The balance between education and respect

[pamamidwife]

Alas, there have been many threads on this board from women who are well educated in birth, passionate about women's healthcare and the increasing rates of unnecessary surgical intervention across the country. Still, in every thread, there seems to be a voice that reflects anger towards birth activists from women.

We currently live in a country that has a high cesarean rate, with little or no improvement in overall maternal and infant mortality rates over the last ten years. The cesarean rate is getting higher, with more and more doctors being enticed to do cesareans by their malpractice insurance in exchange for lower premiums. Even a current presidential candidate believes that cesarean births are safest across the board. The 23 countries ahead of our own that have better infant/maternal outcomes have much lower cesarean rates than we do. I consider this a huge reflection on how we are treating our mothers and babies in general - and it's something that I would love to see change.

How do we continue to empower and facilitate trust with women while offering, sometimes, an alternative to the model of care that most women receive? And, if we do so, why are we deemed as being horrible people?

Are there birth activists that do not understand that cesareans are sometimes warranted?

Do we need to have a disclaimer with every post that says, "and yes, I know that sometimes cesareans are warranted"?

For those women who have felt that cesareans were the best choice in their pregnancy/birth, why would they get upset that there is growing concern over the rate of UNNECESSARY cesareans? Do they believe that this high rate of cesareans is actually something that is better for us as a nation? Why are they so angry at us? Surely, if you felt a choice was solid for you, why would you be so angry at someone for wanting women to have solid choices and care in childbirth?

We cannot go back and pick apart people's birth stories. We SHOULD NOT do this. Hindsight is 20/20 and this serves no purpose.

However, if I had a dollar for every woman that said to me, "If I was at home, I [or my baby] would have DIED."

Then they tell a story of highly managed inductions or labor patterns, a diagnosis of "failure to progress", which is more like "failure to be patient" with hospital "protocols" not based in evidence, drugs in labor, etc.

Does anyone not feel that the nearly 25% of cesareans that are being performed across this country (and this rate is growing) is something that should be viewed as a warning sign?

Women are walking around believing that they "cannot dilate" or "cannot birth a big baby" or "cannot go into labor on their own". They are told by the medical model repeatedly that their bodies have failed them. NOW, this is different from women with serious health issues or anomolies that warrant surgical birth. These are women who are relatively healthy - they just didn't fit into what a certain linear mode of thinking wanted them to. Still, it's about how their bodies are less than - and they carry that failure with them, often times, into mothering ("I cannot make enough milk", "My baby just won't latch on", etc.)

Empowerment and informed choice in any situation is a positive thing. If women are not told anything but one side of the story, how are they to make informed choices?

And, in light of empowerment, how can we birth activists get along without all these disclaimers for people who have had a different experience? Where does the anger from these people come from? Do they not feel heard in general? Surely we live in a culture that is more supportive medicalized and surgical birth than, say, home birth. Is it just on these boards that they feel alienated?

Please, there has to be some willingness on both parts to communicate openly and honestly. We are great at posting "reactive" posts - where we react to something that someone has said, rather than taking the time to listen to what our intention is with posting.

I am asking this with an open heart and an open mind. As a midwife, I am bombarded by stories from women who are feeling betrayed by their births. This is surely a not so good sign -

I have had a number of clients (and in the past two years, I have a higher cesarean rate than most midwives in my area) who have had surgical births. Does this mean that I look down on them? Hardly! Do these women feel that they are less than empowered or encouraged about their birth? Not from what I hear. Nearly all of them are still fighting for birth choices and normalcy in birth - even with their cesarean histories.

Where is the balance? Why is their so much anger and opposition?

[Greaseball]

I don't know. I have posted a few times on the VBAC forum in the past and some people told me they thought my posting there was inappropriate since I had not had a cesarean. VBAC is a subject I am interested in; that's why I was posting there. You don't have to have surgery to feel passionate about the rise of unnecessary surgery. I quit posting there because I was tired of writing "Please forgive me; I haven't been cut" before everything and wondering if I was going to offend someone.

I know I have a lot of knowledge that is worthy of passing on. But the fact that I have not experienced the issue I am posting about, or that I'm not a birth professional, is seen as a sign of disrespect to those who have been through it.

I know what you mean about "my cesarean was necessary!" I think if people are really secure about their decisions, they will not get defensive. We do not co-sleep and we vaccinate. Those are just the decisions we thought would work best in our family. I don't feel the need to explain them more than that and I don't reply to all the co-sleeping threads with "well, it doesn't work for everyone, you know!" I'm secure with my decisions.

I think women don't want to believe they have been unnecessarily operated on. They listen to the reasons why the doctor wanted to operate and they believe them so they don't have to admit they were basically assaulted for convenience sake. For the first year after dd was born, I went around telling everyone that I was so glad I had gone to the hospital, that I "wouldn't have been able to give birth" without assistance, that I would surely have been in labor for 3 days, that I'd most definitely go to the hospital next time, and that I probably would have had to transfer anyway. I didn't want to admit I had put myself and my baby at greater risk for no reason.

There are some formula feeders who go to the breastfeeding forums, and I really don't want to say "But I know breastfeeding isn't for everyone!" after each post.

[TurboClaudia]

Empowerment and informed choice in any situation is a positive thing. If women are not told anything but one side of the story, how are they to make informed choices?

This seems to be the crux of the issue of education and respect. I would hope that all people feel empowered to take responsibility for their health and the maintenance of it. However, this is not necessarily the case. And if the prevailing culture of our society is "the quick-fix," i.e. pop a pill, have surgery, etc., than pressure to take responsibility for one's own care lessens. Our litigiousness and sense of entitlement only adds to this. And a foundation of our culture is the right to speak out, about injustice, inequality, untruths and so on. But respectful listening to another's point of view is not an overt foundation of our culture.

That said, I do think the anger and opposition I've observed online (here at MDC and elsewhere) is rooted in the anonymity of web communication. Some people become less fearful of retaliation when sitting in front of a computer and write things they might never say to a person's face, friend or foe.

Regarding birth activism, I am more of a one-on-one activist, getting to know a person and then gently planting the seeds that there might be a different way. To my closest friends, my passion for natural, intervention-free, unmedicated birth stems from an educated background. I have learned to temper my passion when speaking with people who trust our medicalized birthing culture, but it makes me inordinately sad to do this sometimes. However, if a person is not accepting of my thoughts or my advice, then it is more important that I listen to their concerns and respond to them wherever they are coming from.

warmly,
claudia

p.s. Pam, we really need to have tea together sometime. Love and hugs to you...

[LiamnEmma]

I see what you're saying, and I agree with this argument when the light is shined on any hot topic. For example, breastfeeding...for women who bottlefeed, why feel the need to explain and rationalize, whatever? Because they feel crappy about not having breastfed. Rightly? Maybe. So I say, shine the light back on yourself too and ask yourself why it bothers you if someone rationalizes her cesarean...if you feel comfortable with your beliefs (and I really do agree with them, I promise), why does it bother you that some women haven't worked their way through the whole process yet? Because I see it as that. Some women who have had cesareans--necessary, unnecessary, whatever--haven't processed it yet, and to me, that speaks to a larger issue all around, and yeah I agree that it's about empowerment. But denial is very powerful and some people don't work through every trauma. So now, for me, when I hear someone rationalize why they didn't breastfeed, or why they needed pain meds during birth, or why they had cesareans, I just listen. Every person's experience is different amd we come to them based on our past experiences, and just because I was able to a, b and c, doesn't mean that someone elses life experiences also allows them to a, b and c. Maybe they e and d.

The older I get, the more I realize that there are reasons, often far more emotional than physical, for everything. I can totally see why a survivor doesn't bf. I can also see why a person has a c-section or has an epidural, or vaccinates, or has an abortion. And once we allow one reason in, we have to allow for the others as well. Do we agree with them all? No. Absolutely not. But I do think that's where the education part of it comes in. And education does not have to shout unnecessary csection here!!! It can quietly teach about the birth process, and the way hips are meant to open up for big baby heads, and the way transition makes you feel, and how pushing in different positions helps, and how a water birth can decrease pain, and all that other stuff, without ever once putting a cbirth momma on the defense. kwim?

[stayinghome]

Well said, Pam!

I think about this a lot. I don't have any answers though.

[anothermama]

That is THE BEST post I've ever read on an online board. Period.


To address your post.....

For one, we are a nation of individuals. Our "American Spirit" is all about being yourself, being unique, being different....and people don't like to admit that they are part of an "average" or part of the "norm". We've made this an insult to say "Your birth was very average". Our children are all "special", our births are all "unique"....even if the reality is our kid is pretty normal and our birth was pretty average. And so.....every woman in birth is conditioned to talk about HER unique circumstances that are totally unlike anyone elses...(except they are JUST like everyone elses...). And it's culturally ingrained in us to be insulted when someone says "Well, actually...no, this situation is really typical".

And another thing...it's a parenting issue. Women seem to feel inherantly defensive with OTHER women when it comes to parenting and mothering. It's a subtle competition almost. And to be ANYTHING less that completely supportive of a womans birth choices means you are critical of her mothering skills. I know ...I know..thats not what it REALLY means, but many many women seem to take it this way. And I know that I've really defensive when someone critisizes my parenting....who woulnd't be?

It, sadly, has nothing to do with the facts or how the medical establishment is keeping women in the dark.....the first thing that strikes in the personal thing...and thats a womans individuality and her mothering. When someone feels *personally* attacked, they'll block out the "bigger picture".....I've done it, and I'm sure you have too.

And I don't know how to change that other than to just be consistant in what I say to other women...and hope that maybe along the way I hit a nerve with a woman or two.

[anothermama]

Originally posted by LiamnEmma
Rightly? Maybe. So I say, shine the light back on yourself too and ask yourself why it bothers you if someone rationalizes her cesarean...if you feel comfortable with your beliefs (and I really do agree with them, I promise), why does it bother you that some women haven't worked their way through the whole process yet? Because I see it as that. Some women who have had cesareans--necessary, unnecessary, whatever--haven't processed it yet, and to me, that speaks to a larger issue all around, and yeah I agree that it's about empowerment.

For me, it bothers me because it rarely seems to be about working through it. It's about justifying what happened to them, probably in order to make them ok with it in themselves...and thats it. It doesn't seem to go further. It seems like, especially with birthing issues, the "working through" is really just being ok with what they did...and then they want to make everyone ELSE ok with it.

I don't know if I'm explaining that right. But it's not usually about working it out to learn...it's about working it out to be ok with where they are right then, and not grow or learn. And...often then spread misinformation.

[Laurel]

Just a few thoughts...

I haven't given birth so I can't comment on that specifically, but I have experienced inability to bf, despite huge efforts to induce lactation. I guess I can comment on human nature.

I keep hearing people say that if you made a confident, informed choice, you shouldn't feel defensive. But for many women, including me in my situation, it wasn't a choice--the choice was taken from me. For a woman who had a c-section for a legitimate reason, it probably wasn't something she chose--it just happened. I think that makes a difference in how you feel about it. When we use words like "empowerment", that really stings, because even though it may have been the right thing for the situation, how can one be empowered if one didn't have a choice?

I think there is just a lot of grief and pain involved in things like this, and it sometimes makes people's reactions more emotional than they would otherwise be. I can know rationally in my head that my situation was the exception, and I can wholeheartedly support the right and best way of doing things, but it still hurts, and sometimes that emotional pain screams louder than the rational brain, even in discussions like we have here. I don't agree that defensiveness is always because a person is insecure in their decision. I think defensiveness is a natural reaction when a topic is emotionally painful for us and we wonder if anyone really cares to understand. I do think that we can get so caught up in discussing "issues" that we forget that the people behind those issues are real individuals with real feelings. No mother is a stereotype, but we talk in stereotypes a lot.

I think there are discussions that do cross the line from advocacy to downright meanness. (Maybe not the entire discussion, but certainly individual posts.) I rarely post on bf'ing boards but there are times when I have felt the need to explain my situation because sometimes it really does get out of hand. And many more times it doesn't get out of hand at all, and I don't post, but it still stings. I do feel the need to explain (some would say "justify") my situation. Why? Because I don't want to be misjudged--I want to be understood, and I want people to appreciate my experience. I think that's a very normal, human thing--to want to be loved and valued and understood. The fact is, without the explanation, I would be judged here. Probably I am even judged by some *with* the explanation. No matter how much I know that I did my best and did the right thing, it still hurts to think that I am lumped into a stereotype called "formula feeders". And like I said before, for me I think the reason it is so touchy is because I did not choose it.

LiamnEmma, I loved your post! I think I'm rambling here and not making any sense, but just wanted to put forth the idea that emotions do strange things at times, and I think that's what most of the defensiveness being discussed is about--people's (not always rational) feelings.

[LisaG]

It's really weird and kinda creepy when ya'll crawl into my head and listen in to my private conversations with myself

I was pondering a lot of this on my drive home tonight. What creates so much division and antagonism and how can we create an environment that honors and supports women and their birth experiences while at the same time empowering them to become educated about their choices?

And then I wondered why am I so bothered when I hear stories from women who think they would've died had they not had a c/s for x, y, z reason? Why do I care?

It bothers me that women who have any experience with birth in a natural, non-intervention manner are becoming an endangered species. It bothers me that we as a society are so NOT bothered by the current labor and birth environment.

Yes, we need to come to a place of moving on from our experiences. I wouldn't want anyone to continously beat themselves up for making difficult choices. But I do wonder (and I'm glad I'm not alone in this) - why when I (or anyone else) shares info that suggests things could be different next time is it perceived as a tearing down rather than all of us beautiful, wonderful, strong, courageous women coming together to reclaim our power - however that might be done and in the variety of ways that it will be done.

I hang out on the ICAN list a lot. I am continually amazed at the courage, wisdom, compassion and openness on that list. Those women are awesome! And while we certainly don't all agree, there is the common goal of improving birth for all women and decreasing unnecessary c/s.

Nobody wants to hear that a choice they made didn't have to be like that. Does that mean we refuse to say things could've been different so others don't feel bad? How can we use our less than ideal experiences (birth, life or otherwise) as a catalyst to create positive change?

In my personal experience I had large uterine fibroids and a nearly complete bicornuate uterus. Women in both circumstances have successfully gotten pregnant and given birth without surgical correction. Some have managed this without any difficulty, others have had tremendous difficulty and complications. After much researching and soul-searching I realized that MY best decision was removal of my fibroids and reconstruction of my uterus to join the 2 uterine cavities. Certainly not the "right" decision for everyone, but it was for me. I was in the fortunate position of having time and good resources to support me as I made my decision. And where am I going with this?? I'm starting to wonder myself . I guess my point is that there can be many "right" choices - but let's be educated, empowered and conscious! And let's support each other in this process rather than getting hostile and defensive. We certainly can all learn something from the process.

Alright, I think I've rambled on long enough. Hopefully, it's somewhat coherent.

LisaG

[Greaseball]

And then I wondered why am I so bothered when I hear stories from women who think they would've died had they not had a c/s for x, y, z reason? Why do I care?

For me, it's because it shows yet another way the male-oriented medical system is overpowering women. If you can make a woman not trust her own body, and believe that you can make her body work right, you've got a lot of power over her.

Also, it doesn't just stop with the individual women. Having a cesarean makes it more likely that your daughters will as well. Pretty soon doctors will forget how to do anything else. They already forgot how to deliver breeches...

And I also care about their babies. Cesareans are risky for babies when done for elective reasons. It makes me sad to see babies' lives risked for convenience or money issues.

[miserena]

Perhaps the cesarean issue is just too highly emotional for use as a focal point for birth activism. Maybe you could focus on the general notions of empowering mamas and improving maternal/infant outcomes by promoting practices which could or do lower c/s rates, such as:

-medical malpractice reform
-educating that pregnancy/birth is a natural process, rather than a disease
-promoting the midwifery model of care
. . . the list could be endless

Just some thoughts,

Michelle
mama to Eileen 11/04/01, unplanned c/s

[SamuraiEarthMama]

Originally posted by anothermama
For one, we are a nation of individuals. Our "American Spirit" is all about being yourself, being unique, being different....and people don't like to admit that they are part of an "average" or part of the "norm".

and yet, we are a nation driven by peer pressure. starting at an early age, children in schools are subjected to tremendous amounts of pressure to stay in line, not rock the boat, parrot the right answer, and above all, NOT be a square peg!

to deviate from the mainstream is considered freakish, bad and unamurrican. to question authority is strongly discouraged and punished.

yes, our "american spirit" was founded upon independence, but that spirit has been beaten down, homogenized and diluted to the point of nonrecognition. as long as people are treated like sheep, they will continue to follow the herd, and be uncomfortable and wary of anyone who chooses to be different.

people who hit their kids say "my folks hit me and i turned out ok." people who were forced into the humiliation of compulsory education subject their kids to the same coercive treatment believing it's necessary. and people who were raised to believe doctors are gods will submit to the knives and drugs.

it's frustrating. you want to scream "wake up!" to people stumbling along in their dreamworld. but you can't. all you can do is be patient, and work quietly with those who are beginning to ask questions, and raise your children to reject the mainstream.

it's about conditioning from a very early age. as long as babies are bunged into childcare, children are warehoused into schools, professions are packed into cube farms and the elderly are squirreled away in convalescent hospitals, the focus on the family and community will continue to dissolve and fade.

jessica mitford, legendary muckracker, said "follow the money." we also have the incredibly powerful influences of corporate interests driving the directions of that conditioning (witness channel one and coke's influence in the public schools). we've allowed the power to shift from the individual to the corporation, and it's not going to be easy to get it back (maybe impossible). drug and insurance companies drive the policies of medical service providers, and we won't be able to change that without a massive paradigm shift.

maybe i've become cynical after years of work on the california midwifery legalization campaigns. i don't think change can happen anymore at that level without huge amounts of cash. i believe our hope lies in raising a generation of kids who are secure enough to stand up for themselves and their families.

so, subvert quietly when you get the chance, and raise hellraiser kids. that's my solution!

katje

[OnTheFence]

I may be the only csection mama posting on this thread. Excuse the typos this morning.

I am going to tell you why I am angry (and not particulalry at one person but in general) with the activisim I often see going on with people I know in real life and on these forums. The activism that some portray is often time with a holier than thou attitude. Comments are made repeatedly about the empowerment of women, educating women of the evils of the medical establishment, and the constant judgement on others birth experience whether they have had a csection or augmented birth or even a birth in a hospital for that matter. There is a lot of "empowerment" to boost ones on ego and try to help some poor umsuspecting woman, with the attitude that we are all like sheep being led to slaughter. There is a message of mistrust sent out to women when ever they discuss their OBs opinions, etc with others on this forum or medical intervention that took place if they had hospital births. Often times when I read the VBAC forum or this one particulalry about interventions or surgical birth the tone comes across like this "I mistrust what you are saying. Your doctor is a fool but next time I hope to beat it into your head that the next time you can have a baby in your living room with no problem." Of course this is said with sugar and delight but the under current is a sarcastic tidal wave.

I am not sure which poster in this thread said what, but I wanted to tell you why I defend my two csections. For one they were necessary. No one can debate the necessity of it more than I can. I spent years recovering emotionally from the first one I had. I've done more research and spent countless hours studying mullerian anomilies and birth than I can recall. Fortunately I have had resources available to me living near a medical school and being active in web forums where there is a lot of sharing of information. Did I have to justify my surgical birth? Yes. I needed to know it was necessary that there was nothing I could have done differently, that the outcome would have been the same had I been with a midwife or a physician TO MOVE ON. And why did I have to go to such great lengths to do this, because of women who call themselve activists for women said and judge otherwise. (the sad thing is I WAS ONE OF THESE WOMEN) And it still happens 7 years later. For some reason some crunchy homebirthers believe that my weird transverse baby hooked in some strange position through two different sections of my uterus, me with broken ribs could have given birth vaginally in some magical way and we all lived to tell about it. That my multiple attempts to have my baby turned holistically and medically must not have been done right by me or the practioner I saw. It gets old.

Should activists for natural vaginal childbirth put disclaimers? No. Should they qualify all their statements about surgical birth? Maybe. Do I have a problem with the csection rate? Yes. Do I think there are too many unnecessary csections? Yes. My problem is when one assumes that a woman who comes on this forum and says they had to have a surgical birth immediately its thought that either she or her doctor did something that led to it. (or heck midwife) This is what I find wrong with some of the "activists" I have met here on this forum or in real life, they are the ones who truly lack balance. They cant see past their agenda to see a woman and her child. They cant see past their own knowledge and experience to see that other persons knowledge and experience.

In the past year I have seen too many women attempt natural vaginal deliveries at home or in hospitals risking their babies and themselves to prove that they can have a vaginal delivery. They discount real risks and take faulty advice from people on the internet or because they read the Silent Knife and think that the medical establishment is wanting to gut them like a fish and steal their young from the womb. Some women think that having a natural vaginal birth is the end all and be all as an introduction to become a mother of a child. It isn't. There is much more to mothering than that. I dont think much of a woman who puts her life and child at risk to try to prove something to the rest of the world, medical establishment or even herself. I have read time and time again about fear based medicine, well there is a flip side to that as well and its here running rampant through these forums and in other circles.

If you want to advocate for women, children and their health, do it without judgement or superiority.

(excuse the typos, toddlers running wild and cant check)

[Missgrl]

I think it is sooooo important at this point to remember that we are all humans with feelings and we all walk in different shoes. The old saying of "don't make judgements until you've walked in my shoes" seems to fit perfectly here. It is hard as a moderator and a c/birth mom to try and be partial and to not interject personal feelings. In this forum it is ok to discuss the high c/s rate and the curse of the medical doctors pushing c/s and the fear of malpractice etc. But let's remember that doing so hits home with alot of us here, and in discussing these things sometimes it sounds as if you are passing judgement on the way our beautiful babes were brought into this world. It is no secret that most c/birth members here carry alot of baggage about their deliveries. We are very open to discuss them either to vent, support or get passed feelings. We open ourselves up in order to heal. It is difficult to talk about such deep rooted feeling with people that have not been through the same situation. No two c/s's are the same just as no two vaginal births are the same and to make blanket advice is sometimes turning the knife in the wound. Continue the discussion....just remember their is a loving, caring woman on the other end of the keyboard.

[pamamidwife]

Yes, I agree about respect. It's important.

And, to figure out what your intention is behind posting anything. Are you just reacting or is there something that you feel is important and pertinent to the discussion? These are rules that I'm trying to abide by - I don't always succeed, however.

It sounds like women get most upset when their cesarean births - or heck, any birth! - are picked apart by others when they have not asked for feedback on it. (I'm guilty of this, too!)

Am I right when assuming that this is the biggest piece that many women have with "birth activists"?

[OnTheFence]

Originally posted by pamamidwife
Yes, I agree about respect. It's important.

And, to figure out what your intention is behind posting anything. Are you just reacting or is there something that you feel is important and pertinent to the discussion? These are rules that I'm trying to abide by - I don't always succeed, however.

It sounds like women get most upset when their cesarean births - or heck, any birth! - are picked apart by others when they have not asked for feedback on it. (I'm guilty of this, too!)

Am I right when assuming that this is the biggest piece that many women have with "birth activists"?

Not entirely.
I think one thing that has bothered me over the past seven years (and guilt of as well) is that someone else interjects that they know differently about your and your body or your situation. In the past six months two of my friends had surgical births. One was looking and actively preparing for a natural vaginal birth. After her water broke she went to the hospital on her husbands demands. In fact he got very angry at the two of us laughing and cutting up before she went to the hospital. Well when she got there, they discovered her baby was a footling breech and they decided to do the csection. Well while they were waiting for the spinal the baby started have decels and finally just vanished. The nurse checked her and realized there was a prolapse cord. My friend woke up in recovering over an hour later not knowing what had happened. Was her csection necessary. I believe so!
Now four weeks later, my best friend had plan for a natural delivery. She was 2 weeks over due when her water finally broke. She called me and told me she was on the way to the hospital. After six hours there she let them give her pit even though she was progressing. Then she got an epidural. Then labor stalled out. Then her baby started getting distressed with the additional pit. So she had a csection. Now I personally believe that this was unnecessary. My friend made decisions not thinking clearly, but all in all made choices that led to this. I never said anything to her about it, even though I clearly felt that had she not let them give her that pit she would have had her baby in due time. One night after he was born and she called me and talked to me about the emotional decisions she made and choices that made that led to her surgical birth. She admits she handed her power over to a doctor and that her surgical birth could have been avoided. I *knew* that this was something she would come to terms with later. She didnt need me to tell her.

I think when you want to be an advocate for women, you need to allow them to tell their story and give them some time to process their own choices. And sometimes, like Laurel said, we have no choices. You just end up where you are at because that is what fate had in store for you. If a woman comes here and says "what could I have done differently?" then by all means help inform her. I think a good example of this recently is IOF. She did all the research, made plans for a VBAC and a surgical birth, and then in the end went with her gut. I believe following your instincts is just as important is knowing black and white facts. (and why some people chose repeat surgical births, or epidurals, or induction methods) I hope you understand what I am saying Pam, my kids are all over creation today and I am not sure I am thinking straight.

[2BMamaof3]

I just wanted to add my voice to this thread.

I don't have anything to add at the moment.

I am a birth activist, but am very interested in pamamidwife's original thread questions.

I appreciate LiamnEmma (??)'s perspective and thank you OnTheFence for your experiences and advice.

I have been "bitten" by the sting of birth activists as well...even though I had a homebirth!! My homebirth was deemed too medical or not holistic enough....I didn't listen to my body enough....my midwives were to medical. Sigh. So I'm interested in finding that balance between informing women, empowering women and being an activist for birth.

Abby

[LisaG]

First off, Kim thank you for contributing to this discussion. I appreciate that you take the time for this.

In the past year I have seen too many women attempt natural vaginal deliveries at home or in hospitals risking their babies and themselves to prove that they can have a vaginal delivery. They discount real risks and take faulty advice from people on the internet or because they read the Silent Knife and think that the medical establishment is wanting to gut them like a fish and steal their young from the womb.

Next, at the risk of stepping on toes - can I very gently, and respectfully add in that the opposite concerns me too? In terms of women who think that a c/s (or c/b - never quite sure which terminology is more preferred) guarantees a safe outcome that a v/b can't? There are risks, very real risks, to both. And it really, really concerns and bothers me when I hear of women who had a crappy v/b decide that a c/s/b is the answer. Not because of their choice, but because of the assumption that things shouldn't have been/couldn't have been different with their v/b and therefor their only option in order to avoid the traumatic vaginal birth is to have a c/s/b. It saddens me that that's the environment of birth.

On a more personal note, I would venture to say, based on a couple previous posts by you in another thread, that given my bicornuate surgery history I would fall into that group you consider are taking the unnecesary risk of self and baby for a vaginal birth. While I'm sure some women do feel it necessary to "prove" they can have a vaginal birth (and I'm not sure why that's always a bad thing), I'd also like to suggest that some of us have arrived at that decision informed and have decided that the risks are worth it, just like other women have decided the risks of a c/s/b are worth it. I've decided that my risk for rupture increases the more incisions made in my uterus and therefore choose not to create another one if at all possible. Nor do I want to increase abdominal adhesions, risking my future fertility. Nor do I wish to once again recover from major abdominal surgery, or any of the other risks/side effects of c/s/b. I have decided what risks I am most comfortable with, and I suppose some could argue that it's completely stupid to be concerned about risk of adhesions when we're talking about the risk of the life of a baby. But there is no risk free option. Having a c/s/b doesn't mean something catastrophic couldn't happen either.

So here we are, back to freedom of choice, back to education, back to making choices with eyes wide open. Back to having compassion for our choices, our situations that brought us to those choices.

Which also brings me to a question - why does suggesting that a women could be better educated somehow get translated into "so you're saying I'm stupid and dumb"? :

When a woman has a doc tell her that her baby is gigantic and it couldn't possibly fit through her pelvis and the woman doesn't know that u/s are notoriously inaccurate for predicting fetal weight, that even if the baby is big - small women are usually able to birth big babies given proper support and positioning which hardly every happens when a doc won't catch a baby in any other position besides lithotomy, that pelvimetry is a crock, that position and proper support are just about everything in that equation - WHY does suggesting that something could be different next time get translated into "you were a stupid woman that was duped by your doctor"? Why does suggesting that your doc is misinformed get translated into "you didn't go to medical school, therefore how could you possibly know more than my doc?"

Do I trust doctors and birth? No, not really. Not because I think they're bad people, or out to get me, but because the entire system of birth and medicine sees birth as a medical emergency and what could possibly happen "normally" with that attitude?

So yes, I do feel obligated morally and ethically to say something when I hear stories of CPD or other scenarios that have a high likelihood of being mismanagement related rather than defect related. I also feel obligated to say this the gentlest way possible and to be compassionate in my suggestions. Did I like it when a friend suggested that my surgeon might not be accurate when he told me I'd have to have a c/s/b - especially right as I was starting to get somewhat ok with the idea? Nope. I'd asked a couple of people, I'd been told by the holy grail of medicine, and so here I was, one of the "unlucky" ones who couldn't have a v/b. Well, she wouldn't shut up. So I said, alright, I'm going to dig deeper, see what I can find and then know that regardless of my decision I've found out what my real and true options are. I think we owe that to each other. We owe it to each other to help open eyes - and that goes both ways, I've had my eyes opened as much, if not more, by women's c/s/b experiences as well as v/b.

Well, I think that's enough from me for now Again, I hope it's reasonably coherent.

LisaG

[stafl]

Re: The balance between education and respect

Originally posted by pamamidwife

And, in light of empowerment, how can we birth activists get along without all these disclaimers for people who have had a different experience? Where does the anger from these people come from? Do they not feel heard in general? Surely we live in a culture that is more supportive medicalized and surgical birth than, say, home birth. Is it just on these boards that they feel alienated?

...

Where is the balance? Why is their so much anger and opposition?

I really want to take the time and read and re-read all the replies, but am limited in the amount of time I can spend on the computer with an active toddler and a newborn.

Pam, I love reading your posts, and cannot for the life of me recall ever reading anything offensive that you have written.

I did have a c-section with DD1, and understand the defensiveness some "birth activists" stir up inside me and other women.

I remember reading Henci Goer's book during my first pregnancy, and I just knew nothing like that (a medicalized birth) was ever going to happen to me. I knew that all I had to do was be educated and strong and stand up for myself. It didn't work out that way, though. In reality, the hospital and doctors and nurses took all the fight out of me. I was told that my baby would die if I didn't obey and bend to their rules and procedures. Instead of the empowered woman, I became a statistic. I personally experienced that unecesary c-section I had read about, that certainly was not going to ever happen to me! And I remembered that it wasn't long before that I had been looking down my nose at women who gave in, who were naive enough to believe what their doctors had told them. (edited to add - that is sarcasm, but I have seen this sort of attitude when this issue comes up)

And when I read a post on this board or others about how horrible c-sections are...well, it does sometimes strike a raw nerve. It's like telling me that I'm weaker or somehow less of a woman that I allowed them to do that to me. Some posts have actually left me in tears. I know I can't be the only one. It can be just like certain activists are twisting the dagger the surgeon left in my heart, telling me how I could have avoided what happened to me when they weren't there, they really *don't* know what I went through.

I think it all comes down to being supportive without judgement, respecting other women regardless, and not trying to put yourself in their shoes because you will never ever hear the entire story of what happened at their birth(s).

[Greaseball]

I try not to give unsolicited advice IRL, but on one of these boards it's more likely that I will. Anonymity helps. IRL when a woman tells me she had an epidural and then a c/s, I just think, well, that's probably why...

The thing is, I'm probably right. I probably do know more than the doctor does. The WHO estimates that 50% of sections are unnecessary, so if someone has one there is at least a 50% chance they didn't need it. If they had an emergency, there is a good chance that is caused by the doctor as well.

When a baby's life has been risked by surgery that has a 50% chance of having been unnecessary, I care about that. I'm sure people who have never even been pregnant would care too.

If someone says "Your baby probably would have been safer if born at home" there is a very good chance they are right. Most babies and mothers fare much better at home.

I see it going both ways. I read posts from people who have had hospital births saying to other people, "Why in the world would you want an unassisted birth" or something similar. We all judge each other.

If someone tells me that I'm making a dangerous choice for my baby, I try and open my mind to the possibility they are right...if I still think they are wrong, I just stop listening to them.