The Rights of Childbearing Women

I always talk about how important it is to educate yourself about your options and your rights. This will hopefully clarify what those rights and some options are. I ran across this blog by Doula Momma that lists 20 rights of childbearing women.

This article originally appeared on The Childbirth Connection. Please refer to their article for a list of resources and if you want more information.

"The Rights of Childbearing Women
This statement outlines a set of basic maternity rights that Childbirth Connection has identified and promotes for all childbearing women. It applies widely accepted human rights to the specific situation of maternity care. Although most of these rights are granted to women in the United States by law, many women do not have knowledge of their maternity rights.

Fundamental Problems with Maternity Care in the United States
This statement was developed in response to serious and continuing problems with maternity care in the United States, including:

• The United States is the only wealthy industrialized nation that does not guarantee access to essential health care for all pregnant women and infants. Many women, especially those with low incomes, lack access to adequate maternity care.
• A large body of scientific research shows that many widely used maternity care practices that involve risk and discomfort are of no benefit to low-risk women and infants. On the other hand, some practices that clearly offer important benefits are not widely available in U.S. hospitals.
• Many women do not receive adequate information about benefits and risks of specific procedures, drugs, tests, and treatments, or about alternatives.
• Childbearing women frequently are not aware of their legal right to make health care choices on behalf of themselves and their babies, and do not exercise this right.
  

We must ensure that all childbearing women have access to information and care that is based on the best scientific evidence now available, and that they understand and have opportunities to exercise their right to make health care decisions. Women whose rights are violated need access to legal or other recourse to address their grievances.

The Rights of Childbearing Women
* At this time in the United States, childbearing women are legally entitled to those rights.
** The legal system would probably uphold those rights.

1. Every woman has the right to health care before, during and after pregnancy and childbirth.
2. Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks.* Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.
3. Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all.
4. Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.*
5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care.* (Only second sentence is a legal right.)
6. Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.*
7. Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.*
8. Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby.** She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health.
9. Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.* She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.
10. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.* (Please note that this established legal right has been challenged in a number of recent cases.)
11. Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.*
12. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.*
13. Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.*
14. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.**
15. Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.**
16. Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.*
17. Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.*
18. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.**
19. Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.**
20. Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.**
    

1999, 2006 Childbirth Connection

Differences Between Physician and Midwife - My Personal Reflections

I'm 30 weeks along in my pregnancy and doing well. This is my fifth baby, but it is a new experience for me because I am planning my first home birth and working with a midwife for the first time.

I had a prenatal checkup yesterday, and with each visit I am increasingly amazed at the difference in care I'm receiving from my midwife compared to what I've experienced with my obstetrician. At each prenatal visit, my midwife does the urinalysis, checks my blood pressure, weight, measurement, baby's heart rate, etc. She does all of the clinical things that my obstetrician (or his nurse) would do at a prenatal checkup. But she does much more than that.

Visits with my obstetrician generally lasted no longer than 10-15 minutes at the most. The majority of the visit was used for the clinical work I mentioned above, with a few minutes to talk with the doctor. My midwife reserves about an hour for each appointment. Very little of that is taken up by clinical procedures. The majority of the visit is spent talking. There is so much that a pregnant woman goes through. From my personal experience, I feel that the obstetric approach addresses mainly the physical changes in an expectant mother, and the midwifery approach looks at the woman as a whole and tries to address all concerns; including physical, emotional and mental.

My midwife asks questions that I don't remember my physician ever asking (in 4 previous pregnancies). She asks me about my diet, what I had for breakfast, lunch, and dinner the past day. She asks about my family, how my husband and kids are doing and how we are getting along. She gives me nutritional advice to help with my concerns about iron levels, getting enough good nutrition to help me feel better and have more energy. I feel that my midwife really cares about me personally, and that deep sense of care is reflected in the way she talks with me and conducts each prenatal visit.

I have a good obstetrician. He has always taken care of me, answered my questions and addressed all of my clinical needs. I've never had a complaint about him. The difference in care with my midwife is more emotionally fulfilling for me. I can talk with my midwife about anything, but when I go to a physician I tend to keep the questions on a purely clinical or medical level. I also have the comfort of knowing I can call my midwife at any time, with any concern, and she will answer the phone and answer all of my questions.

I'll put it in a nutshell: with my midwife I know that all of my clinical and medical needs are being taken care of as they would be with a physician, but I also have the added security of feeling emotionally and mentally supported as well.

My midwife only attends home births as a midwife. She has 15 years of experience as a direct entry midwife. She is also a doula and attends hospital births in that role, so she is familiar with all different birth settings. I am comfortable with her because I know that her views on childbirth match my own, and I feel completely supported in my plans for a home birth. Our prenatal visits are in her home, which is beautiful and comfortable.

Midwives differ according to their certification, training, office set-up and more. Certified Nurse Midwives only attend hospital births and most often work under the supervision of a physician in an office. In general, CNM's are more clinically focused and may not be able to schedule a long appointment for open discussion, depending on the office procedures and how busy they are. If you are looking for a prenatal care provider, please see my earlier post: Choosing a Prenatal Caregiver: Doctor or Midwife? Please also consider putting together a list of questions and concerns to use in interviewing caregivers and considering your options.

Key Questions About Your Care

Key Questions About Your Care

by Penny Simkin, PT, CD (DONA)

Answers to the following questions will help you participate in your care responsibly and help you know what to expect.

When A Test is Suggested:

1. What is the reason for it? What problem are we looking for?
2. What will it tell us? How accurate or reliable are the results?
3. If the test detects a problem, what will happen next?
4. If the test does not detect a problem, what will happen next?
   

When A Treatment of Intervention is Suggested:

1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
2. Describe the treatment. How is it done? How likely is it to detect or solve the problem?
3. If it does not succeed, what are the next steps?
4. Are there risks or side-effects to the treatment?
5. Are there any alternatives (including waiting or doing nothing?)
6. Ask questions 2, 3, and 4 about any alternatives.

In an emergency it may be impossible to fully explore these questions. Your caregiver should tell you how serious and urgent a situation is.

Mothering Magazine Interviews Ricki Lake about The Business of Being Born

I've blogged about this film many times before, but I just have to keep mentioning it, because I think it is so wonderful and informative about childbirth! I was browsing The Business of Being Born website this morning and found that Mothering Magazine interviewed Ricki Lake about the film and her upcoming book, co-written with Abby Epstein. The interview was recorded and is available to listen to on the Mothering Magazine website. It's a wonderful interview, and I was touched by Ricki's passion. I feel the same passion for pregnancy and childbirth, and I applaud Ricki and Abby for the amazing work they are doing to inform the public about childbirth options. Please take a few minutes to listen to the interview, and if you have not seen the documentary film yet, I urge you to get a copy of it and watch it. It could change your life!

Epidural: Procedure, Benefits, and Potential Risks

The most common form of pain medication used in childbirth in the United States is the epidural block. Despite its widespread use, I strongly feel that the majority of pregnant women in the United States are not properly educated about the use of an epidural block. Here is some information that every woman should consider when deciding whether or not she will choose an epidural in labor.

How an epidural is done:

• The drugs used in an epidural are usually a combination of an anesthetic (like bupivacaine) and a narcotic or opioid (like fentanyl). Dosage depends on the anesthesiologist performing the epidural.
  
• The mother must have an IV line to ensure adequate fluids.
• Constant monitoring of the mother's blood pressure and baby's heart rate is needed.
  
• The mother is placed on her side or sits up and leans forward to receive the epidural.
• The anesthesiologist cleans the lower back area.
• A local anesthetic is given and then a hollow epidural needle is inserted between two vertebrae into the epidural space, just before the membrane that covers the spinal cord.
• The mother usually feels pressure.
• A test dose of the medication is usually given to ensure proper placement and effectiveness of the epidural.
  
• A thin, plastic tube called an epidural catheter is threaded through the hollow needle into the epidural space and the needle is removed.
• The catheter is taped to the mother's back.
• Generally each contraction will get easier, and the mother will begin to feel pain relief in about 10 to 20 minutes. Her legs may feel warm or tingly and may feel heavy.
• The lighter the epidural dose, the more control the woman will have to move her legs and the easier it will be to change positions.

Advantages to using an epidural:

• Allows the mother to stay alert throughout labor and delivery.
• The baby is less medicated compared to if an IV narcotic is used.
• The mother can rest during a long labor.
• Can provide pain relief, particularly when labor is induced with pitocin.

Potential side-effects of an epidural:

• The woman's ability to move around or change positions may be limited. She is generally restricted to the bed.
  
• The medication may cause an erratic fetal heart rate. Local anesthetics cross through the placenta.
• Drugs can cause various degrees of maternal, fetal, and neonatal toxicity.
• May slow down labor (particularly if given before 4-5 cm dilation).
• May increase the possibility for use of pitocin.
• May make it hard for the mother to push the baby down. Some women don't feel the urge to push at all when they have an epidural. This is generally related to how strong the epidural is.
• May increase the likelihood of the use of forceps or vacuum extraction.
• May cause a fever in the mother when used for long hours.
• May make it more likely the newborn will be screened and treated for infection.
• Some mothers experience nausea, vomiting or itching when epidural narcotics are used.
• May cause short-term urinary incontinence, and a bladder catheter may be inserted into the mother. A full bladder will generally slow the progress of labor.
  
• Delayed fetal rotation and descent.
  
• Spinal headache if the epidural needle goes in too far (if it punctures the spinal space). This is usually a severe, debilitating headache that can last for a couple of weeks. A blood patch can be done to help repair the damage and alleviate the headache.
• Postpartum backache.
• Possible long-term paralysis. This is more rare than other side effects, but it can happen. I have a friend who experienced a numb spot in her leg for several months after having the epidural.
  

Click here to see photos of the epidural procedure by Patti Ramos

This information was paraphrased and compiled from An Epidural for Pain Relief: Making an Informed Choice by Nicette Jukelevics, MA, ICCE and Pregnancy, Childbirth and the Newborn by Penny Simkin, PT, CD(DONA). For more in-depth information about the risks and benefits of epidurals, please also see The Thinking Woman's Guide to a Better Birth by Henci Goer.

Excellent Comprehensive Information on Pregnancy and Childbirth Care and Options

I found an incredibly informative article through another blog the other day, and I took the time to read it completely before passing it on to my readers. It's an article written by Marsden Wagner, M.D. and posted online just last month. I've seen Dr. Wagner on some of the films I've watched about childbirth, and I'm sure I've read excerpts from his books in the various works I've read on the subject. The article is entitled "Natural Birthing Options: Technology in Birth- First Do No Harm" and it's an excellent read! It's long, but gives a concise summary of the medical childbirth system that currently exists in the United States today, and the risks and benefits attributed to it. He also gives advice on what expectant parents should do to ensure they get the right information and what to do about it.

Every expecting woman should read this article. It's much shorter than any book on the subject, and gives great information. If you are interested in reading more than an online article, please check my list of Recommended Reading on the right side of this page. One book in particular that I found to be informative is Henci Goer's Thinking Woman's Guide to a Better Birth.

If you are a more visual person, I would recommend watching the documentary film, The Business of Being Born by Ricki Lake and Abby Epstein. I was able to check the DVD out from my local library, but you can also purchase a copy of the film from their online store. It's an excellent documentary that discusses the maternity care system in the United States and the effectiveness of it.

I believe that all women should be informed and know what their options are and what the risks and benefits are for all of those options. We need to make informed decisions rather than simply go along with what someone tells us is best. Empower yourself!

Here is a link to Dr. Wagner's website