Tuesday, July 31, 2012

Freedom to make informed personal decisions...

In my pre-motherhood days, I believed that feminism was a bit of a historical artifact, that its time and usefulness had come and gone.  Women accounted for large portions of university attendees, labour force participation rates among women had climbed, women even occupy positions of power and prestige.  I believed that as a woman, I was free to choose in much the same way as a man (and perhaps in someways, even more free than most men) what I did with myself.  I never really saw being a woman as being a barrier or precluding myself from having fundamental rights and freedoms.  If being a woman meant I could choose to pursue advanced education, choose to pursue a professional career, choose to marry or remain single, choose to be a mother or remain childless - how could it not mean choosing what to do with my body should I decide to be a mother?  How can decisions so fundamentally personal as to *how* a child is born or *how* a child is fed be subject to outsiders determining what is in my and my child's best interests?  Surely as a woman and as a mother, would I not be in the best position to make this determination for myself and my child?

The City of New York and Mayor Bloomberg doesn't think this is the case.

The Society of Obstetricians and Gynaecologists of Canada doesn't think this is the case (although many of its members do support a woman's right to choose how her child is delivered unless a medical reason precludes that choice from being reasonable).

Many Natural Childbirth Advocates, including Dr. Klein, would prefer if access to certain choices, including epidural pain relief in labour and maternal request cesareans, were strictly limited.

It is one thing to undertake research and better understand the reasons and outcomes of the choices that are made - and to seek to better inform those who must ultimately make such decisions.  Knowledge is a good thing, and the pursuit and dissemination of it should be encouraged.

It is quite another thing to assume that those who must make such personal decisions (note these are decisions that have very limited impacts to people outside of the family unit) are incapable of making these decisions for themselves and to develop policies and practices that effectively constrain individuals from making a choice that is ultimately in their own, and their child's own, best interest.

It is admirable to want to increase breastfeeding rates and rates of normal birth - particularly among those who would like to do so and who have determined that doing so is in their own best interest.  However, doing so in such a way that infringes on the right of others to choose differently, in pursuit of their own best interests should be deplored.  Women should not be forced to breastfeed, forgo pain relief during labour and delivery or forced to deliver vaginally, if they have determined for themselves that doing so is not in their and their child's own best interest.

If feminism is ultimately about a woman's right to be fully informed of her personal choices and to freely choose among them - then feminism is as relevant today as it was 100 years ago.  Feminists should not stand for such clear infringements and violations of women's personal autonomy - if a woman cannot decide what to do (or not do) with her own body, she at the most basic level has been deprived of a fundamental human right.

I may not make the same reasonable personal choices as another woman, but I fully respect another women's freedom and right to make those different reasonable personal choices.  To do otherwise is insidiously misguided and misogynistic.


  1. I stumbled upon this blog the other night and was so fascinated that I read the whole thing. Let me start by saying that I think it is very wrong that the doctor lied to you about there being a reason he could not provide the c-section. If he did not want to do it, he should have just told you that right from the start and he was wrong to let you believe that it was going to happen.

    That being said, I am wondering if you have taken any responsibility for the fact that you suffered so greatly by giving birth naturally? After all, it is no secret or surprise that a woman who is pregnant can go into labour. You should have at least prepared yourself for the possiblity (no matter how remote it may be) that things were not going to go exactly as planned. I would argue that you were negligent of your own care and that you should put the burden of your mental health issues on yourself rather than completely blaming the doctors and medical staff. Yes, they did you wrong, but you should have done what you could to prepare yourself for the possibility of natural childbirth. After all, one of the things they teach at the pre-natal classes (which you neglected to take) is that while it is good to have a birth plan and know what you want, you should prepare yourself for something going wrong. Had you done that, it likely wouldn't have been as traumatic for you and perhaps you would not be struggling as greatly as you are. Take some ownership of your own mistakes.

    On the issue of autonomy, you are correct that you should have control over what happens to your own body. If you don't want any chance of experiencing natural childbirth, don't get pregnant. Simple as that. That is the only way you are 100 percent guaranteed to never have to experience childbirth again.

  2. Anonymous - so should sexually active women prepare themselves for the possibility of being raped?

  3. Further - you are assuming that the harm was caused by a lack of understanding of the process of childbirth - I understood the process very well before hand, and had absolutely no desire to undergo it, but in your books that is a reason to forego motherhood altogether...

    I do not believe I was negligent in any way - no more so than a person who is raped is negligent for not carrying a weapon or otherwise 'protecting' themselves from the wrong acts of others.

  4. I think all women (sexually active or not) should be aware of and avoid dangerous situations as well as learning ways of protecting themselves. Self defence classes could give a woman a fighting chance in a rape situation. I'm sure that you will teach your own daughter to recognize danger as much as possible so that she hopefully never has to experience a rape.

    And no, I am not assuming that the harm was caused by a lack of understanding of the process. I am assuming that the harm was caused by you not being prepared for even the possibility that it would happen, as you yourself have said. You said in your first post after your daughter's birth that you "wish [you] had felt prepared for what would occur". You have gone on and on and on about how it was not what you wanted and you were determined it was not going to happen. You could and should have prepared yourself for the possibility. You were pregnant. Labour happens eventually. What if you had gone into labour at 34 weeks and you didn't have the c-section lined up yet? It might be rare for it to happen that early, but it happens. You should have prepared for the possibilities the same as a woman who plans for a natural birth should be prepared that it will not go according to plan and she may have to deal with an emergency c-section. Rape is not something that is guaranteed to happen just because a woman is sexually active. Labour IS guaranteed to happen eventually to a pregnant woman if something else does not happen to get the baby out first. Your comparison is not a good one.

  5. Anonymous, I don't think that any woman in the developed world gets pregnant without both:

    a) knowing that labour epidurals are available and

    b) knowning that babies can be born via planned surgical delivery.

    A choice to become pregnant does not equal a choice for a natural (whatever that means) delivery and it certainly doesn't equal a choice to experience severe pain.

    Mrs W's story is not a story about poor pre-birth preparation. It is a story about mysogynistic healthcare rationing and medical battery and disrespect of autonomy.

    The shocking thing, is that women in Mrs W's community find that both operating room time and anesthesia resources are scarce. And they are shocked, absolutely shocked, when they show up in labour to find that an epidural is not actually available...not "oh, the anesthesiologist is next door, you'll have to wait 30 minutes or so" but "the anesthesiologist can't come...at all. Ever. You'll just have to tough it out."

    Seriously. Labour doesn't happen eventually. That's what planned c/s are for...and that choice should be supported for properly selected and prepared candidates.

  6. Yes. Labour DOES happen eventually if a c-section does not occur before. Denying that fact time and again does not make it less true. I did not comment on whether she was right or wrong to want a planned c-section. I commented on the fact that it is exactly what it sounds like: a PLANNED c-section. Just because it is a plan does not mean that things will always happen according to plan. Mrs W seems very intelligent and yet she failed to even allow herself to admit the possibility that just maybe something might happen other than what was planned. What if there actually was enough operating rooms and enough anaesthesiologists on a regular day, but that day there was a big accident and it was life or death for too many people to let a labouring woman who had planned a c-section to have that time? Should the accident victims die even though most times a baby can be born without c-section? My point is that had she prepared herself for the possibility she could have dealt with it better rather than finding it so hard to get over the experience.

    If Mrs W had bothered to take pre-natal classes she also could have learned how likely or unlikely an epidural would be. I have not weighed in on the debate about planned c-sections as an option, you are making an assumption about my opinion on that subject. I did not say that getting pregnant means that you are making a choice for a natural delivery. I said that the only way to guarantee 100 percent that you will not have a natural delivery is to not get pregnant. It just angers me to no end when people do not take responsibility for the consequences of their actions. A choice to get pregnant absolutely does equal the willingness to take the risk of experiencing natural delivery.

  7. In what way does suffering emotional distress and anger over unnecessarily experiencing a painful and potentially traumatizing event constitute not taking responsibility for one's actions? Victim-blaming is an ugly facet of human nature, and that's exactly what you're engaging in here, anonymous. Distress? Trauma? It's your own fault, right? If only you had mentally prepared yourself it wouldn't have bothered you.

    Nevermind that childbirth classes are hardly protective against emotional trauma. Forget the fact that Juno's caregiver betrayed her trust and lied to her. Ignore the fact that childbirth can be excruciatingly painful, and Juno was denied the safe and effective pain relief that most women in the developed world are able to choose. Gloss over the evidence that natural childbirth can result in negative physical and psychological consequences. Dismiss the notion that Juno is an intelligent, adult woman who, after considering the risks and benefits of delivery mode, made an informed decision about what she wanted done with her own body, and it was completely disregarded, as apparently other people share your opinion that pregnant women forfeit their rights to make their own medical decisions, be treated with respect and dignity, or maintain bodily autonomy.

    Let's instead focus on figuring out a way in which she was negligent so that we can blame her for her distress. Let's make up some completely hypothetical scenarios to distance ourselves from the truth.

    There was no big accident the day Juno went in. She was an adult who made informed decisions about her medical care (with the apparent guidance and approval of her health care provider) that were then callously and needlessly disregarded by her care providers, who also failed even to provide her with adequate pain relief. The only reason anyone considers this state of affairs acceptable is because she was a pregnant woman.

  8. ^ Thank-you Adequate and Anonymous#2 I agree with your sentiments...

  9. To what degree does the system have a responsibility to pregnant and birthing mothers to ensure adequate access to epidural pain relief and surgical delivery is available? Anonymous is right - pregnancy will result in birth nearly 100% of the time absent early miscarriage or abortion. The system has lots of forewarning on this - perhaps it is negligent in ensuring the needs of pregnant and birthing mothers can be met. Expecting epidural pain relief or even access to surgical delivery is not unreasonable, particularly absent completely unforeseeable circumstances. I pay my taxes, why should my needs be given less recognition than the needs of anyone else-particularly when there is no choice in how those needs are met (pregnant and birthing mothers must use public hospitals in Canada, there are no private birthing facilities). Further, Victoria General is a level 3 hospital (handles high risk pregnancies) and performs one of the largest volumes of deliveries in the province - if a women cannot expect these things at Vic General, where in BC can she expect these things? Yet, in some people's eyes, it is the women who should be responsible for the lack of adequate access...yep, I had a lot of control over that (not).

  10. I have to laugh at the idea of childbirth classes somehow changing the outcome. I had a similar experience--being forced into natural childbirth when I desperately didn't want it--and not only had I attended childbirth classes, I had also been through natural birth before. I knew exactly what to expect and it did not for one moment make the situation less traumatic or the care I was given less cruel and negligent.

    Really, the idea that practicing some breathing exercises with a pillow and watching a nurse ram a baby doll through a model pelvis makes any difference at all when you're in severe pain, terrified of injury to your baby or yourself, and your dignity and autonomy are not being respected by your caregivers is absurd.

    Being pregnant shouldn't mean giving up your rights and it shouldn't give health care providers a pass on treating you with dignity, respect, and compassion. I continue to be amazed by the number of women who are apparently willing to accept this state of affairs.

    I really respect you for blogging about this, Mrs. W.

  11. Did Mrs W know where she lived when she made the choice to get pregnant? She seems perfectly capable of finding statistics about how often epidurals and c-sections happen after the fact. It sure doesn't sound (by her own statistics) that "most woman" are able to choose epidural. She talks about how she prides herself on taking calculated risks. So you only admit that you took a risk when the outcome is the way you wanted it? If she wanted to better her odds of getting childbirth the way she wanted it, perhaps she should have fought this battle before choosing to get pregnant. The system may not be right, but she chose to have a baby while that system was in place.

    Having a baby does not make you a victim unless you were raped. I didn't deny that the way her care was handled by the doctor was wrong. It was, without a doubt. But no matter what the circumstances were the day that she was not able to get her c-section she should have known that there was a possibility that it might not happen. That is where her error was. Can you admit that? Just because she wanted a c-section and decided that under no circumstances was she going to have a vaginal birth didn't mean it wouldn't happen. You only have control over the things you have control over. Getting pregnant? Yep, you can control that. When you go into labour? What else might be happening at the hospital that day? Nope, no control over those things. Therefore it is your responsibility to prepare yourself for the possibilities. I feel the same about a woman who ends up with a c-section when she wanted natural childbirth. Is that woman a victim too? Remember, Mrs W was feeling like a victim even before she knew that the doctor had lied. She even asked her husband in the delivery room if she could sue.

    I'm not saying that being mentally prepared for the possibility would have made it completely painless and not the least bit traumatic. But if she had allowed herself to acknowledge the possibility, when she went into labour and was told she could not get a c-section on demand, maybe her thought could have been "oh sh*t, I guess this is happening so I better go with it" rather than "can I sue" and "I hate my body" and all of those other thoughts. She said herself at one point that she may have made it worse for herself by trying to fight it and not relaxing.

  12. You're right. God forbid someone would be angry or traumatized after being lied to, denied pain relief, and forced to go through an unwanted vaginal delivery for no reason whatsoever, apparently, other than the fact that she was a pregnant woman.

    Who said she didn't realize that there was a possibility that she'd have a natural delivery? I'm sure she realized it was possible, feared it, and did everything within her power to ensure that it didn't happen. What exactly is it you think she ought to have done?

    I think we all acknowledge the fact that car accidents are possible when we decide to drive or ride in a car, but we're still allowed to be upset or traumatized when someone else's negligence causes an accident. No one pops in to say "You should have prepared yourself for the possibility so you wouldn't have been so traumatized' or blames you for making the choice to get in a car.

    How would you feel if you consulted a doctor about a time-sensitive condition you had and agreed upon a surgical procedure to address it, then showed up at the hospital for the expected treatment and were denied it for no good reason and forced into a painful and traumatic alternative treatment that you wouldn't have chosen?

    How about a patient in severe pain from broken bones caused by a skydiving accident? Or someone with a painfully abscessed tooth from too many sweets and poor oral care? Someone who fell down stairs after too many drinks? Is it ok to deny them pain relief because they brought their own conditions on themselves? Of course it isn't. So why do we accept it for pregnant women?

    Why are you so obsessed with assigning blame here? Why can't you let women make reasonable, informed choices about what happens to their own bodies or let them feel however they do about the process, especially when they've been treated abysmally, without resorting to victim-blaming?

  13. Again, when you choose to get into a car there is no guarantee that you will get into an accident. When you choose to get pregnant you are guaranteed that one way or another that baby is coming out. And you can be guaranteed that it might happen sooner than you want.

    I'm not saying there is no blame for the doctor. I'm asking her to own her own part in what happened. I would hate to be lied to. But the fact is that she was playing a victim before she even knew about the lie. At the time that she went into labour she was under the impression that there were emergencies going on that made it impossible for a c-section or painkillers at that moment. The emergencies that she believed were happening would have been good reason.

    It's okay though. Thanks for the debate. I can see that everybody else is allowed to place blame for their situations on everybody else and not take any responsibility for their own choices whatsoever. Whether you like it or not, a woman's body was made to bring a child into this world through vaginal delivery. I'm not saying that's the way people should do it, I'm just saying that it happens and sometimes when it happens there is nothing you can do to stop it. If you choose to get pregnant, don't play the victim if you have a baby vaginally. Especially when there are so many statistics (which Mrs W herself has provided) to suggest that there is far from a guarantee that painkillers or a c-section will happen.

    And I want to go way back to a comment that Mrs W made in her second response to me, that I was saying she should forgo motherhood altogether. I wished I had responded to that in the first place, and so now I will: I never said you should forgo motherhood. But knowing what you know about the way deliveries happen right now in British Columbia, perhaps you should have considered adoption or a surrogate mother. I know that a year later you found out about the lie, but you felt you were a victim before knowing that lie. (And is the hospital even allowed to give information like that, or is it possible that THEY are the ones lying and trying to cover their own butts?) That's the part that upsets me. Do you not see that you were taking a risk? You took a gamble and it didn't go your way. Sorry, back to the motherhood thing. Mrs W, you seem like a very loving mother. I admire that you are not letting your feelings about this affect the way that you love your daughter and that you are doing everything in your power to make sure she does not feel like you blame her.

    I wish you all the best with baby #2 and I really hope that you can have things go the way you want. But I also hope that if, for some reason it doesn't happen the way you want it to again, that you will recognize that you CHOSE to take that risk again.

    I will not debate this with you further because for the most part people here are arguing a somewhat different point than the one I am trying to make. Now we must agree to disagree.

    1. Every response to to this individual's comment has either unintentionally missed the commenter's point entirely, or is deliberately ignoring the point and addressing different issues altogether.

      The point is, when you get pregnant, your baby is going to have to come out, and you don't have any control over how *early* that process begins. A scheduled c-section at 39 weeks doesn't guarantee that labour won't begin naturally at an earlier date. So what Anonymous is saying is that regardless of the arrangements that were in place, you ought to have been mentally prepared for the possibility that you would have to give birth naturally.

      Had you been prepared for the chance that either a) your labour would begin earlier than the scheduled c-section date; or b) that an emergency situation at the hospital would have pre-empted your elective surgery, the degree of emotional trauma suffered would have been, arguably, much less.

      Yes, an injustice was committed here. Your caregiver let you down. You have every right to be disappointed and angry about this. But you also ought to have know that there was no 100% guarantee that your baby would remain inside you until the scheduled c-section date/time. Perhaps your caregiver was negligent in failing to explain this possibility to you; however, you seem like a highly intelligent and educated woman, and I am surprised that you did not ever consider this idea yourself.

  14. "Playing the victim" is such an insensitive phrase, particularly when applied to someone who has been victimized by the very people --supposedly ethical and caring professionals-- whom she trusted to care for her. And what does "don't play the victim" mean? Don't complain? Don't be traumatized? Don't speak out?

    Women shouldn't have to accept barbaric treatment simply because they chose to get pregnant. That way of thinking is sexist and archaic and needs to change. Kudos to Mrs. W for speaking out about it.

  15. Anonymous - your point is hypothetical. I've stated before there are no statistics on how many people want/need an epidural but cannot get one. Nor are there any statistics on how many people want/need a csection but cannot get one. There are anecdotes, but anecdotes are not statistics. The statistics that do exist have to do with how many csections or epidurals actually happen. It was reasonable for me to think that in a major Canadian city, in a hospital that handles high risk pregnancies, that I would have access to a csection/epidural pain relief. The health authority has repeatedly stated that there is no shortage of anaesthesiologists in Victoria. When I made my plan with my doctors they didn't tell me that there was a y percent chance it would not happen - I had no reason to believe there was a significant chance of undergoing a vaginal birth. Conversely, a woman planning a vaginal birth has about a 15-20 percent risk of undergoing an emergent c-section if it is her first time giving birth. So a woman planning a vaginal birth and gets an unexpected csection is not in the same category as a woman planning a csection getting a vaginal birth. Further, I was and am very aware that absent early miscarriage or abortion, birth happens one of two ways - I never asked for fetal teletransportation - I planned given the options that were available. In terms of adoption or surrogacy - you can't be serious that those should be the options for women who would like to avoid a vaginal delivery???? Firstly, they are tremendously expensive, secondly they make the process of getting a maternal request csection look easy. Further, what about the woman's desire for biological offspring, or to breastfeed or to experience pregnancy?? I also find your statement that this is a fight I should have fought before I become pregnant - its funny, because at that time I would have had no standing to fight this fight, I had no reason to believe that there was a fight to be had - I believed in the constitution, I trusted my care providers, I believed in the health system -- I had no reason not to. You know what, I blamed myself for what happened for more than a year, I blamed myself and bad luck....only to discover that there was more than enough blame to go around and that I wasn't being fair to myself - I deserved better, women deserve better and I certainly don't need folks like you saying I need to 'take responsibility' - I did as best I could and am doing as best I can. Responsibility needs to be taken, but I have come to the conclusion that it's not women who make reasonable childbirth plans who need to take responsibility - its people who think that being a women and being pregnant is reason enough to deprive women of making medical decisions for themselves and to withhold resources to facilitate those choices who need to 'take responsibility'

    1. Did you make this plan with your doctor BEFORE or AFTER you got pregnant?