vbac and choice

December 5, 2008 § 1 Comment

lawd have mercy.  nancy wainer writes in midwifery today an article entitled:

VBAC & Choice: Many Questions and a Few Answers

Rather than discuss the subject of choice ad nauseum perhaps we need to ask some questions.

Who would choose a cesarean?

What type of woman would choose to be cut open? Who would choose to be totally numb from her breasts down and to have major abdominal surgery, rather than to give birth normally? A woman who is into convenience and control?

there are alot of women i know who have chosen cesarean.  it is insulting to women to assume that to choose a cesarean means that they are uninformed or have ‘control’ issues.   but lets get through her list of questions…

C-section is an ultimate example of lack of control: The woman is totally immobile while another individual wields a sharp object and starts to slice. Have the dangers of anesthesia to mother and baby been fully explained, or have they been downplayed? Does the woman know what happens to many women sexually when they have a c-section? Does she understand how traditional childbirth education classes, given late in the pregnancy, support cesareans and increase the chance that it will be the mode of delivery? What brochures and information have been left out of her packet of goodies? Who disseminates the information that creates her “choice” of a c-section? What kinds of births did her mother, her aunts and her sisters have? Does she know that what is considered normal prenatal care in this culture—waiting in a waiting room and then being seen for six minutes by whoever happens to be “on” that day—is often worse than no care at all? Does she know that one blood pressure (BP) reading does not clinically prove pre-eclampsia? Does she know what to do if she does have a higher BP reading than normal? Does she have any idea of the vital role nutrition plays in the outcome of her pregnancy? Does she understand that many of the tests that are part of her routine care are unnecessary? Does she know what kind of births her obstetrician had, or what kind of births his wife had? Did she ask, does it matter and does she understand that the answer to that question may influence her care provider in many ways? Why is she willing to have to “recuperate” (as opposed to just rest) after having her baby excised from her body? Does she understand that all living consists of risks? What information is missing when a woman in our culture thinks it doesn’t make any difference in bonding when a mother has a cesarean?

wainer implies that if the mother does know the answer to these questions she would never choose to have a c-section.  and that last question about bonding after birth just irks me.  i have seen women who bonded really well after their c-section ( i did with my daughter…)and i have seen women who have had ‘natural’ vaginal delivery and then did not feel like bonding with their child right away.  there is a great diversity of ways to become a mother and of responses after delivery, there is no universal ideal.  the important question (the one that wainer leaves out) is whether the mother feels empowered by the choices she has made.

yes, there is alot of misinformation in the medical world (and in the homebirth midwifery community) about the risks of various types of birth.  yes, mothers need to be able to make informed choices.  and frankly, i dont know any mother or person for that matter who does not understand that all living consists of risks.

Plenty. Pulling the wool over someone else’s eyes is easy, and goodness knows that the sheep continue to march to slaughter. No, pain doesn’t make a mother, but the process of meeting fear head-on and conquering that fear just might. Sadly, many women “choose” a c-section, desperate to get it (the pregnancy, the fear) over with and not willing to find strengths within that will help them as they parent and travel the rest of their lives.

having a c-section takes inner strength.  it takes strength to weigh the costs and benefits and come to the best decision that you can for yourself, your child, your family, and your community.  it takes strength to breastfeed or bottle feed a child if you are still suffering from the effects from the surgery.  it takes strength to tell folks that you had a c-section and see the look in their eyes that says: oh, you failed, or your body failed.  it takes strength to take another route away from the ‘ideal’ and ‘natural’ birth and carve your own way.  it takes strength to define pregnancy, birth, and motherhood on your own terms and not on some pre-historical idealized ‘noble savage’ natural birth terms.  all parents, no matter the route they choose to become parents, must face that fear and find that strength.

Do they know to reduce milk intake and to read authors who actually understand pregnancy and birth, such as Ina May Gaskin, Marsden Wagner or Henci Goer? Do they understand how they become oh-so-compliant patients? Do they “get it”—that new mothers who have had major surgery are at a distinct disadvantage for so many reasons?

excuse me?  a distinct disadvantage?  godfuckingdamn.  first, if the mothers are at a ‘distinct disadvantage’ then why is it that some of the strongest mothers i have known have had c-sections?  is it because they had the inner strength to deal with these ‘disadvantages’? maybe that made them stronger.  and what distinct disadvantages, is wainter talking about?  she never tells us, instead directing us ican’s website.

The Compleat Mother’s Jody McLaughlin often reminds me that we all know that given the “kind” of vaginal delivery that is being “offered up” at most hospitals these days, “choosing” a cesarean can seem, at least on the surface, the best of the alternatives. However, we know that a decision that is made out of fear, or based on a traumatic past experience, is not a decision at all; it is a forced reaction. A decision that is made without adequate information can’t be considered a true choice.

and yet it sounds like wainer expects for pregnant women to make their decisions based on fear as well.  and i am confused as to why a decision that is ‘based on a traumatic past experience, is not a decision at all’.  even if we have the full amount of knowledge that wainer recommends, and choose a ‘natural home birth’ (as i did), dont you think that part of that is based in the ‘fear’ of what could happen to us or children in more medicalized settings?  most people’s decisions, especially about motherhood and birth are complicated including lots of (and often contradictory) motivations, knowledges, recommendations, past experiences, future hopes, etc.  and equating the decision to have a c-section with ‘uninformed’ and ‘fear-based’ is incredibly disrespectful to a complex person making complex decisions.

i strongly support women who have vbacs, dont get me wrong.  but there is not one choice that is right everyone.  and respecting a person’s intelligence, choices, and paths to motherhood is always a good answer.


§ One Response to vbac and choice

  • MamaPenguin says:

    What an excellent post. I was just following links and came across this post and could not agree more. Her questions and her assumptions strike me as insulting and offensive. I’ve met exactly zero women that have entered into the myriad of choices associated with labor and delivery as flippantly as one might choose between pretzels and potato chips, but it does seem as though mamas with c-section histories are accused of just that.

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