WAKE UP Call....... Ina May Gaskin
We must wake up to the fact that it is easy to scare women about their bodies, especially in countries in which midwives have little or no power in policy-making, relative to physicians and the influence of large corporate entities. This takes no real talent. Given such imbalance, fear ignorance, and greed begin to reinforce each other, and rates of unnecessary intervention soar, with women and the babies suffering the consequences. Birth care must not be profit-driven.
This makes incentives to cause problems, not prevent them. For this reason, there should be no more fee-for-service payment – for instance, financial reward for the unnecessary use of a vacuum extractor.
If all countries put the welfare of mothers and babies at the centre of maternity care policy, midwifery would have to grow strong again. In some countries, such as my own (USA), it will be necessary to greatly increase the number of midwives as just one of the ways to prevent complications and to reduce rates of medical intervention in birth. We’ll need lots of doulas as we make this transition. Midwives need to have a say in the major issues surrounding birth.
In countries where they currently work under the intense domination of obstetricians, the work will be to bring the relationship back to one of balance. Midwives cannot allow obstetricians to bully them, because doing so is almost certain to mean that labouring women will be the next ones to be bullied.
Attempts to make home birth illegal in any country (happens in many European countries) will only distract from the real problems and exacerbate them, since planned home birth for healthy women provides a necessary safety valve for women who want a wider range of choice than their hospital might offer and a learning opportunity for midwives to learn about women in their natural state. Home birth midwives must be able to make a living from their work, and insurance companies should not be permitted to keep home birth midwives from being compensated for their work. Home birth midwives are being persecuted in almost every country, even in The Netherlands (see the results of Tuchtzaak Midwives, July 16 2013), where home birth services have a long and honourable tradition. I believe the development of a country can be measured by the degree to which it respects the right of a birthing mother to receive a woman centred birthing experience, whether the birth occurs in a home or hospital setting.
In this regard the current situation in Hungary greatly disturbs me. There, the failure to fully provide and protect this important right is highlighted by the prolonged discrimination and mistreatment of the independent midwife Dr. Agnes Gereb. Agnes has spent more than 20 years trying to defend the fundamental rights of mother and child and in doing this she has been imprisoned, recently received a further 2-year prison sentence and has been held under house arrest for the past year.
Birth shouldn’t be thought of as money-making commodity or condition in which large institutions or governments control and dictate how women will give birth, ignoring individual mother’s wishes and needs. Inevitably, this too often puts bullies in charge of women’s bodies, something no other mammalian species allows. Some countries have midwives who are totally subordinate to physicians. In these countries, it’s typical for very harsh methods of birth care to be applied, and outcomes show this. It’s time to stop this sort of behaviour.
Traditional people, indigenous people don’t permit such behaviour. We need to learn from them.
Ina May Gaskin, part of the speech by receiving the Right Livelihood Award 2011