Thursday, 28 August 2008

Dr Strangebirth – How I Learnt To Stop Worrying and Love the Caesarean

The second part of a trilogy of posts about Wriggly's arrival. The first part can be found back here.

Public holidays are wonderful things, especially around the year’s end. They give us time and excuse to catch up with friends and family, and even when it rains it’s really rather nice to know that you’re often being paid to eat trifle and try to find batteries for new toys.

Unless of course you are heavily pregnant, the fetus is lying all funny, and your midwife won’t really talk to you about it other than to stoke your simmering fear. Then the public holidays that dot the end of December and beginning of January seem to be specifically sent to torment you, by making sure that hospitals are running on a skeleton staffing rota and thus no one is available to talk to anyone not actually in labour.

Into the dark cavern I was inhabiting stepped Jenny, an ex-midwife from my partner’s church. She furnished him with a number of leaflets, produced by National Women’s, which clearly explained the process of undergoing a C section. They were a much needed antidote for the almost anti-medical attitude of my own midwifery clinic.

Once we actually got into the hospital system it was a revelation. The day after Boxing Day we headed to Waitakere for an attempt at ECV, with the aim of putting the fetus in the right position for a natural birth. In the car boot was a bag packed in case the attempt at rotation instead prodded the baby into coming early. I was nervous.

Luckily the midwives and obstetrician were not. Tom and his team were relaxed, friendly, informative, and I felt like there was nothing we couldn’t achieve together. Of course I was wrong – despite three attempts at moving the fetus around, it wouldn’t flip. The ECV process was like a very very firm massage of my distended abdomen, much more violent than I had expected. It was mostly uncomfortable rather than painful, but the care of the hospital staff, and the presence of my partner, enabled me to relax and even laugh. Tom was obviously gutted that he hadn’t succeeded with the turning, and booked me in for an “elective” caesarean a week before the due date.

“Elective” is a word that seems to have a bizarre meaning in our health system. It indicates that the patient has had some choice in the matter. Yes, I had to actively decide to have a caesarean, and the midwife did seem surprisingly eager to give natural birth a go despite the intractable breech position. My worst case scenario, my Plan Z if you will, had long been hours of painful pushing followed by an emergency caesarean under general anaesthetic. I knew that I would not cope well in that situation, would not be in a position to make good decisions, and that I would be terrified of not coming out of the anaesthetic. I also knew, from past experience, that I get very ill after a general, and I could not imagine that would be a good start to breastfeeding or motherhood, staggering about the place and unable to keep food down.

So my election of a caesarean was one of many of those decisions women seem to have – no choice at all really. We tried everything to turn him before C Day, including a stupid diet based on principles of categorizing food into yin and yang and eliminating one of these entirely (I forget which was which, but meat was good and sugar was bad). You try eating nothing with any form of sweetener, including fruit, for a week after Xmas and at the business end of pregnancy.

As it turned out, while the surgeon was twisting Wriggly out of my body she commented that there was no way he was coming out naturally and I would have ended up on the operating table regardless. By going the elective route I’d effectively put myself in the best position to be undergoing an operation – well-rested, well-fed, well-supported, and in a good mental state – that was in fact necessary. A hundred years ago I guess that there’s a possibility that we both could have died.

It annoys me that many people portray those who give birth by caesarean as “too posh to push.” Around a third of NZ’s babies are delivered through the sunroof these days, and by talking up the evils of the surgical option in ante-natal classes many facilitators are effectively adding to the guilt and self-doubt of one in three of the mothers in their classes.

Very very few women would choose a caesarean if they knew they could have an uncomplicated and safe natural birth. The recovery time from a caesarean is enough to put you off – it’ll still be another six months or so before I am fully restored. Having your life suddenly and severely curtailed by the arrival of your firstborn is shock enough without also dealing with the aftermath of an operation that is the equivalent of a serious car accident. And speaking of cars, not being able to drive for six weeks afterwards does rather tend to exacerbate the loss of independence.

If a woman knows all this and still chooses a caesarean when natural childbirth is a viable option for her then I think we should respect her choice. It’s her body, her birth process, and frankly what she says go. Tales of doctors who want to remove women from any decision-making about the end of their pregnancy infuriate me no end. The focus should be on helping the mother to deliver her baby with the least difficulty, in a manner that pleases her as much as possible and keeps both her and child safe.

Part Three sometime soonish.


homepaddock said...

Julie there's a whole post's worth on the politics of caesareans, but until I have time for that: I was guided by the belief the whole point of being pregnant was to have a healthy baby.

Delivery plays an important part in that but how the baby comes out isn't nearly as important as that s/he does in a way that is best for his/her health and the mother's.

I had three caesareans and two of my chidlren died. Their deaths weren't related to their births, they had brain disorders. But it does give me first hand experience of both disability and death and from that the conviction that the pain and inconvenience of a caesarean and its aftermath are preferable to a disabled or dead baby.

Anonymous said...

Wouldn't it be nice to live in a world where women who needed c-sections got them with no fuss and no stigma and women who didn't need them were never given them unnecessarily.

Anonymous said...

Caesareans defintely have their place (and my first baby was born this way). Truly elective c/s for non-medical reasons aren't all that comon here so far but I do wonder if the public health system should be footing the bill for elective surgery with no medical indication even if it is a woman's choice?

I agree with hungrymama too

The ex-expat said...

Truly elective c/s for non-medical reasons aren't all that comon here so far but I do wonder if the public health system should be footing the bill for elective surgery with no medical indication even if it is a woman's choice?

I don't think that you can have a 'non-medical' c-section in the public health system.

Personally if I was ever going to have a baby I'd want to be out cold and woken up sometime later after things had gone back to normal... so perhaps a 20 year slumber?

Anonymous said...

I don't think that you can have a 'non-medical' c-section in the public health system.

You can if you get the "right" Obstetrician. And even if you pay an OB they still claim their fees under maternity benefits (same as midwives or GPs). The fee they charge a woman is on top of that.

Its also pretty easy to come up with a psuedo-medical reason which would be an issue if "user pays" is bought in in these cases.

barvasfiend said...

"“Elective” is a word that seems to have a bizarre meaning in our health system. It indicates that the patient has had some choice in the matter.

Very very few women would choose a caesarean if they knew they could have an uncomplicated and safe natural birth."

I almost think that many midwives prefer to you "make" this decision which isn't a decision at all, so they can remain in denial about the simple truth - that medical science works marvels. Sometimes it is shit, especially things that it doesn't see that often. It has also been guilty of being an oppresive regime. But the midwives' common refrain of "Women have been having babies since the beginning of time" is apt - we have indeed, and this is how medicine got the hang of figuring out where things often come unstuck.

I firmly believe women should embrace medical science and mobilise it for their own ends. Rejecting medical intervention, or maintaining the facade of rejection (hours of pain followed by emergency intervention) is a position seemingly supported by many midwives.

It is so good to hear a woman making decisions for herself, but also making the decision to take advantage of medical advice even though you are not (I am assuming) a clinician. Thank you for your story........

as you said;

"A hundred years ago I guess that there’s a possibility that we both could have died."

Anonymous said...

Barvafiend - I'm not entirely sure what you are getting at when you say: I firmly believe women should embrace medical science and mobilise it for their own ends. Rejecting medical intervention, or maintaining the facade of rejection (hours of pain followed by emergency intervention) is a position seemingly supported by many midwives.

Medical intervention in birth can be life-saving but there are also many interventions that are hugely over-used and when used unnecessarily introduce significant risks to both mother and baby. During my first birth I accepted my midwife's suggestion of an epidural which caused my blood-pressure to drop to 72/35 this is a common side-effect and was utterly terrifying. I have a friend who birthed her son while being prepped for a c-section and another who was told by her OB that her pelvis was to small to ever birth vaginally (she proved him wrong with her third).

Obviously I'm not saying that medical intervention is never needed (and Julie's stubbornly breech baby is a great example of when it is needed) but embracing medical intervention in every birth is not doing anyone any good.

Julie said...

Thanks for all the feedback. I want to stress two things:
1. I have a lot of respect for midwives, and the work that they do is vital. Sadly my midwifery clinic was not a good match for me, although I'm sure they would be very good for many women. So I don't have a problem with the midwife-dominated system we have (except that it is under-resourced imho).

2. I could have tried to have Wriggly the natural way. It might even have worked, and we may have avoided an emergency C section, I'll never know now. And if I have any more kids my preference would be to have a vaginal birth if at all possible. My understanding is that these days there is not the automatic assumption that "once a C, always a C" which still existed even 6 years ago (when my sister had her second child).

Ultimately who should decide whether the surgical option is necessary? (and I tend to think that vaginal birth is medical too, not just C sections, but I'm no medical expert) As long as the pregnant woman is empowered to make the decision, as often as possible, then I don't see a problem with the option being available, even to those who might not need it.

Interesting discussion, and homepaddock I look forward to your further views on this too.

Anonymous said...

I don't even know where to start. Should I start with the article itself or the comments? Sigh.

Big heads up for you folks out there. No one and I mean NO one can make anyone else feel guilty. If someone does feel guilty about a "choice" they make then perhaps they should look inward and examine why that is?

Another heads up, breech is not a disease. It is a variation of normal. Breech babies are born vaginally without the need for surgery all the time. Granted that almost certainly wont happen if you employ a surgeon (or a hospital midwife) to assist in what is a normal function of a woman's body. Of course it is a choice to opt for a surgical birth over a vaginal birth, even if your baby is breech.

"I don't think that you can have a 'non-medical' c-section in the public health system."

Of course you can. They happen every day. If the actual c/s rate in the western world should be around 10% (as the WHO suggests) and we have rates upwards of 30% (over 80% in some hospitals) what do you think the 20% are classed as? Of course they are non-medical c-sections. They are unnecessary c-sections.

I know people like to trot out the old favourite "as long as the baby is healthy thats all that matters, birth isnt important". Seriously though why do we devalue the experience of the mother and baby SO much? Why is the way women and babies are treated and the fact that major abdominal surgery is so far from optimal and normal when it comes to birth disregarded? Surely the way women and babies are treated is important? Is that not an integral part of feminism? I get so sad when I hear women devaluing the experience of women and children. We all deserve to be treated with dignity and respect and sadly hospitals dont do that at all when it comes to labour and birth :(

I am under no illusions as to how this post will probably be received. I sense I will probably be shot down in flames as one of those women who "make" other women feel guilty. That is if this post even makes it onto the comments page.

Anonymous said...

I too am saddened that a normal variation of a normal physiological process of the human body is now seen with such horror. It furthers saddens, and deeply disturbs me that the commenters have also bought into the misogyny which underlies today's normalised obstetric environment. This is not "choice". Choice is a concept which has been taken by the patriarchy and used against us. We now tell each other that pole dancing, cosmetic surgery and unnecessary interventions in birth are all just a "choice" and that the outcomes of all these are somehow equal with the refusal to engage. This is a lie, a myth and because we are raised in misogyny, our bones and fibres are steeped in it, we take it on board and regurgitate it. It does not serve us, it serves commerce and misogyny - medicalised birth is not only an assault on women's bodies but on our souls and the bodies and souls of future generations of adults who are brutalised at birth.

It is nonsensical to say that it doesn't matter how babies are born. If it doesn't matter, evolution would not have worked out an elegant system whereby the process not only offers the birthing woman support with the stress of early parenting by a blend of hormones science can't measure or replicate, but provides to human babies the start of their immune system for life. Caesarean babies have higher rates of complication at birth from death to breathing difficulties, are separated from their mothers and placentas when humans are designed to slowly move from foetal circulation to adult circulation, they have greater likelihood of childhood and adult allergies, a high likelihood of being unable to suckle because so many are removed prematurely (breech babies are all removed as premature foetuses) and lately it seems from research their risks of diabetes are also higher than that of vaginally born babies. A woman who has surgery is likely to be rehospitalised with infection (superbugs anyone?), likely to experience difficulty with breastfeeding (as does the babe who cannot suck), she risks emergency hysterectomy which risk increases with subsequent surgeries, she risks shocking complications from epidural anaesthesia and also that the anaesthesia won't work and she'll feel the surgery. It is not on a level with the normal physiological process - obviously.

The Term Breech Trial which compared caesarean with managed breech birth (supine, lithotomy, episiotomy, forceps, all completely contrary to gravity) has been consistently debunked for many years however surgeons, who make money from surgery, continue to lie to women and tell them it is safer to have a caesarean than birth a breech baby. Surgery is rarely safer and is supposed to be for EMERGENCIES, not just a variation of normal that surgeons have convinced everyone is life threatening. As feminists we owe it to ourselves to get a more useful critique than the one Big Daddy wants us to have - oh it's all choice you know. There's no such thing as a free choice in a patriarchy, what a joke.

Women live with the trauma of the lies and violence which coerced them into surgery for the rest of their lives. Many women experience Post-traumatic Stress, they are unable to bond with their baby because the hormonal processes which facilitate this normal human response are so disrupted. This is not about blaming women, or making women feel guilty (no one can make us feel anything, let's look to ourselves first when those powerful responses sweep through, hey?) this is about putting the blame where it lies - with surgeons, with big business, with patriarchy and with the entrenched normalised misogyny that tells women our faulty bodies will kill our babies during the normal event that brings them earthside. We deserve better, so do our babies. In this obstetrically defined world, the "healthy baby" simple means "not dead" is does not mean "in optimal normal physical health for the newborn of the species". Healthy babies deserve healthy mothers and no woman who has undergone major abdominal surgery, is healthy.

I too am a survivor of unnecessary surgery. The pain of realising I had bought the lies was immense but the journey to healing was wondrous and my next child was born after a three day labour, in my home. She was safe, I was safe, I will remember it with joy for the rest of my life. Five years from my surgery however my child is still recovering from the effects on his gut, our smashed attachment, and I will never think of his birth day with the joy we both deserved. I feel immense sympathy for women in this position but it is up to us to move from the lies the surgeons tell us as we have moved on from lies like "husbands can't rape wives" or "provocative clothes get you raped and you deserve it". "Women can't give birth" is on a par with those patriachal constructions, let's not embrace them.

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.

Anonymous said...

And to leave information for those reading, some references.

Lisa Barrett's blog entry on breech. Lisa is an independent mw in Adelaide, Australia.

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 - overview - turning - turning - studies

Book review on breech babies.

Ina May Gaskin on catching surprise breech babies!

Homeopathy to turn babies in utero.

A great site on moving breech babies.

A Natural Breech Birth - hospital

More than you could ever hope for from the UK midwives (I love these women!)

About 500 birth stories with clear descriptions.

Lovely story! Home breech lotus birth! (Quick, call RANZCOG and tell them one got away!!)

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.

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.

Stepping Outside the System to Birth - embracing women's power and rejecting obstetric control by Janet Fraser

Some caesarean risks
The risks to the mother associated with Caesarean surgery include but are not limited to;
infection of pelvic organs (1)
laceration of internal organs (1)
intrauterine infections (1)
blood clotting (1)
decreased bowel function and other bowel problems, days after the procedure (1)
mis-positioning of the placenta in later births (placenta praevia, placenta accreta) (1)
subsequent ectopic pregnancy (1)
increased chance of experiencing future infertility (1)
risk of requiring additional surgeries such as hysterectomy or bladder repair (1)
there is twice as much blood loss during a caesarean than a vaginal birth (1)
the likelihood that the birthing woman will die from a caesarean is four to eight times greater than a vaginal birth. (1)
Caesarean surgery limits mobility for up to 6 weeks which impacts on ability to care for a new baby
after delivery women who delivered via planned caesarean surgery report more abdominal pain than women who delivered vaginally (2)
more likely to suffer from longer periods of more intense fatigue following birth than women who delivered vaginally (3)
much longer recovery, taking longer to return to physical and emotional fitness
planned caesarean surgery in term breech births is associated with increased short-term maternal morbidity (2)
Cesarean surgery cause ileus (intestinal paralysis associated with abdominal injury)(4)
intestinal obstructions and adhesions (4)
pulmonary embolism (4)
Mendelson's syndrome (acid pulmonary aspiration) (4)
women giving birth by caesarean surgery are more likely to suffer long term psychosocial problems, such as postnatal depression or post-traumatic stress syndrome than women giving birth vaginally (1, 2, 3, 4)

In addition to this future births become limited;
- increased risk of miscarriage (9)
- as mentioned above; mis-positioning of the placenta in later births (placenta praevia, placenta accreta), subsequent ectopic pregnancy and increased chance of experiencing future infertility (1)
- difficulty achieving a VBAC due to hospital policy restrictions, such as time limits on labour, often restricted to the bed, and too higher risk to be induced due to the double risk of UR (and only 25% of Australian previous c-section surgery mothers are ‘allowed’ to attempt VBAC, yet these achieve a 80% success rate)
- repeat caesarean surgery is related to much higher risks than vaginal birth after a previous caesarean (VBAC), including higher risks of infection and many other risks such as increased risk of hysterectomy and maternal death {8}

The risks to babies are;
laceration injuries are more common among caesarean surgery births (this increases when there is a non-vertex fetal position), including lacerations causing blindness (2)
increased risk of stillbirth in subsequent babies (6)
more likely to suffer from respiratory complications (2)
more likely to suffer from CNS depression (2)
more likely to suffer from feeding difficulties in the period immediately following the birth when delivered via caesarean surgery than when delivered vaginally (2)
Greater risk of infant hypertension; nearly five times higher than babies birthed vaginally (7)
Caesarean surgery babies may be more susceptible to schizophrenia than children born naturally (4)
there is evidence that Caesarean surgery babies have an increased risk of allergic disease (4)
risk of iatrogenic prematurity (9)
studies are being conducted into the links between the use of opiates and other drugs administered at birth and later drug abuse in the adult offspring

In addition to the risks of the operation, there are also the many risks involved with the anaesthesia, including spinal or epidural. Side effects from spinal or epidural include many common and minor effects, like urinary retention; postpartum bladder dysfunction, headaches, vomiting, fever, uneven, incomplete or nonexistent pain relief, however major risks (5) include;
- Convulsions
- Respiratory paralysis
- Cardiac arrest
- Allergic shock
- Nerve injury
- Epidural abscess
- Maternal death
- Loss of perineal sensation and sexual function

1. The Medical Model of Reproduction, A Path to Artificial Wombs, Sarah Eaton (2005) New Antigone Vol 1 Spring October 2005.

Trisha Johnston, Michael Coory, Epidemiology Services Unit, Health Information Branch.

3. Dr Sarah Buckley, "Gentle Birth, Gentle Mothering"

4. A quick summary by Olubusola Amu, Sasha Rajendran and Ibrahim I Bolaji,
BMJ 1998;317:462-465 ( 15 August ); /

5. Goer, Henci, The Thinking Woman's Guide to a Better Birth (Berkely Publishing Group, 1999), Quoted in

Anonymous said...

6. Professor Gordon Smith, report in The Lancet Medical Journal

7. Medscape Obstet Gynecol 2001;97:439-442

8. The American College of Obstetricians and Gynecologists, (2006) Volume 107(2, Part 1), February 2006, pp 240-245

9. The Medical references for this article are listed here (mainly from Obstet Gynecol);

Other important reads;

Breech Babies Website;
Contains information and research papers about breech birth, and women’s birth stories.

Breech presentation Author: Richard Fischer, MD, Co-Division Head, Maternal-Fetal Medicine, Professor, Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Cooper University Hospital

The Caesarean Epidemic Issue 8 Spring 2004, Natural Parenting, Birth Options, Birth Reform, Online Access, By Bruce Teakle is the President of the Queensland Branch of the Maternity Coalition. Maternity Coalition (MC).

World Health Organization. Appropriate technology for birth. Lancet- 1985;2(8452):436-7.

Boyce PM, Todd AL. Increased risk of postnatal depression after emergency caesarean section. Med J Aust 1992;157(3):172–4.

Rowe-Murray HJ, Fisher JR. Operative intervention in delivery is associated with compromised early mother–infant interaction. Br J Obstet Gynaecol 2001;108(10):1068–75.

Julie said...

A few responses to the first anon comment that has come through since I last commented (presumably from the DUFC?):

1. "No one and I mean NO one can make anyone else feel guilty."

And yet you go on to try to make people feel guilty in your comment. Starting out like this really just served to piss me off. Then stating that we would probably censor your comment, despite the fact that it doesn't break any of our moderation rules, really really pissed me off.

I don't feel guilty for having a c section, not one jot, although as I've said in this post and in the first one (the post you are commenting on is the second in a trilogy) and in comments, I would have preferred a vaginal birth with no intervention necessary. My caesar experience was positive, partly because I had the mindset that it wasn't a failure on my part to have a C section and I realised that it was the best option for both of us in the circumstances. I make no apologies for not angsting about having a caesarean.

2. "breech is not a disease."
Where did anyone claim it was? I don't think there was anything wrong with me or my child because he was breech, it was just the way it worked out. I think the figures are around 4% of babies still being in breech at the time of birth.

3. "they are unnecessary c sections."
Who is deciding whether they are necessary or not here? My whole point is if a woman, fully informed of the pros and cons, wants to have a c section then she should be able to.

Yes we should be aiming to keep the number of caesars as low as possible. But we should not do this by restricting women's choices about their bodies and about their births.

We could bring the caesarean rate down, imho, by supporting women more during pregnancy, by putting more resources into the midwifery system so that midwives don't have to have so many on their books to make a living, by de-mystifying natural birth and encouraging women to celebrate it rather than fear it. No doubt there are many other good ideas too, that don't involve restricting a woman's right to choose.

What are the logical consequences of restricting access to caesareans? Seems to me that the attitude of restricting access is rather like determining who can and can't have abortions.

For some women the birth is actually not that important. It's a bit like (and this is probably a comparison that will serve to annoy some, but I can't think of anything more analogous) how for some women (and men for that matter) the wedding is really important, while for others they just want to get it over with so they can get on with being married. Can we not just accept that some women don't feel as intimately into their birth process as others and respect that?

Ok, will respond to the rest if I get a chance, others feel free to chime in to agree, disagree, or anything in between!

Azlemed said...

In response to the first anon post, I had a hospital midwife for my third child last year. there were two of them and to tell the truth they were much better than my independant one that I had for my first two children,

C-sections arent always necessary but in Julies case it was the best decision for her and her child....

Why can we choose to have abortions yet we get slammed if we have a c-section....

we have choice for contraception, choice for having/not continuing a pregnancy yet having choice in birth is not allowed by some who think natural is the only way.

I have been lucky and had three very quick (under 3hrs each time) natural labours. And I have been made to feel bad about it. Yet both my daughters spent time in neonates for jaundice, and I have been hospitalised 3 times for mastitis. yes birth is easy for me but afterwards isnt so great.

We are supposed to support each other as women yet we insit on telling each other what is best when it comes to birth.

j... you did the right thing for you, and thats what is important.

The ex-expat said...

Oh for fucks sake anon, you have just demonstrated why the politics of childbirth suck ass big time.

This poster went through an incredibly personal and painful procedure which they willing to share in the hopes of simulating and thoughtful debate only to have some busybody *YOU* tell them they didn't do it the right way.

You are just the same as the *evil* medical professionals you rail against, pushing a woman in a direction she doesn't want to go just because *you* think it is the right one.

It is her body and she give birth anyway she damn well pleases free from judgment and condescension dressed up as concern and moral righteousness.

Julie said...

Ok, you want to talk evolution? Then bring it on. Because evolution is not just about a process by which our species is adapting and changing over time in the sense of our physical bodies, it is also about behaviour, and about technology. Tool use is a technology we have evolved, medicine is an area of knowledge that our species has evolved/developed to help our physical and mental wellbeing.

We don't live on the savannah anymore, we don't live in the trees anymore, we don't live in the oceans anymore, we don't live in caves anymore (or at least none of the people reading this do). So why should we turn down technology that we have developed to help us because it would mean that our births might be different from what Lucy experienced millenia ago?

I respect your right to have a homebirth, a water birth, a termination even if you so please. In fact if you go back and read the first post in this series you'll discover that I actually wanted to have a water birth with as little medical intervention as possible. But that would require not jumping on me at the first opportunity and not willfully misinterpreting parts of my post, so I don't suppose you'll be doing that.

Where did I say that I viewed vaginal births with horror? I don't. Where did I say that a caesarean was guaranteed to be safer than a vaginal breech? I didn't. However, as you'd see if you'd read my first post, I was operating in something of an information vaccuum on the issue, as my midwife basically refused to discuss the situation with me.

Where did I say that caesareans were preferably to vaginal births? I didn't but you seem to have jumped to that conclusion simply because I had a c section and I am not all angsty about it.

Where did I say women can't give birth? Of course they can - I'm surrounded by women who did, vaginally and through the sunroof. Or are you claiming that my son is still somehow unborn?

Ok, that was a bit facetious, I understand what you are getting at when you claim that people think "women can't give birth" - that women can't give birth vaginally. I've yet to meet ANYONE who thinks that. The point is that every woman should be able to make the decision, for herself, about how she chooses to give birth, without coercion or judgement, including not coercing women to have c sections.

I did not think a caesarean guaranteed me a healthy baby. Having had friends and family who have had stillbirths, late term miscarriages, early term miscarriages, children born with holes in the heart or other major illnesses, I did not take anything for granted about Wriggly's health, I just hoped.

As for the information you have provided about C sections, who is scaremongering now?

And thanks the e-e and azlemed for sharing your views. A I know it can't be all that easy for you to share, particularly when some people have come into this thread without the open-hearted manner that you have, so I really appreciate your comment.

Azlemed said...

I have other friends who have had emergency c-sections after 26hrs of labour, none of the three were because the baby was breech, all three were because the babies got stuck. the mum who has had two c-sections after two labours has said that she now is ok with what happened and would choose and elective c-section if she has a third child. for her labour didnt work due to other factors which would have left her and the baby dead 50 yrs ago. c-sections for her are the best outcome.

For me the birth of my eldest was ok, but the haemorrhage afterwards, the trip to theatre to get the rest of the placenta removed, and the neonates stay were in some ways as scary as a c-section would have been.

Anon (number 2) needs to get real and understand that we have to make choices, and how we birth our child is one of them, we have freedom to vote how we want, and not be ridiculed but freedom of birth choice is....

stargazer said...

just another thing to throw in the mix. yes mothers have been delivering vaginally for thousands of year and this is the natural way it was meant to be. but mothers used to die a lot in childbirth too, and how often does that happen now, particularly in developed countries? not a whole lot. neither does baby die during the birthing process anywhere near as often.

i'm comparing this to personal experiences of relatives in india who died in childbirth due to lack of available medical care in remote villages; away from all the modern technology which could have rushed them into an emergency caeserian and more importantly, blood transfusions, which could have saved both mother and baby.

the fact is that the technology and interventions have saved lives. i totally agree that interventions may be used unnecessarily and to the detriment of both baby and mother's health. yes, there is more activism to be done in that regard. but to dismiss it altogether or to condemn women who have had to use interventions is just plain wrong.

if anything is to be learned from julie's experience, it's that information is vital to ensure women can make informed choices. and attitudes of medical staff are vital to ensure that they fully discuss all the options with a proper assessment of the risks. i think you did wonderfully julie under the circumstances. am eagerly awaiting the third instalment (and may there be many more!).

Anonymous said...

I gave birth on a Christmas Eve, it was a different country, my kid was in a good pozzie, the midwife was marvellous, and it was all pretty quick. My point "the midwife was marvellous" is essential. I was in pain, I was scared (although there was nothing "wrong" medically) and she treated me respectfully, offered suggestions and options rather than instructions, and managed to get across the idea that she had complete confidence in me. She also convinced me by her manner that I could have complete confidence in her. I'd never met her before the day I went into labour. Three hours later the boy was born. Great midwives are worth their weight in gold. It's such a shame there are less fabulous midwives around the place, and that we don't get to choose who a public hospital will have on shift. It's an issue that effects all women who give birth (because midwives are variable in private hospitals too).

I agree that women need to be able to make their own decisions, and I share your disappointment that good information was so hard to come by.

(Incidentally, Christmas Day is not a good time to discover that your hospital breakfast has been swiped: the cafeteria is closed and there's no coffee anywhere. I also missed out on the physiotherapy you're supposed to do before discharge, and my son waited a month or so for his newborn hearing test, fortunately I was offered a lactation consultant in my local area, because there wasn't one at the hospital)

Anonymous said...

Sorry Im coming back to this a little late, I was the first anon ;)

I didnt mean to offend anyone by suggesting my comment would not be published on here. Sadly it seems that most places on the net these days will ban people or remove posts immediately if they do not reflect the original posters thoughts. I see that is not the case here and for that I am very grateful. :) I had no idea what your guidlines were. Im sorry, I really should have checked that.

Im also sorry if people have taken my words as some kind of guilt inducing spray. That's really not what Im about at all. I truly cant make someone feel guilty about something they have no guilt over, that was the only point I was trying to make. (I also didn't swear at anybody or call them names which is more than I can say about some of the comments here).

I say the things I say, not to try and make women feel guilty or upset anyone but because I care about the experiences of women and children during labour/birth. I care that women across the world are treated like a piece of meat, lied to, raped during labour every single day and yet dont seem to be aware of the fact that this treatment is terrible and inhumane. I am surrounded by women who are still trying to pick up the pieces as a result of that abuse of power, years after their birth experience (myself included). It's heartbreaking and soul sucking. It makes me sad and angry. I have made a decision to do everything I can to help people stop and think that there might just be a better way when it comes to childbirth and our maternity system.

I made the comment breech is not a disease to highlight the ridiculous recommendations dr's will give you if you have a breech baby. They will not allow you to give birth vaginally. In fact most of them have probably never even seen a vaginal breech birth. Where exactly is the "choice" you are all speaking of in that scenario? The answer: there isnt any. Neither is a woman given any "choice" when she is told her baby is too big or too small or she is told her pelvis is too small or the wrong shape or her labour is taking too long or isnt progressing in a textbook manner. She is told that there is something inherently wrong with her body and the good dr needs to fix it. When you are faced with "if you dont do X your baby will die" where exactly is the "choice" in that sentence?

Choice is a big, fat joke when it comes to birth. Women arent giving birth in a bubble. They are giving birth within a culture that sees a woman's body as inherently fault and in need of fixing. Childbirth, obviously being linked to a woman's body, is seen as dangerous and risky. Most dr's and midwives regularly engage in scaremongering of the worst kind in order to get women to follow their orders. If people are naive enough to think that dr's make choices based solely on safety and what's best for mother and child then good luck to you I say because you're gonna need it! Unless you take yourself out of the medical model when it comes to childbirth there really is no choice for women. It's either do what your Ob wants you to do or face some massive scare tactics so you what your Ob wants you to do.

No one I know (including myself) says that caesareans should be banned altogether. Of course for true emergencies caesareans are absolutely necessary and indeed life saving. I have never denied that and neither has anyone I know. However medical intervention has gone to the absolute extreme in childbirth, to the detriment of women and children. Sure medical technologies should be there in the cases of an emergency but their routine use causes problems, not solves them. An independant midwife I know has around a 5% transfer rate from homebirths. As far as Im concerned (and luckily the WHO backs me up ;)) that is much closer to what our caesarean figures should be.

Rather than just "give" women the "choice" to have a caesarean (a "choice" usually made based on a fear of vaginal birth - which I completely understand given the culture of fear surrounding birth) why not pump all that money spent on caesareans into programs that would help women address those fears rather than bury them under a surgeons knife? The reality is that caesareans are more dangerous and emotionally damaging than a vaginal birth for both mother and child (and before people start jumping up and down about how emotionally damaging so-and-so's vaginal birth was I would ask within which context it happened - in a hospital I would guess). They have long and short term side effects that can sometimes last a lifetime (lack of chemical bonding between mother and child, increased risk of haemorrhage for mother, lack of proper gut flora colonisation for baby, chance of being born prematurely and therefore taken away from mother etc etc) I'm sorry but I just cant stand by and watch the health (both mental and physical) of mothers and their babies be minimised or downright ignored.

Julie said...

Anon no 1, thanks for returning and commenting again.

Two quick things:

1. You seem very definite that every woman who has had a c section is traumatised by it, even if she doesn't realise it yet. That seems a bit OTT to me. And it seems to me to be an attitude that encourages women to expect to feel traumatised by a surgical birth process, which I think is a bit irresponsible really. If a woman is happy to have a c section, happy before and after, who are we as other people to naysay her happiness and claim that she is actually distressed about it, she just hasn't consciously realised it yet?

2. In terms of the issue of choice in birth, would you be ok with caesareans being available to women at their choice, in a system where vaginal birth was more supported? Or do you think c sections should only be restricted to medical emergencies?