Five years ago, when I was pregnant, I hired a very supportive doula to help me through my pregnancy and labour. She was Rebecca Schiller and I had no idea she would go on to write an important book called Why Human Rights In Childbirth Matter and become the director of the organisation Birthrights. So, I decided to have a chat with her about why she’s no longer a doula, but a campaigner for women’s rights in childbirth…
SH: I suspect that when most people hear the words "human rights", they think of something far away – an oppressive regime in a distant country, perhaps. But your book, though it does discuss childbirth everywhere, from Tanzania to Los Angeles to Aboriginal Australia, is very much about what happens to British women right here, right now. It takes something very personal, which you’ve experienced countless times, and makes it political.
RS: I had got into being a doula through a very simple desire to support women at a pretty transformational and often vulnerable time. I have a human-rights background (I did an MA in War Studies, with a focus on human rights, and I worked for Human Rights Watch), but I thought I was leaving that world behind when I became a doula. Then I found myself bearing witness to – and seeing the impact of – maternity care that was treating women as less than human: things being done to them without consent; women being shouted at in birth, their needs ignored. As someone with a human-rights background, I couldn't help but see these as rights issues. And there was only so much of it I could passively take as a doula before I needed to be more active in tackling the problem.
SH: I know that one phrase you heard again and again, working with labouring women, was “Am I allowed?”
RS: The “Am I allowed?” question comes up so much. Women would ask if they were allowed to eat, drink, go to the loo, wash, sit in certain places, make noises. There was a lot of asking for permission before doing anything. There's less of that at a homebirth I think – because women are in their own homes, so feel less like guests than they do in a hospital. But even then, the one that gets me every time is when women ask if they are allowed to touch their own vaginas to feel the baby coming out, or express surprise that they are allowed when they are encouraged to. It's really strange how we've become so disengaged from our own autonomy in birth that we can't believe we are allowed to put our own hands on our bodies and babies, but we aren't surprised when other people examine us internally – sometimes without asking.
The ‘Am I allowed?’ question comes up so much. Women in labour would ask if they were allowed to eat, drink, go to the loo, wash, sit in certain places, make noises
SH: It’s such a powerful thing – we really need to talk about this. As for the permission thing, people are always amazed when I tell them I went 18 days past my due date before agreeing to be induced. They always say the same thing: “But you’re not allowed!” As if there was a fixed legal deadline. I know the very real dangers of going too far overdue, but this idea of “not being allowed” is dangerous, too – it strips us of our own relationship with our bodies, which can then affect our relationship with our babies.
RS: Sadly, “You aren't allowed,” is said by maternity staff all too often in a birth context (eg you’re not allowed to use the pool, not allowed a homebirth or a caesarean). It shouldn't be used, but it is.
SH: Cathy Warwick CBE, chief executive of the Royal College of Midwives, has just said that your book “should become essential reading for all maternity professionals”. The great thing about putting childbirth in the context of human-rights law is that it takes our experiences – which can be so intimate and secret, known only to some women – and puts them on to the national stage. This makes the personal political.
RS: I think we've been much better – certainly in the developed world – at putting other reproductive rights (abortion, contraception, sexual consent) into the bigger picture. But, perhaps due to the feminist movement's reticence to really tackle childbirth, it's remained a rather undefended domestic issue. It's vital that birth rights are seen as part of that bigger women's rights project, but that also we don't politicise individual women's experiences in birth – there's too much of that as well.
SH: That’s interesting because when I first met you, you were very interested in homebirths, extended breastfeeding, drug-free labour and all the "natural" stuff. You’ve had two very successful homebirths yourself, but have you changed your mind about it all?
RS: Many women attach a lot of significance to the choices they make in pregnancy, birth and feeding. It's part of creating our identities as mothers. If things go well – and they did for me – it's understandable that we want to share that. So, when I discovered that lots of women were finding it hard to access homebirth and breastfeeding support services, I started to campaign around that. But I began to see that birth and parenting had become entirely dichotomised. If you promote homebirth, you alienate some people and are seen to be in opposition to medical intervention. I talk in the book about how this dichotomised presentation of the issues distracts us from a common theme.
SH: So, you get all these arguments about which is best – the natural way vs the medical way – and women end up picking a side in that fight, either to be a stinking homebirth hippy or some kind of medical junkie, drugging the baby. Your point is that that fight is distracting us from what really matters, which is how women are treated at what is possibly the most vulnerable time of our lives.
RS: I decided that the human-rights-based approach of advocating for women, rather than for a particular kind of birth, was more powerful. Putting individuals at the centre of their care should mean more people get what they want and need – whether that's a homebirth or a caesarean. Campaigning in this way has meant Birthrights, the charity I co-founded, has found lots of allies across the reproductive rights and birth world. We're bringing people and organisations together who are only just realising that we're all fighting the same fight. Women aren't trusted, the system often doesn't respect them, they face barriers whether they want an epidural OR a water birth. The standard hospital experience can really impact negatively on their sense of self, feelings of strength as a mother and how they feel about their baby. Twenty-four per cent of women we surveyed said they didn't feel they'd consented to the instrumental (forceps or ventouse) procedure they had. So, that's a pretty big deal.
After nine months of intensively planning the most natural childbirth possible, the epidural was probably the best moment of my life
SH: It’s a huge deal. Personally, I planned an entirely natural homebirth, with your help, and ended up getting the absolute opposite for various reasons. But I also knew that when I was in the hospital with you by my side and I asked for an epidural, you’d help me get one, even though they kept fobbing me off, saying that the person who could sign it off was on his lunchbreak etc. I was in such deep distress by that point. (And can I just say here that, after nine months of intensively planning the most natural childbirth possible, the epidural was probably the best moment of my life. Which came as a great shock to me – it went against everything I believed in.)
RS: Yes, as your experience highlights, the other problem with polarising things is that women can feel awful – like failures – if plan a goes wrong. It can also mean that if things go off course, it's assumed this is going to be a bad experience. The idea of foregrounding respectful care is that it transcends the nitty-gritty of how the baby comes out. It's about people looking after you, making sure you are treated with dignity, whatever takes place.
SH: To end on a positive note, can you mention the success you’ve recently been having with Birthrights?
RS: Birthrights is working in a number of ways, from advising women directly on legal issues to providing training to NHS Trusts on these issues and getting involved in strategic legal cases. The policy tide is definitely turning. We wrote to the recent review of maternity service in England to advocate that "respectful care is safe care". The report of that review had a vision that stated "personalised care is safe care". The message is getting through! And our training is in real demand.
SH: Thank you.
Why Human Rights In Childbirth Matter by Rebecca Schiller, Pinter & Martin £6.99
Join Birthrights, the human-rights-in-childbirth charity, and help start a new chapter for childbirth by hosting a bookclub in October. For more details, visit the Birthrights website.