few small home-birth support programs run out of public hospitals, home birthing will effectively be outlawed.

In a recent interview on Radio National's Life Matters, Dr Hilary Joyce, the new president of the National Association of Specialist Obstetricians and Gynaecologists, dismissed the significance of this ban by pointing out that only a small percentage of women in Australia choose to give birth at home. And yet, she complained, the issue is given a disproportionate voice in the media.

The assumption underlying her argument — that minority rights are unimportant and can be casually overridden — is both offensive and antithetical to the fundamental values of a liberal society. But Joyce's emphasis on the small number of women directly affected by the legislation also obscures a deeper problem. It is not only the rights of the minority who undertake home birth that are at stake here. This is an issue that impacts on all women.

In the past century we have seen a profound shift in the status of women, from being virtual chattels owned by husbands or fathers, to the attainment of full citizenship and (supposedly) equal rights with men. This hard-won legislative and cultural change has allowed women greater freedoms, but it has also given rise to an expectation of physical dignity, and of ownership over our own bodies, as epitomised in liberal abortion provisions and stricter sexual assault laws.

The legislative squeezing-out of home birth represents a serious regression in this reform process. Given that the new laws will effectively make private midwife-assisted home birth illegal, the Federal Government is acting to deprive most women of the ability to make a fundamental choice about their own bodies; the choice to birth in a non-medicalised environment.

Birthing is an extremely intimate, uniquely visceral, sometimes terrifying physical experience. There is much that will inevitably be out of a woman's control during her confinement, so allowing her to birth in the place in which she is most comfortable is fundamental to maintaining both her personal dignity and her sense of ownership over the experience.

Just as adequate abortion rights are important for all women, not just those with unwanted pregnancies, so the fundamental right to birth in the way one chooses is an issue for us all. In this respect the proposed legislation is a setback for all women, not just those who would take up the option of a home birth if it was offered to them.

If we truly live in a society where women are granted ownership of their own bodies, and if home births, properly supported, are a safe option, then why shouldn't women have the right to choose that option?

Many assume that this is the crux of the matter; that home births are simply unsafe. But the facts suggest otherwise. International studies, and experience in countries such as the Netherlands and Britain, have conclusively demonstrated that for uncomplicated pregnancies, home births carried out with proper support are just as safe as hospital births. At a time when our public hospitals are in the grip of a very real crisis the decision to give birth at home, with proper support and preparation, seems not just reasonable but prudent.

Yet, all too often, those who favour home birth are presented as a fringe group of maternal kooks, the sort of women who recklessly put ideology before health and safety. Of course, there is a long tradition of dismissing troublesome, non-compliant women as kooky, and of deriding their views as irrational or even childish; a tradition that is implicitly continued in the proposed scheme.

Such a paternalistic provision, effectively telling women what is and isn't good for them, cuts to the heart of women's collective dignity and autonomy. While women were once routinely patronised in this way, the contemporary assumption is that those bad old days are behind us.

Sadly, this does not appear to be the case when it comes to birthing.

Monica Dux is co-author of The Great Feminist Denial, published by Melbourne University Press.