On Culture, Cuts, and a Coherent Message.

by Courtroom Mama on February 16, 2010

(cross-posted at The Unnecesarean, where I am now guest blogging. Woo!)

Jill’s recent post about BaZi and planned cesareans brought up a question that has been lurking in my head for a long time.  Some of the comments on Facebook showed a distaste (to put it lightly) for elective cesareans on auspicious dates.

The tenor of the conversation reminded me of a particularly difficult conversation in international women’s human rights: female genital cutting. Most of the major US-based international human rights organizations have campaigns against the practice, and we even have a cute acronym, FGM (female genital mutilation).  This was all well and good until activists from the global south were like “um, hey guys, we’ve undergone the procedure and we don’t feel like we’re ‘mutilated.’ Hello, cultural hegemony!”

This, along with some interesting critiques of Western campaigns against FGC, has made me ask myself some tough questions, specifically am I inappropriately applying my values to someone else’s experience? After much reflection, it occurs to me that I have virtually no context from which to judge the practice. What entitles me to judge the “validity” of a culture or religion? I can fight against the practice being carried out on unwilling young girls in dangerously unsanitary conditions, and work toward a world in which women are valued and don’t feel “unclean” just by dint of being women, but ultimately it’s not my call to make. (and yes, it is WAY more complicated than this, but that’s a whole different blog!) It seems like the best I can hope for is education, informed consent, and harm reduction.

So, following that logic, what entitles me to judge a woman’s reason for a cesarean section, whether it be tokophobia or astrology? Astrology and numerology are central to some Eastern religions; is there a hypocrisy in supporting a woman’s right to refuse a cesarean on religious grounds but not the right to have one on those same grounds?

I recognize that, according to studies and surveys of women who have given birth, the truly elective cesarean is so scarce as to be nearly mythical in the United States. Nevertheless, I think it may be valuable for us to examine our gut reactions to the specter of elective cesarean surgery regardless of the reason. Most of the evidence that I have read indicates that the risks to a baby from cesarean surgery are approximately coequal to those of vaginal birth, and that the real difference lies in the risks to the mother (who is often invisible in the calculus of whether a cesarean is warranted in any given situation).  There are legitimate concerns that putatively elective cesareans are “elected” based on scare tactics or misinformation. This is a Very Big Deal, and I don’t mean to dismiss this fact; however, the message of the birthing rights movement at large is a lot less clear in the hypothetical situation of a woman who has read the studies and nonetheless made the decision to bear the risks and have a cesarean section.

I personally know a woman who had an elective cesarean section. She delivered one child via emergency cesarean section –after a very, very long labor– for true CPD with serious fetal distress. Her surgery was conducted under general anesthesia, and the experience was traumatizing to her. Rather than attempt a VBAC delivery as her OB encouraged her to do (obviously she’s not in the U.S.), she preferred to have a planned cesarean. In fact, she had to fight for ERCS. She would rather have another cut than possibly have to be put out again and miss the first hours of her baby’s life.  She had serious complications with her second and third surgeries, but those babies were never in any danger and she got to spend time with them as soon as they were born.  I can’t say I begrudge her that.

Sure, you say. That was a repeat. But what about a primary? I know another woman with an android pelvis and generations of family history of surgical or medically-assisted deliveries (with catastrophic injury to the pelvic floor) because of this. If I were in that situation, I might consider still trying to deliver vaginally. But I’m not. Consider this: if you were the one making the rules, how long should she have to labor before you decide that she’s officially obstructed? Who gets to make that call? If she gets to make the call to refuse, shouldn’t she get to make the call to consent as well?

If there is going to be a cohesive movement for the rights of childbearing women, we need to figure out what exactly our values are.  Are we simply anti-cesarean or anti-medicine (because, as Emjaybee points out, some feminists think we are)?  And what do we lose if we are? I’ve witnessed online conversations in which people go off on doctors who administer epidurals as “War Lords” (presumably meaning drug lords, pushing drugs to fetuses?) and the words “slice and dice” seem to roll off the keys a little too easily.  Even though it is in the minority, this type of rhetoric creates “noise” that undermines any coherent message we’re trying to convey.

At a recent birth conference, Robbie Davis-Floyd urged attendees to consider our audience.  Despite Randi Hutter Epstein’s characterization of our current birth culture as an ‘era of extremism,’ the vast majority of women will fall somewhere in the middle ground between unassisted birth and elective cesarean surgery. In fact, most will want to deliver in hospitals, most will want epidurals. My sense is that, again, the best we can hope for is education, informed consent [and refusal!!!], and harm reduction. We can work toward a culture in which pregnant women are valued and their rights aren’t threatened, and we can demand evidence-based maternity care, but when it comes down to it, isn’t it the woman’s call?

If we want to reach who Dr. Davis-Floyd refers to as “the epidural woman,” we should make sure that our message is clear.  To the extent that any message has even a whiff of judging the woman as opposed to the practice, or paints all of any type of practitioners with a single stroke, it will fall on deaf ears.

And if we don’t want to reach the Epidural Woman? If we choose to cast disdain on the moms on Babycenter or on those insipid TLC shows, we should get comfortable at the margins, because it’s pretty easy to get pushed aside if your message doesn’t resonate.

{ 4 comments… read them below or add one }

KM February 17, 2010 at 10:23 am

Wow! I really enjoyed that! It’s hard to separate our beliefs from our opinions in the sensitive area of child birth activism. It becomes a lesson in self control, and retraining our way of thinking to say “That is not what I would choose, but I will not judge you for choosing something I myself cannot understand”.

We claim to want to “the right to choose” but viciously attack a person who exercises that right.

All that being said, I think a fair amount of misinformation goes in to the choices many women are making these days, and it’s difficult to “zip it” in the face of a person who feels confident in the choice the made, based on a lie that they were told.

Keep up the thought provoking work!

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Courtroom Mama February 17, 2010 at 11:25 am

Thanks so much for the props. I totally agree that it is really hard to “zip it,” which is all the more reason that birthing rights people need to be doing a lot of serious outreach to women before they have their kids. People do a lot of mental gymnastics to make things make facts fit their mental schemata, and sometimes feeling that it was, say, a nuchal cord that caused their baby to be in distress and not the pitocin induction, and “oh my goodness thank god they saved my life” is a lot easier than trying to change their entire schema to realize that everything they were told was a lie. And why is it that sex education (to the extent that it exists in the country anymore) doesn’t include information about childbirth other than one gross-out birth video?

Lastly, I wish that we could get out of the adversarial relationship that we have with obstetrics for just a moment to say “look, we know that you are not all evil, but there are some docs out there who are telling women lies. They’re hurting the profession, and you need to check that shit.” I don’t know about medicine, but law is a self-regulating profession with strict ethical guidelines, and lawyers that fall short can be disciplined. If this exists in medicine, we shouldn’t be afraid to pull some cards, you know?

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cpn February 22, 2010 at 12:28 pm

I loved this post.

I had a cesarean section last year. I’d had an un-medicated birth before and I expected the same, but that just not how it went down. I’ll never know if medical interventions caused my cesarean or not.

Due to the trauma I endured because of the impersonal way my cesarean was done I felt compelled to research and advocate for more human cesarean protocol. Luckily, I’m not the first person to think of this and there is some good information out there.

I was truly shocked and hurt when this good information was met with dramatic opposition. I was attacked for “promoting elective cesareans”. There really seems to be a need for middle ground folks as one way to birth is never going to be right for every woman.

Thank-you for bringing this issue to light. I’m hopeful that we can come together from all points on the birth spectrum to ensure physically and emotionally healthy mums and babes.

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Courtroom Mama February 23, 2010 at 12:02 am

Thanks for your response, and thank you for trying to humanize cesarean surgery. I’m sorry that you were met with such opposition! My theory has always been that ‘natural’ birth advocates are anti-surgery because of the way that women are degraded or ignored during surgery. Unfortunately, it seems that this is not unequivocally the case. If I were to find myself in a situation where I needed a cesarean, I would hope to retain some semblance of a “birth plan” (as in getting to see my baby as soon as possible, having things explained to me, not being unnecessarily restrained, etc) rather than losing all autonomy because I’m agreeing to surgery. I envision the primary agenda of birthing rights as being to ensure that medical care respects the dignity and informed decision-making of women, no matter what their circumstances of birth might be.

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