A n3wb in the Childbirth Controversy

I’m new to The Childbirth Controversy.

Until about two weeks ago, the debate raged around me in dark corners of the internet, where angels fear to tread. I bought shwarmas, read Dresden novels, and rolled my eyes watching Supernatural, only vaguely aware that some people had very strong opinions about birth tubs and c-sections. But ever since I started telling the story of Tom’s birth, my eyes have been opened. No matter who I tell it to, there is judgement, repudiation, antagonism, and even hostility. Though some of the comments on the original post certainly qualify, they are by no means exhaustive. We have also heard from the pro “birth experience” side that we should have let the midwives break Renee’s water before transferring, that we didn’t push long enough, and that the c-section was a disappointing failure.

I understand (now) that I stepped into a controversy, and I could have been more clear that a couple of observations were personal experience instead of generalizations. We really did have a doctor who wanted to get us a c-section before a shift change, but had I known how that phrase (almost that exact phrase) is used as a trope to shame women for wanting a c-section–any one that isn’t done only as some horrible last-second intervention (rather than whenever she fucking well WANTS it)–I would have been much more clear about the parts that were actual experience.

However, it still felt as if my post was in many ways commandeered as a battleground in the ongoing debate. People on both sides of the contention reacted to the controversy, and not really to my story.

Let me be absolutely clear about one thing: I feel unquestionably, unequivocally (and even epically) unable to involve myself in the debates themselves. I’m not a doctor. I’m not well informed. I don’t know this fight. It caught me off guard like a minotaur in the hedge maze at Disneyland. I can add neither science nor medicine. Far more educated and informed voices than mine should blog about that aspect of it. I’m glad that my fellow bloggers here at Grounded Parents are much more well informed, working both to increase awareness of the dangers of home birth and to improve midwifery for those who would like a safe option to a hospital.

In my post, I was telling the story of a decision that wasn’t mine to make. It was a decision I would never make. But it was also a decision I had to respect because it was not my body nor my unborn child, and in the end it was a decision with which I found some small amount of peace because we found midwives who seemed more grounded than the woo stereotype.

In telling my story, I picked and chose details that worked with the narrative. I left others out. I hadn’t thought to write a blow-by-blow of the birth experience because that was not the story, and it was within this shadowy ambiguity that I found some people brought their own narrative. Rather than clarify what happened, when, or how, they seemed content to assume.

In the skeptics’ version, the doctor was strenuously telling us we absolutely needed a c-section right that second for the sake of mother and child, and the midwife, standing bodily between them, screamed that the vaginal birth would not be denied. In the natural birth version, the doctor was salivating to do a c-section, scalpels already sharpened and glittering, and the midwife was the solitary voice of reason against the big pharma/medical industry push for expediency, fear of lawsuit, and a bill pushing six figures.

Neither of these stories is true.

I figure maybe it will help if I clarified some details about the event so as to shine a light on those shadowy corners where neither set of assumptions is entirely correct:

• Every single medical intervention came at the recommendation of the midwives. They were the ones who recommended our transfer to the hospital, recommended the epidural so that Renee could get some sleep, calmed Renee and Will down about the intestinal flora and told them to take the CDC-recommended antibiotics, and backed the second doctor’s recommendation for a c-section. They even told us we might want to skip the vacuum extraction. When the midwife offered to break Renee’s water she actually said she would highly recommend against that option, given the risk factors that had already shown up. The whole reason I liked them at all was because they were not the voice of woo against the doctors and the medicine. That was the entire point of the article.
• 80 hours of labor includes the time Renee was still watching Elf, holding my hand to her stomach and saying, “Did you feel that?” She only had three-minute contractions for about 8 hours or so (though they were irregular). At that point she was still only at 3cm, so we transferred to the hospital so she could get an epidural and some real sleep. The next day she woke up, ate, and barely noticed her contractions through the epidural until it was time to push. Pushing lasted about four and a half to five hours before the c-section. Fixating on “80 hours!” without finding out the quality of labor involved is problematic.
• The timber of what happened in that room might be a little hard to appreciate for those who weren’t there. The first doctor made the comment about Renee’s hips almost immediately upon walking in. She told Renee before even introducing herself, “I’m going to let you push for two more hours, and then we gotta think about ‘other options.’ I’m not even sure your hips are wide enough to get a baby out.” Even the hospital nurse looked a little incredulous at that. The midwife shook her head, and looked at us a while later and whispered, “Her hips are wide enough. I promise.”  Renee’s hips are 44 inches wide (normally) and Tom was not particularly big (8 lbs as it turns out). The doctor made the hip comment before she even administered a pelvic exam. (The second doctor disagreed with the assessment and actually laughed at it.)
• The first doctor said things like “other options,” and “interventions may be needed,” and was really pushy and overbearing about it. However she never explicitly recommended a c-section as urgent. After three hours of pushing she said we needed to “think about interventions.” She did this because it had been three hours and that was “long enough.” Her exact reasoning was that if we didn’t do surgery right away, we could get caught in the doctor’s shift change, and it would be better to do it immediately or wait until after the night shift came on. We asked if there was any medical to reason to rush, and she admitted that there wasn’t. We waited.
• It is a post hoc fallacy to assume that because we eventually needed a c-section that the first doctor was right all along. There were over three hours (and a more experienced doctor’s assurance that Renee was fine) between that first pressuring comment and the actual c-section.
• The second doctor had approximately 20 years’ more experience in obstetrics. She was on the night shift because (apparently) more babies actually come out at night.
• (Many have seemed upset that Renee did not immediately defer to the first doctor. I don’t want to get finger waggy, but that seems a dangerous prejudice to bring to any debate where doctors are involved. Should a patient never ask about the reasons for invasive surgery? Do doctors never make diagnostic mistakes? Do hospitals never have protocols that are not in the patients’ best interests? Do we never want to have patient advocacy or a second opinion? Do we blindly trust anyone with an MD?)
• The second doctor told us we had time to keep pushing if we wanted and said she would only recommend a c-section if she thought there were serious health risks involved for mom or baby. She left us to do some more pushing.
• An hour or so later, when Tom’s heart rate had begun to go up to 160 during contractions, and with Renee spiking a fever, the second doctor came in (at the midwife’s behest, I might add), explained to us that it looked like Tom’s head was tilted, and Renee’s contractions were still a little uneven.  We could wait to see if more contractions straightened him out (though Renee was pretty exhausted from her early labor) or we could start thinking about medical interventions. She added that there were some signs of infection and that might be causing the uneven contractions, and that Tom’s heart rate was getting worrisome. We could try for a little longer, but at 170 she was going to strongly recommend we do a c-section.
• At that point, we didn’t wait any longer. We didn’t wait until Tom’s pulse reached 170.  We didn’t even need “a moment to discuss options.” Tom’s health was all we cared about. We nodded at each other and the choice was made. Renee looked at me as a tear slid down her cheek and said, “My mom had one, and I turned out okay, right?” I squeezed her hand: “You turned out great!” After a quick Hail Mary attempt at a vacuum extraction, Renee was wheeled into surgery.
• We did take the doctor’s advice. As soon as a doctor actually gave us medical advice. The second doctor respected our birth plan every step of the way, and even apologized when she had to tell us it probably wasn’t going to happen. (We sent her flowers.)

I’m new to this debate, and I hope to be blogging 300-400-word articles about blowouts and spit-up by next week. However, I recognize my own culpability in some of the misunderstandings about my story. Though the ad hominem attacks were clearly inexcusable, and as a skeptic I try to be extra careful when framing someone else’s personal narrative within existing polemics, not everyone was rude or presumptuous, and many brought up good points that as a newb to the controversy, I hadn’t considered.

While I would love to see skeptics not jump to conclusions, fall into fallacies, or presume intentions, I realize that I told a story in a way where people with some very strong feelings about the matter might feel the need to advocate. So it seemed like clearing things up–at least for those who read the article in good faith and commented with good intentions–was more appropriate than just changing the subject while the comments piled up.

Perhaps the most troubling thing I’ve encountered, though, isn’t a logical fallacy or conclusion leap. It has been simply the lack appreciation for another person’s decisions. Body autonomy has always been important to me as a feminist, and I would respect Renee’s decision equally if she scheduled her c-section in her first trimester or waited all the way until Tom’s pulse was at 170. For me, even writing about a woman’s experience, choices, and difficulties as my story is problematic, and I’ve tried to make it clear that it’s only my experience for just that reason. I was troubled by her decision. I wouldn’t have made it myself. But rational adults, capable of risk assessment, make decisions all the time that I would not–even about their children.

My biggest problem that I’ve seen in the past month is an enormous contempt for people making informed decisions for themselves. The presumption is that if they make a different choice (from EITHER side) that they clearly weren’t really informed. Flying is by far more safe than driving, but we don’t tell everyone who decides to take a road trip with their kids that they’re acting like toddlers. If someone should have multiple sexual partners, we don’t sanctimoniously tell them that they’re lucky to be alive. Yet for some reason with birth, these strident displays of righteous judgement are considered acceptable. That troubles me deeply.

I am a skeptic. I like modern medicine and CDC guidelines and doctors with lots of letters after their names, and machines that go ping. I was wringing my hands through the entire midwife affair. I’m not exaggerating when I tell you I felt (among the fear and anxiety) some measure of relief when Renee was wheeled off by a doctor and two nurses into an ocean of scrubs-colored green.

Still, if Renee should decide to have a home birth VBAC (against my wishes), I get to go through the whole thing again. But it is her body, and it is her decision.

And I respect that.

I want there to be conversations about midwives’ credentials and medical procedures and the chances of complications in a home birth and midwives requiring more education and being more informed and all that this debate implies, but I also want people to understand that it is perhaps more important when blood is up and hot to be extra careful about their own blinders. I have had my eyes opened to a whole new dimension of parenthood that I didn’t really even know was there, but that conversation seems important enough that it should happen with impeccable intellectual rigor so that it can never be dismissed as just a competing theory with its own confirmation and disconfirmation biases.

But on the brighter side, I know that this is the last controversial topic I’m likely to run into as a parent, and that it’ll be smooth sailing from here on out, and that if there is a minor contention, other parents will be totally respectful about it.  Oh yeah.