The ultimate litmus test: vaginal birth or cesarean?

You can tell Jessica Simpson is getting close to her due date - the "Will she have a cesarean?" question comes up. Apparently there is a story circulating the internet (and has been for months) that says Jessica wants to have an elective cesarean to avoid childbirth pain. Is it really true? Who knows.

The thing is, before we go off on a tangent, we need to realize a few things: first, it's her body, right? It's her choice, whether it's an ill-informed one or not. Secondly, the same thing was said of her sister Ashlee - and we still don't know, after two years or however long it's been, whether she had a vaginal birth or cesarean. It's almost like the tabloids picked up the old story and just switched the names.

Ultimately, it doesn't matter. And yet it does. Beyonce went through the same thing - even drawing criticism over whether she was really pregnant - and we find ourselves back in the same place. The entire birth community came down on her for one reason or another, and then had to backtrack when they realized they had fallen for a story that wasn't even true. Does it even matter? It's not our story, we don't own Beyonce or any other mother, and I hope it didn't steal her joy. Jessica is probably facing the same thing - people who question her decision and judgment, starting another battle that proves the mommy wars are alive and well and says, "Welcome to motherhood!" I won't even say it's the natural birth community that's jumping on her case - it's women in general. It doesn't matter in that it's her decision to make and not ours; it does matter in that it might send a message (as if that hasn't been done for decade upon decade) to women that trivialize cesareans and their risks. It doesn't matter in that, in the end, a baby is born and will take its place among the millions of other babies - and there are plenty of celebrities and influential people who don't want to electively have a c-section. It doesn't matter because, in six months, we'll be focused on something or someone else - the next flavor-of-the-month will get pregnant and we'll be asking the same questions about her, too.

After awhile all the questioning starts to sound like a litmus test to prove your worth as a woman and mother among other women and mothers. What next? Proof that she delivered in a particular way? Do we want to see the scar? The episiotomy? It sounds disgusting, but seriously, that's what it's starting to sound like. If she has a cesarean, I suggest we use this time to reserve judgment and instead gently advocate - instead of turn it into a virtual slugfest between people who think they have the monopoly on childbirth, whether it's "I had three cesareans and turned out fine!" or "I had three totally natural births and turned out fine!"

It's her body, and her choice. Whether we like it or not.

Some upset over ACOG's "April Fool's" Press Release on Elective Cesarean

In a recent April Fool's prank, someone, somewhere, issued a fake press release supposedly from ACOG that touted the headline, "ACOG announces plan to stop elective c-sections." Collective eyebrows, including mine, raised in a "What the (!&%(?" moment, before realizing the truth. (The smiley face in the ACOG logo was a dead giveaway.)

Some, including this blogger, thought it was in very poor taste. Perhaps, if it had really come from ACOG. Otherwise, I don't see a whole lot wrong with it.

(This author also said she tried looking for it, but couldn't find it on line and figured ACOG was taking measures to "remove" the falsified document from web pages everywhere. If you do a Google search, you'll still find a lot of hits - and ACOG would essentially have to ask web masters - including those from natural-birth supporting sites like mothering.com, to remove the offending link. Which I seriously doubt they would agree to do.)

At any rate, I agree with the author, who sums the elective cesarean debate up nicely: if you want to have one, and are truly informed of the risks and possible benefits of doing so, you should be supported in your decision. However, the same is not true, sadly, for those women do no not want a cesarean, or who decide to have a natural or normal birth.

In the comments section, it didn't take long before women were quick to be offended: "I had two cesareans and loved them! They were wonderful!" Thankfully, someone further down told this mom, "You are missing the point."

We can argue that these women need to be totally informed of their decision - but I grow suspect when I wonder where, exactly, they are getting their information from. The same OB who, in my last post, told his patient a cesarean was "100 percent safe?" To some, that's their idea of informed consent. To the rest of us, it's a complete joke, and a very misleading, potentially dangerous one at that.

I'd like to see this right to choose extended more to women who seek a VBAC, or perhaps those who refuse a cesarean and end up having an extremely healthy, normal birth and baby - yet some entity in the hospital decides to have children's services investigate. If you have the right to an abortion, as one doctor suggests, you should have the right to choose a cesarean - but what about the right to not choose one?

It's clear to me that when it comes to the birthing choices of women, ACOG doesn't really give a crap. Because they aren't willing to actually make sure that physicians are adhering to their guidelines, it tells me they are all about the doctors, instead of what's best for the patient. Sure, they want to extend even women who have had two prior cesareans the "right" to have a VBAC, but what physician is going to back them up on that? I find many physicians like to get all preachy about what ACOG suggests and doesn't suggest - when it comes to something they mutually agree on, like the safety of home births. ACOG has definitely spoken up about that, and many doctors are in agreement. But what about the stuff they don't agree on? Is ACOG going to investigate a doctor who is unaffectionately known as "Dr. Cut and Slice" by many of his staff? When a moniker like that is given to a doctor, I feel so sorry for the patient, who is usually the last to know.

More reading:
Is ACOG pulling an April Fool's Day prank?
ACOG Announces Plan to Stop Elective C-Sections
The "C" in ACOG stands for "Castrated" 

When a good doctor gives bad advice

In my reading lately, I came across an article from urologist Jennifer Berman's website about her scheduled c-section. Although it's an older article, it still pertains to our current 'birth climate,' and is an eye-opener about a couple of things: namely, how dysfunctional birth has become the "norm," and how even doctors are unwitting victims (although some people would laugh at that term) of the broken maternity system.

Ironically, I was just reading about Dr. Berman's "Why ruin a perfectly good vagina?" comment in Jennifer Block's "Pushed," which made me nearly want to vomit. She may tell "friends" this, but does she give this kind of crappy advice to patients? (Does it even matter? Once they see a "real doctor!" saying this, they're all on board with it and automatically demand their c-section, now!)

I've read about obstetricians who are clandestinely sneaking off on their own to give birth at home, simply because they know the way their industry works and don't want to be subjected to it. At risk for criticism - even to the point of being ostracized - by their peers, they have chosen home birth - or at the very least, gentler birth - as an alternative to the over-medicated, pushed, rushed option that has become what most women associate birth with.

So what about those who don't choose that alternative? How do they give birth?

No differently than any other woman, it looks like. After reading Dr. Berman's account of her first child's birth, I would guess that a buttload of Pitocin (although she doesn't mention it or an induction) might have had something to do with it. She does admit to 'getting the epidural too early,' which she says slowed down her labor (wait a minute - I thought that wasn't supposed to affect labor?!). Her son's weight was estimated (read, "supposed to be") within a certain range and he was larger (nine pounds), and had shoulder dystocia, which resulted in a difficult birth. So, when she got pregnant a second time, she decided to avoid the unpleasantries of a vaginal birth (such as urinary incontinence, prolapse, etc.) by having an elective cesarean.

Part of her reasoning for doing so came from, on her admission, her work as a urologist, where she "saw women who suffered the effects of incontinence and prolapse. These effects are directly related to vaginal delivery."

It sounds like Dr. Berman had the typical dysfunctional birth - pull your baby out as soon as possible, even if your body doesn't have the urge to push, the mother of all episiotomies cut - resulting in a baby that's delivered vaginally, yes, but under forced conditions. Dr. Berman probably hasn't attended any of the births these women experienced to see how the use of forceps, directed pushing, lithotomy positions and vacuum extraction had on their "perfectly good vaginas." I'm sure that at some point in her life, Dr. Berman has experienced constipation. And as a urologist, she knows that prolonged straining on the toilet can cause all kinds of bad things to happen, the least of which is a bowel movement when you don't have the urge to go. Think of that bowel movement as a seven- to eight pound kid. If you have no urge to push out a bowel movement, it's easier to wait until you do, right? The same applies to a baby.

Had I known this, I would have refused to push when told to. Instead of working against my body, I know now that I should have worked with it - waiting, and yielding to the urge when I got it, instead of when a bunch of nurses told me to - and pushed a baby out with much greater ease.

Dr. Berman mentions how her incontinence continued for several months after her son was born and returned later in her second pregnancy. This kind of made me laugh. What urologist doesn't consider that the weight of your unborn child sitting on all your organs is going to cause you, and every other pregnant woman, to leak urine? I think back to before I had ever experienced a vaginal birth but was pregnant with my second child. Had I had a vaginal birth yet? Nope. Was I experiencing bladder leakage? Yep. (Heck, you can still pee your pants even before you've ever given birth!) Dr. Berman didn't mention kegels (or squats, which are actually more effective) at all. Maybe those didn't work? (eyeroll)

Dr. Berman did go on to say that if she has a third child, she will choose a section. That is, if the scar tissue built up allows her to become pregnant. But wait, she didn't mention that, either. And so what - women are only having two kids anymore these days, right?

It saddens and frightens me to think that Dr. Berman openly admits that, had she seen cases of urinary incontinence and prolapse before her first child was born, she would have chosen an elective cesarean then, too. So your urine leakage, however brief it might be, is more important than the health of your child? Avoiding the risk of something that might never happen, or really, in the general scheme of things, might not even be that problematic, is more important to you - to the point that you're willing to expose yourself and your child to the risks of surgery?

Studies have shown that age, and not necessarily just a vaginal birth, can cause incontinence. There are lots of other factors at work - like genetics, the number of children you've had (we all know that those muscles don't work as well as they used to when you're on baby #4) and obesity, so it is totally inaccurate to say these things are "directly caused by vaginal birth." Nor is it accurate to assume that this is even a necessary consequence to having a vaginal birth, but rather reflects how abnormal birth is considered normal in our society. There are ways to mitigate those risks, like by pushing when you're ready and not lying flat on your back, for instance. But, because those two things are so engrained in our idea of how birth should be, it is considered normal to see problems of incontinence and prolapse in women. I wonder: if a good portion of Dr. Berman's patients were home birthers, where, you can assume, the use of Pitocin and epidurals, suboptimal birthing positions, episiotomy and directed pushing are not the norm, would she say, "Hey...wait a minute..."?

What percentage of her patients were overweight? Had a family history? Had several children? Had never had children, maybe?

Ironically, urinary incontinence happens in men, too. But...they don't have vaginas or a uterus. Is Mr. Dr. Berman being counseled by his wife to have some form of surgery to avoid a possibility of this happening to him, too?

Stay tuned ... maybe we'll see them both shopping in the Depends aisle of the grocery store in about 25 years...