Jane Austen who always comes to mind when I click on Science and Sensibility!
So I was idly looking over the admirable Science and Sensibility blog and in the categories I saw, “systematic review”. Two words calculated to stir the breast of the homebirth advocate. So just because I can, I’m sharing that very link.
Enjoy! I did!
The Risks of Cesarean Section
A Coalition for Improving Maternity Services Fact Sheet
© 2010 Coalition for Improving Maternity Services. Permission granted to freely reproduce with attribution.
1500 Sunday Dr Ste 102, Raleigh, NC 27607 | Tel: 919-863-9482 | www.motherfriendly.org
Cesarean section is the most common major surgical procedure performed in the United States. The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of cesarean section. The surgical procedure poses short- and long-term health risks to mothers and infants, and a scarred uterus poses risks to all future pregnancies and deliveries. For these reasons, CIMS recommends that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. The cesarean rate can safely be less than 15 percent84 and 11 percent or less in low-risk women giving birth for the first time,28 yet, in 2007 the U.S. cesarean rate was 32 percent.30 When cesarean surgery rates rise above 15 percent health outcomes for mothers and babies worsen,5 and increasing numbers of scheduled cesareans are contributing to the rising number of late-preterm births.2,6
Cesarean rates have been rising for all women in the United States regardless of medical condition, age, race, or gestational age,52 and while the number of first cesareans performed without medical indication is increasing, no evidence supports the beliefs that these elective cesareans represent maternal request cesareans or that the rise in elective first cesareans has contributed significantly to the overall increase in cesarean rates.52 Elective first cesarean at physician request may, however, play a significant role,39 and the rise in elective repeat surgeries, which has climbed by more than 40 percent in the last ten years, certainly does.64 Although 70 percent of women or more who plan a vaginal birth after cesarean (VBAC) can birth vaginally and avoid the complications of repeat cesarean surgeries,28 almost all women today have a repeat operation because most doctors and many hospitals refuse to allow VBAC.20,35,54
A cesarean can be a life-saving operation, and some babies would not be born vaginally under any circumstances; however, it is still major surgery. Women have a legal right to know the risks associated with their treatment and the right to accept or refuse it.14 CIMS encourages childbearing women to take advantage of their rights and to find out more about the risks of cesarean section so they can make informed decisions about how they want to give birth.
What are the potential harms of cesarean surgery compared with vaginal birth?
Health outcomes after a cesarean may be worse because medical problems may lead to surgery. This fact sheet, however, is based on research that determined excess harms arising from the surgery itself. In other words, women with a healthy pregnancy who have a cesarean rather than a vaginal birth are at increased risk for the following complications as are their babies:
Potential Harms to the Mother
Compared with vaginal birth, women who have a cesarean are more likely to experience:
• Accidental surgical cuts to internal organs.53,60,72
• Major infection.43,48
• Emergency hysterectomy (because of uncontrollable bleeding).38,48,83
• Complications from anesthesia.28
• Deep venous clots that can travel to the lungs (pulmonary embolism) and brain (stroke).28,48
• Admission to intensive care.58
• Readmission to the hospital for complications related to the surgery.18,28
• Pain that may last six months or longer after the delivery.19 More women report problems with pain from the cesarean incision than report pain in the genital area after vaginal birth.19
• Adhesions, thick internal scar tissue that may cause future chronic pain, in rare cases a twisted bowel, and can complicate future abdominal or pelvic surgeries.19
• Endometriosis (cells from the uterine lining that grow outside of the womb) causing pain, bleeding, or both severe enough to require major surgery to remove the abnormal cells.27
• Appendicitis, stroke, or gallstones in the ensuing year.18,46,47,50 Gall bladder problems and stroke may be because high-weight women and women with high blood pressure are more likely to have cesareans.
• Negative psychological consequences with unplanned cesarean. These include:
o Poor birth experience, overall impaired mental health, and/or self-esteem.12
o Feelings of being overwhelmed, frightened, or helpless during the birth.20
o A sense of loss, grief, personal failure , acute trauma symptoms, posttraumatic stress, and clinical depression.37
• Death.12,22
Potential Harms to the Baby
Compared with vaginal birth, babies born by cesarean section are more likely to experience:
• Accidental surgical cuts, sometimes severe enough to require suturing.1,28
• Being born late-preterm (34 to 36 weeks of pregnancy) as a result of scheduled surgery.6
• Complications from prematurity, including difficulties with respiration, digestion, liver function, jaundice, dehydration, infection, feeding, and regulating blood sugar levels and body temperature.25,26 Late-preterm babies also have more immature brains,63 and they are more likely to have learning and behavior problems at school age.25,26
• Respiratory complications, sometimes severe enough to require admission to a special care nursery, even in infants born at early term (37 to 39 weeks of pregnancy).28 Scheduling surgery after 39 completed weeks minimizes, but does not eliminate, the risk.31,32
• Readmission to the hospital.25
• Childhood development of asthma,3,78 sensitivity to allergens,61 or Type 1 diabetes.11
• Death in the first 28 days after birth.51
Potential Harms to Maternal Attachment and Breastfeeding
Failure to breastfeed has adverse health consequences for mothers and babies. Breastfeeding helps protect mothers against postpartum depression, Type 2 diabetes, high blood pressure, heart disease, ovarian and pre-menopausal breast cancer, and osteoporosis later in life.36,71 Breastfeeding helps protect babies against ear infections, stomach infections, severe respiratory infections, allergies, asthma, obesity, Type 1 and Type 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis (a severe, life-threatening intestinal infection).15,36
• Women who have unplanned cesareans are more likely to have difficulties forming an attachment to their babies.23
• Women who have cesareans are less likely to have their infants with them skin-to-skin (cradled naked against their bare chest) after the delivery.20 Babies who have skin-to-skin contact interact more with their mothers, stay warmer, and cry less. When skin-to-skin, babies are more likely to be breastfed early and well, and to be breastfed for longer. They may also be more likely to have a good early relationship with their mothers, but the evidence for this is not as strong.16,57
• Women are less likely to breastfeed.21,44
Potential Harms to Future Pregnancies
With prior cesarean, women and their babies are more likely to experience serious complications during subsequent pregnancy and birth regardless of whether they plan repeat cesarean or vaginal birth. The likelihood of serious complications increases with each additional operation.28
Compared with prior vaginal birth, prior cesarean puts women at increased risk of:
• Uterine scar rupture. Planning repeat cesarean reduces the excess risk, but it is not completely protective.8,49,55,75
• Infertility, either voluntary (doesn’t want more children) or involuntary (can’t have more children).7,12,56,70,74,79,80
• Cesarean scar ectopic pregnancy (implantation within the cesarean scar), a condition that is life-threatening to the mother and always fatal for the embryo.67
• Placenta previa (placenta covers the cervix, the opening to the womb), placental abruption (placenta detaches partially or completely before the birth), and placenta accreta, (placenta grows into the uterine muscle and sometimes through the uterus, invading other organs), all of which increase the risk for severe hemorrhage and are potentially life-threatening complications for mother and baby.17,28,85
• Emergency hysterectomy.42,53
• Preterm birth and low birth weight.6,40,65,73,76
• A baby with congenital malformation or central nervous system injury12 due to a poorly functioning placenta.
• Stillbirth.28,29,40,65,76
Cesarean Surgery and Pelvic Floor Dysfunction
Cesarean proponents claim that cesarean surgery will prevent pelvic floor dysfunction, but it offers little or no protection once healing is complete and no protection in later life.12 Moreover, risk-free measures such as engaging in exercises to strengthen the pelvic floor or losing weight can often improve or relieve stress urinary incontinence (loss of urine with pressure on the pelvic floor such as with exercise, laughing, sneezing, or coughing).9,12
• Cesarean surgery does not protect against sexual problems,4,33,41 gas or stool incontinence,10,59 or urge urinary incontinence (loss of urine after sudden need to void).10,13,24,62,82
• Cesarean surgery does not protect against severe stress urinary incontinence.62,82 As many as one more woman in six having vaginal birth may experience stress urinary incontinence of some degree, mostly minor, at six months or more after birth.10,13,24,62,82
• Perhaps one more woman in twenty having vaginal birth will experience symptomatic pelvic floor prolapse (muscle weakness causes the internal organs to sag downwards).45,66,77,81 With three or more vaginal births, this number may be as high as one more woman in ten.66 However, many other factors, including smoking, hysterectomy, hormone replacement therapy, constipation, irritable bowel syndrome, and urinary tract infections are also associated with pelvic floor prolapse.
Cesarean Section, Care Providers and Place of Birth
To reduce the risk of cesarean surgery, CIMS encourages women to seek providers and hospitals with low cesarean rates (15% or less) and those that support VBAC. Women can access this data from their state health departments. They can also access hospital-specific cesarean rates and rates for other birth interventions for several states at www.thebirthsurvey.com and a listing of hospitals that do or do not support VBAC from the International Cesarean Network at http://ican-online.org/vac-ban-info.
Healthy women at low risk for complications should also know that choosing midwifery care or giving birth in a birth center or at home can lower their risk for cesarean section.68,69 Having a doula reduces the likelihood of a cesarean as well.34
This fact sheet was co-authored by Henci Goer, BA and Nicette Jukelevics, MA, ICCE.
© 2010 Coalition for Improving Maternity Services. Permission granted to freely reproduce with attribution.
This fact sheet is endorsed by the following organizations (as of Feb. 2010). Academy of Certified Birth Educators, Birth Matters Virginia, BirthNet of Albany NY, BirthNetwork National, Birth Network of Santa Cruz, Birth Works International, Childbirth Connection, Choices in Childbirth, Citizens for Midwifery, DONA International, International Childbirth Education Association, Lamaze International, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, Midwives Alliance of North America, National Association of Certified Professional Midwives, North American Registry of Midwives, Perinatal Education Associates, Reading Birth and Women’s Center, The Tatia Oden-French Memorial Foundation, toLabor: The Organization of Labor Assistants for Birth Options and Resources.
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85. Yang, Q., Wen, S. W., Oppenheimer, L., Chen, X. K., Black, D., Gao, J., et al. (2007). Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG, 114(5), 609-613.
About the Risks of Cesarean Section
A Checklist for Expectant Mothers to Read During Pregnancy
Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. There are health conditions where a cesarean birth is necessary for the well being of the mother or her baby. However, more and more mothers these days are giving birth by cesarean section for non-medical reasons. A cesarean poses risks as well as benefits for mother and baby, and should not be undertaken lightly. This educational material is provided by the Coalition for Improving Maternity Services (CIMS) to help all expectant parents become better informed about the risks of cesarean section.
To give the expectant mother time to reflect on this information and consider the impact of cesarean surgery on her health and the health of her baby, care providers are encouraged to introduce and discuss this evidence-based information throughout pregnancy and no later than at 32-34 weeks. The expectant mother is encouraged to take the form home, read and initial the statements, discuss the information with her partner, and raise any questions or concerns she may have with her care provider. The form may then be placed in her chart.
Expectant Mother’s Name: _________________________________________________
Care Provider’s Name: ____________________________________________________
A cesarean section is an operation by which a baby is born by making a cut in the mother’s lower abdominal wall (abdominal incision) and a cut in her uterus (uterine incision). I understand that a cesarean operation may be more dangerous than a vaginal birth for my baby and me.
POSSIBLE PROBLEMS FOR ME WITH A CESAREAN AS COMPARED TO A VAGINAL BIRTH:
1._____ I am more likely to have more blood loss and a longer recovery time.
2._____ I am more likely to have accidental surgical cuts to my bladder, bowel, or gastrointestinal tract.
3._____ I am more likely to have a serious infection in my incision, uterus, or bladder.
4._____ I am more likely to have thick scarring (adhesions) inside my abdomen that may cause chronic pain years after my cesarean. This scarring can make any future abdominal operation I may need more difficult.
5._____ I may have uncontrolled bleeding and need an emergency hysterectomy (removal of the uterus) if the bleeding cannot be stopped.
6._____ I am more likely to have complications from anesthesia.
7._____ I am more likely to develop serious and life-threatening blood clots that can travel to my lungs (pulmonary embolism) or my brain (stroke).
8._____ I am more likely to be admitted to intensive care.
9._____ I am more likely to need to return to the hospital for complications from the cesarean operation.
10._____ I am more likely to feel pain and/or numbness at the site of the operation for several months after my surgery.
11._____ I am less likely to breastfeed successfully. I may lose out on the health benefits of breastfeeding for myself, including: weight loss, reduced risks of cancers, heart disease, diabetes, and osteoporosis.
12._____ I am less likely to have a satisfactory birth experience. I am more likely to have emotional problems such as post-partum depression and post-traumatic stress. Many women experience a profound sense of happiness after a normal birth that flows naturally into bonding with the baby and breastfeeding.
13._____ I am more likely to die.
POSSIBLE PROBLEMS WITH A CESAREAN FOR ME WITH A FUTURE PREGNANCY AS COMPARED TO A VAGINAL BIRTH:
14._____ I am more likely to have trouble becoming pregnant again.
15._____ I am more likely to have complications in a future pregnancy due to the scar in my uterus. If the new placenta attaches over my previous scar, it is more likely to cause serious problems, including: serious bleeding, placenta coming in front of the baby (placenta previa), placenta growing into or even through the wall of the womb (placenta accreta), miscarriage, or pre-term birth.
16._____ I am more likely to have a baby with a congenital malformation, central nervous system injury, or low birth weight due to problems with the placenta.
17._____ I am more likely to have a stillbirth.
18._____ I am more likely to require major surgery to remove cells from the lining of my uterus that may grow outside my womb (endometriosis).
19._____ Since it is difficult to find a physician or hospital supportive of a vaginal birth after a cesarean (VBAC), I am more likely to have a repeat cesarean for the birth of all my future children, although a vaginal birth after a cesarean birth is usually safe. Each additional operation I have increases the odds for complications.
20._____ Research shows that having a cesarean will not protect me from urine, gas, or stool incontinence in the future, or from future sexual problems.
21._____ I may not be able to get healthcare coverage since some insurance providers consider a cesarean to be a pre-existing condition.
POSSIBLE PROBLEMS FOR MY BABY:
1._____ My baby is more likely to be born prematurely if the cesarean surgery is performed anytime before labor begins. A premature baby is more likely to experience the following:
• -admission to the intensive care nursery
• -trouble breastfeeding, digesting food, and regulating body temperature
• -developing jaundice
• -brain development problems and difficulties in learning in school
2._____ My baby is more likely to face complications from anesthesia and postpartum pain medication.
3._____ My baby is more likely to be accidentally cut during surgery.
4._____ My baby is more likely to have breathing difficulties since labor contractions clear the lungs.
5._____ If I agree to a scheduled cesarean, it is normally best to wait for labor to begin before performing the operation.
6._____ My baby is more likely to have difficulty breastfeeding. My baby is less likely to benefit from skin-to-skin contact with me and is less likely to get the health benefits from breastfeeding including: reduced risk for asthma, allergies, respiratory infections, Type 1 diabetes, childhood leukemia, and SIDS (sudden infant death syndrome). If I do have a cesarean, I can request special care to help me and my baby breastfeed successfully before I am discharged from the hospital.
I have read and discussed this information with my care provider.
Expectant Mother’s Signature: _______________________________ Date: ________________
Care Provider’s Signature: __________________________________ Date: ________________
This information is provided for expectant mothers and their care providers by the Coalition for Improving Maternity Services (CIMS). CIMS strongly recommends that cesarean surgery be reserved for situations when potential health benefits clearly outweigh the risks. Please see the The Risks of Cesarean Section, a CIMS Fact Sheet for the references that support this form, available as a free download from www.motherfriendly.org
What are you reading and writing? Here’s a few of the things I’ve found to be good reads lately.
Breastfeeding children and women a “low priority” – Western Australian parliament
Remember the protests in Perth last year about Premier Barnett’s party failing to bring WA into line with the rest of Australia with laws protecting breastfeeding families from harassment? In which Barnett insisted that there would be no need for a law if only women were “courteous” and “modest”? Even after a woman was ejected from a restaurant for merely asking for a more private place to breastfeed; even after a woman was follower and questioned in her workplace by police for expressing milk behind a curtain in a parenting room? In which Barnett pouted that any change to the law would be merely “symbolic” as far as he was concerned?
The GroundSwell Project: social change and global conversations about death, dying and bereavement
The GroundSwell Project is a not-for-profit organisation committed to developing innovative programs that engage young people in community arts projects and global conversations about death, dying and bereavement in order to contribute to social change.
Before I became a doula, I was pro-choice because I grew up in the rural Midwest and saw how abstinence only education, coupled with limited access to abortion, exacerbated class disparities in my hometown. Since I’ve become a doula, my views on abortion have become more immediate and nuanced. The decision to have an abortion is never an easy one. No one makes choices about their reproduction on a whim; I trust the decisions that women make because they are hard-fought. I hope that my continuing work as a doula and as a reproductive justice organizer honors each of the women that I have met in the hospital waiting room.
“Oh for God’s sake why didn’t somebody give this woman an enema?” -OB to woman birthing in 1969. She still remembers these words to this day.
About 4% of babies are in breech positions at term. Of course nowadays the normal course of events is surgery. Is this safe? Realistic? Warranted? Not according to evidence, no.
“Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun, but you wouldn’t dream of pulling open the petals of the tightly closed buds, and forcing them to blossom to your time line. ” -Gloria Lemay
Lisa Barrett’s blog entry on breech. Lisa is an independent midwife in South Australia.
http://www.homebirth.net.au/2008/03/breech-variation-of-normal.html
A video of a breech birth.
http://www.homebirth.net.au/2010/01/frank-breech-video.html
Birthing a baby by the breech at home.
Beech B. AIMS Journal, Vol 14, No 2, 2002, p4-5
Coroner’s inquiry into a breech delivery.
Beech B. AIMS Journal, Vol 14, No 2 2002 p19-20
Breech Presentation – Caesarean operation versus normal birth
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p1-4
Natural, Active Breech Birth.
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p5
Keep Your Hands off the Breech.
Cronk M. AIMS Journal, Vol 10, No 3 1998, p6-8
Why are some babies breech?
Lowdon G. AIMS Journal, Vol 10, No 3, 1998, p8-9.
Turning Point for the Breech?
Thomas P. AIMS Journal, Vol 10, No 3, 1998, p12-13
Breech on Gentle Birth archives
http://www.gentlebirth.org/archives/breech.html – overview
http://www.gentlebirth.org/archives/breechcl.html – turning
http://www.gentlebirth.org/archives/breechtn.html – turning
http://www.gentlebirth.org/archives/breechrf.html – studies
Book review on breech babies.
http://www.midwiferytoday.com/reviews/breech.asp
Ina May Gaskin on catching surprise breech babies!
http://www.midwiferytoday.com/articles/3surprisebreeches.asp
Homeopathy to turn babies in utero.
http://www.midwiferytoday.com/articles/turnbaby.asp
A great site on moving breech babies.
http://www.spinningbabies.com
A Natural Breech Birth – hospital
http://www.lalecheleague.org/NB/NBMarApr01p47.html
More than you could ever hope for from the UK midwives (I love these women!)
http://www.radmid.demon.co.uk/breech.htm
About 500 birth stories with clear descriptions.
http://www.breechbabies.com/breech%20_stories.htm
Lovely story! Home breech lotus birth! (Quick, call RANZCOG and tell them one got away!!)
http://www.birthwell.com.au/birth_stories_priya.html
Footling Breech: A Midwife’s Own Birth Story – by Veronica Wagner
In this memoir a midwife reflects on the story of her birth as a footling breech in Germany during World War II, and the homebirths that she has attended in her life. She touches on both themes, remembering not only breech births, but the role that animals have played in many births she has been involved with.
http://www.midwiferytoday.com/articles/FootlingBreech.asp
http://www.home4birth.com/pregnancy/Breech/index.html
Breech birth is not inherently dangerous if medical intervention is avoided and if the mother is allowed to instinctively choose her birth position and give birth at her own pace. It really disturbs me to not see this attitude represented at all among most people. Every suggestion made, every time you touch a woman during pregnancy, labor, and birth, every time you hint that something about her baby, her pregnancy, her labor, or her birth is not exactly as it should be, is an intervention that could lead to complications.
http://www.birthinternational.com/articles/andrea13.html
Most breech babies will turn naturally before labour. You will probably be referred to an obstetrician as these days few midwives will undertake a breech birth, even though in the past most midwives considered this within their scope of practice. There are still some midwives who are happy to assist with this variation of a normal birth, so it may be worthwhile asking around in your local community to see if you can find a willing midwife.
http://www.aims.org.uk/Journal/Vol10No3/breechCSvsNormal.htm
There are widespread fears surrounding vaginal delivery of the breech presentation and a lack of information generally available on safe vaginal delivery of a breech. There is also a lack of honesty about the risks of caesarean section and sparse knowledge of the post-caesarean difficulties many mothers encounter. These factors, together with the prevailing myths and beliefs that caesareans guarantee healthy babies, more often than not leave the woman with no option but to blindly accept the decisions made for her by her obstetrician.
VBAC is an endangered species.
This is not really surprising since vaginal births of all kinds are endangered and it only makes sense that having created a birthing monster of cuts and scars, Dr Frankenstein would be unwilling to let the monster go use it’s body in some way that silly old evolution intended.
But surely, I hear you cry, surely MY surgeon is different!** She supports my vbac hopes! Her secretary said she was great for VBAC so I had no need to ask further! No doubt someone whose wages are paid by Dr Frankenstein would be utterly objective and truthful in their comments to me, the potential paying client!
So yes, she supports me to birth vaginally so long as we’re both healthy.
Well gee that’s a relief! Here was me thinking you hoping for a VBAC would mean your surgeon would refuse to slice and dice if you got genuinely ill. Phew.
She supports me to VBAC so long as I go into labour before 38 weeks.
Oh nice. So long as you gestate shorter than about 95% of women, you’ll get a bit of a go at labour! Yay! Send out for pizza! Oh but not in labour, because you’re not allowed to eat in case you need surgery.
She supports me to VBAC if this baby is smaller because the last one didn’t fit through my pelvis.
Ah excellent. Of course she’s forgotten to say size estimates are a crock, and she’s totally forgotten that your pelvis works perfectly. I didn’t see you come in with a wheelchair, or on crutches, or with a pelvis so misshapen you can barely walk and your nearest relatives lived in London’s East End prior to WWI.
I was hoping for a vbac but at 36 weeks my surgeon tells me my baby is too small.
Hang on, I thought small was good? And you know, at 36 weeks most babies are small because they haven’t finished growing. Your baby may have another six weeks in it’s growth plan, do you know otherwise?
My surgeon supports me to VBAC, I just have to have a little more monitoring in labour.
Are you aware that “a little more monitoring” is actually going to be you with a bed strapped to your back, monitors wrapped around your belly, probably a scalp monitor shoved through your vagina and screwed into your baby’s head thus preventing you from moving around and actually birthing? Are you aware that evidence does not support this? You will also have a cannula stuck in your vein making it impossible for you to use one hand. Good thing you’re strapped down and don’t need to hold onto anything, hey? At least there won’t be much difficulty moving you about when it comes time to wheel you into theatre for your life saving surgery! What a comfort…
My surgeon said I gave it my best shot, I laboured for X hours and I was tired so I would never have been able to push my baby out anyway.
Ah yes. It’s a good thing birth normally lasts about 30 minutes so no one’s ever tired by it. You know, no one rushes up to marathon runners and says, “Hey you look really tired, just grab a cab to then end. It’s ok, you gave it your best shot, don’t worry about it!” And I often see footballers being carried off the field so they don’t get too exhausted, poor things. And of course your surgeon’s trusty crystal ball would have told them exactly how long your labour was going to be, so that was easy to predict. And since you never get to sleep again in your whole life, you would never have caught up on any sleep. One could argue that we have lots of time to sleep, but only one chance to birth a baby but one wouldn’t want to upset anyone with logic, hey?
My surgeon said that my scar was hanging on by a thread so I should never attempt to VBAC again!
Golly gosh, Batwoman! Hey how come there was no sign of imminent rupture with all that monitoring? How come your baby has Apgars of 9 and 9? Although it’s gut has been irretrievably altered, but let’s not mention that.
And sadly, my surgeon informed me that my uterus was paper thin so that’s another reason I will have to have “elective” surgery next time!
It’s the simple things which say the most, isn’t it? Get a normal household type balloon for kiddie parties and the like. Study it closely. See how thick it is at this resting state? Now blow it up, watch it change colour and get thinner as the same amount of rubber stretches to take on a large amount of air. See that? It gets thinner. Now see what else? Look down, look at your amazing body with all it’s muscles, tendons, bones and ligaments and remember that pregnancy is a normal use of your body and all those things are keeping your uterus firmly in place. They’ve held your baby through a long gestation, constant workings of the muscle as it tones for labour. If you don’t doubt your lungs can breathe and your gut can digest, give your amazing uterus some credit too.
** Far be it for me to point this out, but there’s a basic contradiction in going to a surgeon to avoid surgery, isn’t there? Do I go to a plumber and hope she won’t fix my pipes? Do I go to a mechanic and ask her to look at my car but not recommend any mechanical alterations?
Do you really want a VBAC, or are you pretending so you can humour those boring people around you who have all those “facts” about how it’s better for you? Are you just really scared because you know, in our birth-hating world it would surprising if you weren’t and I have immense compassion for you.
You know, it’s ok to have fear, but you’re not going to avoid a hole in your uterus by having surgery. In fact, you’re going to guarantee your uterus has more than a hole, it will have a big slice that someone will put their hands in and rip open. If you want to keep your uterus intact, you will stop hoping, start planning and make some better decisions about models of care.
Pick a surgeon, don’t be surprised when you get surgery.
In recent years as midwife-assisted homebirth has become more topical in the mainstream press, so too freebirth* or family birth, has also become more widely known. Our culture of control over women means that the shock value of women birthing autonomously is on a par with those women who chained themselves to parliament houses for the privilege of voting. The politicised nature of birth, and the heavily contested zone of women’s bodies, means that any choice outside of an external careprovider model is scrutinised, criticised and demonised. Those who birth in hospitals, with their poor outcomes and constant newsworthy crises are seldom asked to justify their decision despite the clear evidence that their choice is the suboptimal one. How refreshing it would be to see women in L&D quizzed over their reasons, research and capabilities to manage the system they’ve chosen.
*[Important nomenclature point: “Unassisted Childbirth” while a popular label, still epitomises the notion that the norm for birth is “assisted” and yet a woman birthing without a medical attendant is seldom actually “unassisted” just supported in different ways from assisted births.]
There are a number of broad reasons often given for those who choose freebirth – note that this is not the same as women speaking for themselves. Some reasons include the cost of private midwifery care, availability of midwifery care, fear of careproviders or previous trauma. All of these are still coming to us via a paradigm which assumes the only model for birth to be one in which women seek external care provision. This argument posits that only “damaged goods” or those without access to midwives would need or want to birth without an attendant, thus cementing the primacy of the external careprovider in birth. For some women, some of these factors do come into play. For many women these are not factors which they consider when planning a birth. Those living in major cities, for instance, have little trouble locating independent midwives.
The pressures on independent midwives are well known to those of us who work in birth and it cannot fail to be acknowledged as reprehensible that obstetricians who work without evidence or woman-centred care are favoured on every level over those who would seek to offer women something of benefit to them, their families and also the wider community. What some midwives fail to recognise however is that the very pressures on them from those bureaucracies which seek to stamp out homebirth are filtering down to clients in a very real way. The obstetric model of “care with strings” is the one promoted by these bureaucracies so women are forced to accept birthing under conditions which may indeed favour a midwife’s continued access to registration but does not support women to achieve the births they desire. However the end result is arrived at, some women are thus unable to find midwives to care for them and decide, given the demonstrable dangers of our hospital system, that they will be an autonomous consumer within the healthcare system and care for themselves.
Freebirth is thus not an attack on midwifery but for some women it is an indication that midwifery as it stands is unable to fulfil the needs of many consumers. Perhaps rather than viewing freebirthing women (and those who support them) as another enemy, it would serve some careproviders to use this information to reflect upon how to manage these issues without clients being affected. The use of freebirthing women’s stories to promote midwives’ campaigns for professional recognition is a misguided approach and only furthers the existing paternalism around birth. Midwives should be freely available to all women and to exploit some women’s decisions to birth without a midwife in order to further a very different agenda does not seem a deeply considered strategy. Increased availability of midwives, desirable as it is, will not alter every woman’s freebirth plans given the range of reasons women might choose freebirth in the first place nor should it since women’s right to choose within birth must be inviolable.
However a woman arrives at the decision to pursue freebirth, it almost always boils down to a desire for autonomy. Autonomy is not available to women in the hospital system, it is not available to all women choosing independent midwifery for complex reasons, some of which are stated above. In fact it is generally not available to (nor is it pursued by many) women in our lives outside of birthing. Some women want to truly make their own decisions around their bodies, births and babies. This can only be a radical concept in a world where women are seldom supported in their basic rights to bodily integrity.
Imagining women with an automatic right to full autonomy is disturbing to many of us, enculturated as we are to believe that women are communal property, subject to the invasive gaze of authorities both public and private. It seems a difficult concept for careproviders who come from a background of normal socialisation and through inherently misogynist training to grasp, but it is as difficult a concept for many women to grasp and those who do are a (maligned) minority. Some women even recognise that it is their response to the client/careprovider dynamic which leads them to choose autonomous birth and thus avoid their own socialisation to hand over their power. Careproviders might even find their own personal and professional satisfaction concomitantly increased by taking similar steps.
It would indeed be refreshing sometime to see the tables turned and women who choose birthing options known for poor outcomes, and venues in which their power is expected to lie dormant questioned about why they would make such dangerous decisions. Of course this can only happen in a world where it is no longer normal for women to unquestioningly accept what is offered as “care” in the maternity system and what passes for “choice” when you inhabit a faulty feminine body in a patriarchy.
