Written by Rebecca Brown
There has been plenty of debate about women’s right to choose how they give birth. Some of it stems from the negative experiences of women who have felt unable to have the birth they want, instead being pressured or even coerced into delivering their child according to health professionals’ preferences. At the extreme end, this can involve forced caesarean sections and other highly invasive interventions being performed against women’s explicit refusal.
In the UK, performing surgery (or any other physically invasive intervention) on a person without their consent is illegal. This is true as long as the person is deemed to have decision making capacity. ‘Capacity’ refers to the ability to understand the information relevant to making a medical decision, weigh the evidence and communicate their preferences. Importantly, someone can still have capacity even though they appear to be making a bad decision (for instance, they may prefer to expose themselves to a high risk of death in order to avoid what may seem like a much less serious injury). The absolute right to refuse invasive medical interventions extends to interventions intended to benefit the unborn child.
The stakes here are high: in some (thankfully uncommon) situations, both a mother and her baby’s life may be in danger, yet the legal protection of her autonomy means that doctors may not force her to undergo lifesaving (for her and her baby) interventions to which she has refused. Whether or not women’s autonomy is, in practice, quite so highly respected is questionable. But in theory there is strong protection of women’s control over what happens to their bodies during childbirth.
And yet in situations where the stakes are likely to be much lower, there are instances where women are not given the opportunity to decide to which risks they and their foetus are exposed. For example, pregnant women are sometimes prohibited from bouncing on trampolines, or playing netball by companies which have decided, on their behalf, that such activities are too risky. Women gestating a foetus already have quite a long list of (nice!) things they’re advised to avoid (including caffeine, alcohol, and unpasteurised cheese) and whilst these come packaged as recommendations, they create a norm to which pregnant women are expected to abide. This can, to some extent, turn into stigma directed towards visibly pregnant women who dare to drink coffee, have a glass of wine or eat brie in public.
Part of the problem here is the poor quality of the evidence base around what behaviours pose risks to a foetus during pregnancy, combined with a heavy leaning towards caution and an expectation that a woman should be willing to sacrifice any number of small pleasures in order to reduce the (also small) risk of harm to her foetus. But another problem is the willingness of people – often complete strangers – to tell pregnant women how they should behave.
Given the kind of outcomes at stake in the introduction to this blog, the rights of pregnant women to decide whether or not they have a bounce on a trampoline or play netball will seem trivial. But treating pregnant women as incapable of making decisions for themselves is absurdly patronising. If a non-pregnant woman is deemed capable of understanding, weighing and reaching a decision about whether or not to run the risk of injury in order to participate in a netball match, why is a pregnant woman not deemed competent to make the same decision?
Step by step we are leaving the respect to individuality and we are heading to the world in which the society will tell to its members what is “good”.
Naturally it is finally the individual’s decision what he/she will make with his/her own life.
But we deny this. We deny freedom and our responsibility.
Because it is more comfortable if somebody (i. e. some far and anonymous group of people) decides instead of us. In this case we replace the burden of decision making to someone else. And moreover we as well can replace our possible guilt. Just this is the most temptating lure.