When doctors don’t support women’s choices

As you can tell, I am back to reading my google alerts.  I came across a post titled “Cesarean vs. VBAC – Birthing Story” and decided to read it.  It seems to me that this is the very type of woman who needs the support and resources that ICAN, CIMS, Childbirth Connection, Conscious Woman, and the like provide.  Women are understandable very protective of their birth stories, so I didn’t post a comment.  However, she may come across my post if she tracks her pings.

I’d like to address specific details of her story.

  1. “I was instructed to read through the risks of VBAC and give in my consent in writing…. this during my first visit to the doctor.” She wisely decided to wait to “consent” to the mode of delivery.  Understandably she had concerns and questions due to the manner in which the information was presented to her in her first visit.  Furthermore, she states that her doctor never seemed to discuss the benefits of normal birth.
  2. “No mommy would want to carry a healthy baby for 9 months only to risk the baby’s health during delivery.”  Absolutely!  And natural birth advocates believe that every woman deserves the right to weigh the risks and benefits of cesarean versus normal birth for herself.  OBs are not upfront about the risks to both baby and mother from cesarean delivery much less the harm that occurs once mom and baby are home.  Doctors suggest procedures and tests that have not been proven to aid the birth process yet may have a negative impact on normal birth.  These include continual fetal monitoring, artificial rupture of membranes, induction, vaginal exams, IV, episiotomy, and the list continues.  These interventions usually only benefit the doctors and nurses.  And did you know that amniocentesis carries a substantial risk for pregnancy loss?
  3. “My mid-wife advised me to wait till the 35th week before I made any decision. But the doctor would not wait till such time. Even before I gave my written consent on my preference I got a call from doctor’s office about scheduling my C-section for the 13th May. (my due date was 26th May).  This irritated me to great levels. While one of the major benefits I was going to get by opting for C-section was a date of my choice, the doctor had deprived me of the same by just giving me one option.”  OBs suggest that it is safer to perform a cesarean before Mom goes into labor.  However, scheduling a cesarean 2 weeks before a due date is risky.  It is sad that this OB was intent on taking this woman’s last “choice” away from her.
  4. “Besides, I knew that I was making good progress and could go in for VBAC.”  Women should trust their instincts about birth and surround themselves with people who support their needs and desires.
  5. “During my 40th week appointment, the doctor examined me and said that I had made no progress at all since 37th week. The baby’s position and the cervix measured the same. She also scared me that the baby was big and it could be a very hard delivery for me.”  The next day at the hospital she began labor on her own. 
  6. “The nurses who were monitoring me repeatedly started asking me if I really wanted to go in for C-section which was scheduled at 11:30am.”  Hooray for her nurses!!  It seems like they wanted to encourage her to have a normal birth!
  7. “I got a call from the doctor immediately … I must say it almost sounded like a threatening call. She said if I didn’t go for C-sec at the decided time, she was not going to be available for the entire week and that some random doctor from the hospital.”  Yes, that was a scare tactic.
  8. Her “big” baby weighed just over 7 pounds.

The reason I’ve quoted and listed these points from her story is that this story is all too common.  When are we going to stop this abuse, this subversion, this last form of modern sexism?

5 responses to “When doctors don’t support women’s choices

  1. Yikes.

    Fwiw, my husband’s cousin’s story was similar in at least this one regard — her doctor told her she could have a vbac IF she went into labor before her C-section… which was scheduled at 38 weeks. So, yeah, she could “attempt” a VBAC if she happened to go into labor after 37 weeks but before 38 weeks. Talk about a window of opportunity!

    Needless to say, she had a repeat C.

  2. Kathy, this is why I posted about this woman’s story. I’m afraid that it’s all too common. Thanks for your comment!

  3. Is there any actual evidence that C-sections are more dangerous if they are done once labor has begun? It seems to me that if a woman chooses to have a C-section, at the very least, it should be done when the baby is *ready* to come out, not up to 4 weeks before (assuming a baby could emerge anywhere from 38-42 weeks). If I *had* to have a c-section, I’d want to be darn sure that the baby was ready to come out.

  4. Trish, I agree with you — I’d want to be sure the baby was ready. (I read a story a year ago in which the mom chose to have her baby just before term because her first baby was stillborn at 39 weeks, and she thought it would be okay. Her 2nd baby lived, but was in the NICU for 6 weeks because she was just too young, even though it was 36&1/2 weeks.)

    However, there is some evidence to suggest that C-sections undertaken after labor starts have more complications or dangers than C-sections done prior to commencement of labor. It seems quite probable to me, however, that this may be due more to doctor error (in trying to cut a baby out of a mother as quickly as possible in a true emergency, rather than taking his time and being calm in a planned C-section) than due to the inherent dangers of a C-section during labor. What I’ve read hasn’t made it clear to me if this has even been studied — if C-sections have been divided into 1) planned C-sections, 2) unplanned unnecessary or quasi-necessary C-sections, and 3) unplanned emergency C-sections — and the rates of complications of each group been studied, to see if the “code blue” C-section complications have skewed the real risk for in-labor C-sections vs. pre-labor C-sections.

    What this boils down to, is that *in retrospect* it may have been better to have just had a C-section the day before labor started, but there was no way to know *that* at the time. The increased risk of complications in an in-labor C-section is not enough to warrant an otherwise unnecessary C-section.

  5. Kathy,
    You wrote:
    What I’ve read hasn’t made it clear to me if this has even been studied — if C-sections have been divided into 1) planned C-sections, 2) unplanned unnecessary or quasi-necessary C-sections, and 3) unplanned emergency C-sections — and the rates of complications of each group been studied, to see if the “code blue” C-section complications have skewed the real risk for in-labor C-sections vs. pre-labor C-sections.

    Very good questions. I don’t think the data is normally separated in that careful a fashion. I’ll have to look into that, and of course, if I find anything out definitive, I’ll be sure to write about it.

    Best,
    Kimberly

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