About that school registration form in California…

Since this story came out the other day, about an elementary school in California asking parents to indicate on an application form whether a child was born vaginally or by c-section, I’ve had a blog post brewing.  But I’m spurred to actually write it now because of discussion currently ensuing on The Unnecesarean’s Facebook wall.  Evidently, a lot of people believe that it’s both acceptable and wise for a school to ask this question on a registration form. 

To be frank, I first read about this story on The Onion, and was sure that it was a joke.  It struck me as particularly funny-weird because I was asked the very same question on the application form for Annika’s first daycare, and I thought it was kind of hilarious that The Onion would do a spoof of something I thought couldn’t possibly have actually happened to other real-live people. 

At the time when I was asked, I recall doing the head-scratch and wondering why on earth the daycare needed to know this information.  When I asked, the daycare provider told me that it was so she could assist my child with healing from her birth.  Cue vomit.  

It’s no big secret that I hated my c-section and that I wish that my daughter’s time on earth could have started differently.  But the truth of the matter is that my sadness is more to do with me than with her; I’m big enough to admit that any concerns I’ve had about her experience of those first hours of life are more projections of my own experience of trauma than genuine worries about her.  All evidence suggests that she’s fine and has been from the start.  The c-section really sucked for me:  and that matters enough on its own without trumping up some story that my daughter is forever damaged by the way she came into this world.  

This is not to say that the circumstances of a birth are never relevant.  It’s certainly possible for a child’s birth to have an impact on cognitive function, and that is something of which schools need to be aware.  A friend who is a school psychologist explained this to me when I started ranting about the ridiculousness of asking the question.  People who are trained in assessing such things need to ask questions about birth to ensure that they don’t miss any clues that could help them assist a child in need of educational intervention. 

But there are at least two major differences between what my friend described and what I’m talking about now.  The first is that a specialized psychological or educational assessment, performed for a child with an identified need, is very different from a general school application form, which is circulated among a wide variety of people.  The second is that the question rests on an irrelevant dichotomy rooted squarely in the ideology of the person asking.

If the goal of asking about the circumstances of birth is to understand whether or not a child needs particular kinds of support, the question needs to avoid the red-herring, limited c-section vs. vaginal birth dichotomy, and instead be open-ended:  how was your child’s birth?  A vaginal birth can be chock-full of potentially traumatic complications and/or interventions.  Moreover, while I certainly advocate allowing the physiological process of birth to proceed unhindered (some people call this natural birth), I also acknowledge that unhindered processes can sometimes be really hard on everyone involved. 

The point is:  vaginal or natural birth does not necessarily equal peaceful birth, and c-section does not automatically equal trauma.  A question that assumes that one type of birth is inherently more traumatic than another type of birth with no qualifications or consideration of individual circumstances is asinine, and the response to it is irrelevant.

**Edited to acknowledge the school’s appropriate response to the controversy.

First ICAN Cowichan Valley meeting: Success!

The first ICAN Cowichan Valley meeting took place at my house this past week, and my immediate response was why did it take me so long to get around to organizing this?!  I wish I’d done this 4 years ago, when I was postpartum with my daughter.  If you’re unfamiliar with what ICAN does, you can read their mission statement and more information here.  It’s critical to have an organization advocating for women, and supporting women who experience cesarean sections, and ICAN does incredible work in many different ways, both through its central office and local chapters all over the world.

The turnout for the Cowichan Valley meeting was better than I expected.  Out of respect for confidentiality, I’m not going to write anything about the women who came, but suffice it to say that there is a clear need for this group in our community.  It’s gratifying to feel like we’re doing something for one another in the immediate sense of offering face-to-face emotional support, information and resources.  More than that, it’s energizing to be taking concrete steps to make a bigger change:  to ensure that women have access to VBAC, to talk about how to make the c-sections that do happen more family-centred and woman- and baby-friendly, to strategize around how to talk with our care providers and ensure that we’re being heard, before c-sections happen as well as afterward.

These meetings are small steps, to be sure, but sometimes even the tiniest movement is meaningful.

After a surgical birth

I spent a lot of time today thinking about how women and babies are treated immediately following caesarean deliveries.  This topic is often in my thoughts because of my own post-op experience.  For reasons I still don’t understand, I was not allowed to touch or hold my perfectly healthy newborn daughter until we were out of the OR and in recovery, about 45 minutes after she was delivered.  In the OR, both of my arms were strapped down, and everyone present just ignored me when I asked repeatedly to touch her.  Being completely stripped of power as an individual, as a woman, and as a parent in the first hour of my daughter’s life is still one of the worst memories I have of that day.  The resulting anger and loss is almost indescribable.

Two things today made me think about this even more than usual.  First, I made the mistake of watching A Baby Story on TV at the gym this morning while working out on the elliptical machine.  (My theory is that watching shows that inevitably piss me off will raise my heart rate a little more, increasing the value of my workout.  Totally bunk science, I know, but it’s my way of justifying really bad TV choices.  Anyway.)  In the show, a woman who had hoped for a vaginal birth gets a c-section.  The hospital staff dismiss her sadness and fear prior to the surgery; afterward, they ignore her as she calls for her newborn baby, who she can hear but not see crying somewhere beyond the curtain separating her head and chest from the rest of her body.  Her baby is brought close to her face for a minute or two—already clean, dry and swaddled—but then whisked away, leaving the woman lying there with a stunned and wounded look on her face that resonated just a little more than I would have liked. 

It wasn’t easy to get the images from this morning’s A Baby Story out of my mind, and then later in the day, by coincidence, I happened upon this post at Cesarean Parent’s Blog.  The author describes a situation that should be the norm post-op in cases where a baby and mother have no health issues requiring immediate attention.  Just like after a vaginal birth, women who have had caesarean surgeries should have the opportunity to have skin-to-skin contact with their newborn babies.  Not all women will want this, and in some cases it won’t be appropriate.  Obviously women and their health care providers need to make smart decisions responding to the specific context and requirements of each birth.  But barring the need for immediate medical procedures, offering a woman the chance to hold her baby—and keeping the baby close to her/his mother— is the humane thing to do.

I write about this here because the reality of a 30-40% caesarean rate means that more women than would otherwise expect or require a c-section need to be ready for the possibility that they will have one.  For those for whom the birth process is important or who want to see and feel their babies fresh from the womb—before they have been sanitized, weighed, measured, poked and prodded by a succession of strange hands—it might be worth spending some time thinking about how an ideal post-op period would look and feel and what the hospital staff, attendants and others might be able to do to support their wishes.  None of this guarantees a positive experience, and achieving an ideal is far from the point.  The point is not to stay ‘in control’ (no such thing in birth), but simply to remain subject instead of becoming object.  For some women, preserving those post-birth skin-to-skin moments amid the challenges of a surgical procedure (especially one with such a troubling political context) can make all the difference in terms of their overall feelings about their births, their babies, and themselves.  If doing so poses no medical risk to mother or baby, and, indeed, has myriad proven benefits, why not?

ICAN of the Cowichan Valley

Forgive me, readers, for it has been many months since my last post.  I took a little professional detour (can you detour from an already diversified path? hmmm…).  It was interesting, and among other things, gave me an opportunity to reevaluate my values and priorities. 

And now that I’m back from my sojourn, I’ve re-prioritized my work around birth advocacy.  To that end, I’ve (finally!) gotten around to doing something I’ve been talking about for years:  I just started a new chapter of ICAN, the International Cesarean Awreness Network, here in the Cowichan Valley.  ICAN of the Cowichan Valley, like other ICAN groups, will offer resources and information about cesarean sections, and provide support to women who are recovering from a c-section or trying to avoid an unecessary surgery. 

After I had Annika, I attended one ICAN meeting down in Victoria.  But for a variety of reasons, including distance (it was a 2-hour drive, round-trip), I never managed to get to another one.  I’ve always regretted that, and wished I’d had a practical option beyond suffering in isolation with the aftermath of her birth.  I did have a wonderful circle of online friends who helped me through those years, but there is a lot to be said for face-to-face, local connections, especially in the postpartum phase.  And there is also a lot to be said for a specialized group like an ICAN support group.  It’s often hard for women to talk about their experiences with surgical birth, as many people still trot out the ‘but you have a healthy baby!’ dismissals, and unecessary c-sections have become normalized in our society.  ICAN groups can offer a safe place for women to connect with others who are likely to empathize, and willing to listen without judgment to their stories.

I’m still in the process of getting the group up and running–it was only officially registered yesterday, and I have yet to plan any actual events or meetings!  My hope is to find a central space where we can gather, perhaps beginning in late May or early June, and go from there.  So, local folks, please help to spread the word and encourage people to contact me at icancowichan@gmail.com.  Local and far-flung, like our Facebook page. Thanks to all of you for helping me let people know about this important new resource.

Taking traumatic births seriously

I went to see a new doctor this past week.  I’ve been trying for five years, without much luck, to find a doctor who is a good fit for our family.  But we live in an underserved area, and unfortunately there just aren’t a lot of good choices–the doctors who are recommended most highly have full practices and won’t even take names for a waiting list.  So I had  high hopes when I went  into the new clinic on Tuesday, and I went in with a positive attitude:  this will be The One.

Unfortunately, I think I was wrong.  It was all going okay until she asked me if I had any concerns I wanted to address right away.  I said yes, there is one.  I decided a few months ago that it’s time for me to see some kind of counseling professional to go through the details of my second child’s birth, and process what it all has meant in the nearly four years since.  Although Annika’s birth was extremely traumatic, I made only one attempt to discuss it with a professional.  When she was a few weeks old, I went to see the nurse at the health unit who was responsible for counseling women with postpartum depression.  I don’t know if I was suffering from PPD per se, but I was definitely suffering emotionally, and she was free, so it seemed like a logical choice.  She was nice enough, but after I explained the situation (planned homebirth turned emergency c-section after 5 days of prodromal labour and all kinds of crazy things happening, etc.), she told me that I had to stop “wallowing” in self-pity, accept that I had a healthy baby and move on with my life.  Given the fact that I still hadn’t gotten up the nerve to remove the bandage covering my incision, and I still needed help getting in and out of bed because of the pain, I thought her remarks were insensitive and, at the very least, awfully premature.  Needless to say, I didn’t try to talk to anyone about it again for a long time.

But on Tuesday, I decided the time had come.  I’m working with pregnant and postpartum women now, and want to ensure that I don’t project my own issues on to them.  It’s a professional responsibility as well as a personal necessity.  It’s not easy to ask for help, especially with mental health issues, but I sucked it up, put on my big-girl panties, and decided to give it a go.  To be fair, I was nervous and probably didn’t explain very well, but I was assuming that a trained family doctor wouldn’t require a whole lot of detailed explanation, that she would have either seen this before or at least have some sense of how to handle it.  The conversation went as follows.

Me: “Um, well, I’m wondering if you can recommend a counselor or a therapist who I can talk to about my daughter’s birth?”

Doctor:  “Why, did something happen?”

Me:  “Well, it was really hard–I had planned a homebirth, but we ended up with an emergency c-section, and I was pretty depressed for a long time afterward.”

Doctor:  “Is your daughter okay?”

Me:  “Yes.  But–”

Doctor (interrupting):  “Well, then, why do you need to talk to someone?”

Me:  “Um, well, I want to figure it out…figure out why I’m still bothered by it.”

Doctor:  “But your daughter is fine.”

Me:  “Yes.”

Doctor (laughing):  “Maybe it’s like some kind of [laughter increasing] post-traumatic stress disorder?”

Me (feeling ridiculous):  “Well, I don’t know if I’d go that far…I don’t know what to call it, but it’s hard.”

Doctor (still laughing):  “I don’t know anyone who really does, uh, that, but I can ask around.”

Cue me feeling like a complete idiot, totally dismissed, and wishing I’d never brought it up.

Luckily, sufficient time has passed and I’ve been around the block enough times with doctors and therapists that I could handle this–I wasn’t destroyed by it, although it was humiliating.  And I could put it in context:  her reaction wasn’t about me, it was a reflection of a large, systemic problem–ongoing stigma and ignorance about mental health issues–and a smaller problem that is a subcategory of the first:  a tendency to dismiss women’s mental health concerns, particularly around pregnancy and birth.

So instead of being destroyed I got angry.  Not in the doctor’s office, of course; there, I was a good girl, laughing with her as though she were right, as though I was silly to have brought it up at all.  I played my part in the cultural script perfectly, even though it went against everything I believe in; it wasn’t like I decided consciously to play the part, it was the only choice I could make–the possibility of pressing my concerns, of insisting she take me seriously, evaporated the second she started laughing. 

What is it going to take to change this?  I was struck while Annika was a baby by how little support there was for me to access.  Once the 6-week postpartum visit came and went with my midwives, I was on my own, and there was really no one there–outside of family and friends–to provide any kind of meaningful or helpful assistance.  And while I put on a brave face and muddled through, I think women can expect more than that–I think women deserve more than that. 

If a woman is traumatized by the nature of her birth experience–for any reason, whether or not you believe her trauma is “justified”–she deserves care, and she deserves to be taken seriously.  She is not “wallowing” or making a big deal out of nothing.  Birth is a major life event, and for some women it is one that may require days, weeks, months or years to process.  Is it wrong to ask for healthcare professionals whose jobs include pre and postnatal care to assist with that?

The doctor I saw on Tuesday should not have laughed at me.  I wish I hadn’t laughed with her, because I don’t believe it’s a laughing matter.  Birth trauma is serious.  It can destroy a person’s quality of life and impair her ability to parent appropriately; it can hurt a whole family.  Women’s feelings matter; women’s experiences matter.  Birth matters.  Stop laughing, stop dismissing, and listen.  Asking for help is really hard–if a woman has the courage to go that far, give her the courtesy of going with her and doing what you can to offer some support.

Resisting erasure

This post by Courtroom Mama makes me want to stand up and cheer.   It confronts a common tendency to counter natural birth advocacy with the claim that any critique of mainstream birth practice is automatically a self-righteous judgment and denigration of the women who move through that system.  This line of argument declares natural birth advocacy irrelevant—or worse, anti-feminist—by claiming that those who work to expose the problems in the mainstream system are actually working to limit women’s birth choices.

Courtroom Mama takes on an issue that has great personal relevance for me.  My own advocacy work really started after having my second baby by c-section, when I realized that the current system makes it virtually impossible for women to know whether or not they are receiving appropriate maternity and birth care.  Unnecessary interventions are so common—in both medical and midwifery models of care—and misinformation and fear are so ingrained as the basis on which both health care providers and the women they serve make decisions that I’ve begun to wonder if “informed choice” in prenatal and birth care can ever be more than a pipe dream.

Part of my struggle to come to terms with my c-section has been acknowledging that no matter how educated an individual woman is (I knew a lot) or how skillful and trustworthy her providers are (my midwives, and the OBs on call at the hospital the day Annika was delivered, were awesome), the system sucks.   Although unassisted birth is not for me, I can understand why some women choose to move as far away from formal prenatal and birth care as possible, to try their damndest to get outside of a fundamentally broken system.  Because however risky birthing unassisted might seem to many of us, the fact remains that the mainstream system is just as risky in its own unique ways.

And it’s this denial of risky-ness in the mainstream that has been at the heart of my struggle.  It’s the fact that if you walk into a hospital in labour you are all too likely to come out with unnecessary stitches, or to be treated like an object instead of a subject at the moment when you are most vulnerable, and then to face a world that denies not only your right to complain but to even acknowledge that you’ve been treated like crap. 

It seems that the mere acknowledgment that it is normal for women to be treated poorly during pregnancy and birth—to be treated with disrespect, to have their bodies manipulated unnecessarily as a result of, frankly, bad science—is so threatening that there is a veritable cottage industry dedicated to erasing our complaints. 

One of the most powerful forms of erasure is to flip the argument and claim that women who speak out against mainstream practice are just self-righteous whiners with nothing better to do than try to make other women feel bad about their birth experiences.  There’s no doubt that there are a lot of self-righteous whiners out there.  However, the world of natural birth advocacy certainly doesn’t have the market cornered on that.  Moreover, as Courtroom Mama puts it so succinctly, “just because someone is ambivalent about their birth experience,” it does not mean she thinks “that everyone MUST give birth in a certain way. This is horseshit.”

So, let’s put the name-calling aside where it belongs and focus on the more important issue here:  that women are speaking out of turn,  and that telling us to shut up, for whatever reason, just isn’t going to work anymore, especially if it’s because it makes you have to think about your own experiences from a critical perspective.  That is not self-righteousness; that is unapologetic analysis allowed to make whatever impact it makes as individuals digest and apply it. 

Ultimately, as Courtroom Mama explains, advocacy in this context is not about telling anyone what to do.  There are political implications when women choose medicalized births.  Those choices shore up a system that does as much harm as good.  But would I ever deny a woman the right to choose that kind of birth?  Absolutely not.  Yet I will still critique it.  Why?  Because the only way to make change is to take the risk of questioning the status quo.  Those questions might hurt sometimes.  Believe me, I’ve been on the receiving end of the hurtful questioning, so I do understand.  And at the same time, the questioning must continue because I don’t believe women really do get to make choices unless we actually have options, and the only way to actually have options is to be sure that we have good information from trustworthy sources.   Right now, when it comes to pregnancy and birth, most of us just don’t.  And those of us who think we do (or in my case, thought we did) can’t even really be sure because the whole system—the research designs, the funding bodies that control the research, the peers who review it, the journals that publish it, the providers who put it into practice—is so completely twisted and separated from what should be fundamental, which is giving all women appropriate and safe care. I wish it were different, but wishing won’t make it so—questioning might.

My favorite part of Courtroom Mama’s post is where she writes, “there is an ideal way to give birth, but not a right procedure. The right way is the way that leaves the mother feeling at peace with the birth. If she’s at peace with her elective cesarean or her epidural or her water birth, that is the right way. If she’s left feeling disempowered, scared, unsure, this is the wrong way.”  Indeed, this is the crux of my argument, and the sentiment that motivates my work.  Women deserve to feel at peace with their birth experiences, and confident about their birth choices.  When I question common birth practices, it’s not to make anyone feel bad—there is already more than enough sadness and pain going around in this context.  Rather, it’s to make that peace and confidence possible for more women, to insist that regular women—not only doctors and midwives—have the right to be part of conversations about birth, to say what we like or don’t like, what works or doesn’t work, and to be heard, whether or not people like what we have to say.

Expectations

I’m not sure how I feel about this story: http://offbeatmama.com/2010/06/caesarian-empowerment

Basically, a woman describes the days leading up to her c-section and her son’s birth, and concludes that it was an empowering experience.  I have no argument with that.  I do not argue with people’s descriptions of their own experiences; only they know how they felt/feel, and it’s not for me to question.

Indeed, when I read this bit, I could really identify with this mother’s words:

My entire self was not raging with ‘oh no! my mother-club-initiation might not be possible’…the only thing rattling and screaming in that entire infinite few minutes was, ‘Get him out. Get him out. He can not die. No way. Not now. Out,’ my oxygen masked face eyes blazing alternately into le bebe’s soon-to-be-father and the doula’s eyes, both extending their ferocious and magnificent support. Because this was no longer about my precious experience. It was about le bebe getting the hell out of my body now to survive.

I remember that moment so clearly from when I had Annika (second baby).  After months of planning a homebirth, and years of commitment to physiological birth, the moment came in my labour when what started as mild fetal distress the night before became serious, and I knew–from the feeling in my body, to the looks in my midwife’s eyes and the eyes of the OB on call–that she wasn’t going to be born according to plan. I remember telling the doctor to “fix it!  fix it!” and I was ready, at that moment, to let them kill me before allowing any harm to come to my child.  There are few times in life when I’ve felt as certain and full of purpose as I did at that moment.  (Interestingly, it has been difficult to remember that in the 3.75 years since…but more on that another time.)  So, I get the part about knowing for yourself what you and your baby need, and I am not in the slightest bit questioning that aspect of this story. 

The part that has me ruminating is the idea that a surgical birth is something that women should not grieve.   This mother writes,

But the point is the birth of the child and the child was birthed. I pride myself on appreciating and respecting other people’s perspectives and beliefs, but on this matter, I am unwavering. A caesarian is a powerful birth unto itself, without need for apology, and with only reason to celebrate. Those who do not agree are grappling with expectations and not reality.

A caesarian can be a powerful and legitimate way of bringing a baby into the world, and there are ways–particularly when a surgery is planned in advance–that one can make the most of the situation, personalize it, and so on (on that note, I wishI had read the chapter in Birthing from Within  on this before my c-section, but I was in the it will never happen to me  camp–live and learn…).  But I am not sure that is really possible in emergency situations where you have minutes before the first cut.  This woman seems to have had a full night to think about it and ready herself mentally for what was about to take place.  I had less than half and hour between the Moment of Terror and seeing my baby outside my body. I wish I had spent those minutes calmly connecting with my body and my baby, etc., but the reality was I spent them sobbing out of a) fear for my baby, and b) deep, deep sadness.  Maybe I needed a reality check, but I started grieving the loss of a physiological birth the moment I realized it was not going to happen.  

No woman needs to apologize for the way she gives birth.  Ever.  But I have trouble getting behind the idea that a caesarian is something for which there is only reason to celebrate.  A baby is a cause for celebration.  A healthy baby even moreso.  But in a context where interventions are overused, iatrogenic complications rampant, and c-section rates skyrocketing far above recommended levels, it is hard to isolate a surgicalbirth–however justified and legitimate it may have been–as a straightforwardly joyous event. 

 I do not mean for a moment that a woman cannot feel joy when she has a c-section.  I was thrilled to have my daughter born safely.  I was relieved that she was healthy and that any distress she endured during labour seemed to have had no lasting impact.  I remain grateful to the people who supported me that day, even though I still often question the decisions they guided me to make leading up to the Moment of Terror. Ibelieve that this woman felt empowered; I, too, felt very sure of myself on the day of my surgery, sure that it was the right thing to do, and not in the slightest bit victimized by any part of the process.  

And I also grieve my c-section–as necessary as I knew it was in the moment–because it was a loss for me as an individual.  My baby and I are separate entities; we always have been, even when we were linked by an umbilical cord.  My experience was tied to hers, but it was not about her alone.  Her health did not cancel out my trauma.  Perhaps the root of my grief was expectations–that is one way to look at it.  But I am not certain that there is anything inherently wrong with expecting to birth a baby without the use of a scalpel.  Obviously in some cases that expectation remains unfulfilled.  But I do not believe that the outcome–the necessity of the scalpel, the presence of the scalpel, the action of the scalpel–cancels out the legitimacy of the wish, the plan, the belief in the possibility that a body will work as a body is designed to work. If we lived in a world where we could be certain that medical intervention in birth only did good, I might be more easily persuaded. But when 40% of women are giving birth surgically, I have to question the situation.  I think the problem is less my unrealistic expectations of my own body, and more a system that makes intervention and surgery the new normal.

Every woman will experience birth–surgical or otherwise–in her own way, and each individual experience deserves respect.  I am struggling to figure out how to support women in a way that emphasizes empowerment (as the story in this link does) and yet also does not erase legitimate sadness or grief or a political context that is hostile to physiological birth.  I know I made the right decision when I locked eyes with the OB and did not even have to tell her to cut; we both made the decision at the same time.  Both of us knew.  And I still hate that it had to happen, wonder if there was anything we could have done differently that might have prevented it, and will go to my grave doing what I can to ensure that no woman ends up cut unless there is really no other way.

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