6 British Journal of Midwifery • January 2014 • Vol 22, No 1

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Last night I had one of those slightly nightmarish dreams, a dream that anyone who speaks regularly at

conferences might recognise. You know the kind of thing: you can’t get to the venue and you know a lot of people are waiting, you find you have no slides or, as in my case, despite millions of ideas, you have no notes on your topic, the topic being human rights in childbirth.

So, in my dream, in a panic I found a blank piece of paper and quickly jotted down five major headings. Then it seemed I filled in those headings all night long. My dream was not surprising; I have been thinking about this column for days, turning over ideas, finding the central point, loving the juxtaposition of ‘Birthwrite’ and ‘Birthright’. My awareness of human rights as a basis for high-quality care has come slowly over time while I learned from experience; for example, learning about the humanisation of birth through my visits to Brazil, and my work with Hungarian activists and midwives fighting for justice for midwife Agnes Gareb and more humane maternity services for Hungary.

Birthrights, founded by Elizabeth Prochaska, is the UK’s only organisation dedicated to improving women’s experiences of pregnancy and childbirth by promoting respect for human rights. The organisation has made clear the centrality of human rights to a healthy positive birth. Birthrights says: ‘We believe that all women are entitled to respectful maternity care that protects their fundamental rights to dignity, autonomy, privacy and equality’. Combined with the White Ribbon Alliance and its campaign for respectful care, a balance of the right to good physical care and a good experience of care is clearly paramount.

At the recent round table meeting, The Difference it Makes: Putting Human Rights at

Professor Lesley PagePresident, Royal College of Midwives; Visiting Professor, King’s College London, UK; and Adjunct Professor, University of Technology, Sydney

the Heart of Health and Social Care, Stephen Bowen, Director of the British Institute of Human Rights (BIHR), described human rights as a means of achieving good quality health-care experiences as well as outcomes. Jon Rouse, Director General, Social Care, Local Government and Care Partnerships, with a responsibility for maternity and child health, described human rights as a ‘mindset’—a mindset that, I think, would set us to change in what Jon described as a ‘stepwise fashion’.

Human rights are not an add onMy dream was a sign of my growing realisation. Human rights for those receiving and giving care are not an add on to be consigned to the small print, but should be integral to everything.

Respecting human rights, we should be driven to reduce inequalities in maternity care: inequalities for those in the world who have no access to a midwife or doctor around birth; inequalities in outcomes for mothers and babies within countries including the UK; inequalities in access to the care that has been shown to offer a safe beneficial option for low-risk women and their babies, free standing or alongside midwifery unit care and midwifery-led continuity of care.

But a human rights perspective will also help us formalise an important balance: a balance between safeguarding those in our care, and ensuring autonomy and the right to respect, dignity, autonomy and privacy. This

is fundamental but will also lead to a more positive experience as the woman and her family start on the pathway to family life—an experience that will help the woman make the transition to mother, the man to father, and will alter the woman’s view of herself. This is all essential to the long-term care and health of the baby to maturity, a secure attachment with the baby, and the integrity of the family.

Respect for dignity and autonomy requires that women should be helped to make their own decisions about their care; complex decisions that require a weighing up of risks, in the light of their own circumstances, their values, hopes and fears. Women need the support of professionals, midwives and, if necessary, doctors who are skilled and knowledgeable but also empathetic, compassionate and able to care. Support for individual decision making, made by the woman herself, is central to a human rights based maternity service.

Maternity care based on equality, dignity, respect, autonomy and compassionate care needs midwifery or medical care that is relational. For midwifery, the importance of the ‘with woman’ relationship built up over time has been shown to be beneficial time and time again. In the UK we have strong foundations, but there is work to be done in extending effective patterns of practice, midwifery-led continuity of care, and out-of-hospital care and birth.

Birthrights for every woman and her babyThe birthright of every childbearing woman, each baby and every family should be the best start in life wherever they live, with access to the right services for them, the attention of a midwife and, for those women who need one, a doctor who they can get to know and to trust. Human rights are about living well together; the way babies are born contributes to and reflects the nature of our humanity. Build maternity services that influence future generations and the way they will live on a foundation of human rights and we are far more likely to live well together. � BJM

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Birthrights for every woman: Just a dream?

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