Why human rights in childbirth matter

“My mother had a positive and very medicalised birth which is exactly what she wanted.” But doula and reproductive rights campaigner Rebecca Schiller decided on a homebirth. This opened her eyes to the importance of choice when it comes to childbirth…

Rebecca Schiller, 34, lives in Ramsgate with her filmmaker husband Jared and two children: Sofya, six, and Arthur, three.

“I started working as a doula six years ago. When I went on maternity leave during my first pregnancy I had my dream job at Human Rights Watch but after having a doula, a positive birth and getting really interested in childbirth I suddenly felt vocational about supporting other women at such a time of transformation, strength and vulnerability.

I watched friends having a very different experience from me and saw how little support so many women have in an era where they often haven’t held a baby until they hold their own. That made me feel strongly about doing something to fill that gap.

I’m from a medical family – my mother’s a radiographer and my father’s a doctor. My mother had a positive and very medicalised birth which is exactly what she wanted. So it was a huge surprise to them (and to me) when I became interested in having a homebirth. I’m not a fan of needles and the thought of examinations and anaesthetics freaked me out so I decided to stay at home if I could.

I hired a doula and booked in with my local homebirth team. I went into labour a few weeks early, my labour progressed quickly and within eight hours my daughter was born – just before 7am and only 40 mins after the midwives arrived. It was a really empowering experience. My husband was a great support and though it wasn’t pain-free there wasn’t any point where I felt I couldn’t cope.

With my son’s birth nearly four years later I knew a lot more and had been to a lot more births, which I think actually made me less relaxed. I had moved house and my local hospital didn’t have a homebirth team so I hired an independent midwife. Bang on his due date my son came hurtling into the world in an incredibly intense 40-minute labour.

Our lovely midwife arrived 30 minutes later so it was just my husband and I. I definitely preferred the eight-hour version – there was far too much happening in that 40 mins for me to stay calm and in control. But shortly after I was tucked up in bed, eating a sausage sandwich and looking out at the sea so even though it was a bit quick it was still a lovely experience.

On the father’s role in childbirth…

I think it depends on the couple’s relationship, the father or partner’s personality and how those around the couple help him to support her. I’ve worked with couples where the support from the partner was very practical and others where their partners have been incredibly intuitive and tactile.

For me, as a doula, I’ve always tried to give partners the space to be the main birth partner while also acknowledging this is something they haven’t done before and are emotionally caught up in. It’s a lot to expect of a partner to be a brilliant birth companion when they’ve never been to a birth before a may well feel afraid.

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Becoming a reproductive rights campaigner

My doula work really prompted me to become a campaigner. It made me see how profoundly birth could impact on women. When they were treated with respect and dignity it could strengthen them, but when birth caused trauma and damage it could make them feel negatively about themselves, their babies and their families. I also saw the wide variety in maternity care, the rights issues in the system and the strain that midwives and doctors were under in a stretched service.

Sadly I don’t get to do as much doulaing as I used to. It’s hard to be ‘on call’ for a month at a time alongside my Birthrights’ commitments (as chief executive). But I still get to support friends and repeat clients which is wonderful. There’s nothing like being there with someone for the birth of both of their children.

Maternity services

We need to ensure that maternity services are really equipped to meet the needs of individuals rather than expecting women to fit themselves into an inflexible system. At the moment women often find that policy and protocol (and sometimes the directions of Trust lawyers) dictate what they can and can’t do.

In some areas, homebirth services have been suspended despite a policy push to increase out of hospital birth. In others, a focus on driving down caesarean rates means women who’ve had a previously traumatic birth are being denied a caesarean section in their next pregnancy. Women often can’t win whatever they choose.

We need to see these as systemic and cultural issues that impact on all women regardless of the choices they wish to make. This isn’t about one kind of birth over another but us all working together to design a system that respects the women at the centre of it, provides them with support and evidence-based information and ultimately trusts them to make the right decision for them and their families.

For particularly vulnerable women – such as those at the lowest end of the socio-economic spectrum – hard outcomes like the maternal mortality and stillbirth rates are much worse. That’s another area where the human rights approach can help and highlight health inequalities that need tackling.

Maternal health in developing countries

Maternal health is a very complex issue. In somewhere like Tanzania, for example, rural women will face very different issues from those in the city. But talking to maternal health activists who work around the world it’s very clear that culturally sensitive, respectful care is a huge part of the solution. You can build a very shiny hospital but if women know they will be treated badly there they won’t come.

On my trip to Tanzania earlier this year midwives, doctors, village elders and new mothers all explained that involving men in the work and making it part of a broader sexual health and reproductive rights project was essential. If a woman’s husband doesn’t allow her to attend antenatal clinic or isn’t happy to pay for her to travel to the hospital during labour that’s a huge stumbling block.

Birth has for too long been a rather dusty, forgotten corner in the reproductive rights world. The feminist project has struggled with how to deal with it and contemporary discussions about birth are so often polarised – some are in the ‘natural’ birth camp while others consider themselves advocates of safety.

Writing Why Human Rights in Childbirth Matter

I wanted to write something that elevated birth rights to the same level as other reproductive rights and demonstrated how leaving them undefended could be dangerous for the women’s rights movement. I was keen to create a narrative around birth that everyone could get behind, that wouldn’t polarise and that shone the spotlight on the individual women at the heart of birth around the world. Something that demonstrates that respectful care is integral to safety and that choice and safety aren’t in opposition.

I’ve been delighted with the reception to my book Why Human Rights in Childbirth Matter. Most of all I was thrilled to have Cathy Warwick (the CEO of the Royal College of Midwives) give it a resounding endorsement. She said:

“High quality maternity care means putting individual women and their needs at the centre of everything we do. That is not always as easy as it sounds. However this book shows how powerful a human rights framework  can be as we transform the delivery of maternity care and try to negotiate ‘the sticky corners…’.  I believe this book should become essential reading  for all maternity professionals.”

On combining motherhood and a career

It’s a juggle! I’d love to say I’ve cracked it and glide through work and family life in a state of zen and efficiency but honestly it’s a bit of a scramble. My husband and I both work from home most of the time which means we can be flexible. He approaches parenting and home-life with total equality which I think is very rare. So we both spend some time in the week taking it in turns to look after our youngest, collect him from the three and a half days childcare he does have and share the school run/cooking/household tasks.

I do find it hard to switch off from work but am making a real effort to be more disciplined with my iPhone use. I can’t pretend it’s not stressful at times – and it would be much easier in some ways to have a more predictable and traditional job (and full time childcare) but I feel very lucky to be able to spend so much time with my family and somehow shoe-horn the work in.

In an ideal world, birth would look exactly like each woman’s vision of it. She would see the same caregivers who would support her no matter what and if plans needed to change she would be at the centre of that decision. For women like me an ideal birth is a hands-off homebirth, for others a calm epidural birth and for some a caesarean. But for all women kindness, someone to listen and someone to trust in who also trusts them is key.”

Why Human Rights in Childbirth Matter by Rebecca Schiller, Pinter & Martin £6.99

Visit the Birthrights website, follow Birthrights on Twitter: @birthrightsorg and follow Rebecca Schiller: @hackneydoula

Photo credit: main image by Gabrielle Hall. Tanzania images are by Joseph Were, courtesy of Amref Health Africa.