The “A-Word”: A Birth Activist Speaks Out

This post orginally appeared on in the Women’s Rights blog

Recently, I spoke at Perinatal: A Symposium on Birth Practices and Reproductive Rights
at George Mason University. The task for the featured round table
panelists was to determine legal and political strategies to advance
reproductive rights in childbirth. My contribution included noting that
childbirth rights advocates need to involve our work into the more
mainstream causes of human rights and reproductive rights, including abortion rights.

The audience, fellow childbirth advocates,
ignored my comments on abortion. Apparently, the "a-word" is not
acceptable language among childbirth reformers. I discussed the abortion debate from a mother’s perspective in a prior post,
and understand that women who devote their lives to improving birth
outcomes and lowering infant mortality rates are invested in the life
of the fetus. However, my comments never took a side on the abortion debate. I merely observed an unfortunate consequence on childbirth rights from this debate.

I observed that one unexpected effect of
the abortion debate was to give more importance to the choices and
beliefs of third parties regarding the medical care of pregnant and
laboring women than to the choices of the women themselves. Doctors and
hospitals have relied upon Roe v. Wade and subsequent law to impose
medical treatment on pregnant women in utter disregard of their legal
rights to informed consent and informed refusal. Pregnant women’s rights are ignored while the fetus receives legal representation after the 26-week gestation period.
The justification has consistently been that the government’s interest
in the life of the fetus found in Roe overrides a woman’s decision in
her own healthcare and medical treatments.

A 2003 University of Chicago study of the
directors of 42 U.S. maternal-fetal medicine programs around the
country found: 1) 14% reported that their hospital used court orders to
compel unwilling women to have operating room (c-section) deliveries;
and 2) 21% considered coerced c-sections ‘ethically justified’ to spare
a fetus possible harm – even over the woman’s physical resistance!

One example of forcing medical treatment against a woman’s will is court-ordered c-sections. To
impose medical treatment on a pregnant woman is unethical as it does
not necessarily even save the fetus and often endangers the mother

In Pemberton v. Tallahassee Memorial Regional Medical Center,
a woman named Laura Pemberton took her forced c-section case to court.
The U.S. District Court found that "the state’s interest outweighed the
mother’s interest" under
Roe, because she was in her third
trimester. Her labor was progressing well and the baby was not in
distress, but the court found that her decision to give birth naturally
was less important than the medical professionals’ opinions that there was up to
a 5% risk in natural birth. (Note that there was also a measurable risk
in surgical birth, but presumably, it was somewhat less.
to Childbirth Connection, the additional risk of a vaginal birth after
c-section (VBAC) is only 0.14% in comparison to a repeat c-section.
After the forced c-section, the plaintiff went on to give birth
naturally to three additional children, which demonstrates that the
forced c-section was unlikely to have been medically necessary.

It is detrimental for childbirth advocates
to continue to censor themselves from even mentioning the a-word, let
alone any overlap between these two major reproductive rights issues.
Women must combine forces to discourage these infringements on our
reproductive rights by maturely finding common ground on the abortion
debate. Otherwise, our own divisiveness on abortion restrictions will
only favor third parties who use these controversial restrictions to
further encroach on women’s reproductive rights. Just as the vast
majority of society believes in exceptions to abortion restrictions for
the health and life of the mother, let us educate society about the
need for ensuring that these restrictions do not infringe on a pregnant
woman’s right to make her own medical decisions during labor.

As a young birth advocate, I am truly
standing on the shoulders of the leaders of this movement, as it only
seriously began in the generation before me. Lamaze, one of the first
philosophies of natural childbirth, was invented in France in 1951, and
childbirth education courses were made widely available in the 1970s.
Thus, the men and women who revolutionized childbirth are the same men
and women who are guiding it today. I am filled with admiration and
gratitude to these reformers, who often put in time and energy to
mentor the next generation. They are ground-breaking leaders in a
unique combination that few other fields encounter today. Therefore,
the younger generation of this movement holds them in higher esteem
than otherwise. Young childbirth advocates feel pressure to respect the
established preference to separate from other reproductive rights
proponents, especially abortion activists.

However, I also detect that the climate is
changing within this movement as it reaches a tipping point. Childbirth
rights groups are gaining momentum and mainstream acceptance; we are an
"emerging market" in the fields of law and policy, especially in health
reform, reproductive justice, and human rights. Today’s young birth
activists will have the opportunity to have a larger-scale impact on
birth reform as political leaders become more receptive to these ideas.

Childbirth issues are receiving increased media attention. On October 15th, CNN
ran a story about Joy Szabo whose local hospital refuses to grant her
wish to have another VBAC. This refusal goes against medical evidence,
because Ms. Szabo has had a previous VBAC. Medical wisdom teaches us
that another c-section after a VBAC is actually more dangerous for
mother and baby than a repeat VBAC. In
a prior post on this issue,
I noted that the International Cesarean Awareness Network (ICAN) found
that many hospitals were banning VBACs. Since that post, ICAN has done
an additional survey and
found the bans to be much more prevalent; 1434 hospitals out of the 3000 hospitals surveyed either have explicit or de facto VBAC bans.

Today’s young leaders are also more comfortable discussing abortion laws
and how they are affecting childbirth rights, and acknowledging that
abortion restrictions are being misused to disrespect pregnant and
laboring women’s decisions on childbirth. While a diplomatic approach
to the abortion debate will be helpful to making our cause a bipartisan
issue, a self-imposed segregation from even tangential issues will
prevent it from reaching its potential significance to women and
reproductive justice. The current strategy, in other words, will
eventually be ineffective in ensuring that childbirth rights are
respected and valued, because there will always be the a-word loop-hole
for opponents to capitalize upon. When we start to find common ground
with fellow reproductive rights advocates, we will be as widespread and
well-known as every other major women’s rights cause, including breast
cancer, workplace discrimination, and yes, the a-word.

After all, it is not a bad word; the term is abortion.

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  • clydweb

    As a doula and abortion activist I’ve often been frustrated by the reluctance of the childbirth community to engage in discussions on reproductive justice. It seems so natural to me that ensuring that women have choices in childbirth is a natural outgrowth of ensuring that women have choices when faced with an unwanted pregnancy. Why is it so hard to view it the other way around?

  • progo35

    clydweb-probably because some of the birthing advocates involved in that movement aren’t too eager to jump on the pro abortion rights bandwagon-they see their role as providing choices in childbirth, something one can support regardless of his or her position on the abortion issue. Some people in these committees may not want to take a role in supporting abortion rights because they do not regard abortion as a right.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • progo35

    It just reminds me of the fact that many people involved in reproductive health care do not regard abortion as a right. For instance, a friend of mine originally considered being an OBGYN. She decided to go into pediatrics, and I feel grateful for her sake that she did, lest she have to be harassed by people who feel it’s her duty to perform abortions or refer for them.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • ahunt

    I was unaware that OBGYNs were being harassed. Who, when where? Is there a pattern?

  • progo35

    Contending that unwilling OBGYNs should have to perform abortions or refer to someone who will constitutes support for violating important conscience rights and would result in dissenting OBGYNS leaving their field. Yet, people here are ready and willing to encode this requirement into law. Therein lies social harassment.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • ahunt

    No one here contends that any doctor must perform an abortion, and laws are in place.


    Perhaps a "truth in advertising" posting at "intake" would address everyone’s concerns?

  • progo35

    No, but people here HAVE argued that if a doctor isn’t willing to perform an abortion, such as those performed by Tiller, he or she must provide a referral to another doctor who will. Forcing doctors to do this violates rights of conscience and constitutes harassment. Arguing that doctors must do this constitutes supporting harassment, and people have argued for forcing doctors to provide referrals on this site.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • harry834

    you’ve given up commenting on the "Born Alive Myth" post? It seemed everyone there had enough links and rebuttals to counter you. Care to rebut back?

  • crowepps

    I’m not sure you mean it this way, but your comment seems to imply that a doctor who doesn’t ‘believe in’ abortion has the right to refuse to allow a patient to go to a different medical provider so that he can prevent her from making choices of which he doesn’t approve.


    I agree that no doctor should ever be forced to be complicit in anything which offends his or her conscience. If they aren’t willing provide appropriate medical care when requested and refuse to refer, then the only thing left for them to do would be to hand the patient their chart and tell them to find another doctor on their own.


    If the patient is in the fourth or fifth month of a pregnancy and the doctor has just given her the news that her fetus is non-viable or grossly deformed (the type of patient that Dr. Tiller helped) that would seem to skirt close to the edge of malpractice, but I suppose some doctors would hold losing their license to practice less important than offending his or her conscience.

  • julie-watkins

    I think this is a public health issue. Hospitals, like CPC’s, should disclose potential clients what they will or won’t do. An OB-Gyn/hospital that can handle births would be able to handle late term abortions. If it’s a hospital that “doesn’t do abortions” there’s a risk to the mother’s health because they might let a crisis go too long before operating. If a hospital wants to have a policy that no medical staff can make referrals then I’d have a problem with the state accrediting that hospital for OB-Gyn.