Tuesday, August 10, 2010

It's not just an issue of Maternal Request

I probably spend most of my time writing about maternal request cesareans, and have certainly dedicated the last six years of my life to helping make the decision to request surgery a more widely respected and accepted birth plan.

However, more and more I'm just as concerned for the health and safety of women (and their babies) to whom the thought of requesting a cesarean would never occur, but who are not being properly advised of the risks and benefits of surgery versus a trial of labor as they relate to their personal circumstances.

There are numerous cases (most often highlighted in litigious court cases after the birth) when risk factors for vaginal birth problems that surface during pregnancy and/or labor are ignored or downplayed.

Birth involves risk
Stillbirth, severe injuries for the baby, debilitating pelvic floor injuries for the mother and post traumatic stress are just some of the outcomes that can result when an ideological natural birth plan is prioritized over and above timely medical intervention.

And it's one thing if the woman WANTS a natural birth plan - in other words, vaginal delivery was her maternal request - but quite another when the woman is ambivalent about the birth plan. She just wants a healthy baby and to feel satisfied at the end of it, and relies on her midwife or doctor to arrive at that outcome.

I know that I'm on record as saying that I believe a planned cesarean delivery at 39+ weeks is the safest way for a baby to enter the world, and that's the main reason I had cesareans for my two children, but as I've also said, I completely respect the choice of women who believe that a trial of labor is the best way to go.

What concerns me now is that in an attempt to protect the interests of women who WANT a vaginal delivery, the interests of women who WANT a cesarean and women whose best interest it would be to schedule one for medical reasons (and they don't mind either way) are being put at risk.

For example, we know that studies exist that show better outcomes with elective cesarean delivery in cases of breech, twin, macrosomia (big baby) and repeat cesarean versus VBAC. But there are some women who feel confident about their chances to labor naturally and who want to have that option but feel like they are being forced to have a cesarean. They feel very much wronged and campaign against what they perceive as unnecessary surgery.

Well, two wrongs don't make a right. Forcing a woman to attempt labor when she clearly wants a cesarean or advising a trial of labor in cases where a cesarean has been shown to have better outcomes (and then not reacting properly if/when things begin to go wrong) is dangerous. The law courts agree with this, and that's why usually, when serious problems arise, somebody is made to pay.

But there are thousands and thousands of cases that never even make it to litigation, where women are left physically abandoned and psychologically destroyed by a birth experience that in the event, didn't live up to its entirely unpredictable expectations.

My advice to women?


...whatever your birth plan...

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