Book Review: All That Matters, by Rebecca Schiller

This short book written for the Guardian by writer, human rights activist and doula, Rebecca Schiller, is easily digested in an hour or two. But don’t be misled by its brevity; Schiller has given us an important document.

As a breastfeeding counsellor, a core part of my education was reading The Politics of Breastfeeding, by Gabrielle Palmer. A book that puts infant feeding in it’s political, historical, economic and geographical context and serves as a call to arms: knowing what undermines the health and well being of babies and mothers and campaigning to change it is a vital aspect of our work.

Until now there has been no equivalent to Palmer’s work on the subject of childbirth. The fact that much of the content of ‘All That Matters’ is well documented elsewhere is immaterial; here is an accessible, informative round up of the political landscape of childbirth around the world. This book is a primer for us all – birthworkers, parents and policy makers.

‘All That Matters’ takes us on a romp around the world and through history, documenting the human rights abuses of pregnant and birthing women that are becoming increasingly common. Whether it’s episiotomy without consent in a US hospital, forced cesearean section in Brazil, imprisonment for ‘fetocide’ after a stillbirth, lack of safe intrapartum care in Africa or the everyday lack of dignity and respect in birth rooms around the world.

A vital aspect to the book is a clear explanation of the fallacy that ‘all that matters is a healthy baby’. Exposing the illogic of this assertion and the violations of bodily integrity or emotional abuse it allows, reminds the reader that cultural memes are not necessarily factual or useful.

…by this logic women become important merely as containers, the vessel…Something to be cared for because of its contents, but not because of its intrinsic value…

An overview of the work being done around the world to protect and promote Human Rights in Childbirth is an illuminating read – depressing at times given the lack of progress and even the retrograde steps being taken in some countries to undermine woman-centred, culturally-sensitive care. The wholesale evacuation of pregnant Aboriginal women to hospitals in the city, away from their social support networks is an example.

An examination of what we actually mean by terms like human rights in childbirth, birthrights, dignity, respect and choice is fundamental to any effective discussion of the topic. Schiller enables the reader to move out of her cultural bubble and put herself in the context of a worldwide movement, one that seeks to change childbirth for the better. Of course, what ‘better childbirth’ actually means is an issue hotly contested and this little book expertly puts paid to the controversy: there should be no value judgments surrounding the definition of a ‘good’ birth. It is simply one in which the mother feels in control, safe, supported and free to give and withhold consent according to her emotional, physical, cultural and spiritual needs and desires.

Any discussion of rights and responsibilities within a subject matter of such interest to all women (as Schiller expertly points out, this topic effects even the one fifth of women who remain childless, as the legal, social and employment opportunities available to them may well be affected by their status as potential mothers) must inevitably lead onto how childbirth rights campaigns fit into the wider context of feminist thinking. Clearly, the behaviour experienced by many women around the time of childbirth is inherently patriarchal, even misogynistic. The ‘be quiet and do as you’re told, there’s a good girl’ mentality is alive and well and probably living in a maternity hospital near you.

Of course, one of the main problems with aligning campaigns for improvements in maternity services with the wider struggle feminism represents is the criticism women attract that they are making certain choices in childbirth to make a political point. As Schiller ably points out, this is sheer nonsense and, given free access to their choices and the absolute risks attached to those choices, women will opt for things that they consider to be in their baby’s, and their own, best interest. Feminism has, until recently, largely overlooked childbirth because of the complex nature of these issues.

Women who have elective caesareans, epidurals, homebirths, unassisted births, bottle-feed or breastfeed their children until the age of four aren’t trying to make political statements.’ Nevertheless, we have become used to thinking this way. Women who express one opinion are accused of making another group feel guilty because, even if it isn’t present (and oftentimes it is), a value judgment is instantly associated with a particular choice. One of the ways feminism has struggled to tackle the inequalities in birth is the overbearing presence of the political and moral lens in the argument.

Thankfully, this eloquent book isn’t all doom and gloom. Schiller finds space to detail some of the positive work going on around the world to protect women’s reproductive rights, not least the organisation she herself co-founded, Birthrights, which seeks to educate and advocate for mothers. There is much going on to improve the education of Health Professionals, but it is the grassroots work going on, driven by the users of maternity services themselves that are making an impact; mother to mother support paradigms, such as doulas, birth choices discussion groups and online support are perhaps beginning to empower mothers to demand safe, appropriate, loving care.

As Schiller says:

Our ability to become pregnant is the root excuse for treating women as second-class citizens. The punishments, control, surveillance and barriers to full and equal participation in society are imposed disproportionately…

So, if you are a birth worker, health professional, mother, father or feminist, this book is about to find its way onto the screens of any thinking person with an interest in maternity. I say, don’t delay; you won’t regret reading it.

Download the book here:  http://guardianshorts.co.uk/category/guardian-shorts-originals/ and follow progress on Twitter: #allthatmatters