Friday, February 27, 2009

The individual's experience versus Trends in the System

I was afraid this might happen. One of my readers was offended by my post regarding Cesarean births. Perhaps if I explain myself a bit further some of the offense may be tempered. If any of you are feeling similarly, know that my post was not a manifesto criticizing any individual experience, but rather a look at trends within a larger Canadian system which lend themselves away from the optimum, evidence based management of pregnancy, labour, and birth.

Here are a few things about me that are true:

#1. I had a cesarean section birth with my first baby. I don't regret my choice to have that cesarean section, given my circumstances and the position of my baby in my uterus at the time of delivery.

#2. I highly value individual birth stories and respect each one. As mothers and as care providers we do not write the birth story: rather, it writes itself. I have a fundamental respect for the autonomy of birth stories and recognize intellectually, emotionally, and experientially that sometimes birth stories write themselves as cesarean sections.

#3. I know that the most consistent factor in women describing their birth experience as positive is that they did not feel a sense of a loss of control during their birth. This means that women who had opiates during labour, epidurals, vaccum extraction, forceps deliveries, or surgical births overwhelmingly describe their births as positive if they were in control and their input was highly valued during the entire process. Cesarean births can and should be respected and positive experiences.

#4. I am an extremely empathetic person. I think with my mind and with my heart. Part of the reason why I advocate for lowering the cesarean section rate is because I care so much about what happens to women and babies, as individuals and as part of a larger system. The evidence points towards lowering the overall cesarean section rate of the SYSTEM, but it does not point towards the eradication of surgical births. If there were no surgical births, my reader and her babies would not be alive or well. My oldest son might not be alive or well. And countless other women and children as well.


Here are some things about my cesarean section rate post that are true:

#1. I address the system, and not individuals.

#2. My post begins with acknowledgement that the development of surgical birth is positive.

#3. The statistics.

#4. The evidence based solutions I put forward were actually all used in the case of the reader who posted her comment. She had a midwife, mobile labour, encouragement of a trial for VBAC, and a good support system.
If you knew me better, you would know that I believe that if you had a midwife and wound up with a cesarean section, you can be pretty darn sure that you NEEDED a cesarean section.

#5. The reason why I state so clearly that cesarean birth is more dangerous than vaginal birth is that I was so surprised when I found out this fact. Most people I know also find this a surprising fact, which is I think in part responsible for the increasing popularity of elective sections. If we know the risks involved we can make informed choices pertaining to care. In the individual case of my reader, the risks involved in refusing surgical birth were far worse than those involved in choosing surgical birth, so obviously she made the best decision!! So did I, in my own case. However, for many women this is NOT the case, and I think the surgical birth rate being as high as it is, increases maternal morbidity and mortality rates. I also think this is unacceptable.
I know of someone who wanted to have a VBA2C (her first section was for failure to progress, and her second scheduled because she wanted to be certain of her delivery date and figured she could try for a vaginal birth the next time around) but her doctor told her it wasn't possible. This is not true.
I know of someone else who was told that her body was incapable of birth because she is small of stature and has a small pelvis. With her first baby, on the advice of 3 different obstetricians, she had an elective cesarean and delivered a 5 lb full term baby. The first thing she thought when she saw him was, "He knew to grow small so that my small body could give birth to him." She never got the chance to try.
I know of women who have had two, three, and four cesareans and were never once encouraged to try for a VBAC.
I'm fairly sure that if people knew that surgical birth is still more dangerous than vaginal birth despite advances in medicine, they would think twice before electing to have surgical births when not medically indicated! This is why I mention the risks so clearly. Not to 'put fear into having sections,' nor to make anyone feel like 'less of a mother.'

#6. My post addressed the system as a whole. It mentioned no individuals, and this was intentional. If I were a teacher I could simultaneously cheer for a student who earned an A+ on their report card, or who graduated from high school, and criticize a certain aspect of the educational system, without cheapening that students' achievement, or negating my support of them as an individual.
The same goes for obstetrics.


I hope this rounds out the reception of my first post for everyone.

4 comments:

Dawn and Dale said...
This comment has been removed by the author.
Dawn and Dale said...

I'm a mommy of 6!! 4 via c-sections and 2 grew in my heart not my tummy!

Just as proud of how all 6 came to me! Just thankful they are here and healthy!! :)

P.S. The post above was from me! lol I had a big spell error!! lol

Louise and Gary Chapman said...

Melissa, just wanted to let you know that I took no offense to your C-section post. I never, ever imagined that i would've had one. If my first labour had been different I would've tried a VBAC. I do have to say though, that I am so glad that I did not have to go through labour and a C-section again. I'm very happy with my elective C-section, my recovery was WAY better. I can't say how my C-section affected Koen because I don't know what he would've been like had he been born vaginally. I do have to say though...if we had to pay for a C-section, i wonder if I would've had a VBAC. What does it cost? Maybe $10,000 for surgery and hospital stay?

lori lls said...

You are a researching queen. Thanks for posting this information. The risks about C-sections are something we don't hear much about.