Tuesday, July 19, 2011

Please don't call my birth "unnecessary"

I have hesitated posting this for months because I know two dear women who are active in the community I'm about to describe. Dear friends, forgive me in advance if I offend you. But once again, this issue keeps me up tonight. This blog has always been about honesty and advocacy, as well as processing of my own thoughts, so the time has come to export this out of my head.

I bear two scars from the birth of my son: one that lies a few inches below my belly button, and one that lies several inches above it. The physical one has long since healed. The one in my heart still pains me to this day, even though my son is nearly 6 months old.

"Unnecessarean." It's a term coined by the unmedicated birth community to describe c-sections that they deem were needlessly performed. It's a term wrought with looks of pity, heavy sighs, and moral superiority. I'm sure some of them even pat themselves on the back for being so clever in their verbiage.

The unmedicated birth community has unilaterally, universally decided that their way is best, and that their methods should always be employed first. Modern western medicine ought always be a last resort. After all, women have been having babies for thousands of years, right? They even go so far as to call their community "natural," as if the births among the rest of us are "unnatural."

We were overjoyed to find out we were pregnant. Almost immediately, we were asked all sorts of questions. Where were we going to deliver? At home or in a hospital? Did I want an epidural? How did I feel about c-sections? I will be honest and say that at that moment, I couldn't have cared if the baby teleported out of me, or came out during one of my many barfing sessions, so long as he arrived safe and sound in my arms.

I began doing some reading. A couple of friends had completed Bradley classes. My best friend recommended them. Another dear friend said she hated every second of them, but still recommended them. So, we eagerly enrolled. I will say that from talking to other women, a person's satisfaction and success with the class seems to depend largely on the teacher.

I knew from the get-go that I didn't want a C-Section. But not for the reasons that the unmedicated birth community says I shouldn't have wanted one. After 7 years of infertility, you start to feel like everything is assisted. And you start to feel like your body can't do anything the way it ought to. And in 30 years, I've never broken a bone, had a major dental procedure, undergone major surgery, or been a patient in a hospital. So, the thought of surgery freaked me out. Not because I thought it was going to put me or Matthew at risk, but just because, hey! It was major surgery! Who looks forward to that, even under the safest of odds?

Enter the Bradley classes and books, and the literature and battle cries from the other side. The Bradley workbook has a handy little chart that says essentially that there is always some position, maneuver, technique, or other alternative method to get you out of whatever jam you're in that's threatening to end in a c-section. And that's the end of their story. If you end in a c-section, it's most likely because you didn't advocate for yourself enough, you didn't educate yourself enough, you gave your doctor or the hospital too much leeway, or you simply didn't try hard enough or wait long enough.

I'm here to tell you that despite what your 30 year old books and one-sided classes say, that's simply just not always the case. Sure, women have been giving birth for thousands of years without modern technology. And they and their children have also been dying in the process for equally many years. Matthew would have been among the victims, and it's likely that eventually, I would have been too.

I say as loudly and strongly as I can: You are not helping women when you teach them that they ought to fear and distrust their doctors and that the hospitals are out to get them! Before the classes, it never would have occurred to me that a woman who had undergone a c-section would feel shame or failure. But in the eyes of these women, she is less-than. I am less-than.

If a woman doesn't trust her doctor, she shouldn't be in her care to begin with. You should be encouraging your clients and friends to develop relationships of trust and open communication with their care-providers. But to posture yourself as knowing more about both birth and a given woman than her many-years educated doctor and to bully her when she is already hormonal and frightened woman with scare tactics and one-sided information is unconscionable. To do it in the name of "advocacy" is laughable.

Is it true that there are some doctors who perform needless procedures on their patients in the name of convenience and expediency? Sure. But those guys are lousy doctors. You should focus your efforts on THEM, and not on procedures that some...many...women end up legitimately needing. Sure there are jerk doctors. And there are even some women who schedule c-sections for vanity or convenience--but that's not most of us. There are also midwives and doulas who are overconfident in their abilities and tarry too long in employing professional medical help, sometimes resulting in tragic deaths of babies and their mommies. The unmedicated birth community doesn't corner the market on caution, safe deliveries, or patient care. I CHOSE a hospital birth. It's not because I didn't know I could give birth in a bathtub in my house or in a cozy little birthing center. It's arrogant to assume that a woman who doesn't do things your way does so simply because she doesn't know any better. For a community that claims to value women so highly, you certainly don't seem to think much of most of us.

There are two sides to every coin. You think an ultrasound is unsafe. I think that doing external versions on babies without being able to see if you're going to entangle or compress their cord or fluid is unsafe. Bradley says there is no reason to take any medication of any kind at all during pregnancy. Another author I read said that not eating well is akin to child abuse. We came to the conclusion that my rapid weight loss and inability to eat ANYTHING (I went 6 consecutive days not being able to keep one bite of food or drop of liquid down) was more risky than medication, and that eating SOMETHING, even if it was a sugar-filled "nutrition" "shake" was better than nothing at all. I labored for 14 hours without an epidural. You think they're unsafe and that the body does better without them. When I finally got one is when my body finally was able to return to normal function. It's up to a woman and her husband to determine what risks they are and are not willing to take. And unless you are that woman or her husband, it's not your business what she decides. It doesn't serve any constructive purpose for you as a community to editorialize procedures, practitioners, facilities, and births that you know only anecdotally at best. Why do you have any opinion at all on what kind of birth I had?

When I finally went to c-section, I had been in labor for a total of 30 hours, including 6 hours of pushing. I'd also had two other incidents of false starts--one was 7 hours of intense contractions about 2 weeks before he was born, and another episode was 4 hours, about a week after the first. I went in to the hospital already dilated to a 6 before active labor had begun. But for some reason, though it tried with all its might, it just didn't work right.

Matthew was just stuck. You know what my Bradley teacher said was the proper response when a doctor tells you that your baby is stuck? That "babies don't know they're stuck, or in the wrong position, or can't fit so that's not a real reason."

After 30 hours, I can tell you it IS a real reason. My doctor, bless his heart, tried EVERYTHING. I asked him at the very beginning of my labor what he and his wife wanted when they had kids. He said that they wanted an unmedicated birth. So several times I asked him, "if this was your wife, knowing what she wants for a birth experience, what would you do?" And he'd answer me accordingly.

We tried different positions. We tried different lengths of pushing. We tried different degrees of force. The doctor reached in and tried to turn the baby to un-wedge him. At one point he told me to stop pushing and sleep for an hour to see if rest would rebuild my strength. At another point, he reached up inside to hold the baby and feel my cervix to feel first-hand if I was pushing properly and forcefully enough. Matthew just wasn't coming. For whatever reason, my pelvic cavity wouldn't accommodate him. All the pushing was just forcing his poor little head down, but the rest of his body wasn't coming.

And then, his vitals plummeted. My sweet doctor, who had avoided the "c word" as long as he could, put his foot down and said we needed to go. There were no alternatives left. When my sweet baby came out, he wasn't breathing. I didn't know that at the time. I didn't know it until just recently, when I received a bill for "infant resuscitation" and nearly threw up on reading it. I recently had the courage to look at the pictures my husband took in the operating room. Matthew was purple. Instantly relief and gratitude for the wisdom of my doctor and God's provision of excellent care swept over me. The baby was wedged so hard in there that they literally had to pry him out with the surgical equivalent of a crow bar. The doctor said that I could have pushed for days longer and the baby still would not have come out. Matthew would have died, and in the "good-ol-days" before c-sections, I would have, too.

I anguished about the decision to have a c-section. I begged my mother and husband not to tell ANYONE that I had had one. I refused to shower for days because I couldn't bear to take the bandage off and see the scar. When I finally did, I wept big, ugly, uncontrollable tears, to the point where I scared my husband when he found me curled in the shower, sobbing. All I kept thinking was that I had failed my son and I thought that if people knew I'd had a c-section, they'd think I was a coward who gave up. Eventually I realized that no one outside that community would even care how I gave birth. But it never would have occurred to me that I would have had reason to feel shame had those silly thoughts not been planted in my head by well-meaning extremists.

I accept responsibility for my feelings. I realize now that I was hormonal and unreasonable and irrational. But I felt betrayed by the very people who said they are out to help and protect women. I wonder how many women would have been spared a lot of fear and shame and guilt if they had received a more balanced education about c-sections. Birth can be scary. It ought to be surrounded with grace, unbiased information, encouragement, and empowerment.

I think it's wonderful that you want women to know that they have options when it comes to birth. And as much as my Bradley class was terrible in actually preparing me for the REAL world of births that don't go exactly according to plan, I do appreciate that it educated me on what my rights were in the hospital. But that's about the end of the benefit it provided us. My dad's best friend is a widely respected OB and has been for many, many years. My mom asked him after my birth if it was normal for women to feel so much anxiety in the birth process. He said he'd only seen it in women who had gone through Bradley training and that actually, he no longer would work with any patients who chose to go through those classes. That tells me that we were not alone in our experience.

Scare tactics might be effective in the short term. They sure get a lot of attention and press-time. And witty little monikers even make you sound clever. But at the end of the day, you don't know what's going on in each woman's situation. Sometimes there just AREN'T any more options. You can post your blog articles and your status updates and disguise your judgment in witty quips, but for as many women as you help, you isolate equally many more. We ARE listening. We are curious about what you have to say. But when we hear judgment, it makes us reluctant to seek your help. "Unnecessarean" isn't clever, or funny, or witty. It's insulting and condescending. If you want to describe YOUR OWN caesarean as "unnecessary," it is your right to do so and I am sorry for you that you ended up with a care provider you could not trust. But to sloppily label a whole category of births simply because they share a procedure in common is completely irresponsible and irreverent.

Please don't call my birth unnecessary. It saved my son's life, and I will forever thank God for it.


  1. It makes me sick to my stomach that you have to post this. It makes me sick to my stomach that we, as moms, are so anxious to assert our opinions, that we bowl right over the reality of individual experiences. It makes me sick to my stomach that we, as moms, are so self-righteous, that we would cut someone to the core and cause months of agony and sleepless nights. Whatever happened to camaraderie and encouragement? How about "You did a great job and look at the reward for your efforts?" How about "I'm so glad everything worked out for the best?"

    Vaginal vs. C-section. Breastfed vs. bottlefed. Vaccinated vs. Unvaccinated. Why are we causing such divisions amongst ourselves?? Why can't we just say, "This is what worked for me. This is what I've found in researching *both* sides of the issue, but you have to do what's best for your family"?

    Kudos and hugs to you for having the courage to call out your naysayers.

    Your little sweetpea is all the affirmation you need. :)

  2. "Sure, women have been giving birth for thousands of years without modern technology. And they and their children have also been dying in the process for equally many years. "

    As a society, we seems to have a nostalgic desire for "the good old days" that can lead to quite a distortion of what those days were actually like. Thank God for modern medicine.

    Thank you for this post - as someone who has not traveled down this road, it's so good to have someone who has pointing out some of the potholes to watch out for. Your articulation on this highly emotion issue has been fabulous.

  3. I am SO glad that you wrote this. It put some of my thoughts into words nicely. Matt and I have watched "The Business of Being Born" which wasn't too bad and I am looking forward to what more they will put out this year. However, just last weekend we watched "Pregnant in America" (which happens to be about a couple from Tuscon) and many times I wanted to throw things at the screen. A movie that is an hour and half took us about three to watch because we had to stop and rant. I was skeptical five minutes in because I noticed a white board in the background that said "Hospitals are not our friends." UGH. I knew what I was in for watching this. They did bring some good things to light -- but there was some other not so great stuff, too. Of course, I am more sensitive about the whole thing being pregnant.

    I have friends in the home birth movement, Bradley, etc. In the end, I agree with you that it is an individual experience and story to be told. The end result should be, "Great job! Look at this little life." Rather than, "Better luck next time."

    However, I DO appreciate that Banner Hospitals are doing away with elective c-sections and inductions. Do we hear a "hurrah" from anyone? No, but I am VERY glad to see a hospital to take this step. I am also glad that I will be delivering at a Banner hospital again. I am also thankful that my OB is a huge proponent of VBAC and so is the hospital.

    OH! And I am sure there is a whole other tirade about episiotomy. I did NOT want anything to do with this. However, after an hour of pushing the doctor gave me some options. While I was sad about that I gave the go ahead and Miss A came out on the next push. She needed a little extra room and I tore a little less.

    And I am now okay with admitting that once I get to a certain point in labor I will be ordering up my epidural again. HA!

    Thanks for writing this, Jen. I may share it with new mamas who are thinking about Bradley so they at least get a taste for the other side and I cannot emphasize enough to new moms preparing for labor to think through c-section stuff because you never know. It wasn't in my birth plan but we talked to a few people about what would happen with a breech birth. It is a dying art to deliver a breech birth "naturally" but even then the baby needs to be "just so." Miss L and I would have been statistics as well. I think her cord was wrapped around her neck and she would have hung herself.

    Kudos, friend, kudos.

  4. I am so sorry to hear that you continue to struggle with these emotions. I hope that writing this blog is cathartic for you. I couldn't have said it better myself! You did a great job and made wise decisions all along the way. Some women believe a c-section is the easy way out and should be informed otherwise, but this surgery is a life-saving procedure and we should all be grateful for its existence and appropriate implementation. I am SO grateful you had a c-section to save the life of you and your baby!

  5. Jen, I can identify with your experience at several levels. I did Bradley classes too, and found them pretty worthless when it came to the test. I also had a very necessary c-section for one of my births.

    But, given all that, I don't think that women who are advocating against unnecessary c-sections are attacking you. You're very confident in the necessity of your c-section (and from what you've wrote, I certainly agree with you about that necessity!). So . . . when they're attacking the common practice of unnecessary c-sections, they're not attacking you.

    Do you think it's possible that you're stepping in front of an attack that's not aimed in your direction? I'm just wondering because, even as a woman who's had a c-section, I don't feel like birth advocates are attacking me. Like you, I have confidence that my surgery was necessary to save the lives of my children. So I can hear "unnecessarian" and just let it slide off, because I know that it's not aimed in my direction.

    I don't think it's aimed in yours either. Though I'm very sorry that their advocacy brings up such painful issues for you. But it might be easier to find peace in these discussions if you refuse to take on burdens that aren't yours. Thank God modern medicine was there to save Matthew, and thank God it was there to save my twins. I don't think either of us need to feel offended that birth advocates are trying to stop practitioners who are - as you point out - bad doctors.

    I just hate to see you take on a burden that you don't have to take on, and this is obviously weighing heavy on you. I'd suggest that maybe it's one that you're not under an obligation to carry.

    Anyway - I'm totally saying this with the assumption that the articles and such that triggered this weren't specifically aimed at you. I haven't seen them as far as I know - so if I'm wrong, I take it all back. :) I'm sure I'd jump down the throat of anyone who told me - specifically - that I ought to have taken a different route with my monoamniotic twins! :D But hopefully you'll find that the "unnecessarian" comments aren't aimed at moms like you, but rather at the practitioners who are looking out more for their own convenience than for the good of their patients. I don't think you should have to carry any guilt here.

  6. Jess Snell-thanks so much for your thoughts. I need to noodle on them and I appreciate the challenge. I think writing was cathartic for me. I know that my c-section was justified and necessary. I just wonder if I would not have struggled so much with telling the doctor "yes, go ahead" and with guilt afterwards if c-sections hadn't been so over editorialized before hand. In my ignorance, I believed them when they said that with enough time, effort, and creativity, I could work my way out of nearly any c-section situation. As such, I was completely unprepared when my labor got to that point. I think that kind of education sets women up for failure when all the creativity and time in the world doesn't work.

    Thanks everyone else for your thoughts and encouragement, too.

  7. Awesome post. I never struggled with how my babies were born...ever. By the time medical science helped me get one I was 40 and had already attended the labors/births of several friends and family....all that ever mattered at the end was a healthy baby. AND...the best labors/births (even c-sections) were those where the mother did not try to orchestrate and plan every moment prior to it happening. Because she was free of expectation...she labored on through or accepted the "you need a c-section" diagnosis with little emotional baggage and was able to fully embrace that she was about to meet her baby and how that happened really wasn't as important as she may have thought. I am so sorry you had so many "must haves" ingrained in your mind before going into labor with Matthew. I have followed your story since you were very early pregnant and was very disapointed for you and could not fully understand why you were so very scarred and ashamed. I had two scheduled c-sections...first one due to my lovely breech baby...2nd one because...hey..why not? The first one went fine and why labor if I don't have to right? Plus..due to my age...it was just safer. And these were wonderful, wonderful days and the surgery was just a blip in the day when you compare it to what I got from it. I am so bummed you didn't get to relish in the moments (even the ones that went astray) because they really are good.
    I do often wonder how it would have felt to labor and push my babies out and feel that euphoria that women describe about vaginal child birth....but they are fleeting thoughts...because that one day really is not as important as all the days that follow and it is my story and obviously the way God intended it to be right?
    I really, really hope you can someday let go of the hurt and pain that the anxiety of Matthew's birth brought...I agree with everything you wrote about not giving a balanced education to expectant couples and letting them decide for themselves the path that is the best for them. That is just wrong...and there is nothing wrong with striving for an unmedicated birth either...just be open to what may happen and don't let it put you or your baby in danger.
    Hang in there. Thanks for a very well written opinion (that I just happen to agree with).

  8. Yes. Just - yes.

    I (like many others, it seems) felt extraordinary guilt following Noah's birth. It didn't go like I wanted it to, and I was even careful not to put too many expectations on myself! I stayed away from Bradley classes, but somehow, the militant "all-natural is better" philosophy still creeps in. And I had a vaginal birth! But I felt guilty for being induced (at 42 weeks after trying EVERYTHING. Yes, even that.), for getting an epidural before 5 cm, for getting the epidural at all.

    MY soapbox is breastfeeding. Because I drank that Kool-Aid, and I embraced that philosophy, and my body failed me. At my best - my BEST DAY EVER - I got 6 ounces total when I pumped. It was usually more like 3. I think Noah was exclusively breastfed for a total of 10 days in his life, and most of those were supplemented with pumped milk from prior days.

    I won't even start with the guilt I feel for my choices today.

    Why do we judge each other? And worse, why do we let ourselves feel guilty? We're all great moms; we're all doing our best. Why can't we believe the best about one another and support each other's choices? Or - most importantly! - why can't we always believe the best about ourselves?

    Motherhood is like junior high all over again, except with babies, bottles, and vaccines instead of boys, make-up, and clothes. Women judge the moms who fall outside what is trendy, and the ones who make un-trendy (yet acceptable) decisions feel small.

    Epiphany: This is why women love being grandmothers. All the perks of soft squishy babies without the responsibility and crushing guilt. Looking forward to that...