Wednesday, April 14, 2010

The Blame Game

I promised myself that I would write *something* in honor of Cesarean Awareness Month, since I am not doing much of anything else for it. In a discussion just the other day with a dear friend, this topic came up. The Blame Game.

Women really and truly believe that they or their baby were the cause of the disappointing or scary outcome of their birth. When an induction ends in a cesarean, a woman is told one of three things, all placing blame on herself or her baby:

1) "Your pelvis was just too small."

2) "Your cervix failed to finish dilating."

3) "Your baby was too big."

What should these three really say?

1) "The epidural you had and us having you push on your back made it impossible for your body to birth your baby on your own."

2) "Your body wasn't ready yet, and it was PROTECTING the baby."

3) "The epidural you had and us having you push on your back made it impossible for your body to birth your baby on your own."

The blame ( okay, most of it...women still need to take responsibility for poor choices, such as choosing an induction or epidural ... research women! ) needs to stop being focused on mom's body being "broken", or baby growing to be far too gigantic for mom to birth. Let's face it. Inductions fail for a reason. And it's still an induction if you were contracting regularly, but not dilated much, so they hooked you up to pitocin! Inductions fail because the body isn't ready, and it's doing just what it's supposed to do - PROTECT that baby inside. Your body hasn't failed you, it's done its job perfectly! Unless you have rickets, or had a terrible pelvic injury prior to labor and birth, your pelvis is not going to be "too small" to deliver the size baby you grew. Period.

And baby growing too big? Not going to happen unless you have uncontrolled diabetes mellitus, or there is a congenital abnormality. We're talking a very small % of babies are born with this ... yet how many women can you think of who were either talked into an induction or cesarean on the basis of their baby being too big? I was one of those women. And my GIGANTIC 8 1/2 lb baby boy suffered for it.

It makes me so sad when I hear women say that they ended up with a cesarean because their body didn't work right, wasn't the right size, or their baby wasn't the right size. We need to put the blame where it belongs 99% of the time - with intervention. A healthy pregnancy that is allowed to progress naturally, with no interference, will have wonderful outcomes the vast majority of the time. That's just fact. The more you screw with it, the more you're screwed.

Care providers need to stop covering their asses by playing the blame game with women. Or even more concerning, they need to learn that these things aren't true. Because if they really believe that it has nothing to do with inductions, AROM, epidurals or drugs .... that's even scarier than them passing blame.


Kayce Pearson said...

Incredible post!! Women need education and support to know that their body truly works best when left alone! I try to tell people that their body won't work if someone is telling them to poop, and everyone says that has nothing to do with birth.

Not only are they not educated, it is so much easier relying on someone with a license than researching on their own. It is truly sad.

Karen Joy said...

While I agree virtually 100% with what you posted, a small part of it struck a bit of a raw nerve... I was present as the birth coach of a dear friend last August. It was a hospital birth, but I had "sold" her on benefits of birthing with no meds and no interventions. She had been laboring for about 24 hrs before she went to the hospital. By the time she got there, it appeared both to me and the nurse that she was in transition. Her ctx were 1-2 minutes apart. However, she was dilated to ONE, the same as she had been for weeks. They did an external fetal monitor on her as part of assessing her, and while that was on for 30 minutes, there were consistent and worsening late decels. The did do an emergency c-section. It turned out that the baby had let go of her meconium, and it appeared that it had happened some time previous -- baby's skin was green, she had copious meconium aspiration, and ended up in the NICU for 2 weeks. Baby's blood was very acidic (7.07 ph), showing serious sign of oxygen deprivation. OH! Also, my friend was 41-2. No induction, no AROM, no intervention (other than the monitor, if you can call that an intervention), she didn't get to the hospital too early... I felt like I witnessed a true, valid, honest emergency. From the time she entered the hospital to the time the baby was OUT elapsed only 30 minutes.

That event has helped me understand and appreciate the (RARE, OCCASIONAL) need for OBs.

The only thing I'm wondering is, if she had planned to birth with a midwife, perhaps the late decels would have been detected sooner with a Doppler?? In that case, would there been anything anyone could have done to avoid the section?? Or, maybe it's true that some women (RARELY) just DON'T dilate.

Obviously, this weighs heavily on my heart... (if you want to read the whole story, the original post is here: I'd appreciate any of your midwivery insight, experience, and wisdom.)

Karen Joy said...

(Just reviewed my own original post, and I do have a few details not QUITE right -- baby was in NICU for 9 days, ctx were at 3 min upon arrival to the hospital... but essentially, it's the same.)

Christine Fiscer, Traditional Midwife said...

Karen Joy ...

Unfortunately, there *are* situations that necessitate the dreaded cesarean. I'm grateful that we have the ability to do them when needed. Don't get me wrong, I'm glad that we have Obstetricians and hospitals for emergencies. I happen to have an absolutely amazing OB here that I can call if needed. Sadly, this isn't the case in most places. :(

However, just going off of what you told me, I wouldn't be surprised to hear that baby wasn't in a good position for labor/birth. Usually with moms who have labors that start and stop and start and stop, and then get majorly intense where you're sure they're in transition but aren't ... have to do with a malposition. With a malposition, it may be impossible for the head to apply even pressure to the cervix to dilate it. While the body was working to turn the baby ( the contractions ), it didn't work.

This could be something as very simple as the head being cocked slightly to the side...that might have gone unnoticed. As a home birth Midwife who is with clients all through labor, I have to say that most would probably have caught the decels earlier. That's why home birth offers so much closer care - it's all one on one.

I'm sorry to hear about the baby - NICU time is absolutely horrible. My cesarean baby ( my 2nd ) spent 9 days in the NICU as well, and it was torture for me.

Saffy said...

I just found your blog and it certainly is thought provoking. Both my pregnancies have resulted in c-sections (both under GA). The first due to severe PE and placenta previa, the second because of the 1st (classical incision) and fetal distress. I'm grateful that my second pregnancy ended well - even with 12 days in the NICU.

One thing though that disappoints me and probably always will is that I'll never get to experience a more 'natural' birth - heck, at this point I'd even settle for being awake.

I've had friends 'elect' to have c-sections because they're either afraid of delivery or, I can't believe this, they want to choose the birth date. In my humble opinion, this is plain wrong.

Christine Fiscer, Traditional Midwife said...

Oh Saffy, I'm so sorry!

But I'm hoping I can give you some hope. Women HAVE VBAC'd with a classical incision! It *CAN* be done! Please don't give up hope of having a natural birth, because it's very possible. Yes, the risks are slightly higher than that of a VBAC with a bikini line incision, but it's possible and it has been done. :)

If you're interested, I can send you the link to a group for women with "different" types of incisions - Inverted T, and Classical.

Don't give up hope!

~ValianEfforts~ said...

Hi Hi Hi!!! I love this post and as someone who has had 2 natural and a c-section I can completely agree and understand this post!!! I would like to say though that my water broke, and I had to be put on pitocin because I was in labour but was not progressing, that ended in a c-section because I swelled in my one leg to twice the normal size of my legs making it so I could not push. Very good post though

Christine Fiscer, Traditional Midwife said...

ValianEfforts - sadly, the pitocin and c/s probably could have been avoided. Women can go up to 2 weeks with water broken and no labor, safely. Not progressing simply means your body wasn't ready yet.

Unfortunately, you don't have this option when you birth in the hospital or have a Midwife who doesn't trust birth. :(