Never Good Enough

I found an article today that made my eye go a bit twitchy. It is called “A family centered cesarean is not a substitute for a fully supported natural birth or VBAC“.

I have no idea why the author thinks they are the authority on what is or isn’t a substitute for a natural birth, I would think that the woman giving birth would have to decide that on her own. I am sure there are mothers that have had a vbac and then a c-section for a later pregnancy. A poll of them would be more useful than just making a blanket statement.

The article is intended to demonize c-sections, as usual. What struck me is that physicians who do not feel comfortable with a “natural” vbac (see: almost none) are still considered bad for offering what is called a family-centered c-section.

And mothers, if when you are discussing your desires for your natural birth with your provider, they immediately start talking about the “family centered cesareans” they offer for mothers like you, please please please recognize this as a red flag, and consider transferring care to a more supportive provider….one whose immediate response is what they can do to facilitate your natural birth and then, only if all other options are exhausted, will perform the most family centered cesarean possible

No matter how much OBGYNs pander to natural child birth advocates, its just never good enough. I think I would do the same thing if I were in the OBGYN’s shoes, just to try and prevent anyone from having a dangerous birth at home.

The reason that most providers require close monitoring and epidural anesthesia for VBAC in the hospital is that the risk of a catastrophic uterine rupture is best managed under those conditions. A life saving c-section can be performed quickly under those conditions. An unmedicated VBAC makes it impossible to catch the problem early, which can result in death for the infant. It can cost the mother her uterus, or her life.

I just wish people like the author of the Birth Blissfully article  had to explain how superior a natural vbac is to women who have suffered a uterine rupture during a vbac. Here is one from baby center:

The room filled with people, they threw the sheet curtain on me, didn’t even have time to hang it up before I heard the doctor say “cutting!”  Thank goodess I had the epidural so there was no time wasted there.  She had my baby out so fast, literally within a minute or so.  DD’s arm and shoulder had went through my rupture into my abdominal cavity.  She was breathing but a little limp – it’s so scary to think that minutes later would’ve been a different story.  They rushed her to the NICU, right by DH who had no idea that she had even been born yet.

It seems that she came pretty close to death, too. She lost 2 pints of blood, had multiple transfusions, and had to stay in the ICU for monitoring. One of the big things people dislike about c-sections is that you may have to spend time away from the baby while getting stitched up, but this mom ended up going days without seeing her daughter because they were both in their respective ICUs and couldn’t visit each other. Here is what she has to say about her decision to vbac:

I spent more time thinking, praying, and researching this vbac decision than any other in my life.  Ironically, it was the worst decision of my life.

I feel the exact same way about my choice to birth out of hospital with direct entry midwives (though luckily I did not have this type of health outcome). I looked into it so much, but sometimes doing research is just assuring yourself that what you want is really what you need. It takes a lot of humility to realize when you are reinforcing your previously held beliefs vs when you are actually trying to get to the truth.

A fully supported VBAC, for this mom, would have meant death or serious injury to mom, baby, or both. A c/section is a fine substitute for that risk, that is probably why the vast majority of moms choose repeat c-section over VBAC when presented with information about risks. It isn’t because women are stupid or uneducated, they just have different priorities than NCB advocates. There is nothing wrong with that.

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No, OBs are not accountable

I was reading this post from the skeptical OB today

as you may or may not know, I was banned from the skeptical OB for calling Dr Amy out on being a fence sitter on the issue of date rape. Remember that any time she complains about being “silenced” by home birth bloggers for asking uncomfortable questions. She does the same thing to people who think there isn’t a neutral zone when it comes to rape.

IN this specific post Dr Amy says a survivor of sexual abuse who had several cuts to her perineum done to her body against her will during labor, by an OBGYN isn’t experiencing violence. She doesn’t even condemn the behavior of the OB at any point. She laments a series of home birth deaths in australia, one of the summaries she quotes points out that the mom chose home birth because she had been treated so poorly in the hospital. The only violence in birth is when the baby is injured? Here is as close as she gets to saying anything condemning that horrible physician:

Don’t get me wrong. I’m not claiming that hospital care is perfect. Although there is rarely any violence, there is a great deal of poor and disrespectful treatment.

Beforehand she literally says that the baby being inside the woman fundamentally changes the interaction. She talks as though women are simply vessels for children, and that being such a vessel fundamentally changes the way that a woman would experience having her gentials repeatedly cut against her will. The lack of empathy is very telling. The woman who was cut against her will, over and over, well before crowning, should be comfortable going back to the hospital because Dr Amy is apparently the ultimate authority on what constitutes violence or not. Its laughable, especially from a woman who insists that one must be an expert on a topic in order to have an opinion. Dr Amy goes on and on about the inability of midwives to call out their fellow midwives for negligence and damage done to patients, but here Dr Amy does the same thing and ignores deplorable conduct on the part of a gynecologist.  She goes on to say:

However, the chief victims aren’t Western, white, well off women; the chief victims are the elderly, people of color and those of lower socio-economic status.

For a skeptic she sure has an aversion to actually linking to evidence. Being white and college educated are one axis of privilege, but it doesn’t erase being female. It doesn’t erase the fact that women, regardless of any of their other characteristics, are targets for sexual abuse and violence by virtue of being female. Why anyone would believe that this problem vanishes in the hospital is beyond me. One kind of oppression does not erase the other. Dr Amy’s total ignorance of contemporary feminism and social justice movements is showing once again.

ANYWAY, I wish i could comment so I could let everyone know that NO, you don’t have many avenues for redress if your OBGYN decides to do all kinds of shit to you without your consent. You need a ton of money (enough to pay a lawyer for a lengthy and probably fruitless lawsuit). Medical boards don’t give a damn about this, and the doctor and hospitals have better lawyers than 99% of the population.

Women have many legit reasons for choosing home birth, and this is one of them. A lot of the people in the comments section of the Skeptical OB, who claim there are Very Serious Consequences for physicians who do things against your will, are living in a dream world. In the real world, your word doesn’t matter at all. I know from first hand experience. The issue at hand here is that midwives and home birth do not solve the problem. Horrible attitudes from other people about abuses of women during hospital childbirth (including disbelieving the women, rebranding their experiences as “disrespect” instead of abuse or violence, insisting that they will be compensated despite all evidence, etc) makes a vulnerable population easy pickings for midwives. I know that seeing unauthorized procedures done to patients during my time working in hospitals was instrumental in my decision to have an out of hospital birth. I knew that these doctors were not accountable because they did it all the time. There isn’t anything that holds them accountable for these issues. A suit for battery is unlikely to succeed and is hard to pull off. Ignoring the problems won’t make them go away, and will in fact drive more women to seek care from midwives, who at least pay lip service to how damaging abuse during childbirth can be to patients.