Monday, November 5, 2012

Mum's the Word on Maternal Choice Cesarean

I never had any desire to have a vaginal birth. In another time or place, I may have considered foregoing motherhood or adopting rather than subjecting myself to the conventional whims of nature. However, knowing that cesarean was an option, I knew that foregoing biological motherhood would be an unnecessary toll for wanting to avoid a vaginal birth. I knew that cesarean birth was a feasible (safe and effective) way to have a baby - I lived in a first world country and could find nothing that indicated that women in Canada weren't allowed to have cesareans on demand or that such a choice would be inaccessible in my own community. For myself, it was clearly preferable over conventional birth. It seemed to me that the biggest challenge would be finding a doctor to accede to the request-but given the controversy around maternal choice cesarean, I knew that while many doctors would not accede to a request, that many other doctors would. I felt confident that I could secure a maternal choice cesarean before I even got pregnant - even if it would have meant travelling to access care.

That being said, I also knew that rejecting a conventional birth (a trial of labour in a hospital) would not be a socially acceptable choice. None the less, I was open about my plans during the pregnancy with my daughter. Not because I wanted the stamp of approval from others, but because I felt that it was important for others to know that it was an informed choice that I had made freely. A choice I felt best met my needs and those of my child. That I was happy with choosing cesarean, and that any concern about my birth plan was misplaced.

By the time I was admitted to hospital for the birth of my daughter, there was nothing that had been said to me that had changed my mind about vaginal birth or cesarean birth - not for the lack of trying by others and a hefty dose of misinformation about cesareans. Others regaled me with the horrors of cesarean birth - It's major abdominal surgery! The recovery is horrid! What about the scar! Adhesions! Infection! They further regaled me with the virtues of vaginal birth - it's the way nature intended! With an epidural, it's not painful! The recovery is easy! Thanks, but no thanks. Conveniently absent in the vaginal birth love-in was any acknowledgement of the virtues of cesarean (indeed it does have advantages) or the genital warts of conventional birth (indeed conventional birth is not completely a thorn-free bed of roses).

I was even open about my choice with hospital staff when I was in hospital awaiting for the cesarean that did not happen for the birth of my daughter.

My experience of vaginal birth proved to me why I had wanted to avoid it in the first place, even in the absence of the worst consequences of vaginal birth. I pooped in front of people. I experienced the worst pain of my life. I was terrified. I tore. My daughter needed narcan and resuscitation. I was left feeling violated and abandoned. I developed a vaginal infection. For more than a year afterwards, I had mild urinary incontinence. My enjoyment of intimate relations with my husband was adversely impacted. Memories of my daughter's birth continued to haunt me, and rather than looking at photos of that day with a sense of joy or accomplishment, they are a reminder of the worst experience of my life. I felt socially isolated among other mothers, particularly those with strongly held beliefs about conventional birth.

After my daughter's birth I understood why so many women who prefer birth by cesarean are mum about their preferred path to motherhood. I understood why some mothers make up a medical reason for their cesarean - it is far more socially acceptable to say you had no choice in the matter and in some cases making up a medical excuse might be the only way to access care. In some cases, where cesarean is seen as being inaccessible, some women are choosing to forego motherhood - choosing to prevent pregnancy, adopting or aborting. Other mothers are paying a hefty financial price for their preferred method of birth.

Indeed, during my pregnancy with my son, I found myself being a lot more mum about my choice.

However, being mum doesn't help other moms who share the same view on birth. Being mum does not make it easier for the next mom to make and exercise her choice. It does nothing to ameliorate the undeserved stigma or shame associated with being a woman who would prefer to avoid a conventional birth and choose cesarean. It does little to address the misinformation or myths about mothers who choose cesarean (the vast majority of whom are not "too posh to push"). It does little to address the misinformation or myths about elective cesareans as medical procedures - or even the misinformation or myths about other birth related medical procedures (such as epidurals). It does little to address the problem of those who would seek to deny moms like me their chosen path to motherhood and it does little to help women make truly informed decisions about the birth choices available to them (have I ever blogged about how little data is out there on maternal request c-sections and how they are not formally tracked in administrative databases???). Maternal choice cesarean needs to be an accessible, accepted, and respected choice - and as such moms like me can remain mum no longer.


  1. You strike me as one of the type of upper class white person who feels entitled to anything she pleases. This sort of arrogant mindset does not serve you well, it only makes you come across as snooty and reprehensible. Not everything should be accessible simply because you want it. This is a product of the over-consumption way of living that is not healthy nor admirable. It's not anyone else's problem that you have issues with squeezing a baby out of your vagina. It's not anyone else's responsibility to make sure this doesn't happen. It's YOUR responsibility to mature a bit and realize not everything in life is convenient, clean and pain-free. And it's nobody's job to make it that way.

  2. Hello Anonymous -

    I know you do not know me. I know you are coming from a place of judgemental ignorance. I know it is hard to comprehend why it is important for women to have access to the full spectrum of choice in childbirth, and not just those that are the cheapest (natural unmedicated child birth). I know you think I have an arrogant mindset - but I would ask you to look in the mirror and ask whether or not the label is more aptly applied to yourself. My race and my class have nothing to do with the issue at hand - and frankly, I do not care if a Canadian is black, native american, asian or otherwise nor do I care if they are on welfare, middle or upper class - they are all equally entitled to the full spectrum of choice in childbirth as there are risks and benefits regardless of the node of delivery chosen, and every person is ENTITLED to autonomy with respect to significant medical decisions and access to medical care.

    I know too well that not everything in life is convenient, clean and pain-free - but that doesn't mean that we should make it unnecessarily painful, degrading and hard. Or maybe you think it's okay to do so because it is only women who give birth?

  3. If you're insinuating that I dislike or hate women, you are wrong. Your idea of "autonomy" is based on a sense of believing you "deserve" to not have to deal with the "pain, degradation and difficulty" of giving birth. Why do you deserve this? And why do you believe birth has to be this way? Me and many other women do not see nor experience it that way. Are we wrong? If you can't handle birth then why do you think it's okay to waste taxpayers dollars and whine on the internet about medical providers not respecting your "autonomy"? It's not anyone else's fault that you are selfish and incapable of accepting what is and isn't medically needed. You take away resources from the women who actually need them simply because you feel it's your "right" to get what you want when you want it. The hospital squeezed you in when they didn't have an emergency c-section to perform--doesn't that tell you anything? That maybe you are taking up their time, money and resources when they could be helping others or taking a break? I doubt any of that is important to you. Your autonomy is clearly more important than anyone else or even what is medically needed. People who use medical resources when they are not needed are simply milking the system. How is that acceptable?

  4. I was pregnant, I needed to deliver my baby, there are two ways to do that and there are risks and benefits with each way. I am not comfortable with the risks of vaginal birth. That is my choice. That is not milking the system. How about I don't tell you how to birth your babies - and you don't dictate how I birth mine?

  5. >>Your idea of "autonomy" is based on a sense of believing you "deserve" to not have to deal with the "pain, degradation and difficulty" of giving birth. Why do you deserve this?

    Why? Because she's a thinking, feeling human being and she deserves to have her bodily autonomy respected, her pain minimized, and to receive treatment that doesn't leave her feeling degraded or traumatized--like every other human being in every other medical situation.