Friday, December 16, 2011

On Birth and Privilege

I like the idea of various groups that are pushing for more natural childbirth options - more midwives, fewer hospitals, fewer c-sections.
I see something interesting happening though - while they stress that women should prepare for their births, prepare to go into battle if they have to deliver at a hospital, birth plan in hand.....they don't stress having a backup plan. And they're mostly militant that any other option besides what they're presenting is a bad idea.
Must be nice to have the education to know what the options are. And to have health care resources (like being in a state where midwives aren't outlawed). And to be healthy enough, and have a baby healthy enough, to remain relatively low risk (based on Acorn's birth, Leaf and I automatically risked out of any midwife practice - hospital or homebirth - in the area, and obviously that was a valid reason to be required to be followed by an OB). And it must be nice to have support people who support those choices. In some places it's also a matter of money - around here, a homebirth is about $3000, though some have sliding scales. If you're low income and on medicaid, at least here, they won't touch the midwife's bill, but they'll pay most of a hospital birth, so the system is flawed to begin with.

Now, it's probably just my perspective, having twice been through a birth that wasn't what I had in mind, but if knowledge is power, then these groups are nearly as bad as OBs who start scheduling c-sections at 35 weeks. Nearly 1 in 8 babies is born early. Complications happen. And when you've planned the perfect birth and get something else through no fault of your own or the birthing staff you're working with, you're setting up a dramatic emotional upheaval - even moreso if you have no idea what the risks really are when interventions start.

I know women who have left midwives and doctors over something as simple as "we want you to have a backup plan, based on your previous deliveries." I know people who've had complications crop up in a third or fourth pregnancy after no issues in their previous ones who were completely lost when they ended up in the hospital, whose birth experience wasn't all that bad, but for whom the emotional strain of things gone wrong left them crushed, alone, and unable to bond with their child.

Does a c-section interfere with bonding? Well, you wouldn't know it to see Acorn, though I can see how it can make it harder. But what about telling women how to cope with that if it happens? Nipple confusion and breastfeeding issues? Most NICU babies here get both bottle and breast if mom wants, with apparently little or no confusion, and more effort to help women to breastfeed post c-section or while on meds like magnesium would go a long way to eliminating the problems caused by the less than optimal birth. And so on and so forth - I have yet to find *any* group that talks about these things, or provides information to moms who do have anything other than a natural birth.

Yes, we all need choices. Yes, fewer interventions are better. But it seems to me that preaching that no interventions is the only way to go hurts women and babies.


  1. I teach Bradley(c), and covering "what-if" situations is a regular part of the course. We cover complications, risks, c-sections, recovery, bonding... it's not possible to cover every possible complication, but I try to stress that if there is a true problem, that's what the doctors are for. There's no reason for the parents to feel they failed if a complication requires interventions.

    The problem is that so many doctors and hospitals treat pregnancy and labor like a disease. They want to intervene even with perfectly normal variations in a labor, or no variations at all, "just in case." So we spend more time teaching couples the "battle plan" as you said. We wouldn't have to if modern obstetrics had a "hands off" policy, instead of the intervention-happy plan they now espouse.

  2. My older sister had everything planned. And then her contractions wouldn't start, so her husband took her to the hospital, and the baby's heart beat was starting to stumble, so she had a C-section. Until today, I think she feels as if she failed somehow.

  3. I agree some can preach a battle plan and stick to it. But there are others also willing to say all that matters is a healthy mom and baby.

    I had two deliveries that wasn't my ideal. But they were still perfect in that I have two healthy children and my health as well.

    In the end we must all do as we deem right. But because doctors are not taking a minimalist approach to birth all mothers really need to be informed of their options.

  4. Oh, absolutely, information is important. But what I'm getting at is that not everyone gets information on how to have fewer interventions...and those who do get that info and then end up in a less than ideal situation are not provided the information they need to deal with the unexpected events.

  5. Exactly. I know women with successful VBACs who feel that way because of the details of how things worked out - it affects their entire relationship with their child.

  6. Which is why when I was doing my own research I looked into what could happen so I could be a little more prepared for those "what if" events.

  7. I agree that they're often quick to intervene. Really, I do.

    But based on what I've seen on preemie boards and other parenting boards, I'm not convinced anyone balances the possible complications and the push for having things the way you want them.

    To be fair, I've never actually made it to my child birth classes, so I don't know the specifics of what various methods teach, but it's certainly not coming across as something that's been considered when I read other people's posts.

  8. I think I-CAN might be the kind of group you are thinking of/looking for - the International Caesarean Awareness Network. The women I know who are involved with it are pretty amazing advocates (though, granted, some women involved in it also can be pushy, as anyone can with a passionate agenda, right?) and the organization's website has info that reminds me of what you're listing. I personally did not encounter the "it has to be no interventions or else you're a failure" line, but I have since giving birth seen it occasionally online, and I think an all-or-nothing attitude is never a good one.