I'm about ready to change the name of this blog: Willow's Unrest. Whatcha think? There's no rest for a birth activist/VBACtivist/lactivist/intactivist. There's no end to the stupidity, the lack of education, the lack of desire to
acquire knowledge. I think that last is the worst. It's one thing to be ignorant. It's something altogether different to remain that way on purpose. You can lead a horse to water...
I know I've burbled on before about feeling burned out,
ready to let it all go. I've spilled miles of ink and tapped keys till I developed callouses about why people ought to care about birth-- theirs and all women's. This is nothing new. But I find I've kept it in until I can't contain it anymore-- hence this post. Forgive me, won't you?
I wrote this several years ago. It's not great, but I still feel this way, so let me get it off my chest-- then I'll get back to my rant. It originated in an offhand comment someone tossed out-- something about "so-and-so could care less about VBAC":
I suppose I could care less. I could choose to accept the near-30% cesarean rate in the United States. That would mean accepting that wholly one-third of women in this country are unable to deliver the babies their bodies conceived and grew. That would mean buying the whole bill of goods-- doctors know best, birth is the business of surgeons-- read men, because even female OBs are conditioned to be metaphorically masculine in the operating room-- and women are just incidental to the process. Our wombs are dark, dangerous dungeons from which our babies must be cut free. Pregnancy and birth is a primitive, nasty, brutish affair that must be managed and controlled and interfered with every step of the way, from the time the stick comes up blue until the baby is released from its mother's imprisoning flesh.
I could care less about VBAC. I could accept that my cesareans were necessary, lifesaving events that were responsible for giving me healthy, whole children. I could bless the quirk of fate that made my daughter stay footling breech, the neat serendipity that gave wrapped her cord around her neck three times and made external version impossible. Thanks to that, I had a cesarean! Hurray! I was a first-time mother, and I didn't have to bother with messy, unpredictable labor. Rather, the nice medpros in blue scrubs wheeled me into a cold operating room-- one of them punctured my spinal column and anesthestised me, another cut me open and gave me my perfect baby girl. Not only that, but in that one stroke, she guaranteed that I would never have to concern myself with birth again-- in future, I need only open my datebook and choose a day that seems best to me to have my precious babies hand-delivered.
I could care less about VBAC. I didn't need to stress myself nearly to the breaking point, searching high and low for a care provider to see me through my second pregnancy. The year of hell I endured, of postpartum depression and PTSD, of being unable to bond with my son, were all entirely unnecessary. Why did I do that to myself? To him? I could have cared less about VBAC.
I could care less about VBAC. I could spend my days at the hospital where I work complimenting the cesarean moms about the roundness of their children's heads (if they were all round, which they aren't) instead of poring over their charts and trying to figure out where it all went wrong. Why couldn't they deliver? Why were they cut? Why is "failure to progress" a valid diagnosis for a *scheduled* c-section?
I could care less about VBAC. I could throw away the list I keep of VBACs and CBACs at my hospital. I could celebrate the surgeries instead-- Goddess knows the list would be far longer. I could stop agonising about this generation of surgically delivered children. I could accept that it's "just another way to be born" and believe that there are no far-reaching consequences of arriving via "vaginal bypass surgery."
I could care less about VBAC. I could turn my back on the research that refutes the position of the OBs, whose concern lies mainly with their pocketbooks and their malpractice insurance rather than with the patients they purport to care for. I could accept that it's right and good for a new mother to be unable to breastfeed her infant because she's too drugged or in too much pain or her IV line won't reach far enough. I could accept that iatrogenic prematurity is nothing to be worried about, a few days in a NICU is a fine start to life. I could agree that not wanting to "stretch one's bottom" is an acceptable reason to choose major abdominal surgery.
I could care less about VBAC. I could take the fading ICAN sticker off my van and stop slipping cards into my patients' education folders. I could insist that homebirth-- not to mention HBAC!-- is dangerous and wrong, and all women can and should simply report to the hospital at 38 weeks on the dot to have their babies removed. I could close my eyes and mind and heart to the pain in the stories I read. I could join the hordes who insist "only a healthy baby matters" and tell my scar-sisters to "get over it." I could ignore my own lingering hurt, pretend my babies and I weren't affected by their "births."
I could care less about VBAC.
Other than the statistic-- the cesarean rate in the United States is now
32.8%, according to the CDC-- I still feel the same as I did when I wrote that, 3 or 4 years ago. Little has changed; I'm a little further out from my surgical deliveries, but I'm no less outraged. I certainly don't want another one, should I ever be blessed with another pregnancy ! And yet I'm still expected to button my lip, keep it to myself, pretend that it's
only a healthy baby that matters. Say nothing that might offend. Or frighten.
Let me back up; I've wandered off into my rant without giving any context. Sorry about that.
I'm a nurse. I became a nurse in self-defense, after my CBAC in 2002. My experience was so horrific-- so degrading and inhumane, that I was determined never, ever to be at the mercy of medpros again. For my entire nursing career I have worked in one facility, a mid-sized urban hospital that I must decline to identify. I work primarily in mother-baby, though I sometimes go to NICU or labour & delivery. I spend the vast majority of my time caring for new mothers and infants. Education is such a huge part of my job that last year I became a Certified Childbirth Educator through
CAPPA, and I'm one of my facility's instructors for the hospital-approved Prepared Childbirth Class. I teach 4-6 classes annually, to (usually) first-time parents, covering the typical "What to Expect from Your Hospital Delivery" curriculum. On the up side, I get to use the
InJoy Birth/Parenting Education videos, which are well made and comprehensive-- the ones we use were filmed at the same hospital where I delivered my first child, and "my" midwife is featured, which always gives me pause for thought. On the down side, there's little room for, as Opus was wont to do,
departing the text. I have 5 hours, total, over 2 weeks, to cover pregnancy, labor, birth, postpartum, and newborn information. I'm not allowed to teach breastfeeding at all-- I'm required to refer my couples to the hospital's Official Breastfeeding class.
Cytotec? Can't go there.
VBAC? Can't cover it.
Circumcision? Nope. Other than to answer basic questions, I can't say anything "controversial." Nothing that might dissuade a mother from opting out of the culturally and medically sanctioned norm. I'm not technically allowed to provide resources-- the best I can do is say, "I strongly recommend that you look ____ up and educate yourself."
My opinion doesn't count for anything, as far as the hospital is concerned. Never mind evidence-based. Forget personal experience. Hell, don't even worry about patient advocacy-- which is, as a nurse, my highest concern! Just stick to the party line, and for Goddess's sake, don't make waves!
Deep breath. Okay. I try to toe the line. I answer questions in a manner as vanilla as I can make it. I think I usually manage... or I did. I'm due to start a new class tomorrow night-- and today the nurse-manager of our labour & delivery unit informed me that I need to "be more aware" of what I'm saying. Apparently, she received a comment from a patient who took my class last December, who was (understandably!) upset because I allegedly said that "if you have a c-section, you might as well leave the hospital in a body bag."
First of all, I assured the manager-- as I am assuring you, now-- that I never, ever, ever said any such thing. I have never uttered the words "c-section" and "body bag" in any kind of proximity to one another. I've wracked my brain, and I can't figure out anything that might have given anyone such a notion. The manager replied that she didn't know where the patient had come up with the idea, maybe I said it, maybe I didn't, but just be careful. I reiterated that I would, and hung up the phone.
Then I wept.
I do teach my classes that cesareans, while sometimes necessary and lifesaving, are not the optimal way to begin motherhood. I have, when asked, elaborated on potential consequences, both in the short term and in future pregnancies. I emphasize that most of the time vaginal birth is preferable, and it's well worth it to try to avoid surgical delivery. When couples ask me about my deliveries, I try to stick to the basics: I had a primary c-section for double-footling breech, a failed induction and repeat c-section, and then a homebirth VBAC. I don't tell my stories. I don't talk about the years of postpartum depression and PTSD. I have spoken of the wound complication I had after my CBAC, because a dad asked if anyone ever had incision problems. Yes, postpartum wound infections occur. I was lucky; I "only" developed a seroma and minor infection; I didn't have a
full dehiscence that required surgical treatment, debridement, packing and repacking for months, as
some mothers have.
Essentially, I'm forced to abide by a version of "Don't ask, don't tell." I'm not supposed to offer anything off menu, so to speak. But if asked, I'm not going to lie... and I'm not going to "pretty it up." I will never tell a client "I loved my c-sections!" But I certainly never have, and never will, tell an expectant mother that having a cesarean will kill her. **
True, my CBAC made me want to die. I can't pretend otherwise. I once sparked a flame war on a prominent pregnancy and birth support forum by stating that I would rather bury a child than endure a forced c-section. Was that overly shocking? Unquestionably, though in my defense I was mired in severe depression at the time, and words cannot describe the anger and bitterness that were my constant companions then. Did I truly feel that way? Yes, I did. Do I now? No... probably not. But if another woman, after a traumatic birth, chose to express herself that way... I would support her.
I wept because I would never intentionally frighten a pregnant woman. I would never set out to horrify or hurt another mother. But somehow... I did both. I'm angry and remorseful and frustrated. Why go on? Why, if all I do is cause distress?
Maybe I should just... care less. Stick to the text, never depart. Why, yes, inductions are
always medically necessary! Of course epidurals are safe for you and your baby! Your doctor
always has your best interest at heart-- he would never section you at 5 pm for "failure to progress," even though the
Friedman curve is a myth and you labored nicely to 7 cm in 10 hours, just because he wants to go home and catch the newest
CSI episode! Cesareans are
always the safest option for "big babies!" No, c-section recovery is no big deal at all!
I guess we'll see how tomorrow night's class goes. I"ll be good; I won't scare anyone. I won't express any opinion that's even a millimeter out of lock-step with the hospital's standard operating procedure. Maybe I'll even feign ignorance if someone asks about potential complications.
No, I won't. I couldn't live with myself. I'm a nurse. I'm a mother. I'm a birth activist. There's no rest for the wicked, they say... I suppose I'm living proof.
** I would never say that... but I might recommend she read the details of the
surgical consent form. Unfortunately,
cesareans have killed mothers. But no one wants to hear that-- and if I mention it, I'm the bad guy. Goddess help me, maybe it would be better for all concerned if I went back to my archaeological roots and found someplace that would just let me go dig in the dirt.
