COVID-19 has shone a light on the ‘pandemic of human rights abuses’ that pregnant women face

Pregnant women have faced significant obstacles over the last eight months. On top of the challenges expectant mothers usually experience they have the added stress of a once-in-a-generation pandemic. Add to the mix a consistent stream of inconsistencies nationwide over hospital birthing protocols, and what should be a wonderful experience for most women has become considerably less so.

Women have had very specific birth plans changed and changed back again by government and hospital policy, and many women feel they are being denied the choice to birth the way they want. Health experts also worry how this will affect the health and wellbeing of the children born of the pandemic.

For Melbourne woman Sarah Sherman, pregnant with her second child, it started when she was looking for a new hospital.

“When I went to my first appointment with them, I got to the hospital and the reception staff literally treated me like I'd walked in there with a bomb. They were like, ‘Why are you here?’ They were really rude to me,” she told Nursing Review.

At her next appointment she was told to wait in the carpark, phone the midwife and conduct a thirty-minute interview over the phone before she was allowed to step foot in the hospital for her tests.

Sherman feels that the level of care she has received compared to her first pregnancy is “non-existent” and that this pregnancy has been “stressful” and a “joyless experience” as she battles constant worries over whether her hospital will allow her to have a water birth or even gas and air.

No rights

Professor Hannah Dahlen from Western Sydney University says this is a symptom of the constant infringements on the rights of pregnant women, now brought to light by the pandemic.

Dahlen uses the recent stoush over showers and water births as a case in point. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has come out against the use of water in the birth setting.

“What RANZCOG put out a couple of weeks ago was, I think, giving open slather to deep biases and agendas. Obstetricians have never liked water birth. To be honest, hospital managers are highly suspicious of water birth. Many people find it quite peculiar and only because women insist on doing it do we provide them the support for it, not only because the evidence tells us that actually it's very safe thing to do and women really like it and it helps, do we kind of get forced into it,” Dahlen tells Nursing Review.

The RANZCOG website says: “However, in the setting of increased community transmission of coronavirus (COVID-19), services are advised to suspend the use of water immersion for labour and birth for all women. The protection of our maternity and neonatal health care workforce is essential. PPE is not effective when wet and consequently, the use of water immersion during this period presents an unacceptable risk.”

“I despair sometimes," Dahlen says. “We're just about to publish a paper that talks about how the COVID pandemic has really exposed the pandemic of human rights abuses when it comes to women's reproductive rights. Because very clearly, what came out is guidance from WHO, from The Royal College of Midwives, from many, many different bodies, that there is absolutely no evidence of transmission of COVID in a bath.”

“Unless you had a woman who was known to be COVID positive, and that's a very different case. If you don't have that, then there is no reason that water births should not be an option for women. Now in our massive study that we’ve undertaken where we've got nearly 5,000 responses, we've had two women, two women positive for COVID in that time.”

Mental health fallout

A huge stressor for many expectant mothers has been childcare. Sarah and her husband had recently moved to Melbourne before the pandemic hit and have no family in Australia. Now with stage four restrictions in place and the due date in sight the rules around which family member can be in the hospital has added yet another strain.

“I'm obviously super excited because I get a baby at the end of it, but I'm probably not going to have any more babies after this one, and I didn't get to enjoy just going out and being pregnant and showing people my bump or anything. But not only that, it's just been so stressful worrying about what's going to happen at the birth, who's going to look after [first child] Caer when I birth,” she says.

“Am I going to be able to have the pain relief that I want, or is Drew going to be able to attend the birth with me? The whole thing, it's just been an absolute nightmare, to be honest.”

Dahlen worries about the mental scars that this period will leave on the women and their children.

“None of this has been done with any kind of common sense and consultation with women and what is important to families,” she says.

“My big concern is that the aftermath of the trauma, the psychological trauma of what's going on now, we're going to be part of that. And that aftermath will go on and have repercussions for child development, concern over mental health, then on and on it goes into society.

“We know mental health issues, anxiety is on the rise. We know that if you're pregnant and highly stressed and feel unsupported, we know that has an impact on your baby. Then you're more likely to have a postnatal depression. You interact differently with your baby. Your baby's brain gets wired differently, grows up, and it goes on.

“So when we talk about women who are pregnant and giving birth, we're actually talking about the future of society.”

Viewing birth differently

The differing rules from hospital to hospital and state to state around water and visitation is another issue for Dahlen, who believes that many decisions are not evidence based but decided by an inflexible medical establishment.

“In some hospitals they're saying, particularly in some private hospitals, women should be encouraged to have early epidural. Now, doctors are very comfortable with epidurals. A woman who's immobilised on a bed, they can pretty much do whatever they want. They're not comfortable with a woman who's rocking around the room or in a bath, doing things that aren't part of their domain,” says Dahlen.

“So already, you start to see what gets preferenced, and what doesn't get preferenced, is very much within that medical paradigm. But I also think what we've done, unfortunately, in our historical birth context is take a highly human social, physiological function, and it is the only physiological function, and we have placed it in a medicalised, pathologised, institutionalised organisation of hospital structure. And we are about efficiency. We are about fixing, and we are about pushing out. Moving things along.

“So we put birth in this context, and so the ripple down effect of sickness needs to be fixed, and it's all about making sure that you fix the disease and you get them out; this is permeating into decision making around birth without the realisation that this is a very, very social and physiological function that has long term consequences regarding trauma, the bonding with babies, the way women feel about themselves, and about mothering.”

Dahlen says that society has done women a huge disservice during this pandemic. She says the data shows that worldwide, there has been a 10 per cent reduction in services for women during pregnancy and birth.

“We've really failed … the potential worldwide implication is of more mothers and babies dying. And it is massive.

“Look at the abortion services. When the COVID pandemic began, the message to services offering abortion was they were not considered an essential health services, they were not entitled to PPE. So they had to go down to Bunnings to buy their mask and their gloves. And yet again, we make comment on women's reproductive services by those sorts of decisions.

“There's a big international report that's being put out, looking at the consequences and I'm fascinated, like in New South Wales, we went and shut down one of the only freestanding birth centres in order to have a COVID clinic. You cannot tell me there are no other places to run a COVID clinic. So why did we target that? Because nobody's ever been really happy with freestanding birthcentres because they don't make doctors feel comfortable. So, the agendas have definitely been exposed in this pandemic.”

Sarah is glad that she eventually found a hospital which allows water births, as well as gas and air (she says they “must have a few women on the board”) but laments how this major life event has been changed for her.

“Honestly, I'm just really grateful that I'm not a first-time mum, because as a second-time mum, I feel like so much has been taken away from me, but can you imagine as a first-time mum? You don't even know what to expect. You don't know what it's going to be like.

“After I had Caer, my husband had to go home because of visiting hours in that hospital …I was absolutely traumatised by that, and that wasn't during a pandemic. Can you imagine what that would be like now for a first-time mum? It's just hideous.

“I don't know what they're trying to achieve. I know you're trying to protect people and keep them safe, but the levels of postpartum depression after this are going to be outrageous I think.”

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