Catholic Vancouver April 10, 2024
Right to home birth becomes the latest bodily autonomy issue
By Agnieszka Ruck
Bodily autonomy and the right to accept or refuse medical treatment has been a hot topic in recent years, especially when it comes to subjects like COVID-19 and life issues.
Now some Vancouver women are trying to shed light on another aspect of bodily autonomy that few people think about – the choice of where a mother delivers her baby and who is with her when she does.
“The right to be able to choose how, and with whom, and when, and where you’re giving birth is such a fundamental human right as we see it,” said Carissa Douglas, a doula for five years.
A doula gives physical and emotional support to a woman giving birth but is not a registered midwife or doctor and does not provide clinical care.
“One of the foundational aspects of this work, and this draws a lot of people to this work, is supporting people’s choice in what feels right for them in their (baby’s) birth.”
For many attending a recent rally at the Vancouver Art Gallery, the issue boiled down to a belief that birth is not an inherently dangerous event that requires medical attention every time. They want to choose when and where they access medical care.
“Being able to choose how you access health care and what constitutes a medical experience should be the [person’s] right,” said Douglas.
Helping women deliver their babies is a service as old as the human race, and the privilege of doing so has been in the realm of mothers, grandmothers, midwives, doulas, doctors, and others throughout history. While the vast majority of Canadian women have children in hospital, some families prefer to birth a more “traditional” way, and after the pandemic, their numbers have gone up.
In 2021, 2.4 per cent of births in Canada occurred in a home, birthing centre, or other facility that was not a hospital, according to Statistics Canada.
The British Columbia College of Nurses and Midwives says that, in normal cases, a planned home birth is as safe as a hospital birth as long as screening, planning, and trained midwives are present.
What the BCCNM does take issue with are planned home births without registered midwives present. Since last November, the college has released a series of advisories warning the public about the “unauthorized practice of midwifery,” saying people are posing as midwives and delivering babies when they are “not permitted to do so.”
“Midwife” is a protected title in B.C., and only those registered with the BCCNM are allowed to advertise services under that designation.
The college says doulas play an important role at births but “are not permitted to perform clinical care, including managing labour, performing assessments (for example, checking cervical dilation or listening to/assessing fetal heart tones) or delivering the baby. To do so would constitute unauthorized practice of midwifery.”
However, a group called the Birth Care Alliance is arguing that women have an inherent right to choose who attends their birth and when they access medical services.
That is why Douglas stood at the head of the rally with a megaphone, leading a procession of families with signs from the Vancouver Art Gallery, down Howe Street, to the head offices of the BCCNM.
“There was nobody at that rally … claiming midwifery. No one is claiming to be registered,” she said.
“What we’re seeing, and the reason we’re giving this response, is that choice is being narrowed and limited to very specific providers that are part of a registration through the medical system,” Douglas said. “That is not the right choice for everybody.”
A recent letter to the BCCNM by the Birth Care Alliance lists several reasons why women have preferred to give birth outside the system, from previous negative experiences with midwives to past trauma from sexual assault, obstetrical violence, authority figures, or medical settings.
Some women also feel confident birthing without medical attendants or want to birth at home but live in a rural community and don’t have access to registered midwives.
A birth without a doctor, nurse, or registered midwife present is called an “unattended birth,” and in many cases they are unavoidable, such as when labour progresses so quickly that a woman gives birth on the way to the hospital or at home before the midwife arrives.
In other cases, women are choosing to choose to birth “unattended” (often helped by a husband, friend, mother, doula, or other person).
Lucy Hope Crawley is a traditional birth attendant and has been attending home births for 40 years.
“It is not a degree given by a college. It is wisdom handed down through the ages, woman to woman, mother to mother,” she told The B.C. Catholic in an interview after the rally.
The mother of four said she has education in the field, including doula training, a certificate in neonatal resuscitation, several classes at a midwifery school in Seattle, and “second attendant” training, which is offered in isolated communities for births at which a second midwife can’t be present.
She isn’t a registered midwife. Crawley moved to B.C. 13 years before midwifery became a regulated practice here in 1998, and when she noticed a gap in services for women who wanted out-of-system births, she became an advocate for them.
Crawley has been publicly named in an advisory by the BCCNM as an “unauthorized midwife” and feels she is being blacklisted and intimidated.
“It seems every 20 years or so there’s this rearing of an attempt to suppress the out-of-system caregivers, and that’s what’s happening right now,” she said.
Some women find birthing in a hospital “traumatizing” or “de-personalizing” and “just want a different form of care,” she said.
There is also a different atmosphere at home compared with a hospital. “At home, you have much more autonomy,” said Crawley. “You are in charge. There aren’t interventions that are just done because that is the habit or the rule. When you have a birth in the hospital, there are bright lights and lots of noises. But when you birth at home it can be as quiet as a pin dropping and a dark, warm space.”
Rachel Stevens, a mother of six, has birthed in a hospital and at home. She joined the rally with her children to preserve the ability to make that choice for generations to come.
“We believe in our family that birth is a right that women inherently own,” she said. “Is there a time and place for medical assistance? Absolutely. Do I think that’s the starting place? No.”
The starting place, she said, is an act of love. She hopes women who desire intimacy in the birth of their baby, just as in the making of their baby, can continue to access that option.
“We believe God created humans and are made in his image. Part of that is we get the privilege to create other humans,” she said. “It’s not just about reproduction. It’s about beauty and intimacy.”
The BCCNM, in its notices against “unauthorized midwifery,” warns that while registered midwives are regulated by the college, doulas, birth keepers, and others are not. Therefore there is no regulatory body checking their education or skills, they don’t have access to the same medical equipment or testing, and they don’t have malpractice insurance.
Midwives can also easily transfer women to a hospital if necessary, while the same continuity of care and transfer of records is not possible with doulas or other support people who are not part of the medical system.
The March 8 rally collected the signatures of 150 people as they walked down Howe Street to deliver letters citing their concerns to the BCCNM head offices. They were unable to enter the building and deliver the letters, so they were sent by registered mail.
So far the group has not received a response from the college. A second rally is planned for the same location on April 12.
Ironically, the BCCNM handbook on offering informed consent says midwives “respect the rights of the client to make an informed choice about the setting for birth” and “recognize and support the client as the primary decision maker.”
Douglas is hoping the college does just that.