Occasionally I will read about a woman who is planning on having a cesarean for the birth of her child, such as Ms. Magee. She's done her research. She knows the risks and benefits of cesarean and vaginal delivery, and is prepared to put up with the static of choosing cesarean. It is her body and her choice.
However, because of my experience with my daughter's birth, and hearing of other women who planned on having a cesarean but ultimately did not - I find myself asking the question "What if?". It is all well and good to know what you want and to pursue it and women should expect to have their choices regarding childbirth respected to the degree possible. But what if the cesarean does not happen, then what?
That is the situation I found myself in after my daughter's birth.
That is the situation I worried about throughout my pregnancy with my son.
When I was pregnant with my daughter - I thought the risk of not delivering by cesarean was fairly small - I knew about 10 percent of women did not make it to their scheduled surgery date, but I also knew that few first time mothers had exceedingly short labours, and that the hospital I was delivering at was a tertiary care facility. I believed that if the hospital could provide emergent cesareans for those who needed them within a half hour, that surely if I did go into labour that I would be able to get a cesarean within two hours, and that it would be extremely unlikely that as a first time mother my labour would be less than two hours. In short, I thought the risk of enduring a labour and vaginal delivery, in the circumstance I was in, was vanishingly small - small enough that I discounted the possibility nearly entirely.
What I did not account for, and should not have needed to account for - was the possibility that the hospital and/or my doctors would fail to actually and reasonably facilitate and respect the choice that had been made. I believed that I might get bumped for more urgent cases, but when the chips were down, if I should happen to actually go into labour - I believed I would be an urgent case and would have my care facilitated (possibly bumping others). I believed that my ability to determine what happened with my own body would be respected to the degree possible. I fully trusted, that the system, while not perfect - would be "good enough" - and completely disillusioned when it proved otherwise.
So now I know what if, what if a chosen cesarean does not happen and a woman endures a vaginal delivery she does not want. I know that when it happened to me - I felt violated; I felt isolated; I felt betrayed; I feared the worse; I felt disempowered; I felt traumatized; I questioned my desire for a subsequent child; and, when I was pregnant with my second child I was anxious; I still worry about the longer run impacts to my pelvic floor and psychological health; I am both angry and numb; and I struggle with the experience and the large chasm between what should have been and what is. I know the answer to the question "what if?" - and know that the answer to that question is often not, "The woman will have a vaginal delivery like the billions of women before her, will likely have a healthy child, and get over it so it really is not a big deal to force her to have a vaginal delivery she does not want."
Forcing women who do not want to have vaginal deliveries, when cesarean is an acceptable and available alternative, to have vaginal deliveries - is a big deal, it is wrong, it needs to be addressed and stopped. Further, women need to be confident that their care providers and the facilities they go to give birth will actually and reasonably facilitate and respect the choices that they have made.