Informed choice, informed consent

A few weeks ago, at the Childbirth Rights on the Fringe event, I was fortunate enough to meet the very warm and articulate, Bashi Hazard. Among other actions she is working on at present, is a petition she has constructed to be presented to RANZCOG about women’s right to information in pregnancy and birth with which to be making informed decisions about our birthing and babies.

Bashi says:

Women of Australia,

In response to the “horror intervention rates” story published in the SMH a few weeks ago, RANZCOG issued a statement saying that women have never been better informed about their choices in pregnancy and birth.

Do you agree?  Did you know what to expect when you walked into that birthing suite for the first time?  Had your caregiver already discussed the pros and cons of every intervention, including risks, recovery times and impact on you and the baby before hand?

Did your doctor or hospital ever discuss their induction or caesarian rates?  Did you know you would be separated from your baby if you agreed to a caesarian?

It costs nothing and means everything when women are fully informed about their choices in pregnancy and birth.

If you agree, please join me in telling RANZCOG at https://women.good.do

My warmest regards,
Bashi Hazard, solicitor

You can like her work on Facebook.

You can sign the petition @ Informed choice, informed consent – for all the women of Australia

Thanks, Bashi!

Yes Means Yes

A long time ago, during what some people call First Wave Feminism, women argued that men were unrestrained animals, easily overcome by lusts and that women’s purity was what fitted us up to vote and be politicians in a way that beastly men could not. Motherhood was held up as a high honour, as evidence both of sexual purity being
sex resulting in offspring not for the purpose of satisfying lusts, and also because it showed that men trusted women to care for the most tender and malleable of all: our children. If women were trusted to raise future warriors, and mothers, it was argued, why were we not trusted with the vote? The alleged brutishness of men also meant that women must be on guard to exhibit only modest asexuality and not cause men to fall into the trap of their own
lusts which spurred them to rape. We were on notice to prevent ourselves being raped by being sufficiently chaste and unavailable. It was thus women’s fault, not men’s, when we were raped. And so it has continued into recent times, in large measure.

As noted by some feminists, women are treated as if we live in a permanent state of consent. The comparison between burglary and rape is sometimes made and shows up the double standards we hold around consent. Rape must be proven to have occurred. A homeowner notifying police is considered to be trustworthy enough to be believed that goods have been taken. They’re not asked about their charitable donations because if you’ll
just give stuff away, then how could you be robbed? They’re not quizzed about why they have windows and doors which obviously are just begging burglars to break in and remove stuff. A woman who has been raped must demonstrate the crime occurred in a way that no other victim of a crime is expected so to do.

For many years we have been exhorted to care for ourselves, be safe and avoid being raped, as if our behaviour makes this is possible. We have been told to not walk alone at night, to be careful what we wear because clearly a glimpse of knee causes some men’s attachment to legal behaviours to fly out the nearest window. We were once told husbands could not rape because marriage implied that state of perpetual consent. Feminists changed this only recently although I would suggest the remnants of these beliefs are alive and well and walking into a maternity hospital conveys a similar state of perpetual consent in the minds of many staff and consumers.
We still live in a victim blaming culture where women and children who are assaulted are overtly, and covertly, blamed for our own brutalisation. Birth activism, so woefully uninformed by the feminisms (just as feminisms are woefully frightened of embracing birth activisms), has now begun to face up to obstetric violence and this is
tremendous news. I believe that this is one profound way forward for the recognition of women’s bodily autonomy but it is a hard road because of the invisible layers of meaning contained within the bodies of birthing women.

Recently I saw a brief, and laudable of intent, blog post by a birth activist who was exhorting women to repeat “I do not consent.” in the face of threatened, or actual, obstetric violence. If you’ve been raped, you are probably aware that your words had no effect on your rapist or you wouldn’t have been raped. Most of us answer the threat
of rape with a clear, no thanks, after all. If you have been fortunate enough to avoid rape while physically fighting or talking to the rapist, then you know it was because the rapist decided not to rape you not because your words held magic powers. The same words would not work on every would be rapist and it was the decision of the rapist to cease, not the charm you uttered. Would Hermione avoid rape more easily than the rest of us?

I could name without difficulty many women I know who have uttered something similar to “I do not consent” in a birthing suite. I said, “Get out of my body.” to the obstetrician with her hand in my vagina. She didn’t. When a police chief in Toronto said women had to stop dressing in provocative ways in order to avoid rape, women worldwide answered with a cry of “Are you serious?!” and embarked on marches against sexual violence.

When we exhort women to say no, or curb their own behaviour, we tell women that rape is our fault and stopping it is our responsibility.

As I frequently write, birth culture is just a reflection of the wider culture in which women birth. The rights extended to women in birth can only be as great as the rights extended to us in the culture within which we birth. Equally, the degree to which women recognise the denial of their rights, can only be on a par with the degree to which women recognise their own worth. Women who are used to being paid less, sexually harassed, violated, passively
consuming body myths and products will not walk into a birth suite and suddenly go all Xena on hospital staff. That women be aware of their legal right of refusal is essential but when we tie to it the idea that this will prevent obstetric violence, we begin to tell women, again, that it is their own fault when assaults occur. Knowing burglary to be illegal does not prevent burglary, but may encourage victims to seek justice and not blame themselves for the actions of others.

The dominant discourse around birth is that only selfish women care about how their babies are born. Good mothers inhabit the normal space of perpetual feminine consent, allowing all hospital staff access to their bodies at all times regardless of their own feelings. Bad mothers are women who consider themselves to have a stake in birth, that their own health and wellbeing are important to themselves and their families, that they are capable of making decisions about their baby/ies, and who believe that birth is normal and thus preferable when performed by them, not that technological delivery systems be the default.* In reality, there is no good or bad mother, there are simply women, each deeply invested in the health and survival of her offspring. What is unequal is the quality of information and the degree to which obstetric disinformation has informed a
woman’s decision making process and the capacity of those who love her to provide support.

So if, as a society, we are committed to quelling violence against women, and we consider obstetric violence, what can we do?

Who really needs to hear the right of women to refuse interventions?
Those who perform the interventions.

Who needs to realise that no means no, however we dress, wherever we go?
Those who ignore the no.

Who needs to see the effect of obstetric violence years down the track when women are still unable to drive past the hospital where it occurred?
The people perpetrating the violence.

Who can stop obstetric violence?
Those performing it.

Obstetric violence, unlike most rapes, is carried out equally by men and women because obstetrics is a culture which affects men and women equally. It is not a form of male violence against women but it is a creation of, and reflection of, a wider culture of patriarchy in which most men are privileged above most women. It is, in many ways, an interesting reflection of kyriarchy where intersections of race, sex and class meet. But we cannot get away from the reality that 100% of those on the receiving end of its physical expression, are women in the process of pregnancy or birth and that is a striking fact.

So in case you’re wondering, here are my top ten tips for stopping obstetric violence:

1 Don’t touch pregnant or labouring women without an express invitation or without consent obtained in the absence of duress or coercion.

2 Don’t administer drugs or other interventions to pregnant or labouring women without an express invitation or consent obtained in the absence of duress or coercion.

3 Don’t ask the partners of pregnant or labouring women to aid you in administering drugs or other interventions without an express invitation or consent obtained from the woman in the absence of duress or coercion.

4 Don’t perform vaginal examinations or administer drugs or interventions to unconscious women without a prior express invitation or consent obtained in the absence of duress or coercion.

5 If you can’t stop yourself from acting without an express invitation or consent obtained in the absence of duress or coercion, ask a colleague to stay with you and alert others who can remove you from the room if you behave inappropriately and consider a change of employment.

6 Don’t administer artificial baby milk, dummies, drugs or tests to babies, touch babies or remove them from their mother, without an express invitation or consent obtained in the absence of duress or coercion from their parents.

7 Don’t attempt to coerce pregnant or labouring women and their partners by telling them things you know to be untrue, or with which you intend to manipulate them into consent. This is not consent.

8 Do act with integrity and love in every situation where you are faced with a pregnant or labouring woman just because it’s right.

9 Refuse to be a party to the administration of drugs and/or interventions when you can see that your colleague has attempted to gain consent via coercion or duress or when consent has not been sought at all.

10 Point out to women and to your colleagues when this occurs and report it to your supervisor or NUM.

If you have worked in maternity care and you feel traumatised by what you have participated in, and witnessed, I urge you to seek professional help. And I urge you to consider speaking up because women alone cannot end this violence. If you wish to apologise and take responsibility for your actions in maternity care, please know that
this would be welcomed by me and I would be honoured to support you and publish it on my blog. Someone has to start the process of reconciliation, why not you? When we treat others with scant regard for their humanity, we show ourselves to be equally disconnected from self and this is always a painful place for a person to find themselves. I wish you peace and love.

Women who have experienced obstetric violence are not a tiny minority of birthing women. We are a large portion of unrecognised survivors on whose bodies is written the politics of obstetrics and in whose suicides can be read the depths of the system’s failings. Every woman who finds herself in the space of being able to speak up, is providing
more than she can ever know for those around her, as yet unable to speak. May each of us do what we can to end this pandemic of modern violence against women, babies, families and communities.

What will you contribute this year?

*And we are tired of always having to add “unless it’s warranted” because frankly, duh. The notion that advocates of a normal physiological process are offended en masse and per se by technological support is a derailing tactic to draw attention away from the massive overuse and abuse of that technology on a population whose compliance has been manufactured and should be exposed as such.