Sistersong defines reproductive justice as the "human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities." That means reproductive justice encompasses not only the right to use contraception and choose abortion, but also the right to give birth where and with whom a woman or pregnant person chooses.
During the growing spread of COVID-19 in Canada, I've been reading rather distressing accounts of the latter rights being restricted. Some hospitals have been denying support persons during labour for any patient suspected of having COVID-19, and home births have been suspended in Nova Scotia.
Given the way the pandemic can shift, all hospitals might start these severe measures at any time, claiming COVID-19 as their rationale. Most hospitals in the country thankfully aren't going to these extremes, but the provinces need to outline and implement specific safeguards for patient rights during COVID-19 (and for any other national health emergency in the future).
Stress can cause major complications to a developing fetus and the pregnant person. It's reasonable to assume that most pregnant people are deeply troubled by the very real threat of having to deliver a baby alone. Likewise, labour itself is stressful, but having to do so without a support person would exacerbate emotional and psychological distress.
I realize we're living in challenging times. When it comes to a pandemic, we all need to make sacrifices to limit the spread, but where do we draw the line? What is a reasonable rule and what infringes on our rights?
Even in the time before COVID-19, sometimes our choice of where or how we labour was not up to the woman -- doctors and midwives sometimes had to decide that a c-section is necessary, or that a birth is too high risk to be done at home. It is reasonable to restrict rights if there is a proven medical need for the decision.
When it comes to the pandemic, some of the changes and policies implemented by hospitals and midwives are reasonable in order to prevent the spread of the virus. These might be inconvenient or perhaps disappointing to pregnant people but are not inhumane. For example, routine midwifery/obstetrical appointments being done over the phone, breastfeeding clinics limited to smaller numbers or done over video chat, nitrous oxide not allowed at home or hospital births (my personal grievance), inductions being limited to medical purposes (e.g., for overdue babies, not simply to have one's preferred doctor at the birth), and the prohibition of water birth to prevent the possible spread of infection.
These changes are not so much to protect the pregnant person and their baby from the virus but to prevent the spread to other patients and health-care workers. If one midwife, OB-GYN or nurse catches COVID-19 from a patient or their attendants, not only could the health professional pass it to other patients, but they would then be quarantined, adding more strain to an already squeezed system.
As such, it does make sense to limit the number of support people in a hospital. But denying at least one support person is inhumane.
As someone who knows what it's like to give birth, reports of hospitals making these decisions is disturbing. As someone who is also currently 35-weeks pregnant, this is downright terrifying.
The World Health Organization has stated that "All women have the right to a safe and positive childbirth experience, whether or not they have a confirmed COVID-19 infection," and Health Canada recommends that "the woman be supported in her choice of support person." Why? Because giving birth is not something anyone should have to endure alone. Calling it a "rough ride" physically and emotionally is downplaying it to the extreme.
As an example, my first labour in 2017 was (relatively) short. From the initial cramps of early labour to delivery, I clocked in at 12 hours. As I was low-risk, I elected to have a home birth with my wonderful midwives. It wasn't all fun and games. I had to have an emergency episiotomy, but my daughter arrived safe and sound. As such, I know what it's like to labour, and I needed my partner there with me. While labour itself was bad enough, I can't imagine having no emotional support during that episiotomy (with no pain meds). Two midwives were with me, but they were administering the procedure and monitoring my and my daughter's vitals. They are medical professionals, not support people.
For any new mothers-to-be who have never given birth before, I can imagine the prospect of having to labour alone is highly distressing.
There is some good news. One of the hospitals who had denied support persons, the Jewish General Hospital in Montreal, has reversed their no-support-person stipulation. But why were they even allowed to make that call in the first place?
It's imperative that provincial governments commit to ensuring that all pregnant people are allowed a support person during labour and delivery, even amid medical crises like a pandemic. If the partner of the pregnant woman (in most circumstances, the future baby's other parent) does not pass the COVID-19 screening, denying them attendance makes sense, but the pregnant woman should be allowed a backup person.
Similarly, the Nova Scotia decision to suspend home births is equally frustrating and was a major source of concern for me (I'm in Ontario, but I've spent the last six weeks worrying it's going to happen here). While Nova Scotia does have a smaller pool of available midwives for its patients, meaning if one midwife were to require quarantine it would diminish the profession’s capacity for care, there are ways to deal with the issue rather than a blanket ban. Proper personal protective equipment for midwives and a mask for the pregnant person, requiring patients and their support person to be strictly quarantined for two weeks prior to their due date, and limiting support persons to one (rather than a contingent) should be enough. A blanket ban says that women's rights can be cancelled without regard to context, rather than something that needs to be held in the highest regard.
According to my midwife at least, Ontario will still be providing home births by my due date, though I'm still wary. Who knows what the province will look like in five weeks? If the Ontario government (and all the provincial governments) would mandate strict guidelines to hospitals and health-care providers regarding the rights of women and pregnant people in pregnancy and labour, perhaps I, and everyone else due to give birth in the next few months, could sleep easier.
Tina S. Beier is a freelance writer, author of science fiction novel What Branches Grow, and volunteer blog coordinator with the Abortion Rights Coalition of Canada. She lives in Ontario and champions the causes of women's rights, animal welfare, and the environment.Viewpoint: Reproductive Justice is a blog by the Abortion Rights Coalition of Canada.
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