Two months ago, a mother of three – let's call her Charlotte – scored a victory after a two-year fight. The Southern General Hospital in Glasgow, where she had gone to deliver her third baby, finally admitted to bullying her into taking precautionary antibiotics she didn't want or need. They had threatened that social services would be called to take away her child after the birth.
"But by the end it wasn't about my baby – it was all about their control over me and their power," says Charlotte, whose waters had broken when she was three days overdue. "They didn't like it that I questioned them and they didn't like it when the evidence I asked for to support their case over mine wasn't good enough. I don't know if the consultant was on some kind of power trip because I challenged her, but the result was that I was bullied into something I didn't want because of their threats. Finally I turned my head away and said: 'Just give me the medicine.'"
It was only when Charlotte went to the Scottish Public Services Ombudsman that the hospital apologised. That took two years. The ombudsman's report finally ruled that "[Charlotte] did not properly consent to the treatment administered and was wrongly put under extraordinary pressure during labour when she was in a very vulnerable situation."
Such examples of "foetal supremacy" over a woman's right to choose what is or isn't done to her have prompted a rapidly growing international pressure movement. It aims to draw attention to fundamental breaches around the world of women's human rights during childbirth, many of them in the UK. The movement has united mothers, lawyers, obstetricians, midwives, philosophers and epidemiologists.
On 20 September, 100,000 women all over the world attended screenings of Freedom for Birth. An hour-long British-made film, translated into 17 languages and shown at 1,000 different locations, it presented compelling evidence that pregnant and birthing women's basic human rights are being violated. The nature of these "abuses" vary: examinations pregnant women haven't asked for, inductions they haven't fully consented to, home births that are refused on shaky grounds, midwives sent to jail for attending home births (yes, really) or simply a woman's voice being overruled with the increasingly used threat of a child-protection order.
"Birth, to my mind, is the very frontline battleground for human rights," says Rebecca Schiller, a doula schooled in human rights and a leading UK activist. "Nothing says more about a society, a culture or an individual's attitude to the rights of those around him than his attitude to the rights and responsibilities of a birthing woman. If the moment when our human rights begin as a newborn baby is set against some gruesome backdrop of our mother's subjugation to the deliberate, even criminal, withdrawal of some of the very basic rights we all expect, what chance have we of living a life where our own rights are respected?"
When I first heard about the Freedom for Birth movement – before I talked to Charlotte and many women like her – I confess I was sceptical of the idea of bringing the tool of "human rights" into a medical arena in a way that could make it even harder for over-stretched doctors to do their job. Having had four natural births, all of them in hospital and supported by fantastic nurses and midwives, I found it hard to connect with a movement that used the language of confrontation against the medical establishment. "Doctors don't necessarily have their [women's] best interests at heart," Beverley Beech, chair of the Association for Improvements in the Maternity Services, told me. These human rights violations, she said, were all about "power and control".
Reading on mobile? Click here to watch an abridged version of Freedom for Birth
If this makes it sound like a gender-based problem, it is not. Female obstetricians are just as likely to be guilty of a heavy-handed approach towards birthing women as male doctors. Charlotte tells me it was important to her that she find out the gender of the consultant who had been relaying the social services ultimatums to her staff by telephone: it was a woman, as were all the other doctors involved in the case and the subsequent apology.
It is possible, too, to be cynical and note the irony of overprivileged western women complaining about too much medical maternity care, when women in the developing world are dying from too little or none at all. (This is a strand of the Freedom for Birth campaign, too – the right to proper care and a safe birth for women all over the world.) This kind of criticism misses the point, as Hermine Hayes-Klein, a US lawyer and organiser of the recent Human Rights in Childbirth conference at the Hague, is quick to point out. "Whenever women have campaigned for better rights, it's always criticised as privileged white woman complaining. Fighting for the right maternal care for those women who don't have it doesn't mean that those who do should lose their autonomy in an over-medicalised climate elsewhere.
"And on the point of the doctors, it's not a question of trying to claim that doctors are out there saying to one another: 'These white bitches are in our hospital and need to be controlled!' It's more a question of how they are forced to operate, with multilayered protocols and risk policies. They are working in groups and teams, and they are generally working on the assumption that expectant mothers can be told what to do. What is coming into consciousness is the underlying institutional assumption of who has the final say, because that assumption really affects the dynamic. For some women it will come to a head; for others it won't."
In the film Freedom for Birth Professor Lesley Page, president of the Royal College of Midwives, says: "What we have are systems of care that encourage unnecessary interventions or interferences in birth." And when women protest, many doctors "play the dead-baby card", a phenomenon identified in 2011 by researchers of a Canadian study – implying, often without substantial scientific evidence, that a foetus is at risk and the mother is acting in her own interests, not in the interests of her unborn child.
Elizabeth Prochaska , a human rights lawyer with Matrix Chambers and the co-founder of Birthrights, a charity set up to offer free legal help to British women whose human rights have been violated in childbirth, says there is no basis in law for "foetal supremacy", even if the baby is at risk. An expectant mother has the right to call the shots, not the doctors caring for her foetus.
"The questions being raised over abortion rights have a close relationship to a woman and her pregnancy," Prochaska says. "If a woman decides not to consent to a C-section, you may well have a moral response to that, but where do you draw the line? While I would never say that mother and child are one being, in legal terms they are one being. You can't separate them out. If you do, you end up subjugating the woman to the role of a vessel, and you have to recognise that a baby only has legal rights when it is born. It is a woman's body and that's what makes human rights in childbirth some of the most fundamental human rights there are, because it involves choices a woman makes over her body."
The counter-argument, of course, is to ask: how does a society protect a mother and her foetus from a bad decision? In short, it can't, although separate powers can be invoked if a mother has a mental illness. But to focus on the possibility of a tiny number of irresponsible, selfish women is a distraction from something much more fundamental, campaigners claim; it also weakens the human rights which should guarantee that all women get the birth experience they want.
"It's a complete fallacy that women who want to make choices that doctors don't agree with haven't got their baby's best interests at heart," says Hermine Hayes-Klein. "You show me a woman who doesn't put her unborn child first. There are very, very few.'
It's difficult to put a number on the scale of these alleged abuses in the UK. But it was not difficult for me to find women with stories to tell. Melissa Bowram Hopper, for example, gave birth seven weeks ago at home. A doula by profession, she decided, at 30 weeks, that she wanted an unassisted birth (she says that "birth is not a medical process"). Melissa's midwife was initially supportive, but as her due date approached Melissa was under increasing pressure to change her mind. Melissa finally delivered her baby with her partner in what she describes as a moment of true euphoria.
All was well until social services, on the advice of the midwife, telephoned and said they wanted to see her. When Melissa told them she wouldn't be coming in for an appointment, they later arrived at her home and quoted Section 47 of the Child Protection Act, saying that they feared for the unborn baby (who was by now born) as well as the safety of her toddler. Melissa ran to an upstairs room to avoid them and her partner sent them away. When I ask Melissa why she didn't let in the social worker to show her that her baby was healthy and thriving, she replies that she had felt pushed into a corner. This, according to the human rights activists, is quite common. Disillusioned women who opt for unconventional choices often become less rather than more compliant when hospitals begin using heavy tactics.
Two days later, another social worker appeared at her home with two police officers. Like Charlotte, Melissa says she kept asking herself: "Can they actually do this? Can they threaten to take away my children just because of my birth?" Social services only left her alone once the baby had been checked; the investigation was closed two weeks later. "All I wanted was full control over my life and my birth," Melissa says. "If they had been reasonable with me, of course I would have co-operated from the beginning."
Whatever one might think about an unassisted birth, or about the decision made by one woman in the Netherlands to deliver her breech twins at home (possibly the most extreme example used in the film Freedom for Birth), the fact is it is their right. And yet the woman from the Netherlands ended up being escorted to hospital by police officers and was pressured into a C-section.
This year two legal rulings have brought the issue to worldwide attention. Agnes Gereb, a Hungarian obstetrician and midwife, was convicted of "endangering life in the conduct of her professional work" after babies had died in two cases in which she had attended home births. She had assisted home births for 22 years in a country where the practice was, until last year, illegal, and is still heavily circumscribed. Gereb was sentenced to two years imprisonment and is currently under strict house arrest pending the outcome of a further trial that began this week.
Anna Ternovszky, one of Gereb's clients, was pregnant with her second child at the time of Gereb's conviction. Fearing that any midwife who helped her give birth at home could also be subject to prosecution, Ternovszky took her case to the European Court of Human Rights, claiming that Hungary was violating two articles of the European Convention of Human Rights: the right to private life and the right to non-discrimination.
The court found in her favour. "This European court ruling has the potential to spur radical change," explains Matrix's Elizabeth Prochaska. "It imposes positive legal obligations on all states in the Council of Europe, which includes all EU member states. Together those states have 250 million women, and now every birthing woman in that jurisdiction can turn to her state and say: 'You must respect my authority to choose the circumstances in which I give birth under Ternovszky versus Hungary.'"
Setting aside all the legal and ethical theory, the most pressing question for the rest of us women – and our partners – is: why is the Freedom for Birth campaign needed now? Why are birthing women's rights being violated? I cling to the idea that the majority of obstetricians and hospital midwives are not on conscious power trips, that they don't want to distress women unnecessarily during their labours and that, if asked, they would want women to feel happy. (Although one intelligent, educated mother did tell me how a midwife, who has since been reprimanded, had not only treated her like a five-year-old but also had done so with menace, saying: "We can do it the easy way or the hard way, and the hard way is that I cut you.")
I remain, for the record, the kind of woman much happier to hand over control, or at least decision-making, to a doctor with a greater expertise. That's my choice, but then my experiences have always been positive. What about the women not like me? What about the doctors who are charged with looking after them, or not, as the case may be?
Dr Amali Lokugamage is a consultant obstetrician and on the senior teaching staff of a leading London hospital. She contributes a powerful medical voice to the Freedom for Birth campaign and identifies an ever more risk-adverse climate where fear – both of failing and of being sued – is uppermost in a medic's mind. Given the climate, if I were a doctor I'd be scared.
"There is no doubt that there is an epidemic of intervention," says Lokugamage. "But medical students now only see very little normality. When you only see, during your training, so much pathology and disaster, it skews your perspective and it naturally makes you fearful of birth. The General Medical Council has now said that doctors need to be trained in patient experiences, which basically means hanging around the patients and seeing their perspective. That kind of humanism brings in a new type of social determinant in health.
"Until I had my own baby, I had no idea that birth could be a spiritual experience – because all I had ever seen were problems. It's why most obstetricians and gynaecologists say they'd elect a C-section for themselves or their wives. They are not seeing uplifting physiological births any more. These experiences, like the benefits of natural oxytocin, are not written up in medical journals. Doctors aren't reading about physiological births.
"Combined with that, there is this real fear in doctors of: 'Who is going to pick up the tab if something goes wrong?' Also, many, many doctors are in a state of mild post-traumatic stress themselves. If you have watched the very, very rare case of a woman dying in a pool of blood – a tiny, tiny risk – you will nevertheless do everything you can now to prevent that ever happening again. But the result is often worse for the mother, and the risk ratio is rarely explained."
Louisa Noel, still trying to recover 18 months on from a traumatic birth, tells me that she felt she had lost control of her body as the interventions spiralled out of control. "I felt as though I was being ripped apart. Things were being done to me and I kept thinking: 'I am in a horror film – how will I get away from this?' I was a sausage in a sausage factory and I didn't feel safe. I think about it every day and I am locked into a state of fight or flight."
This importance of providing full information that allows women to weigh risk for themselves came up time and time again with the mothers I spoke to. Sally is a scientist used to working with trial-based evidence. When the hospital doctors told her they needed to induce birth because she had a low level of amniotic fluid, she asked for the evidence of risk; she tells me there was "a deep sigh, as if to say: 'Oh here we go again.'
"There was no firm evidence," says Sally. "So I ended up pretending to go and buy a sandwich, and I absconded.'
"There is this assumption," says Lokugamage, "that doctors are all scientifically ensconced, but if you look at the American guidelines – where C-sections are really high – only 30% of them are based on grade A evidence."
Lokugamage is hopeful that the next generation will be better informed: she is building into her syllabus teaching on the benefits of a physiological birth. "But real change will be another decade away," she says. "There is hope. There is this opportunity to educate doctors in this way, but basically, the human rights issue – the law – at the moment is the only way to push for the kind of birth you want."
Prochaska believes that mothers making their own decisions will lighten the load for doctors and midwives: "Surely it's a positive for them, too? To have a mother making proper, informed choices herself? Many would say: 'Thank god for that. I am not taking on all that responsibility!' What we need are collaborative, evidence-based dialogues."
Alex Wakeford, co-maker of the Freedom for Birth film, ends on a campaigning note: "We hope that millions of women become aware of their legal rights. It doesn't make for easy viewing, but it has the potential to spark a revolution in maternity care across the world. In fact," she says, "we are calling it the Mothers' Revolution."
• This article was amended on 18 December 2012 to spell Louisa Noel's name correctly.
