The Pains of Home Birth (article looking at the bill that threatens the future of home birth in Argentina)
BUENOS AIRES HERALD
The pains of home birth
BY SOPHIE PARKER
For the Buenos Aires Herald
Paola gazes at the tiny baby sleeping in her arms. The mum from Wilde gave birth to Josefina less than two months ago, at home and accompanied by midwives. She has made the journey to Congreso with her newborn and Josefina’s dad and older sister to join a vigil organized by the Argentine Association of Independent Midwives (AAPI). Paola, like the midwives, is protesting against a bill that threatens the future of home birth in Argentina.
A proposed update to legislation regulating the professional practise of midwifery has been in the pipeline since 2007. The original intention was to reflect the varied abilities of university-trained midwives, recognizing a greater range of responsibilities such as overseeing healthy pregnancies, prescribing certain medications and carrying out Papanicolaou tests. However, the bill currently under consideration, presented by lawmaker and president of the Social Action and Public Health Commission María Elena Chieno (Frente para la Victoria) in March of this year following its expiry in 2011, explicitly permits midwives to work only within public and private hospitals. This vital detail undermines the autonomy of independent midwives and effectively eliminates women’s right to choose where, how and with whom to give birth.
While Chieno’s bill, which has already been passed by the Health and Education Commissions, doesn’t expressly forbid midwives from assisting at home births: it leaves the activity in a legal limbo. The legislator’s comments on this aspect of the bill have done little to clarify matters or allay fears. Despite declaring in an interview with Página/12 newspaper in August that a midwife exercising his or her profession in a woman’s residence is not illegal under the update, Chieno then warned that midwives who attend home births could put their professional qualifications in jeopardy.
Outside Congress, a young woman positions herself in front of the traffic, her body bearing a sign that reads: “I’m a dance student. Don’t force me to play midwife.” It’s a clear reference to the worrying likelihood that if midwives fear repercussions for their role in a home birth, women who choose to give birth outside of a healthcare institution will be obliged to do so with whoever is willing to step in.
“Many lawmakers are unaware of the magnitude this bill has if it’s passed,” laments Marina Lembo, president of the AAPI. Lembo and her fellow independent midwives, along with groups of women, families and obstetrics students that have demonstrated against the bill, maintain that the proposed reforms have an impact not only on labour and women’s issues but also come into conflict with identity and reproductive and sexual rights. The midwives also consider the bill discriminates against their profession and have brought their concerns to the National Institute against Discrimination, Xenophobia and Racism (INADI). An association of families, too, has turned to INADI claiming the bill discriminates against those who decide to give birth at home by leaving them without assistance.
The signs and banners unfurled at the vigil provide a visual roundup of the issues facing fallout from Chieno’s bill. A father clutches some coloured cardboard on which thick black letters spell out his indignation: “My child was denied a DNI because he was born at home. My child was denied his identity.” In order to register a birth and obtain a child’s National Identity Document (DNI), parents of babies born at home in Buenos Aires province are currently required to present witnesses to corroborate the event. In addition, mothers and their newborns can be subjected to physical examinations for the same reason. These examinations are similar to those carried out to confirm a rape, says Lembo. “There are families who travel 600 kilometres to register the birth in Buenos Aires City so as to avoid them.” If planned home births are forced to become clandestine, one can only guess what extent of invasiveness and red tape awaits families who reject hospital births.
Despite this, women are still opting to give birth at home. Accurate data reflecting planned home births is difficult to find as official figures do not differentiate between planned and unplanned non-hospital births. But Lembo has seen firsthand how this option is in demand. A home-birth census that has been doing the rounds on social networking sites aims to demonstrate that the growing minority choosing home births do so for a range of reasons and come from varied socioeconomic backgrounds. It was created in reaction to Lawmaker Chieno’s comment in the abovementioned interview that “this all comes down to the desire of an elite, to a trend for rich and famous people. They aren’t the majority.”
The legislator from Corrientes province may have come to this misinformed conclusion based on the fact that families pay out of pocket for planned home births since they are not covered by medical insurance plans. According to Lembo, most of the families that the AAPI midwives attend to are middle-class or middle- to working-class. Some have been saving up to pay for the humanized birth they know they will be guaranteed with an independent midwife.
And one only need talk to Paola or any mother who has chosen to give birth at home to realize that their decisions are based on anything but a celebrity trend. The desire to avoid “the obstetric violence that is common currency in hospitals today”, as 30-something mum Natalia puts it, is one reason. Sofía, a 24-year-old doula from Lomas de Zamora who is studying obstetrics suffered “an unnecessary caesarean section” with her first daughter and found support for a VBAC (Vaginal Birth After Caesarean) from the midwives and doula she went on to have a home birth with. Avoiding exposing newborns to invasive routine tests is also a motivating factor, as is the postnatal care that independent midwives offer. Florencia from Villa Devoto received “invaluable support” from her midwives who provided “advice and contact with other professionals who follow the same premise of respect.”
But what about dads? Karen, a 25-year-old from Monte Grande in Buenos Aires province, recalls that her partner initially wasn’t sure about a home birth but is now a “devoted supporter”. By contrast, Sergio, whose wife Ailin gave birth to their second child in their La Plata home seven months ago, was never afraid of the idea. “If there’s anyone who knows how to receive children into the world, it’s a midwife”, he affirms.
Yet midwives who work in Argentine healthcare institutions generally find their activities severely curtailed by a hierarchy in which obstetricians are the protagonists. Independent midwives are loath to let Chieno’s bill limit their professional autonomy along with women’s choices about childbirth.
There are some positive signs emerging from the conflict, however. The AAPI has been granted an audience with lawmakers where the midwives will present information about their work and the safety of planned home births. A second bill has been proposed by lawmakers Celia Isabel Arena (Peronismo Federal) and Juan Carlos Forconi (Peronismo Federal) and recognizes the right of midwives to assist at home births, although in a rather roundabout way.
If the current bills expire at the end of this year, the midwives hope this will be their chance to enter into discussions with Arena and Forconi and ensure a bill is drawn up that truly reflects and safeguards their rights, both as professionals and as women.