Why does pregnancy and birth often mean the loss of autonomy and free choice for women?
At no other stage in life have I been encouraged to have a flu jab with quite the demented intensity as in the last four months. I've always qualified for one, and never had one, and nobody has ever cared until NOW. Now, I know the risks of flu in pregnancy, and I know how little difference the flu jab makes to anything, so on balance I prefer not to put anything in my body I haven't had in there before (please don't confuse this with some sort of raging anti-vaccination stance - I don't react well to any vaccination and prefer not to have them if it's not strictly necessary).
I've also been told I WILL HAVE the whooping cough vaccination at 28 weeks. Again, I understand the rationale, actually completely agree with it, and will happily have it. But I've not been asked to consent. I've not even been told that dissent is an option.
I've been told I MUST have a GTT (glucose tolerance test, a blood test for diabetes) at 28 weeks on account of being fat and having had a big baby. Now, my 'big baby' was actually spot on in weight for my height and ethnicity, according to the hospital's own growth chart system. I've also had a majorly underweight baby. I've never had diabetes in my life, and certainly not in pregnancy, and yet I have been told to go to the hospital and have this test (which takes two hours) and have never been given the opportunity to dissent, or had it explained that it is a choice.
Then you have the large number of people, including politicians, who believe smoking and drinking in pregnancy should be illegalised. Now, it is perfectly legal to actually kill your baby before 24 weeks of pregnancy, if you want to, provided you go through the proper channels. How can you decide, in law, that a baby has no rights to life before 24 weeks, but definitely has the right to not to be poisoned? It's a totally flawed argument, with extremely limited evidence. As it is, you're told to stop drinking and smoking the second you find out you're pregnant. Now, this has never been a problem for me - I don't smoke, and I don't drink if I suspect I'm pregnant - but it's a big problem for a lot of other women, particularly smokers.
Every single woman in England, if not the entire UK, has the right to ask for, and be permitted a homebirth except in high risk circumstances. Yet, I know many women who are never told it's even an option where they live. Presumably this is why homebirth rates are so low. I want a homebirth, and will blog about the whys and wherefores later on in pregnancy, but I've already had to see a consultant to be 'approved' for one, based on a one-off situation that's unlikely to be repeated. There is a strong sense among obstetricians that homebirths are inherently risky, as opposed to the safety of a hospital birth, ignoring the simple truth that BIRTH is a risky business, and yet women have been doing it to varying degrees of success since we evolved into bipeds.
Much is made of choices around labour. My maternity notes have a whole page in which to discuss my birth plan, and explain on what I would like to happen. Dear reader, I will totally ignore that page, because I know full well that the second something in my labour changes, that plan will get lobbed out the window. I strongly advise you to do the same. Birth choices are only acknowledged and acted upon until something changes. That can be as simple as not having a waterbirth because the waterbirth room is already occupied, to labouring far too fast to have a chance to light the myriad candles and incense, to needing an emergency caesarean. And women are not really made aware beforehand that the time and effort they put into organising their birth choices and preferences in their head, and in their notes, is wasted the second something goes slightly awry. This in itself can lead to angst and unhappiness postnatally.
Women's choice in labour is removed entirely if a risk is detected. Few women are ever given what would normally be called 'informed choice' prior to an emergency caesarean, on the basis that there simply isn't time. This can be accepted, if the baby or woman is dying. However, often women aren't given informed choice when there is no immediate risk to life. I've discussed how induction is rarely explained as an option rather than an inevitability. I was told when I was overdue with my last baby that it was up to the consultant whether I could decline an induction. Er no, it's definitely up to me!
The same can happen with episiotomy, although less so than in the days (1950s-1980s) when episiotomy was done as standard, and one woman was CUT AFTER DELIVERY so the midwife wouldn't get into trouble for not doing it during the birth.
Too often, in the chaos of the delivery room and the fear of perinatal death, the birthing woman is not told what is happening, what has gone wrong, and what needs to happen next.
I don't understand why women's choice is so heavily curtailed in pregnancy and birth. Are we really to be thought of as silly children, who are incapable of understanding risk? Who would put our own prejudices above the health of our babies? Are we thought of as not able to understand the rationale and say no, regardless of what current NICE guidelines are? I mean, it's not like consultants follow the NICE guidelines about perinatal care half the time anyway. Perhaps the real problem is that midwives and consultants simply don't have the TIME to properly explain the reasons for certain tests and advice.
The only real choice I feel I've been given so far is whether or not to have the sexual health blood screening for HIV and syphillis, and whether or not to have the NT scan. Everything else has been done to me.
It's a strange feeling, to feel as though your body is not really your own anymore, simply because there's another person in it.
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