If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.
Dr Michel Odent
Why the need for this Campaign?
According to Human Rights in Childbirth, the WHO and the principles of evidence-based care, families should have freedom of choice to access autonomous (not subservient to doctors) midwifery care in pregnancy and birth from traditionally trained (according to international standards) midwives as this leads to improved outcomes and satisfaction. In fact, healthy low-risk expectant parents have better outcomes and satisfaction under the continuity midwifery-led model of care. Currently in Luxembourg, this is not the case as only the medical model of care is in practice so even healthy pregnant women see highly skilled surgeons (obstetricians) as their primary carers due to the lack of choice. This leads to an abundance of unneeded medical interventions carrying further short and long-term health and mental risks. This is sad because in developing countries there is a great need for obstetricians and it is usually "too little too late", whilst here in developed countries we experience "too much too soon".
To show our solidarity and deep appreciation towards the true role of midwives and to shed light on the inequality between the Midwifery and Obstetric Profession in Luxembourg, we have launched the campaign: #choice2haveamidwife.
We will be interviewing midwives and other birth workers on the topic.
We will have an awareness event: Birth Culture Brunch, themed #choice2haveamidwife.
Please click here to read an excellent summary published on Midwifery Today on the 400-year inequality in Europe, stemming from patriarchy. No one is talking about this publicly (at least in English), let's change that! "Let's make it happen Luxembourg".
What does the evidence say
As you can see, in order to obtain evidence-based care during childbirth, maternity care consumers/birthing families should be able to have a CHOICE in all areas of their reproductive and birthing experience and care.
Why?
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Because the very definition of "evidence-based care" during childbirth (which everyone deserve according to human rights) includes the premise of the birthing person's own values, goals and preferences.
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Because Article 7 of the EU Charter of Fundamental Rights, in addition to Article 8 of the European Convention on Human Rights recognises the right of respect to private & family life of which the circumstances of giving birth incontestably form part of one’s private life.
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The birth experience has lifelong health and mental implications for the motherbaby so of course the birthing person deserves a choice in this in any civilized society wouldn't you think?!
Furthermore, it is well evidenced (Sandall et al. Cochrane Database of Systematic Reviews 2013) that the continuity midwifery model of care is the gold standard for healthy birthing persons (the vast majority of the population) and has vastly different philosophy and outcomes on how birth is approached. We're talking fewer medical interventions, fewer preterm births, fewer pregnancy losses, more spontaneous births and no increase in risk to the newborn. Birthing people should therefore be able to choose which model of care they prefer (#2) as this will impact their chances of having the safest, healthiest and most empowering birth possible. Healthy birthing people forced into the medical model of care (due to lack of choice) have a higher risk of unnecessary, routine medical interventions which carry countless risks and also increases their risk of having unintended surgical births. (Luxembourg's C-section rate is 1 of only 7 countries in the EU higher than 30%, which according to the WHO is a huge cause for concern. C-section rates higher than 5-15% according to the WHO in 2010 indicate an overuse of c-sections.)
In addition, birthing people are not able to freely choose their birth setting due to lack of feasible out-of-hospital options (#3) and in gathering their team are facing immense disrespect for their choice to bring a continuous labour companion for non-medical care into the hospital to support them and their partners together as a team (#4). This has a profound impact on outcomes.
Therefore, we need to advocate for change both from the bottom up (birthing families/consumers need to demand for their choices and rights to be respected) and from the top down (which has historically been very challenging due to the strong medical monopoly and longstanding inequality).
"It is time to put an end to the hierarchical, monopolistic care systems that were constructed on socially and economically discriminatory systems of sex. These systems and today's c-section assembly lines do not optimise maternal and newborn health. Integrated systems with strong midwifery professions as the first line for maternity care, in partnership with and with reliable backup from medical professionals, are the most effective and most efficient strategy for optimising the health of mothers, babies and communities. Health care systems are shifting from the old hierarchical models toward team-based, patient-centered care, which is often called "woman-centered care" in the maternity context. This shift reflects a movement away from the vertical model of care, in which doctors were at the top and everybody else (incl the patient) was below them, to a model in which the patient is at the center of a team of care providers, who are working on a horizontal plane, as equal and complementary partners, to provide care as needed for each individual. This transformation is achievable but only with recognition of the role of power and entrenched inequality in the construction and dynamics of the current system. It is ultimately the responsibility of the democratically elected governments to impose justice and equality for its childbearing constituents."
Bashi Kumar-Hazard (Human Rights Lawyer),
Hermine Hayes-Klein (American Lawyer and director of Bynkershoek Research Center for Reproductive rights in the Netherlands
#choice2haveamidwife
"The fact that the idea of equality between doctors and midwives seems radical is a testament to how entrenched are the systems that have established medicine's dominance over midwifery. The current status of midwives, and the relationships between medicine and midwifery that underlie integration, cannot be understood without recognising the systemic inequality between obstetric medicine and midwifery, awareness of its historical roots and a commitment to dismantling that inequality"
Bashi Kumar-Hazard (Human Rights Lawyer),
Hermine Hayes-Klein (American Lawyer and director of Bynkershoek Research Center for Reproductive rights in the Netherlands
