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Mar312010

VBAC Doesn't Make it All Better

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By Emjaybee

The most common thing I heard from everyone, doctors, nurses, midwives, friends and relatives, when I told them my awful c/section story, was, “Well, next time you can have a VBAC!” 

Well, no actually. I’m not planning to have another child, and that probably won’t change.

And even if it did, what does it do to a woman to say this to her? It tells her “OK, well, you failed, but you can try again!”

And there are so many things wrong with that attitude I hardly know where to start. Here, let’s make a list:

Erasing the grief

A woman who has had a traumatic birth, c/section or no, is in grief. The more she tried for a good birth, the more she cared, the more she believes in healthy empowered birth, the more she is going to grieve. The more she feels her rights were not honored, the more she feels she was assaulted, the more she feels she was treated as less than a full person, the more she will grieve.

And she needs to grieve.  And she needs her grief to be honored. Birth is a transformative event to many women, and the Story of How You Were Born is something mothers are supposed to be able to give their children.

But if that story is full of pain and trauma, she will not be able to tell all of it to her child. There is a lot she will have to leave out, to keep in silence, at least until the child is grown enough not to be traumatized by it; most women won’t tell even then.

All of that is a loss, and that loss cannot be erased by anything, because there is nothing that will make it Not Have Happened. It happened. It exists in her history, it is part of her memories, and most painfully, it is tied up in otherwise wonderful memories that she treasures of her child’s arrival.  Unless she wants to forget the first few days of her child’s life, she does not have the luxury of forgetting her trauma either.

Implicating the woman

A woman who  has had a traumatic birth has not failed, but she has been failed, either by her own body, or by the system. Both are painful.  A woman failed by her body may feel broken, incomplete, less than a full woman, even feel shame, even as she knows it’s not  her fault.  A woman who was coerced and pressured into a c/section, on the other hand, may feel stupid, weak, foolish, and ashamed that she let it  happen to her, even if she knows it is not her fault. Much like any accident survivor or assault victim will often have periods of blaming themselves.

So when others place all the focus on having a VBAC, what they may not realize they are also doing is agreeing with these viewpoints—agreeing that yes, she just needs to do things differently next time and hopefully, that birth will be a “good” one.  Because this one so clearly wasn’t.

Making it about the listener

Look, I know that telling my story is hard on other people; it’s hard on me. I don’t enjoy it and I don’t tell it without cause.  But if I am telling it, especially if the listener asked to hear it, I expect the listener to do me the courtesy of dealing with their own discomfort.  In other words, sure, it does make the listener feel better to tell me I could have a VBAC, because then, they can move on from thinking about my bad experience to thinking about an imaginary good experience I might have in the future. I understand that, but it’s disrespectful to me and to other women telling their stories. We need listeners who will not rush to gloss things over or urge us to think happy thoughts, but who will endure, as we endure, thinking about the sheer awfulness of what happened to us, at least for a little while.

Ignoring negative possibilities

What if a woman does try for a VBAC, but doesn’t get one, for whatever reason? Is she supposed to keep trying till  her uterus can’t take any more? And how will she deal with the newer pain and disappointment she feels after a CBAC? Or what if she can’t try for a VBAC for infertility, or other, reasons? Will her friends and supporters just feel uncomfortable and drop the subject now that there’s no chance for the happy ending? Or will they be with her in her pain, be angry with her, believe in her, accept her as she is, non-triumphant?

Making the political merely personal

This one is the biggest concern.  Because the response to an injustice should not be “here are ways you can do happy related things to make you forget the injustice” but “let’s change this system of injustice so it doesn’t keep happening.”  I was coerced for no medical indication whatsoever, into an induction that led to a c/section, one that increased my risks of mortality and was traumatic in itself in the way it was performed, and in subsequent complications. Other women have stories much worse than mine, indicating clear instances of abuse and bad practice, sometimes bad outcomes as well.

We have a multitude of evidence indicating that unnecessary c/sections are both common and rising to epidemic proportions, with troubling implications for maternal and fetal mortality in this country.  We have a member of the obstetric community on record as stating they were not convinced that a woman in labor was a full person with the right to determine her own medical treatments, an attitude tantamount to declaring women less than human, at least while they are pregnant.

These are injustices that need addressing, not by achieving happy VBACs, but by demanding institutional reform.  You cannot reduce domestic violence simply by giving women relationship advice or access to a divorce lawyer, good as those things are. You also have to enforce the laws against it. You also have to educate children in a way that makes it less likely for them to become abusers. You also have to change public attitudes away from being accepting of abuse. 

Injustices in how women are treated during birth are no different.  You have to assert and defend women’s rights to determine their own care, and to refuse it, even when pregnant. You have to educate doctors and medical staff about those rights, and about the proper way to treat laboring women in their care respectfully.  You have to change public attitudes about birth, away from a painful and dangerous experience always requiring medical experts to a natural event that is, most of the time, achievable and safe for most women if they are treated respectfully and given a minimum amount of assistance.

The medical mistreatment of women highlighted by the skyrocketing c/section rate is not just a string of isolated personal tragedies; it is, to put things crudely, a big fucking deal. If you want to provide support to women you know who are dealing with a traumatic or coerced c/section, the best thing you can do is to recognize and understand what they were up against.

 

 

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Reader Comments (43)

THANK YOU!!!!!!!!!!!!

April 1, 2010 | Unregistered CommenterAmanda

Very good article. Everyone who knows anyone who is in the childbearing years should read it. For me, I had 3 very healing VBACs, but I still look at my c-section scar sometimes and get upset. The VBACs did not erase the fact that I had an unnecessary c-section, but they have helped me cope and realize that my body is not broken. My mother had 3 c-sections, and at least one, if not all 3 were necessary, and I was so afraid that I would be like her and never experience a vaginal birth. Even though I have, my first birth robbed me of so many things, and I will never forget it. So, thank you.

April 1, 2010 | Unregistered Commentercrystal

(((HUG))) I don't know your birth story or when it happened, but I am so, so sorry for the trauma that you experienced and the grief that you are going through. I've walked that path with women, as a doula and it is so, so hard to witness the trauma inflicted on women and know that they are being changed forever by their experience.

My first birth was traumatic, though I managed to escape the GBMC machine with a vaginal birth (pure luck). I don't have many "memories" of it, mostly like watching a movie. Your first paragraph rang very true for me early on in my DD's life. Seven years have passed and I have found a narrative that works for me and her and I'm able to remember in parts (rather than the whole) the sweetness... It has gotten better with time, as it becomes just one element that has shaped my life as a parent, rather than being the defining experience. But this has only happened with time as my DD has evolved as a person and isn't a baby anymore. When she was small, I definitely looked at her and constantly wondered how the birth experience shaped her. Now that she is almost 7, I am able to see her as her own person, not defined by my birth, feeding and parenting choices.

I wish you much peace.

April 1, 2010 | Unregistered CommenterVanessa Manz

This is a really awesome, and thought-provoking post. I am currently just months away from a planned HBAC, my second (and quite possibly last) baby and as long as all goes well, my first birth. I am planning to HBAC because as is the case in many areas of the country, VBAC is thoroughly banned within reasonable distance of my home.
But that's not my point. I never really thought about it from your perspective, and I really appreciate it...
As soon as I realized what had happened to me I did exactly as you mentioned above and got on the "next time a VBAC" bandwagon. Of course, that didn't start with the doctors because so many of them don't believe in it here, or at least their administrations don't... I look back and feel the pain of the combination of my body failing me and the system failing me... but I then pull a Pollyanna because I was lucky and didn't have a bad recovery from my surgery, and while I hate that it happened, I also am in some ways grateful that it opened my eyes to the crisis we have going on. It helped make me an advocate for birth and to an extent an activist. I don't know that I would have found the wonderful friends and support people I have now if not for my unnecesarean.
And it's possible that I could end up with a CBAC. I hope not, obviously, but I know that if it does happen, it will be for a true emergency (for all that may or may not help). But I do know that I will remember your words one way or another...

April 1, 2010 | Unregistered CommenterJennifer

This was great. Thank you for sharing--I will pass it along as well as remember this for when I meet VBACing women. I have a CNM acquaintance who tends to say this to women who are disappointed about cesareans--"you can have a VBAC next time!"--her intention is good, but the sentiment isn't enough.

April 1, 2010 | Unregistered CommenterMolly

I think you bring up an important point about listening. It's very important to let mothers share their stories, and to listen with a compassionate ear. This is true when a mom is relaying any mothering experience.

In the last year, I've been soliciting a lot of birth stories and mothering experiences from women, as a way of 'feeling out' my world and proactively assessing influencing factors surrounding me. I always wait until I'm asked for my thoughts before providing any direct and personally-based response, and even then, I try to use the best and most tactful language I can manage. Sometimes, if it seems like a good moment and at the end of the story, I ask questions which are meant to add direction to my understanding of the situation ("Would you be comfortable trying for a VBAC?" for example). This allows me to gain solid understanding of a mom's experience.

April 1, 2010 | Unregistered CommenterErinn Streeter

"These are injustices that need addressing, not by achieving happy VBACs, but by demanding institutional reform. You cannot reduce domestic violence simply by giving women relationship advice or access to a divorce lawyer, good as those things are. You also have to enforce the laws against it. You also have to educate children in a way that makes it less likely for them to become abusers. You also have to change public attitudes away from being accepting of abuse."

YES!!!!!!!!!!!!!!!!!!!!!

April 1, 2010 | Unregistered CommenterJill P.

*Nod* Exactly. Birth is a normal process and has become warped into "prevent this, prevent that, catch this, catch that, sue this, sue that, forget this, forget that, time this, time that, policy this, policy that, measure this, measure that, yada, yada, next time this, next time that" ...A HUGE non-evidenced mess.

I also picture the Monty Python episode with the pregnant woman and all the beeping machines around and the medical professionals totally ignoring the woman.

I agree wholeheartedly that things need to change as a whole.

I'm in a very slow process of becoming a lactation consultant (I volunteer very part time at WIC as a peer counselor, I'll pick up my volunteering as my son gets older.. then move on to formal apprenticeship) because it's apparent the breast feeding world needs help, too.

I also want to eventually become a doula, but right now I couldn't do it. I can barely step foot into a doctor's office let alone a hospital without feeling panic-stricken.

I am sorry you went through what you did. I'm sorry I went through what I did too. But both of us obviously have taken a negative and used it to fuel passion.

And you're absolutely right. It's a broken system that needs more than the "Well, you could VBAC" band-aid thrown atop it. Thing is they've also picked at the band-aid to the point that it won't even stick most places anymore, too! I often wonder what comes next.

A good way to help with VBAC issues would be to prevent unnecessary c-sections in the first place. Return birth to the normal process it used to be viewed as, and trust in bodies.. Reserve medicine and intervention for emergencies like it should be..

Most countries with good mortality rates generally have mainly home births with midwives and the low induction and c/s rates to match.

Our country should move toward that, and grassroots efforts will hopefully eventually make some policies change.

The thought of pregnant women "not being entire people" is disgusting and a gross perversion of laws and medicine.

Good luck in whatever you decide to do to help, if anything. I think you'd make a great birth educator or advocate ;)

April 1, 2010 | Unregistered CommenterFogedaboudid

Very beautiful post, emjaybee. While, reading, it seems to merely ask people to listen, I believe this post will also be very, very healing for a great many women. It validates them. It puts words to something that is difficult to say to those listening to the stories. It is a great piece to forward to partners, grandmothers, well-meaning friends.

As a midwife, I am blessed to witness the cycle of emotional and physical healing women go through after a cesarean, traumatic or otherwise. I've written pieces about healing from traumatic births, but work very hard to *be* where a woman is in her process, not "fixing" it with platitudes or foisting upon her dream scenarios of the future; I let her lead the way.

We need to hear words like yours, dear friend. We need to hear similar thoughts from the women who hurt and feel discounted. I know the ICAN boards are a place of safety, but the rest of us outside that enclave also need to buck up and listen.

Thank you so much for bravely speaking your Truth.

April 1, 2010 | Unregistered CommenterNavelgazingMidwife

Thank you for this post. As a woman who has had two c-sections, one unnecessary and the other a failed-VBAC...this post hit home for me. It addresses many of my feelings when talking about my birth experiences with friends. I want more children, but I do not like talking about the next child (whenever that happens!) because I have two groups of friends. One group assumes I will have a c-section this time since my CNM told me I had to after my last birth. The other group assumes I will have a VBAC, either at home or in whatever hospital will allow it, because I am a member of a group that advocates for homebirth and women's birth choices, and because I tried for a VBAC last time.

And I don't want to make that choice right now, nor do I want to be judged for some future choice I might make, that might not jive with what someone else thinks is the "right" choice. What if I try for another VBAC? What if I try to have it at home? What if (gasp) I decide to schedule a c-section?

Either decision has it's judgments and advocates. But it's my choice and I'm informed, so I wish everyone would understand how difficult the whole situation is, for women like myself. I think your post will help that, a bit. So thank you.

April 1, 2010 | Unregistered CommenterKathie
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