How Women’s Rights and Empowerment end at the Maternity Ward’s Doorstep

Statements of empowerment fuel Western feminism. The “Girl Boss” era left its mark on our culture through a legacy of stories like “Legally Blonde”, “Erin Brockovich”, “The Devil Wears Prada”, and “Gilmore Girls”. The protagonists of these stories were always ambitious and driven, working hard to balance their professional and public lives, all on their own. Women are superheroes who can do it all; in most cases, they can do it on their own, too. This culture and representation were important for women when they were fighting to establish their position socially and economically, independently from male influence and control. Outside of the screen, however, these notions of empowerment have proven to put an unequal workload on women. From a young age, society expects women to excel academically, break glass ceilings as they establish their positions in science, politics, business, and culture, and succeed in all areas of life, vastly outperforming their male counterparts in education, formal and domestic labour. However, contrary to this narrative of empowerment, one of the most intimate, life-changing, and transformative experiences remains the frontier where empowerment stops cold: childbirth. Rights and self-autonomy are often taken for granted in day-to-day life, and they enter a state of suspension within the sterile walls of a maternity ward. Several factors contribute to shaping contemporary childbirth practices. While this essay refers to “women”, it recognises the diversity of people who give birth, and that not all of them identify as female. Understanding the variety of structures that shape the current reality and practice of childbirth in the West has significant value. As with any other social problem, responsibility for better maternity care falls on multiple agents playing a role in this process. This piece will provide an overview of some structures that play a role in how childbirth is handled in a Western world, and how the woman is positioned within it.

Across Western countries, childbirth has become a heavily medicalised procedure over the past century (Jónsdóttir, 2012). Medicalisation is a process of medicine extending its influence and jurisdiction over non-medical problems and life experiences. When looking at maternal history, it is hard to deny that this process is taking place. For centuries, prior to the seventeenth century, childbirth took place in the domestic sphere under exclusively female supervision all around the world. Only after the discovery and introduction of forceps did medical involvement carried out by men become more significant, which marked a turning point in obstetric care. The role of medical intervention from then on only increased. Over time, the involvement of physicians (who were almost exclusively men until the second half of the twentieth century) became a standardised practice, thus replacing the profession of midwifery. 

Additionally, in the twentieth century, the majority of women began to give birth in hospitals, abandoning the domestic sphere. Over time, practices such as routine use of continuous Electronic Fetal Monitoring, episiotomy, epidural, and even Pitocin became an integral part of labour. Dominance of the hospital model of childbirth and common supervision of obstetricians have contributed to a cultural shift that frames childbirth as a medical crisis rather than a natural procedure. Labour has been taken from the realm of midwives and woman-centred communities into the jurisdiction of doctors and medical staff. Childbirth has become a medical event that needs to be timed and controlled, routinely sidelining women’s rights, autonomy, and voices. 

The benefits of technological advancements and medical aid in childbirth are undeniable. Research shows that there is a striking discrepancy in maternal deaths between developed and developing parts of the world. According to these statistics, the chances of death are as high as 1 in 6 in developing parts of the world, compared to 1 in 30,000 in Western countries. Improvements and better accessibility of health care have led to nearly eliminating deaths caused by infection and post-partum haemorrhage in developed countries. However, an increase in medical intervention led to the rise of caesarean sections. Those now constitute 40% of all deliveries, drastically surpassing the recommended 10-15% by the World Health Organisation. The framework of the recommended 10-15% comes from the lack of association of reduction in maternal and newborn mortality rates with more frequent performance of caesareans.

In addition, there are no proven benefits of caesarean delivery when there are no requirements for the procedure; quite the contrary, caesarean section can cause significant, sometimes permanent complications. Taking into consideration that complications from caesareans and anaesthesia are the leading causes of maternal deaths in the Western world, there is a need to critically re-evaluate the reliance on caesarean sections in Western obstetric practice. Use of modern technologies has become a routine and an inescapable part of delivery rooms. For example, continuous electronic fetal monitoring (EFM) is used in the majority of childbirths “from start to finish”, despite evidence that it does not improve outcomes for low-risk pregnancies and that it increases the likelihood of unnecessary interventions. While in many cases modern aid and solutions can be lifesaving, they also have the capacity to create unnecessary complications, as they interfere with personalised care. It takes attention and authority away from the women by making childbirth a technical procedure.

Many structures come into play in shaping contemporary medicine, science, and childbirth practices in the Western world. Contemporary culture advertises medicine as a neutral social institution that is universal, objective, and essential to individual and collective wellbeing. Yet, it doesn’t go unnoticed that cultural and social structures influence and regulate the creation of knowledge. Feminist thinkers from around the world point out that social biases influence the hypotheses that knowledge authorities are willing to support in science. For the medical sector, these same critiques mention how practitioners’ approach towards medicine plays a vital role in medicalising bodies based on gender bias stemming from patriarchal ideology (Kang et al. 2017, 82). Patriarchal structure is based on rigid hierarchies and dominance. One can easily sense this approach, penetrating the walls of the hospitals, including maternity wards and birth centres. The authority of multiple medical personnel present in the delivery room overpowers the labouring woman,  limiting her agency. Those dressed in white coats and scrubs carry knowledge of babies' and mothers’ wellbeing. This gives little to no recognition of the experience of the person bringing the child into the world. Foucault’s theory of “medical gaze” provides an insight into the mechanism of this power structure within the medical sphere. According to this theory, doctors select biomedically relevant experiences and disregard the rest of the patient’s experience to make it fit into the medical paradigm. This doctor-oriented dynamic takes the patient out of the subject part of the equation. It places them in a position of the object, creating a disempowering and even abusive power structure. In childbirth, women who already suffer psychological stress during the delivery are vulnerable bodies, and a specialist-centred setting where hierarchy is clearly set and agency removed can only further deepen the emotional trauma related to non-autonomous birth.

In addition, in Western countries, hospitals and healthcare systems function within the capitalist framework. Healthcare institutions are largely managed like businesses, which means that efficiency, time, costs, and risk management are prioritised over patient’s wellbeing. Healthcare institutions hire a limited number of workers and predefine the costs they can generate to make a profit. Long, slowly progressing, and resource-heavy labours do not meet these criteria. They generate high costs and keep staff members tied to one patient for an extended period of time. Because of that, many women are compelled to give birth in conditions where their body’s natural rhythm is not taken into account. Labour induction rates and use of Pitocin in all documented labours constitute 31.37% in the US, and 23.9% in European countries. 

Unfortunately, many of these interventions remain without a clear medical reason behind the decision made by the specialist. While the benefits of medical aid and the use of technology are clear, there are also a lot of concerns about the environment that the medicalisation of birth has created for those giving birth. The model of healthcare we are currently subject to leaves little to no space for a more compassionate approach. One in five women in the US reports mistreatment while receiving maternal care, with a clear indication that the overwhelming majority of women who suffer mistreatment are women of colour. According to this survey, most patients report facing a lack of response to requests for help, shouting, scolding, a lack of protection of privacy, and threats of withholding treatment or even forced unwanted treatment. The report shows that even the insurance type at the time of delivery can influence the treatment, with patients owning no or public insurance reporting mistreatment on a much higher scale than those insured privately. Finally, almost half of the surveyed patients mentioned holding back from asking questions and communicating with the health care provider. Reasons behind it vary, but the most common ones stem from acts of gaslighting, embarrassment, rushed process, seemingly overworked healthcare providers, and lack of confidence. When viewed structurally, it is clear that the maternity ward issue is a systemic one. Childbirth culture is impacted by factors like economics, culture, race, class, and other forms of privilege, and multiple aspects of one’s identity and background may either decrease or increase the quality of experience of childbirth. 

Women describe delivery rooms through tales of coercion and fear-mongering, procedures done without informed consent, discrimination, gaslighting, abuse, and threats, that reach daylight as women speak up through any means available. Activists and birth specialists are bringing increased awareness to wellbeing and rights in childbirth. This has its effect. More women are aware of their rights, are more educated on the physiology of birth, and can prepare themselves for what to expect. This alone makes this process less distressful and allows women to navigate the process on their own, in tune with their bodies - something called a positive birth experience. Professions of midwives and doulas grow in numbers of practitioners, and pregnant persons can choose to navigate their own childbirth with the help of one of these specialists. This proves to be an empowering practice, where women can set boundaries and rules for how and where they want to give birth. In case of a hospitalised birth, doulas and midwives can support the labouring women by ensuring their rights are protected and informed consent given. 

Furthermore, childbirth is recognised as a human rights issue under international law. States are obligated by the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to ensure equality in health care, including reproductive services. At the same time, the WHO emphasises informed consent, privacy, and freedom from mistreatment in their Labour Care Guide. In hospital reality, these rights are often curtailed, women’s voices are silenced, and autonomy is taken away. Women, who are empowered and pushed towards achievements and independence in their professional and academic lives, suddenly lose all self-authority in childbirth. 

Childbirth culture in the Western world reveals a blind spot in the human rights discourse, one that demands urgent attention. It is a practice that is built through the intersection of medicalisation, capitalism, and patriarchy. In addition, multiple aspects of personal identity can impact the quality of received care and treatment. Contemporarily, when the importance of intersectionality and accessibility gains more visibility, feminist discourse must take a step back into a long-overlooked area of childbirth and women’s rights. Maternity should not be a sacrifice of self-agency. Quite the contrary, there should be structures to support women and protect their rights, dignity, and authority in childbirth and afterwards. The grassroots movement is already in place, taking action to increase awareness on this topic. Many midwives and doulas are active on social platforms where they educate women on labour and their rights. Women also take on the personal responsibility to advocate for themselves. At-home births under a midwife or doula’s supervision, and with no medical authority present, become more common as this is the form women feel safer and more empowered with. Still, many childbirths happen within hospitals or at some point require hospitalisation due to unforeseen complications. This is why there is still a need for legal and medical authorities to take action and introduce reforms that will create a safer space. It is time childbirth became a celebration of life again, not a suspension of self-agency and human rights.