Editor's Note: This is written by guest author Jennifer Williams, CNM, a nurse-midwife who attends hospital births in Albuquerque, NM.
Shock waves raced through the birth world recently when Caroline Malatesta won a $16 million lawsuit against Brookwood Baptist Medical Center in Birmingham, Alabama. When Ms. Malatesta was pregnant with her fourth child, she sought a more natural birth experience by changing obstetricians and hospitals, believing marketing that promised low-intervention births at Brookwood. Unfortunately, when she arrived at the hospital in labor, she lost her autonomy. She was restrained during her labor, and ultimately her nurse held her baby’s head in for six minutes until the physician arrived, causing permanent pelvic nerve damage.
Ms. Malatesta had her day in court and was vindicated and awarded compensation, but her story is really just the beginning.
A California woman named Kimberly Turbin tried to birth her baby without forced intervention as well, but over her objections, her physician cut an episiotomy without her consent. She is also going to court. This situation likely plays out weekly across our nation. This time it was different: because it was recorded on video.
Lots of birth professionals have shared their opinions about the birth trauma events in Alabama and California, and the most common theme is “Was the baby in trouble?” In other words, was there a problem with the birth that required the woman to give her up personal autonomy in order to facilitate a safe birth for the baby? Would fetal distress somehow excuse the behavior of the nurses or physician in question?
This brings us to the most important question of all. At what point is it okay for a pregnant woman’s autonomy to be taken from her?
And yes, this is a huge question, one that crosses gestational ages, and one that politicians are gleefully weighing in on. Who decides?
Autonomy in healthcare is one of the ethical principles we are all supposed to follow. Autonomy is so respected, that people who follow the faith of Jehovah’s Witnesses sign refusals for blood transfusions, and their wishes are honored even if it results in their potentially preventable death.
Unless you are pregnant.
I worked with an obstetrician years ago. He was a very smart man, a skilled doctor and a very good person to have standing between you and death. He told me a story about ordering blood for a hemorrhaging pregnant woman who was a Jehovah’s Witness. I asked him if she had signed a refusal. He said, “Yes, but I decided to give blood anyway. She can sue me later if she wants, but at least she is alive to do so.”
What is it about pregnancy and birth that allows women’s autonomy to be stripped away? I believe it is our cultural view of mother as martyr. Mothers should be willing to die to save their children, people say. Mothers should give up everything for their children, people say.
I’m a mother. I would die for my children and I would give everything up for my children, but you know what? It needs to be my decision, and no one else’s.
I believe this view of “mother as martyr” is the driving force behind women losing their autonomy. The woman is sometimes seen as a vessel, and if she gives up her autonomy to birth in a way that makes sense to her healthcare professionals and the baby is fine, then that is a price some healthcare professionals are willing to pay.
Except that is not good enough.
I tell pregnant women that the most important thing for a healthy, happy baby is a healthy, happy mother, and this is true in every way, from mental health to nutrition to physical health.
Nurses, doctors and midwives have to filter through a lot of issues, including hospital policy, evidence-based care, ever present worry about malpractice suits, and most importantly, a desire to send home a healthy mother and baby.
The woman is the lighthouse that shines through all of those issues. We always need to hold her autonomy as the center of everything we do. I read the description of the birth Ms. Malatesta desired and the birth she got and my heart broke. I would have loved to attend her birth. As for the doctor in California, I can’t remember the last episiotomy I cut, and I would never cut one without a woman’s consent.
And, yes, I've seen it all. I know birth work presents many hard challenges. But if healthcare providers consider autonomy to be optional, then we are truly taking away a woman's right to be a free and independent human being. It's not optional, folks.
Midwives have a saying: Trust Women. I think that is an excellent strategy.