Tuesday, February 20, 2007

"It is none of your business"

In response to one of the anonymous comments to "Four out of Five":

I care a great deal about what happens to women giving birth. I care that over 30% of American women today have major abdominal surgery in order to have a baby, because most of those surgeries are preventable.

I care because cesarean sections have a huge host of risks to both mother and baby. Here is a short list of some of the risks of cesarean sections, from the International Cesarean Awareness Network:
A cesarean section is major abdominal surgery with all that entails. The surgery itself, as opposed to medical problems that might lead to a cesarean increases the risk of maternal death, hysterectomy, hemorrhage, infection, blood clots, damage to blood vessels, urinary bladder and other organs, postpartum depression, post traumatic stress syndrome, and rehospitalization for complications. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs as well as placenta previa, placenta accreta, infertility, ectopic pregnancy, uterine rupture in subsequent pregnancies and the risk of chronic problems from adhesions. There are also risks to the baby such as respiratory distress syndrome, prematurity, lower birth weights, jaundice, lower APGAR scores (APGAR is the means of assessing the health status of a newborn), and finally in 1 to 9 percent of cases the baby is scarred or even maimed by the scalpel.
I care because there are better ways of doing birth. Three of the four women did not desire a cesarean. Now they are dealing with the aftermath of the surgery. They will always live with their scars and their emotional wounds.

I care because a 30% nationwide cesarean rate is an incredible waste of medical resources. It is indicative of an obstetrical care system that has failed women.

I care because it is so hard to be "allowed" to have a vaginal birth after cesarean in this country. Many hospitals do not allow VBACs--which is ridiculous, because how can you outlaw an involuntary bodily function? The first cesarean often dooms women to repeats, unless she does an extraordinary amount of research and makes choices that are socially frowned upon--such as hiring a midwife for a homebirth, or birthing unassisted.

I care because my friend (woman #4) loves her baby, but hates everything about his birth. She has told me that she feels violated by what happened to her. It IS my business to care.


  1. ...to continue here (see my comment on the "4 out of 5" entry):

    As a mother whose *personal* choice is out of hospital birth, it is my understanding that many other women choose hospital birth but hope to avoid interventions. Not everyone chooses "hospital birth WITH interventions" as anonymous suggests. Not in the sense that one would choose cheeseburger WITH fries. Wouldn't it be nice if the scores of women who prefer to give birth in a hospital nevertheless had access to care that truly minimizes unecessary and unwanted interventions? Is it not acceptable to criticize a status quo where this type of care is systematically denied to mothers?

    If YOU, anonymous, respect the choices of those who give birth in hospitals, then that must include those who want hospital VBAC, unmedicated vaginal birth, and all the stuff that written birth plans are made of. And if you do, it follows that you regret to see the decades long trend of rising c-section rates (not accompanied by improving outcomes).

    Do you?

  2. Right with you judit!

    It's also questionable whether most of the women whose "personal choice" is birth in a hospital are actually making an *informed* choice.

    Do they really know the relative risks of home birth vs hospital birth?

    Have they really been given all of the information?

    Or do they just think that it's what you do, because "everyone" does it and they're told home birth is "dangerous"?

  3. People have to stand up and care or it only gets worse

  4. It's none of her business? I call BULL SHIT! It's her business; it's my business; it's the business of every woman who wants to give birth.

    How are people to learn if stories are never told? How are choices to be made if the options are never given?

  5. "It's also questionable whether most of the women whose "personal choice" is birth in a hospital are actually making an *informed* choice."

    Now that's a completely arrogant comment. I know exactly what the statistics are for a home birth, but I just don't feel comfortable with it. If I choose, knowingly, to have a hospital birth, that does not mean I am not making an informed choice. Just because someone else doesn't make the same decision as you doesn't mean they haven't thought about it.

    Absolutely ridiculous.

  6. I am going to disagree with anonymous. Yes, if Judit had claimed that every woman choosing to birth in a hospital was making an "uninformed" choice, I agree that would be over the top. But she didn't say that. She said many women are making less than a completely informed decision, and I very much agree with that. Most women I know who choose hospital birth do not really "choose" it--they do it because they don't think there is any other way. Most women don't truly weigh the risks and benefits of the various ways to give birth. That's not necessarily an indictment of the women themselves, because I think many of them would if they even knew that other options existed. I certainly would have been one of those women choosing a hospital birth and obstetrician by default, had I not encountered alternatives that led me to do a lot of research and education.

    I have several close acquaintances who went into their births with the attitude that the doctor would do what was in the mother's and baby's best interest. One of my friends told me, "I didn't want to think about what was happening 'down there.' That was the doctor's job." These friends came out of their births with terrible scars, emotional and physical. One of the women, who was still in tremendous pain more than a year after her son's birth, told me, "I love my son, but I don't know if it was worth it."

    Choosing a hospital birth can be an informed choice. But for the most part, it's a choice made on a combination of incomplete or faulty assumptions (ie, nothing "bad" ever happens in a hospital, doctors or midwives will only intervene when necessary) and a lack of knowledge about other alternatives.

  7. Actually that was Rebekkah who said not everyone is making an informed choice. I intentionally avoided commenting on how informed other people's choices are. Some are more informed than others (but none more informed than me! totally just kidding)

    A well informed person can be aware that her baby 's chances of survival is equal at home with in-hospital. And still choose hospital: it's a valid AND informed choice as far as I'm concerned. The combination of deciding factors and priorities are personal, social, familial, etc. in nature, and unique to each woman's situation.

    All I am saying is that choosing the hospital should not have to result in being subjected to procedures that are undesirable to the mother or unhealthy to the baby.

    Studies of home birth show you that much of what is done in hospitals is unwarranted, because you can have equally good outcomes without them. That is a fact, not a value judgement. I do judge unwarranted medical protocols that are not the mothers' preference. I do condemn practices which, without conferring medical benefits, disregard the mental and psychological well being of mothers and infants.

  8. Oops, sorry for the mixup!

  9. No biggie! Now, my turn to put words in someone's mouth: I guess if Rebekka was saying that obstetricians don't fully inform their patients about home birth, she would be absolutely correct in the overwhelming majority. For women who only rely on their doctors for information, it would follow that they aren't well informed. Again, I wouldn't *blame* these women, but I do hope that as many will do their own research as possible.

  10. I was in no way blaming anyone - I think the whole system and the whole culture around birth sucks, and it's not an individual woman's fault if she's caught in that.

    Nor did I suggest that *every* woman who chooses a hospital birth is uninformed - I said most. And I'll stand by that most. It's not just about knowing the statistics - it's about not making decisions based on fear, based on what someone said on another post "if something happened to the baby, could you ever forgive yourself?", based on the fact that our whole culture sees homebirth as something weird and risky, based on homebirth is *just as safe* but if something goes wrong I'm better off in the hospital - instead of things are *less likely* to go wrong at home. It's about making decisions with an awareness of how our culture treats birth, about how that's part of a continuum of the way women (and women's bodies) are treated, about how we see our own bodies. It's an incredibly complex area, and without a lot of thought and a lot of study - or a previous bad experience - it's not remotely surprising that women generally aren't in a position where they *can* make an informed choice.

  11. Boy, you sure do attract the "I'm right and everyone else is wrong!" bitches like flies, don't you?? WHAT'S YOUR SECRET?? :P

    I fail to see why, if they obviously hate your blog and everything you write in it SO MUCH, that they can't just go somewhere else. I mean, what's so hard about that?

    Oh wait, that's right, I forgot we're talking about TROLLS here. Trolls who are too cowardly to even sign their names to their posts. If what they say isn't worth standing behind with a signature, then why should we pay it any attention?

    Carry on fighting the good fight, for women EVERYWHERE.


  12. Hi there,

    I haven't posted before, but I feel like I need to stand up for some of the anonymous women being told to go elsewhere. I'm one of Rixa's high school friends and enjoy reading her blog. It's been very informative and I've learned a lot about having a baby at home. And I enjoy it all the more because a friend is writing it. Perhaps some of these anonymous women are not trolls but, like me, friends of Rixa's who don't want to sign their names because they don't like being cussed at for disagreeing. Rixa, I find your viewpoints thought-provoking, but I haven't ever wanted to add my comments to the discussion because tempers flare up so quickly here.

    Don't yell at me, home-birthing moms. I don't like it, and I won't be posting again. Just wanted to let you know who else might be reading.

    Amy J. (Hi, Rixa!)

  13. Hi Amy J! I do hope you will keep reading and posting. I don't mind dissenting voices. I want to keep the discussions civil and not delve into personal attacks. I could delete all comments I didn't like or that were too in-your-face but I choose not to. It's hard to keep emotions out of these conversations at times and even I have some posts where that shows!

  14. Amy J, I don't know you but I really hope that you won't feel too intimidated by the strength and passion of our convictions. Please stick around!

    The other two anonymous commenters don't seem to be with us any more, at least they aren't posting replies... like to my question at the top of this thread about respecting the choices of women who desire few or no unnecessary interventions during birth.

    Given the current health care system, some of us will end up staying away from it as much as we can. Shocking as that is to unsuspecting readers of this blog. The real shocker should be that it's a perfectly well workable solution. The real shocker should be that anyone, even they could have done the same! The mere idea antagonizes people.

    I experience many many comments from acquaintances that come from a place of defensiveness. "Good thing I was at the hospital, because they needed to do lifesaving procedure X." I know that for some lifesaving X, I will go to the hospital to get X done if X is necessary. But most other 'lifesaving' X never needs to be done and never is done at home during normal labor.

    My acquantance sounds glad to have done the wise thing to save her baby's life (that would leave me in the role of the unwise one). It's next to impossible to convince a mother that her story can be told differently, and I don't really try. Only I find it odd that almost everyone I know appears convinced that their baby would have perished if not for modern medicine. (Except of course the majority of my homebirth friends.)

  15. Ooops! I think my comment has been latched onto and misconstrued. I probably didn't state what I was trying to say clearly. I will admit that I am VERY biased about this issue (I am in medical school, my father is a high risk OB) but I also have an MPH and am VERY aware of the dangers of relying too much on the medicalization of all life's concerns. I've had a lot of talks with my father about the high rates of c-sections and my understanding is that one of the main reasons for such high rates is the fear of being sued. Fetal heart rate monitors were an imperfect technology that became standard of care too quickly and without sufficient evidence backing them up. As the heart rate monitors becames standard of care, doctors became aware of every change in the baby's heart rate--leading to c-sections anytime the baby appears to be "in distress." Although most of the time these babies would be fine if labor proceeded naturally, because heart rate monitoring and c-section when certain criterion are met had become the standard of care--doctors have to follow those guidelines or risk lawsuits. The incredible difficulty of reversing this trend is frustrating (as is the understandable difficulty of conducting research around this subject). I am very interested in issues surrounding birth and the decisions women make about this experience so read a lot of blogs from all perspectives. My comment grew out of 3 main feelings.

    1. most of the physicians I know are INCREDIBLY dedicated to their patients--both mother and child. They work incredibly long hours, make great personal sacrifices, and spend years preparing for the role that they will someday take in people's lives. They are (in general) not evil people trying to violate women. The system is deeply flawed, not the physicians.

    2. the birth process is different for everyone. Many of my dad's patients' children would not survive a natural birth due to congenital defects that require immediate support upon delivery. I have a close family friend (also an OB) who is currently serving with Drs without borders and reading his accounts of women laboring naturally for days and then dying, along with their child, because they don't have access to the evil c-section or western medicing reinforces the idea for me that western medicine can have a role in childbirth.

    3. I have some close friends (who gave birth naturally) but were unable to give their child enough nourishment just with breast milk alone and so had to supplement their breatfeeding with bottle feedings. They have talked about how hurtful it was for them when other women made snide remarks about them not breastfeeding and doing the best for their baby when in reality they were doing everything they could to get enough nourishment into the baby. Hearing about their pain has made me hypersensitive to when women, on either sides of the birthing debate, point out other mothers who have done things differently than they personally would have done.

    As for posting anonymously, I did so because the violence of people's responses scares me, as does the transparency of the internet. That may be cowardly, or it may just be self-protection.

  16. Hi jen (not jen b.) and thanks for responding!

    Please don't think I/we feel that western medicine has no place in childbirth. If I felt like I had no access to an emergency c-section in the event of a real emergency, I would be a lot more apprehensive of birthing anywhere. The fortunate thing is, home birth--even unassisted--is not the same as an impoverished third world mother laboring with absolutely no access to a hospital. I thought that was perfectly clear. I assumed anyone would give me enough credit that I would go to a hospital if I needed to.

    I am somewhat baffled... please don't take this as an attack, but I am really curious as to how I've given you the impression that I try to emulate the unfortunate circumstances of those patients seen by doctors without borders?
    Do I come across so simple minded? Does any of us here?
    Or perhaps we're just talking about a natural-birth-fanatic strawman (woman)?

  17. I don't know where the OB from Drs without borders is practising, but if it's in Africa or elsewhere where they practise female genital mutilation, that would explain some of the horrifying stats. It's pretty difficult to give birth if your vagina has been sewn shut and is obstructed by scar tissue. Malnutrition probably explains some more. We're just not in the same position as third-world women who've been mutilated, who may be malnourished, and who have no access to doctors or hospitals when they really do need them.

    And as Judit said, I don't think anyone here is disputing that doctors are *sometimes* life saving for women in labour.

  18. I enjoyed your comments Jen & Rebekka. Michel Odent (French obstetrician who pioneered radically different birthing rooms in hospitals, birthing pools, and who has written extensively about the longterm effects of birth practices) argues that most obstetricians don't see enough complicated cases--and therefore don't gain enough experience in treating abnormalities--because they are so busy doing "routine" vaginal births to healthy women. He argues that backing up around 1,000 births per year, with midwives in charge of most of them unless a complication develops, is a minimum number necessary for gaining adequate experience.

    My vision for obstetricians is that they become true "heroes" in the sense that they focus their efforts on pathology and true complications (perhaps 5% of all births, give or take). They would be able to hone their skills for complicated cases such as complete placenta previa, placental abruption, placenta accreta/percreta etc...

    Healthy women could still choose a medicalized birth if they so desired--obviously you can't force people to have a home birth--but midwifery care, home birth, birth center birth, unassisted birth, etc would also be actively promoted and encouraged for all who want it. Midwifery of all kinds would be legal, so that women desiring "non-standard" care could get it. For example, UCers could have access to midwives for things they needed: maybe just postpartum care & checking for tears, maybe bloodwork, maybe some prenatal visits, maybe nothing. No one would be forced to have an unwanted cesarean like my friend--or for that matter, a UC when they would prefer a midwife (see a recent comment in "First Impressions" about a woman's partner who's expecting twins). Well, this could be a whole 'nuther post!

  19. I share your vision.

    It's a real tragedy that women are being railroaded into cesareans that they don't need simply because they don't have any other option. Or don't THINK they do...

    I attended a birth on Christmas Day of a first-time mom who switched practices (from CNM to OB) and drove 2 hours to a different hospital to avoid a c-section. Her baby presented breech and nobody would touch her in our town. NOBODY. But she was informed and knew she wanted an unmedicated birth. And that's what she got!

    For my last birth I had 2 midwives drive 5 hours to attend my birth. I considered a UC, and prepared for one, but would have preferred a midwife to attend. (It was a twin HBAC) It shouldn't be so hard for us to get the births we want! It doesn't have to be like this...


Related Posts Plugin for WordPress, Blogger...