The Best Laid (Birth) Plans
I was never really planning to blog about my birth experiences here. Not that I take issue with the concept, just that I figured I would have so many other things to talk about – children’s television, larcenous elves and gender politics are much more my bag.
And really, I’m not going to tell you much about the birth of my children now. Suffice to say, I had two pregnancies and two c-sections.
I’ve deleted about 10 different explanations of the how and the why and the wherefores – I wanted a VBAC with my second, REALLY! I was pre-e with my first and there were issues with his heart rate and the first section was technically classified an emergency, REALLY! I was miserable and not progressing and there were issues and, etc, etc, etc…REALLY!
But you know what? Fuck that. I don’t owe anyone an explanation about why the birth of my children proceeded in the way that it did. We are all healthy, happy, content. Alive.
I tend to back off of sharing these experiences for a variety of reasons – not caring all that much about the means to the end (in this case, getting those beloved alien beings out of me) is certainly part of it. Being in mothering groups can make a gal who really truly didn’t care about birthing feel like she has two heads. And in my day to day life there are maybe two people who care about childbirth as an issue and everyone else just wants cute kid pics (that’s what they tell me anyway). The internet can give a warped impression of what people care about because the people sharing their stories are the ones who care about things. Those of who don’t care that much about the overall birth experience just do our thing and don’t talk about it much. Which, I guess, is part of why I do try to talk about it once in a while. Or at least stick my hand up to be counted as a data point in the question of how women approach birthing, at least online.
For people who are new to the online parenting scene, though, it can be hard to understand, I think, just how controversial c-sections can be, even in skeptical, science friendly, evidence based circles. C-section moms are constantly asked to justify our birth experiences. We are told that we didn’t really give birth because we didn’t push a baby out of our birth canal. We are told that having a c-section is why our children have [insert perceived issue here]. We are told we are not really mothers. We are told we are lazy or inadequate as women. We are told we’re not really feminist, even. We can get a pass if we have a significantly emergent emergency, but not if we schedule a c-section “for convenience”, and there’s not a whole lot of wiggle room in between those definitions for some people.
I feel truly bad for my fellow GP blogger, Chris, for accidentally triggering the landmine that is birthing politics when he was just relating his personal experience in navigating the waters of birth with a partner who really did care passionately about her experience, as is her right. As he correctly points out, there are doctors who will pressure women into interventions they don’t want, whether it’s because they don’t know any better and are following a flawed protocol, or because they want to try to keep some care consistency within the confines of hospital scheduling, or because they want to go get a cup of coffee, or for other reasons I can’t begin to fathom. But this idea that doctors and/or women spuriously push/request c-sections for no “good” reason is regularly used to demean women who have c-sections for whatever reason they choose. And the reality is also that women who want fewer, even no interventions, get no end of grief as well – people question the qualifications of their birth attendants, they dismiss home birth as too dangerous, too weird, too freaky and deride well researched non-intervention-based birthplans as being based on woo and ignorance.
So we need people talking about that side too. And what we really really need is to stop asking for other people to justify their personal choices. The people who give me the most grief when I fail to appropriately (in their mind) justify my birth experiences tend to be some of the same people who pat themselves on the back for fighting for the birth experience they wanted and who feel personally invested in getting other women to make similar choices. That’s part of what choice is – letting go of what we think is right for us and recognizing that it might not be right for other people. I would never tell another woman that she should have a c-section, because it is major surgery and it isn’t a walk in the park. But neither would I tell her that she shouldn’t, even if the reason was for something totally not medical that is…wait for it…none of my business in the first place.
Featured Image via Flickr user Nep.
How do you propose we have discussions of public policy regarding laws, regulations, and medical certifications. For instance, in some countries only CNMs are allowed to practice as midwives, and in some states in the USA midwives are not legally permitted to attend homebirths. As soon as we advocate for any restrictions to protect women and their unborn children some people will take personal offense. But the alternative is no standards or regulations which makes laypeople vulnerable to peddlers of actual woo.
Thank you for posting this. I totally agree. I had two c-sections and am totally uninterested in other people’s opinions about them but also feel that not mentioning a) that I had c-sections, and b) don’t care what others think means the dialogue becomes totally skewed.
On the topic of policies, I think only certified nurse midwives should be permitted to attend births as a person dispensing medical care, and home births (or at very least those for higher risk candidates) should be illegal for any medical practitioners to plan and attend. I attempted VBAC with my second kid and while seeking a CNM who did them a birth center I called *suggested* I do a home birth with a non-nurse midwife. As I had a rare uterine rupture, had I taken that advice I and my baby would be dead. Thankfully I knew better, but not everyone would. Such a choice shouldn’t be a legal option. People need to be able to trust the suggestions condoned by law-abiding medical practitioners.
I completely agree with this. Fact is, while there may be doctors who push c-sections for their convenience (though certainly not to the extent that the lovely documentary The Barfness of Barfing Barf would have you believe) there are just as many, if not more (a higher percentage, at least) of midwives (more accurately, warm bodies with midwifely inclinations who could never manage to become actual midwives) pushing “natural” birth no matter what, for their own convenience and their own stupid goddamned “natural” agenda, and it’s way too easy for them to do so.
I said that last comment in a confusing way- I meant that the only *midwives* legally allowed to practice should be CNMs (certified nurse midwives). I wasn’t suggesting that OBs also be replaced by CNMs.
Thanks Em. The conversation should be that a woman can always make (and have) the choice that she wants.
Thank you so much! One of my friends on Facebook remarked about how in that long thread of replies on the article you linked, almost no one mentioned or seemed to care about what mom wanted. I’m glad you brought it up explicitly.
Just wanted to leave a comment in support of you here. Moms shouldn’t be raked over the coals for choosing (or being forced by circumstances out of their control) to have one type of birth over another, and the thought of people sitting in judgement of you because they don’t like the freaking reason you had c-sections makes me feel sick to my stomach. Are the mom and the baby ok? Then shut up and be happy for them! I’m so sorry you had to deal with that at all!
In response to Martha: I like the idea of only legally allowing certified nurse midwives (as opposed to midwives without medical training) to attend births as the person dispensing medical care, that seems reasonable. When we start talking about making it illegal for medical practitioners to attend high risk home births though, I start getting nervous. I don’t think our legal system is the place to be making that decision for women and their medical practitioners. It seems to me that making sure the midwives are CNMs should really cut down on high-risk home birthing while still allowing the final choice to be between the woman and her medically trained caregiver.
Silver feather, that’s a good point. Simply requiring attending midwives to be CNMs would probably all but eliminate higher risk home births.
DeERcountry, I disagree that women should have any choice available. Of course women can choose to give birth however or wherever we want. But to expect there to be a lawful infrastructure of dispensers of medical care to support any decision just asks for abuse and tragedy. A woman might want to have a VBAC at home, and when she finds a midwife who has professionally attended births for years and that it’s perfectly legal to attempt a VBAC at home, she might think it’s just as safe. But it’s not. Most if not all people trained through the rigorous medical establishment would know that, know why, and be themselves more susceptible to being held accountable for going along with risky choices.
Thanks for this. I wanted an uneducated birth. I was healthy and did everything “Right”. But after 2.5 days if labor ended up with an emergency c section. Long story. And I feel so judged! I live in an area where home births and midwives are popular and I constantly have to hear about people’s beautiful natural birth experiences. Then people want to pick apart what I did wrong.
It’s very difficult for me because I actually did want a natural experience. As you said, best laid plans…
Things are not simple in this area.
To say that women should have all choices is an easy thing to say, but it becomes complicated once you look at actual policies.
What about liability?
What about responsibility?
What about ethics of care?
Fact is, most women are not OB/Gyns or CNMs. They need to trust those who are their medical provider, so how do you regulate their conduct? When is the provider no longer liable? Make the woman sign a waiver?
What about their own ethics and responsibility? Do providers have to support choices they cannot support with a good conscience (and are they liable for the outcome?)
To give an example: One of my own team of CNMs told about her own birth. Labour took long, she went past those famous “three hours”. She’s a CNM, her husband is an OB/Gyn. They looked carefully at the data and decided to try for a little longer. She also said that she would never ever recommend that or support that for one of her patients. Because then she was taking her own risk. She was also a fully trained professional who thoroughly understands the risks and implications, but she could not with a good conscience dump that decision on one of her patients during labour and either back out of the possibly dire consequences or take the responsibility for them.
All this doesn’t mean that we should not fight for and argue for more safe choices for women and better policies. A woman who’s a good candidate for a VBAC shouldn’t be turned away because there aren’t enough resources. And we must fight all attempts to force women into one treatment or another or to punish them for the choices they make. But that doesn’t necessarily mean that I have to support all kinds of bad policies that only look like giving women independence and autonomy. I choose my choice feminism isn’t for me.
Thanks everyone for all the comments. Part of the reason I didn’t get into the pre-birth technicalities and policy issues is because I feel woefully inadequate to substantively comment on that piece – as a matter of policy and regulation, I’m not sure what the right answers are, so I definitely appreciate the back and forth here and encourage y’all to continue!
I do want to clarify that for myself, when I’m talking about choices it is from a lay perspective and largely couched in the layperson rhetoric that gets thrown around in a lot of these discussions. If a woman wants an unattended homebirth, I *personally* have absolutely no comprehension of why. But I also do not have any personal basis to undermine that choice other than to maybe say, “So, have you really considered all of the possible risks?” But after the fact, it is sure as heck not my place (IMO) to second guess the birth method chosen or determined by a woman and her caregivers. That said, I do absolutely agree with Giliell’s last paragraph – there are risks to virtually any decision in the birthing process, be it homebirth or c-section or the full range of options in between and women need to access to honest caregivers who help them access those risks, not push them into decisions that may have as much to do with the caregiver’s philosophy as actual standards of care. I just think that if we could be less judgmental in our day to day lay discussions about birth options, it would be a lot easier for women to really consider all of their options and to feel more comfortable with the decisions they ultimately make.