I’m surprised that more people don’t ask me how I became such a “questioner” of the maternal-fetal care system. So I’ve had a couple of cesareans, but it’s not like I work in a health-related field. What does opera singing and being a professor of music have to do with health? More than you might imagine.
2004 – I was pregnant with my first child; I did all of the ‘right’ preparations – I chose a CNM over an OB based on the recommendation and experience of a good friend (such a RADICAL thing to do . . . choose a midwife over an OB!); I took childbirth education classes from an independent educator; I took prenatal yoga classes and stayed in pretty good shape for most of my pregnancy. As far as I knew, the baby should have just ‘fallen out’ after all of that good preparation. But it didn’t.
My hindsight quarterback post of this birth experience is posted here, but let me tell you how it made me feel. Actually, after the stomach flu > labor and dilation from 0-9cm in mere hours > AROM to speed things up and end my misery > cesarean . . . I felt like a rock star. It was the most intense experience of my life, and I ROCKED. Just ask my hubby! He still talks about how I went to some ‘place’ he never new existed. I broke a ton of blood vessels in my eyes (yes, I was ‘purple pushing’ but no, I wasn’t only pushing ‘high’). I was still violently ill after the cesarean. I had to send the baby to the nursury some. My hubby had to leave because he caught the GI ‘death and destruction’ bug too. (So did MIL!) A lot of things went wrong . . . others were just far from ideal, but whatever. I survived and a lot of things went right too – I recovered quickly from the surgery; breastfeeding was easy for me and my DD. I was performing by 8 weeks post partum and took a few on-campus final interviews for University jobs.
Feb 2005 – I had my post-partum appointment with the doctor who performed the surgery. For the first time, and I don’t know why this was the case, I heard . . . really heard . . . things like “risk,” “uterine rupture,” “dead baby,” “brain-damaged baby,” “repeat cesarean,” “VBAC,” and the like. How did this happen after all I did to ensure that I went against childbirth norms! Why me?!!!
In the heat of the moment when you’re feeling distressed because pushing isn’t relieving the pain or bringing your baby closer to you, the cesarean can seem like an easy way out. I pushed for several hours . . . I resisted pushing when waiting for the OB and then waiting for the surgery. When the OB arrived, she was pretty sure she could help me get the baby out vaginally. However, she quickly gave up and fairly nonchallantly suggested the cesarean. I was READY! Phew, being ‘stuck’ like that sucked, and no one was really helping me get ‘unstuck.’ I didn’t have a doula (because I didn’t think I needed once since I hired a CNM); DH didn’t know any more or less than I. I was totally relying on the medical providers.
Why do OBs not feel the need when childbirth hits a major roadblock to really explain the consequences of the next step? I wasn’t in distress. My baby wasn’t in distress. The OB could have said, “Now Kimberly, you’ve been such a strong mama through this, but I want to offer you a cesarean as an option. Before you agree to it, let’s talk about what happens and what impact this decision may have immediately and for future births.” There was time for this discussion, and it’s not like she was busy with other patients . . . this was 3 or 4 am!
Please care providers, you MUST let us participate in our health care decisions. We need information before we can make life-altering decisions like these. When there is time to inform us of the benefits and consequences of interventions, you are ethically obligated to do so.
July 2007 – I became pregnant again, and a couple of gals from my 2004 due date club reminded me about ICAN. I joined their Yahoo group and dove in. My eyes were opened and resentment poured into every corner of my existence. I lost that baby. I lost the next baby. I stuck with ICAN, began a local chapter, and brought The Business of Being Born to an indy theatre in town. I lost another baby. I found a new doctor who found new things wrong with me. I struggled for my life.
Summer 2008 – I was going to spend the summer in Denver doing research. I began looking for a reproductive endocrinologist so that I could get some answers. Why these chronic losses? Why this misshapen uterus? I continued to struggle for my life. The RE diagnosed what I suspected – really crappy progesterone. He also believed that the misshapen uterus was not a didelphic uterus but a fibroid. He wanted to do a laproscopic procedure to remove the fibroid; I insisted on the less invasive hysteroscopy.
He didn’t find a regular fibroid . . . instead he did his best to remove adenomyosis without compromising the integrity of my uterus. He believed the adenomyosis was caused by the cesarean surgery.
By this time I was pretty disenchanted with traditional obstetrics. I had been misdiagnosed or refused diagnoses too many times. I had lost three babies. I became aware that the cesarean had a negative effect on my ability to have more children.
Current – I hope by now that readers understand that this isn’t about hating cesareans or hating interventions. Not at all. What I have ‘hated’ is:
- Not being asked to participate in my health care decisions ~ How does NOT having women participate in their health care serve mothers and their babies?
- Being made to feel like ‘one of those’ patients for conducting my own research and presenting contrasting information ~ How does being an oblivious patient help mothers and babies? How does being an empowered patient hurt mothers and babies?
- Being denied tests and appropriate treatments that may have helped prevent another heart-wrenching loss
- Being made to feel like my body just doesn’t work; being taught to be afraid of my body; being taught to not trust my body’s wisdom ~ How does making a woman feel badly about her body and breaking down her trust in the physiologic process of birth help her and her baby?
- OBs using scare tactics to win compliance ~ Moo??
- OBs putting their own beliefs about risks (what’s worth it or not) over their patients’ prioritization and contextualization of risk ~ How does putting medico-legal risks above the health (mental, physical, emotion) of the mother-baby dyad help mothers and babies?
- OBs turning a blind eye to the fact that women may suffer from birth immediately (in the 0-6 week post-partum range) and long term (I was still in acute pain after my last cesarean 1 year post partum); once the ‘healthy’ baby has been ‘managed’ out of the birth canal or uterine incision, it seems as though that’s where their responsibilities end, especially if he or she is not the patient’s regular doctor ~ How does making mothers in the post-partum period low priority patients help mothers and babies?
- Exaggerating the benefits of intervention and minimizing the risks to the mother-baby dyad ~ How do increased interventions really help mothers and babies? Are you sure about that??
- Doctors who aggressively undermine the valid experiences of homebirth midwives and families who choose to birth their babies away from the ‘comfort and safety’ of the hospital campus ~ How ’bout cleaning up your own backyard before you start worrying about mowing someone else’s? And again, I ask . . . how does tearing down a valid though very different care system serve babies and mothers?
This. This is how one very mainstream person becomes a birth activist. It’s not about hating on specific people but exposing the inadequacies of operating solely in one mindset with regard to health. The sooner the medical, public health, and alternative care perspectives can truly collaborate, the better health care in the US will be. This will require a radical shift in thinking and practice, especially from those entrenched in the medical model.
Coda – why an opera singer and music educator should care about birth? I am of the opinion that the entire body is the vocal instrument. Impairment of any part of the body can negatively impact the singing voice. Particularly the trauma done to the lower abdominal region during a cesarean section need to be avoided. The abdominal complex is the primary source of support for the singing voice. Interventions and distruptions to this part of the body can have long-lasting negative effects on the singing voice.
Additionally, music gives us the opportunity to engage seemingly unrelated fields. My dissertation dealt with gender subversion in modern opera. Really, how different is this than the institutional hegemony of maternal-fetal medicine. The female body is still a battle ground.