Personal Essay: Pushing Back

“I’m going to have a VBAC,” Annie said, “if it’s the last thing I do.”

We were sitting in a antenatal yoga class and for at least half of each of these classes, we’d talk about where we planned to give birth, with whom, and how the endeavour was going — lots of chatter about lower backs and digestive systems.

Annie, like almost every other second-time mum in the class, had endured a C-section the first time around. And, like almost every other second-time mum in the class, she harboured a sense of failure about the experience, feeling violated by the medical establishment that had allowed it.

And yet her determination to go vaginal the next time around wasn’t just the result of that experience. Indeed, that pre-stretch chatter may have had something to do with her decision. I noticed that women choosing home births, birth centers or midwives got a bigger smile and better feedback from our teachers than those who mentioned the words doctor or epidural (unless they did so with derision). It reminded me of a tense meeting with my OBGYN. She had expressed just as much skepticism and dismay when I brought up the possibility of delivering at a freestanding birth center with midwives as these yoga teachers did about doctors and hospitals.

I’ve learned over the last eight months of pregnancy about the longtime conflict between midwives and doctors, between the medical community and the natural childbirth movement. And we knocked-up ladies, sadly, are the collateral damage of their battle, forced to navigate each side’s distrust of the other, getting bruised in the process. I mean, look at Annie — what she’d ultimately said was that she’d rather die than have a C-section again.

At first, I didn’t think much about the preference for all things natural in yoga — yoga is, after all, endemically hippie-ish, biased toward the non-medical model. At that time I was still signed up with my OBGYN (who wholeheartedly endorsed yoga, doulas and childbirth education classes, by the way), and seeking advice from both my sister the paediatrician and a friend I’ll call Kim, a journalist covering maternity care in this country.

It didn’t surprise me that Kim and my sister’s views didn’t mesh — my sister toes the paediatrics party line on everything from interventions to vaccinations pretty conservatively, though she is as gentle and empathetic as can be. Kim, on the other hand, has many hundreds of pages of evidence on how the medical establishment had failed women.

But I assumed that my own bouncing around between views was a private journey, and one I was well equipped for as a journalist; it’s my job to gather as much information as possible and sift through it, searching for synthesis. Then my husband and I signed up for a childbirth education class. We loved it, don’t get me wrong, but the bias was a little off-putting. We read an article that suggested an epidural could make your child four times as likely to become a drug addict; that you and your child would both miss out on necessary hormones if it didn’t come out the vaginal route; that the hospital would snatch your baby away and do dangerous things to it if you weren’t lucky enough, or maybe smart enough, to select home birth.

The teacher was educating us, of course, trying to reverse the course, and the curse, of the last fifty years that have led to a C-section rate of over thirty percent and a generation of women, like Annie, feeling stonewalled and abused by their doctors. And yet the teacher was making many of the students feel stonewalled and abused, before they’d even gone into labour.

Marie, a cancer survivor in our class, said she had assumed she’d get an epidural, having had plenty of experience with pain… but now she felt guilty, pressured into avoiding it. She and I had both left the same OBGYN after the doctor erupted into a defensive rant when we asked open-ended questions about C-sections. (I’m pretty sure I just said, “I want to ask you about C-sections,” and she spent twenty minutes speaking incoherently about her $175,000 of malpractice insurance and a woman who broke her pelvis pushing for six hours). But Marie’s switch in labour plan seemed almost as odd.

I detected a pattern in these rooms. When women discussed information their doctors had disseminated, the doulas, childbirth educators and yoga teachers I encountered dismissed it. Anyone who complained of having sciatic pain in yoga, a well-known side effect of pregnancy, was told that they had been misdiagnosed and only one body worker in New York (with clientele, apparently, such as Gwyneth Paltrow) could help — anyone else might make it worse. We were informed that there is only one true emergency C-section — a prolapsed cord — and that if you were told you were having an emergency C-section for any other reason that you were being lied to. Once I brought up the anemia my doctor (back when I had that OBGYN) had called to tell me about. “Don’t listen to your doctor,” the teacher said. “Pregnancy is an anemic condition. Ask your friend Kim.”

Kim knows a lot about maternity care in this country — she’s a big part of the reason I ended up leaving my OBGYN in favour of midwives at a birthing center — but haemoglobin is not her specialty. She’ll be the first to admit that. The teacher’s reverence for Kim’s opinion over my doctor’s revealed to me the scope of the rift between the medical community and the natural childbirth movement. So skeptical are the practitioners and advocates of intervention-free birth that they dismiss medical professionals altogether and anoint themselves or others they admire as experts. While my doctor was far too stingy with information, the childbirth educators and yoga teachers were far too free with it, especially tidbits of data that were clearly not true. (My iron, by the way, is still dangerously low, and the midwives say if I don’t up it, I can’t give birth in the centre after all).

This is not to say that misinformation doesn’t come from the medical community as well. I can’t tell you the number of women who come to class announcing the exact size of their baby. “She’s seven pounds, three ounces,” they say, not knowing that their doctors have given them an estimate, one that can be as much as two or three pounds off, and then can be wielded to talk them into a C-section later — the “big baby” reason for getting cut open. Charlie, another yoga mate, was told by her OBGYN that she was endangering the life of her baby by switching to a midwife, that she was selfish and even stupid. (The midwife, by the way, has never uttered a word against doctors, Charlie reported.)

Now, at thirty-five weeks pregnant, I’m properly confused, not sure whom or what to believe. At least I enjoy wading through the information, playing a pregnant sociologist observing the various parties misbehave. Still, I feel bad for the women caught up in that rift, angering their doctors when they get educated, feeling bullied by those who educate them.

I know the natural childbirth practitioners mean well. They want us to be allowed to hold our babies the minute they come out, to resist Hep B shots if we so choose, to learn to ask for more time before being bullied into an operation we may not need. And maybe they’re going too far out of passion. But I think they forget the pregnant women just as much as the OBGYNs do. They’re just as caught up in the cause and not the individual cases. Doctors, midwives, come on — can’t we all just get along?

This much I’m sure of. When, iron levels willing, I’m headed to the birth centre in a month or so, I’m going to try not to forget that what counts is the health of baby and mother, whether that means a C-section and epidural or a fantastically orgasmic birth. Annie might have temporarily forgotten that, scarred as she is, both literally and figuratively, by her C-section experience, and pressured by the pro-natural childbirth forces. Though VBACs might have a success rate as high as seventy percent, they can be still dangerous. If she insists on having a vaginal birth no matter what, it very well may be the last thing she does.