Guest Post: Why can’t we be proactive instead of reactionary?
Wednesday, February 17, 2010 at 5:02PM
This guest post was submitted by reader Susan.
EVOLUTION
I have, quietly, been a healthy birth advocate for almost 20 years. Since my first birth that was more like a horror movie than a joyous occasion. Things were done to me that still bring tears to my eyes and a twist to my stomach. Things that I did not know I could refuse. Things that affect me physically and emotionally ever after.
It came about gradually. My second child was a hospital birth with the limitations of constant monitoring and lithotomy positioning (the two things my OB would not bend to) but no other intervention. My third was a hospital birth with a midwife who protected me like a lion. I would have said this was the ideal situation if the staff had not been horrible to me once she left. Because of this treatment my fourth and fifth were born in the peace of my home where we could curl up in bed after and receive home care for days afterward.
Having experienced this range of situations, I chose to support home birth. To me this was logical. To others I was eccentric, a radical or just plain stupid. They would listen to my reasoning and nod but always say something utterly ignorant like, “Well, squatting in the bushes is not for me. I need drugs! Midwives are not doctors!” At first I thought this was about ignorance and the unwillingness to do research. Over time I have come to realize the situation is far more complex and involves a healthy dose of fear fueled by misinformation. It involves the fact that women should be free to have choice in any direction. I now believe that the best balance would be solid collaboration between woman, midwife, doctor, home and hospital. A birth utopia, if you will. A birth utopia where no one would have to lie and information was openly shared. Truly, if you have looked at the risks and made an informed choice, then you should have the right to make that choice.
I am writing this from a dark place. Lately I have felt this birthing ennui overtake me. I am tiring of educating against the sick stereotype that midwives are uneducated or less qualified. I am ground down by the women who believe that the cesarean rate is too high and the procedure overused but still believe their own operation was a necessary emergency. (I am NOT saying that C’s do not have a place or this situation is impossible but I have NEVER personally met a woman who thought her C was unnecessary. Only online. I attribute it to a need to believe it was necessary to protect against any feeling of loss. Much like the healthy baby pacifier.) I wish to weep whenever a first time mom tells me of her grand plan to go in and sign up for an immediate epidural. When I gently ask if she has considered the risks I am met with the standard, “My doctor tells me it is completely safe.” Like defensive automated phone systems spewing catch phrases. Deaf to all else. I am sometimes shamed when I read comments from women lambasting birth advocates for not supporting their choices to have interventions because it was “the right choice for them”. I am sometimes shamed that I have wavered in being outspoken to be more “politically correct”. My heart breaks for those who have had belief in their bodies stripped from them and their bodies cut open only to be told later that they will never be allowed to birth vaginally because it is against policy. I hate the fear that women feel to go against or outside of the system in order to have a say in their own birth. The joy of birth is being lost to me because I only see despair and struggle ahead. This is dark and heavy on my shoulders these days.
Maternal care is a feminist issue. ALL women should take the time to research and question what is being offered or even forced. Women are using the “choice” banner to defend the choice to give up choice. When the chips are down, who is really going to argue with personal choice? It makes my head spin. My worry is that most women, in majority, will not stand up for their right to control what happens to their body during pregnancy and birth until we have no control. It is going there and we see it every day. Women being imprisoned in hospitals, ordered by the court to undergo surgery, refused vaginal delivery because of a policy made by strangers counting dollars. Women being confined to beds and their bodies forced into hard labor with chemicals under the threat their doctor will “drop them” or their “baby will die”. Women feeling the only choice is to labor at home without an attendant because it is illegal for a midwife or doctor to attend them at home, where they feel safest. To me this is an echo of women hiding in their bathrooms with a knitting needle. You know of what I write.
Why can’t we be proactive instead of reactionary? Why can’t we stand strong to keep what we have a right to instead of fighting for something we have lost?
I am ever thankful to the people out there loudly advocating for all women and their babies to have safe and healthy births and admire your strength to stay the course in the face of such resistance and complexity.
Reader Comments (22)
((((((((Susan))))))))))))
I'm sorry for what you went through.
Thanks for this post. It echoes my thoughts and feelings to the "T."
Having had a scheduled c/sec for breech and an HBAC after ECV, and having seen the VBAC climate in our area, which was already bad, get worse, and having seen firsthand how social services treats people when they are called...I am actually terrified of getting pregnant again. Because I would choose homebirth again, it is what is best for me and our baby (unless of course, there were indications that a hospital would be the better choice). But if something went wrong, aside from grief I may have to endure, I'd be terrified of the establishment, y'know? Someone called it "psychological sterilization."
Unfortunately, it's a horrible time for birth in this country. And I know how you feel, I too am just weary of explaining it to people who don't want to understand, or even to understand that their choice might not be someone else's choice.
Oh, this is so sad. Susan, your exhaustion is valid and hard-earned. Please take heart in the knowledge that at least SOME women are educating themselves and fighting the system. And they are doing what they can to educate their friends and family, and to stand up for the rights of women to truly give informed consent.
Thank you for writing this article! It captures a lot of what I'm feeling right now and haven't been able to really voice. At least not as well as you did, Susan. I'll be sharing the link to this blog for sure.
And to Rachel's post...Even after such a great HB experience, I too fear getting pregnant again. It's nice to have that feeling validated by someone else.
There are a few areas in which I’m proactive, but I tend to be more reactionary. If someone is happy with the way things are going for them and comfortable with the level of research/second opinions/trust, then I don’t really care what they do. On any given day, there are thousands of women who question whether they’re getting accurate information from their doctor or are sick of having to fight for vaginal birth.
I just figure that if people say they’re happy and comfortable, I take them at their word.
On a non-pregnancy/birth related note, I find myself intrigued with the way people make decisions about their health care. The history of how the “everyone is sick” model was marketed in the U.S. is fascinating.
It's hard to be proactive instead of reactionary when what we have a right to does not adequately exist, or doesn't exist at all. I, too, tire of the birthfight. It shouldn't have to be this way.
Susan,
Thanks for this. You should not be discouraged. Because of your efforts and those of the so many other supporters of physiological birth and birth rights, I had access to the information that changed my mind. Before reading about all of this on the Internet, I would have been one of the many duped by the system. I planned on going in and getting an epidural and doing what the doctor said. Now, I'm pregnant and working with a midwife, and planning to deliver a home, and I'm happy and comfortable with my decision.
All these efforts are not for naught, and we aren't just talking to ourselves. Even the lurkers who never speak up help by increasing the visibility of good sites on the Internet.
What we need to do in this country is support evidence-based medical care and individual bodily autonomy as two linchpins of modern health care. It isn't physician versus midwife, or woman versus medical establishment. It should be all of us working to create a healthier country, period, in birth, in life, and in death.
"Birth Utopia" yes, that's a good phrase. I like that a lot.
When people tell me I complain too much because after all I had a healthy baby, I shoot back, "Bad things don't change unless enough people complain about them!" Not that complaining is all there is, but it's a place to start. I used to feel bad when doctors would get all huffy about my uncomfortable birth-related questions; now I enjoy it. I don't expect to change minds with one conversation, but I can plant a doubt, and shake them up a little bit. And the more times a given person (doctor or not) has to deal with a new idea, the more familiar and less threatening it becomes.
Please be encouraged and keep working for women's rights in childbirth! Because of women like you, when I first became pregnant, I was able to fully inform myself about my birth choices and read all the things doctors will never tell you. As opposed to some of my friends ("ooh, get the epidural!" was one of the comments made to me when I announced my pregnancy), after doing the research I realized that the hospital was NOT for me and used a midwife instead... where, 10 days after my due date, I had a 26 hour unmedicated labor that ended in a beautiful water birth. I know that had I been in a hospital, I would have been constantly harassed to get pitocin and so the spiral of intervention would have begun, possibly ending in a c-section -- and most certainly not ending with the euphoria I experienced on the birth of my healthy son. I will never forget that feeling. And I would not have known any better if it hadn't been for advocates like you taking the time to educate and inform. So please keep up the good work!
This exhaustion must be in the air. A couple of weeks ago, I was feeling similarly but was too mentally exhausted to put it into words. Besides any words I came up with, would have sounded more despondent than I really am.
There are people fighting for these rights all over the place, doing many different things, taking many different strategies. That's how grassroots works. And what we're struggling against is so big, with so much power and influence with the PR people to pontificate the rhetoric. When I first entered the arena of birth advocacy, I looked around and saw all of these grassroots efforts and wished that there was some unifying body that could bring strength to their voices. I think organizations like Childbirth Connection and the Coalition for Improving Maternity Services might be able to do that, but we need some of ability to be spokespeople like MomsRising who have a voice in the legislative lobby.
Right now, I'm working in damage control however, lending support to mothers who have been traumatized by the abuses of the system with Solace for Mothers (www.solaceformothers.org) and giving them a place to report on their so called care and find better more respectful care with The Birth Survey (www.thebirthsurvey.com).
I think the arena of birth advocacy needs a policy center. I think class action lawsuits against ACOG is needed for their misuse of and the harms caused by Cytotec, Pitocin and unnecessary c-sections, for their turning a blind eye to proven detrimental practices, for their not sanctioning their members for the care that causes known harms, for the emotional distress (trauma and PTSD) inflicted on mothers by their members violations of human rights and informed consent regulations. The FDA probably needs a class action lawsuit against them too for allowing themselves to be hamstrung by the medical lobby for abuses of Cytotec.
In order this happen, there needs to be organization, some body that collects the reports from women, who seeks out the medical experts who will testify on their behalf. What is happening is wrong, unethical and illegal, therefore the legal system must be involved. There needs to be punishment for providers and recourse for patients. The medical establishment does not police its members well.
There needs to be sensitivity training if you will for providers so they stop the abusive practices that they are using on pregnant and birthing women. And if they don't stop and do it anyway, they need to be aware of the clear and decisive consequences.
Not to mention the need for collaborative care relationships between homebirth midwives and hospital doctors, the legalization of homebirth services nationally and protecting parent's rights to make decisions on behalf of their children.
Boycotts are nice, warning women away from certain providers helps, but its damage control. It will be a long ways down the road before it changed practices. There is progress being made. The work in the last couple of years is really making a difference. I believe that there are ways to harness the collective good for greater impact.
Susan, thank you for sharing, and I feel for you. And I also love the new term "birth utopia"!
I agree with Jenne. There is truly not enough accountability for "care providers" and their actions. And I would love to see abusive docs and nurses suffer consequences for their actions.
I can totally see why things may be discouraging, but don't give up hope! Thanks to the tireless work of advocates and birth bloggers and activists like you, I will be one of the (I think growing) number of women who *will* know her options and her rights BEFORE she gets pregnant. And, barring any complications, I will be birthing at HOME.
"Women feeling the only choice is to labor at home without an attendant because it is illegal for a midwife or doctor to attend them at home, where they feel safest."
This sentence brought me to tears. It echoes the outrage that I am feeling right now. I am 38 weeks pregnant and seeking a VBAC, have an amazing doula but I have been forced becasue of the law to go to a hospital in order to have my birth attended. I thought long and hard about an unattended home birth, but it just didnt seem like the right fit for me. Now every twinge I have and every contraction makes me cringe because I am so afraid of another hospital birth. I had a scare 2 days ago in which my doula and I were concerned I may be showing signs of preeclampsia, and when I called my Doctor their only advise was to go to the hospital. In that moment it was like I was being walked to the gallows, I was so afraid of all of their poking and prodding and I hated the idea of them trying to take over this birth when I have so many plans for how I want the first stages to go. I could just imagine all of the cords and tubes tying me down to this sterile hospital bed while they tried to figure out a way to convince me to induce-- or worse yet, schedule a CS. Luckily my doula works closely with a midwife who was kind enough to let me come down to her home office and get my urine tested and listen to the baby without all of that. Even more lucky was the fact that my BP was only slightly elevated (I'm sure just being in the hospital would have shot it up quite a bit) and there was no protein in my urine.
This whole experience just brings home to me how helpless I am in this system, my birth is in the hands of hospital personnel who have never met me, have no idea the trauma that my first birth caused me. How could these people possibly understand how important this experience is for me and my healing? I have been lucky so far, and I can only hope that luck holds and that I have the chance to prove that my body is not broken, and I am strong enough to make it through this.
I realize that right now this only seems to validate your feelings, but I am also so grateful to all of you who have shown me that I can do this. I feel empowered knowing that there are other women out there fighting for the same rights that I feel deprived of. I will not be a cowering woman in a corner, simply complying with my Doctor's orders, I will have a say in my care, and I will do what I believe is right for myself and my daughter. I dont know if I would have found that strength if not for all of the support and research of the women on these sites. So once again, thank you.
Thank you all so much for your support and kind words. I was feeling low because I worried that this heaviness meant I was weak. I just want to shake my fists and say "WHY???!!" sometimes.
Jill- You're right that actual rights are insufficient. This irks me when I think of the actual power to sway decision and policy that women hold when pulled together. The problem is that the powers that be, and women themselves, have employed this divide and conquer strategy.
Jenne- Your words propped me up a bit and have me thinking toward more active advocacy.
LilRedMommy- You GO, Mama! Keep your support around you and do not lose confidence in yourself and your baby. I will be thinking about you.
LRM, I wish I could do something! Can I interest you in some happy hospital birth stories? I can ask people to link them up on the facebook page along with tips for a great hospital birth.
Jill, you have already done SO much for my self confidence and my birth process. I would love to hear some hospital birth stories and know the stories of some of the women who have been through similar struggles. I am sure I will be letting you all know about how this birth process goes shortly after my daughter is born, but for now I am just trying to relax, meditate on the beautiful life inside me, and focus on the positive experience that I am aiming for. Already because of all of you amazing women I have found ICAN and from there been introduced to my amazing doula, who has become a central part of why I am not going crazy with fright right now. We are a true team and I am grateful to have such strong women to look to for support and comfort. Even though I still have fear, I also have strength and confidence now, and a determination to make this labor and delivery be as wonderful as I know it can be.
Rachel- I had a scheduled c-section for breech and then a very easy hospital VBAC after an ECV.
LRM- I had a great hospital VBAC and you can too. Just focus on listening to your body and ignore everything else. My birth story was quick and simple for the actual birth:
http://cairomama.blogspot.com/2009/03/eva-mahassen.html
My daughter is going to be one on March 5 and I am going to publish her full birth story that includes everything I did to get my VBAC including switching providers three times, flying half-way around the world and then driving 2 hours from there to find the right team. Once it was in place, I simply gave birth. Ideally, I would have liked a homebirth, but my baby was breech and needed and ECV to turn her (nothing else worked and my first c was fir breech) and the homebirth midwife I was planning to use couldn't support me so I had to find a new provider at 34 weeks. I just kept feeing that if I could get her turned, that I could do it and I would do it easily. And that is exactly what happened.
Susan,
I thought I was educated before my first birth, but I didn't fully understand the consequences of a c-section and the bait and switch talk about VBAC. I was talked out of an ECV because everyone I met who had it done said it was really painful and didn't work which lined up with what the doctor was saying. No one in town would attend a breech birth and I was trying to coordinate my husband coming in from overseas. So I had a scheduled c-section and it was a positive experience, just not the one I was planning for.
For my second birth, I decided that if I didn't have a provider who was waving pompoms for me about VBAC, I would not accept that after hearing too many stories of being bullied in labor or pressured, etc. So I did EVERYTHING I could for a healthy pregnancy and good positioning only to have another breech. So many people around me were saying I was going to have another c-section because I wanted a VBAC too badly and I was putting in all this effort for nothing. It was challenging to stay positive, but I did it and it was completely worth it. After everything I went through to have the simplest, safest birth possible, I find it really frustrating when a woman, especially a first-time mom can't be bothered going across town for better care because it's "too far" and she's sure it will "be fine".
Still, I try to focus on the c-sections that I have helped to prevent, especially the breeches. We've had several successful ECVs and two vaginal breech deliveries in our expat group here. Those would have been scheduled c-sections if not for the sharing of stories and spreading the word (Korea has a very high c-section rate, higher than the US).
There are some cases where women just don't want to listen and sometimes they are lucky and sometimes they aren't. Sometimes they will listen for #2 and sometimes they won't. I just try to focus on the people that will listen so that they have choices and resources and support.
Anyway, sometimes you need to take a step baby with advocacy, but keep it up! You never know who is listening. In fact, my 85 year old grandfather ended up preventing a scheduled c-section for breech by telling a former coworker who had a employee who was scheduled for a c-section because of breech and was upset about it, about the ECV procedure (her doctor hadn't given her the option) and a hospital 2 hours away where I had it done and where it was done commonly. The woman told her employee and she went to the suggested hospital to have it done. It worked and she had the baby vaginally. How random is that! I didn't realize my grandfather (who doesn't talk much) was paying so much attention.
Rachel- I had a very positive hospital experience as well, a natural VBAC. Difficult pushing phase, but very supportive medical team. It was awesome and I was so glad I did it! For me, finding a supportive doctor was key, and I was able to find one who believed I had a great chance at VBACing and who was very supportive of women making their own birth decisions. Someday I will finish writing it and make a little blog for it so others can read it, but for now I am busy with two kids two and under!
mamaseoul - YES!!! See, this is why we do this, why we band together and talk, as women have done since the dawn of time. You positively affected the experience of another woman in a similar situation to yours by offering her a choice. *jumps up and down gleefully*
Mamaseoul- Of course, you never know what sticks with whom. It could be the least likely person that remembers and shares. This is a very good point. Kind of like blast advertising!
LRM- I had one amazing hospital birth. My MW was instrumental in keeping the room clear of staff, only allowing the one hospital required nurse, keeping the lights down and letting me stand in the shower for as long as I liked. She just checked me with a hand held doppler every now and then. It sounds like you have a strong team around you and you should know that, with the right support, you can have a very intimate and calm hospital birth. I look forward to hearing how it went!
I am currently out of a job, today's economy is to thank for that. Because I am not married and my fiance is still pushing through a very trying divorce, I have no choice but to be on medicaid, which is probably not much worse than delivering with his (military) medical insurance. What options do I have? I would like a home birth, a water birth for me would be the very best case scenario, but what options, if any, do I have with medicaid?
My mother is an RN in the states of Missouri and Kansas, she has told me that legally if I do not at least take my child to the hospital after birth I can be held accountable, healthy or not, and my child can be taken from me. WTF?
I have discussed water birth with both my mother and my aunt (an LPN in two different states as well) and both have agreed that if at all possible they could help me perform the water birth at home with careful monitoring. Is this going to be my only way to the natural birth I desire?
I am 5' 3" and weighed all of 125 lbs before I conceived and now, at 21 weeks I weigh in at 150 lbs and that combined with my family history of gestational diabetes, (which I have been testing negative for) and my celiac disease, (which is only controlled by diet and has been successfully for five years) and the fact that the father's previous children have been large, (daughter 9lbs 10oz, son 8lbs 11oz) as well as the rest of the children born in his family, and that I have a family history of breech babies, I have been informed that I am looking at a C-Section. Why can I not have a natural birth? I want to be the first person to hold my baby, not after the doctor, 12 nurses and the father, I want to hold him first. I carried him for nine months and I should be allowed to have him in my arms before anyone else. Is this too much of me to ask?
I've asked each doctor I have seen, each nurse, each mother, they all tell me I'm just stressing out over something that is trivial, that I'll have the rest of my life to hold him, what does it matter? I cannot possibly deliver my own baby, its impossible. Water births are dangerous, bacteria, fecal matter, a doctor won't be present, a doctor must be there in case anything goes wrong, what if the baby gets stuck in the birth canal? What if you tear? What if the baby is too big? What if the baby goes into distress? There's just no way to monitor the baby's heart under water. Just stop pushing for something that will not happen.
All of these what ifs and no positive feedback from any of the doctors, why can't anyone say anything positive for a change?
Should I take the home birth route with my mother and aunt or if I must be in a hospital, because of fetal distress or some other truly life threatening emergency, how can I have the most relaxed natural possible birth I want? What can I bring to the table to discuss with my doctor so that I am happy with my birth?
Thanks to everyone who posts to this,
-Looking for answers