Wednesday, June 30, 2010

Re-Blog: Are C-sections a Violation of Women?

This is such a great post by the Midwife at Birth Sense that I had to re-post here. I love the truths it reveals about cesarean sections and I love the message.
(Since she just posted it yesterday, please go over to her site to post comments, so I don't steal her glory.)

May you never feel violated from a c-section. All C-sections should be life-saving.

Are C-sections a violation of women?

The other day, one of my colleagues was discussing how she felt about c-sections.  “Every time I see a woman undergoing a c-section, I can’t get past the idea that it is a horrible violation of her body,” she stated.  “Even when I as assisting in the c-section, that gash in her body seems so wrong.

I wasn’t sure how I felt about her comment–I know that there are too many c-sections done; I know that some c-sections are unnecessary; but a violation of the body? 

Yesterday, I saw a woman in my office for her first OB visit.  this was her third pregnancy.  Her first and second pregnancies were both scheduled c-sections.  When I questioned her about the reason for the c-sections, she told me that her doctor said she must have a c-section because she had the HPV virus and was group B strep (GBS) positive.

I asked her if her HPV virus was manifested in genital warts.  On rare occasions, genital warts can be so large that they obstruct the birth canal.  In these cases, a c-section is necessary.  However, my patient assured me that she only had the virus, no genital warts.

I explained to her that neither HPV nor GBS were considered reasons to have a cesarean birth.  She looked at me blankly.  “That’s not what my doctor told me,” she replied.  I was shocked that a doctor would outright lie to a patient regarding the necessity of a c-section.  Yes, I believe this woman was violated.

Sometimes it is less clear whether a violation has taken place.  Another patient of mine was pregnant with her second baby.  Her first child had weighed only 5 lbs., but the delivery had been very difficult.  Her pelvis was smaller than usual, and even though the baby was small, his shoulders had gotten stuck during the birth.  With her second pregnancy, she was dismayed when I told her the baby was in a breech position about four weeks before her due date.  This baby also felt substantially larger than her first one–I estimated about 8 pounds.

A friendly OB with whom I consulted was willing to try to turn the baby in a process called ‘external version’, but the procedure was unsuccessful.  My patient now pleaded for a vaginal breech delivery, but the OB did not think it was safe, based on how difficult the first birth had been and the fact that this baby was about 3 pounds larger.  My patient became more and more angry as she tried to find someone who would help her have a vaginal breech birth, but every provider she spoke with felt it was too much risk to the baby.  She finally consented to a c-section, but when I saw her at her postpartum visit, she was very angry.  She felt she had been forced against her will into a c-section, and insisted that if she had another baby, she would go to a “third world country” where they would allow her to have her baby the way she wanted.  She felt violated.  This was a very sad situation for me, because I wanted to support her in her choices, but also did not feel personally safe trying to deliver her baby vaginally.  I envisioned how I would feel if her baby was partially born and I could not get the head and shoulders out.  How would I explain to her if her baby died because I could not deliver the baby?

It is my goal that none of my clients will ever feel violated by a c-section.  Note that I did not say “none of my clients will ever have a c-section”, but none will ever feel violated by a c-section.  A client of mine arrived at the hospital shortly after her water broke, and we noted a large amount of bleeding.  The baby’s heart rate was indicating severe distress, and a quick ultrasound showed that the placenta was partially separating from the wall of the uterus.  My client agreed to an emergency c-section, and in speaking with her afterward, I asked her how she felt about it.  she was a woman who was committed to natural birth, and had had four children without drugs or interventions.  “I’m so thankful my baby is alive,” she said.  “I don’t have any problem with the fact that I ended up with a c-section for this baby.”

I think this may be the key.  Too many times, unnecessary c-sections are excused by telling women to “just be happy you have a healthy baby,” and making her feel she is callous in wishing for a vaginal birth.  However, when a woman knows deep inside that the c-section was life saving (which is what all c-sections should be), I have found that she is able to accept it much more easily than when she questions the need for it.

So my goal is that none of my clients will ever feel violated by a c-section.  May you all have beautiful, normal births.  And on the rare occasions when fate intervenes and makes that impossible, may you be at peace and thankful for a surgery that, used wisely, can save lives.

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