EBAC - Empowered Birth
After Caesarean.
On the Ozmidwifery List the
topic of "The Outcome" was raised. It concerns the journey
that women make in planning for the birth of their children.
I would like to share some of the comments made with you
all…
Dear listers, I was having a conversation with a
colleague recently, we were discussing where the buck
stopped with responsibility, whether it was the midwife or
the doctor, that is another topic for discussion, anyway my
colleague made the statement, something along the lines of
'at the end of the day it is the outcome that counts'. I
then started to explain that I felt that the journey itself
also held great importance, I would like to throw this onto
the list for discussion and am very interested in other
people's thoughts.
regards Pete
(Pete is a midwife in the Busselton region, WA.)
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A response:
Hi Pete, and fellow Listers.
How often do we hear women say 'I don't care what happens
as long as my baby's healthy'. I also had an obstetrician
say to me once that he couldn't understand what all the fuss
was about (women's rights etc with regards to birthing) when
it is "only a few hours out of their lifetime".
To coin a phrase used by Germaine Greer at the last home
birth conference in Byron Bay, " to deny women autonomy in
their childbirthing, then has the potential to carry on into
all other facets of their life".
How often do we see
this!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
The journey is of great importance - not to just how it
shapes the immediate outcome, but how the potential exists
to transform the lives of the woman, her baby and her family
indefinitely!!!!!!
This discussion hinges on the 3'Cs often thrown around in
birthing circles and in the literature of the 90's and into
2000.
- CHOICE
- CONTROL
- CONTINUITY
- Some of us even add the forth C
As an independent childbirth educator, working with women
in the community, one of my many and privileged roles is
listening to women as they talk about previously damaging,
both physically and emotionally, birthing experiences.
One of the major criticisms I hear levelled at standard
obstetric services, is that women giving birth in these
institutions, often describe to me their feelings of
powerlessness.
They tell of their inability to maintain control, and in
their disappointment of surrendering all control over the
pregnancy and birthing experience, or of having had it taken
away by the obstetrician or the midwife.
Women often express their guilt and again disappointment
in their lack of assertiveness to be successful in
articulating their needs/wishes/desires etc.. and in truly
having these needs met.
I find the language used by women who share their stories
with me affirms their feelings of powerlessness. They often
make comments of the "THEM" that do things to them, or "I"
"HAD TO HAVE THIS" or "I HAD TO HAVE THAT"
No CHOICE, No CONTROL and the only CONTINUITY experienced
here, described by these women is DOMINANCE.
While many obstetricians and midwives working within
these institutions would feel that this criticism is
unjustified, the issue of control over the birth process is
a very real and forever recurring theme central to my
discussions of birth and the reality of the lived
experiences of women I work with.
Control, or more importantly, women's denial of, is
identified by women who share their experiences with me, as
the dominating factor in how they perceive their experience
in the days, weeks, months, years and even decades after
their childbirth experience, more so than the immediate
outcome, whether it be by their definition, positive or
negative.
The greatest sadness I find here in all of this is that
it takes a woman to first have this experience before she
discovers that there are better ways than others to have a
healthy baby, and also just as importantly a healthy mother
as well.
Preparation for childbirth, part of this journey, should
be more than just learning about and discovering the sheer
mechanics of decent, rotation and 'delivery'. For childbirth
also has to do with emotions, and sadly, discovering and
learning about our emotions and feelings surrounding birth
are all to often ignored or simply not acknowledged as part
of this journey.
We tend to accept the premise that if we emerge from the
experience relatively physically intact, with a live and
healthy baby, then we should be thankful and have nothing to
complain about.
However within this thinking this there is the hugely
costly mistake, in terms of both dollars and in peoples
lives, of denying the emotional/psychological/spiritual
aspects of birth which are all to often dismissed and
trivialised as part of the highly medicalised male dominated
birth, experienced by the vast majority of Australian
women.
I often think about that statement of Germain's about how
in denying women autonomy in birth, the potential is there
to affect then all other facets of women's lives. This to me
resonates so strongly in what I see, and in what I hear and
why then perhaps things are the way they are for some!!
The fragmentation of maternity care together with the
fragmentation of self - mind, body and spirit - by
medicalised birthing practices, the exclusion of midwives as
primary carers for healthy women and babies, or the
ignorance of their importance, the refusal to place women at
the focus of care, and the treatment of the woman's
experience of pregnancy and birthing as an "episode" or
"just a few hours of her lifetime" is to deny the profound
nature and significance of this life altering experience -
and to suffer the resulting consequences that will
ultimately affect all of society, by accepting such.
Yours in birth,
Tina Pettigrew
Birthworks
Childbirth Educator and aspiring B.Mid Midwife.
====================
Another response:
Hi Pete,
Thankyou for this discussion re 'the journey'. Speaking
from a woman's point of view, and especially from sharing
the emotions/stories of so may women within the support
group I'm Convenor of, the journey is so very important,
more so when a previous journey has been traumatic
(emotionally/physically)is some way.
If the outcome is perfect, like it (luckily) usually is
after a caesarean, then why are women left feeling
traumatised? They try to push these feelings behind them and
focus on their perfect child, but the journey that brought
this child to them was not the one they had envisioned
during their pregnancy. One woman said to me '...I thought
I was going crazy. How could I feel so negative about
something that had such a positive outcome... My beautiful
son."
If they planned a c/section, chose this way of birthing
their baby, then generally they are happy with the journey
and the outcome. If they planned a natural birth, with
massage oil, candles, warm baths and gentle love and support
and end up surrounded by lights, technology and abrupt
impersonal caregivers, then something really bad happened
during that 'journey' and no matter how perfect the final
outcome, the stress of getting there will have long-term
effects.
It's all based on what we plan. But do you know something
else I discovered just lately? Women need to be able to plan
that journey and be supported in those choices, whatever the
outcome. I'll try to explain...
Sometimes women plan a VBAC, as a way of healing from the
trauma of a previous c/section experience. They aren't
always successful though, occasionally these VBAC's go
'wrong' and the mother has another c/section. You would
think she'd be devastated, wouldn't you? But it all depends
on how she was supported and encouraged, and how much trust
she had in the decisions that had to be made and suggested
by her caregivers.
If she was 'allowed' to plan a vaginal birth, surrounded
with love and honour then she won't be stressed during her
pregnancy, and fighting the system, so to speak. She can
spend time envisioning a natural birth, and retrieving that
faith in her body that may have been lost during her last
birth experience. If her abilities are affirmed by the
caregivers surrounding her, and she is not forced to submit
to the fears of others (continual monitoring, fasting, etc,
in case of problems... just in case an anaesthetic becomes
necessary) then she will have faith and she will not be
fearful herself.
Often, with this support, women will birth their babies
naturally. And it will truly be an empowering experience,
and a healing journey.
If something happens during the pregnancy/labour, and a
c/section becomes necessary, they will have trust in the
carers advice. If the c/section is truly necessary... Those
are the magic words. Fear is not a reason, certainly no
reason to slice a belly unnecessarily. If that c/section is
truly necessary, and not just a possible necessity (run out
of time, labouring too long, etc) then the journey to reach
that point will have been empowering, and being involved in
the final decisions regarding the outcome will continue to
be empowering.
Telling a woman how to labour, how to birth, when it's
time to change tactics, removes her power and her
responsibility. Discussing these things with her, involving
her in the 'big' decisions, will allow her to hold onto her
power, her dignity, her rationality and allow her to
continue to have control over her personal 'journey'. It's
her journey, remember, not yours.
Taking that away, her right to be involved in the
decisions, is like grabbing her 'virtual' hand and saying
"We are going up the mountain this way" dragging her along
behind you. Know what I mean? It's so much better to show
her that track 'up the mountain' that you know is safer, and
guide her along it in such a way that she chooses it
herself, listening to your experience and wisdom, rather
than being brow-beaten into submission in a paternalistic
manner.
The 'I know better than you, I'm qualified' attitude can
make women feel like little girls. How can they possibly
take on the role of Mother when they have been reduced to
this during one of the most important experiences of their
lives? An experience that is not repeated as often as it was
in the past, sometimes only being experienced the once? I
feel that this why natural childbirth can make women feel
like they have been initiated, passed some magical boundary
into adulthood, whereas birthing by c/section (or in some
other way that removes the mother's natural birthing ability
- forceps, episiotomy, etc) can leave her feeling like she
missed out on that vital initiation ceremony. She may feel
that she has been left a child herself, failed the 'test',
yet with a child of her own to raise. Her faith in how her
body can perform this natural function has taken a severe
battering, one she may never recover from without lots of
support and empathy.
So, outcome vs journey. Which is more important? I'm
still confused myself. Everyone wants a healthy baby at the
end of their 'journey' and may blame their healthcarers if
that doesn't happen. But I believe they blame their carers
because the responsibility of the labour/outcome was removed
from their own shoulders and gladly accepted by the
paternalistic attitude of the primary carer involved. Women
now choose hospital to birth, because it is the safest
place, they choose drugs because why should they suffer
pain, they choose Obstetricians because it's less risky if
something goes wrong. They surround themselves with false
securities when nothing is so unsecure as the birth of a
baby, is it? This is a very naive attitude.
No matter how well you plan it, there are no guarantees.
Life would be boring if there were. We can only plan our
'journeys' through life, suffer grief when they don't go to
plan, and be supported to try again if we choose to.
Hopefully we will find healing in the love and empathy of
the people we choose to accompany us on our journeys. As I
read the emails on this list I realise there are many
midwives that I would gladly choose to accompany me on a
personal journey, I just wish I had known about you all when
my journeys were actually happening... But, like it or not,
I've chosen you all to accompany me into the future, so come
on, let's tackle that mountain. Which track would you
advise???
PS - Sorry for this digest of thoughts. Once I get
started...
Birthing Beautifully,
Jackie Mawson.
============================
Then I extended the email by posting the next response:
Do you know a term I am coming to despise???? VBAC. How
about that? It's lost its original meaning for me. It was
coined in the eighties (I think) by Nancy Wainer Cohen (I
could be wrong) to give a better name to the journey women
take in attempting a 'Trial Of Scar'.
Now, although I find VBAC a better name than TOS it still
really, really bugs me. Women who've experienced a c/section
aim for this VAGINAL BIRTH and that becomes their focus...
No matter how they get it - induction, augmentation,
forceps, vacuum, epidural, etc, etc.
Birthing their baby through their belly, with all the
necessary sterility and technology, may have traumatised a
woman so much that she wants to avoid a repeat of that 'loss
of power' scenario at any cost. She WANTS a vaginal birth!
She wants to recover her power as a woman. But the loss of
control she experienced previously can be repeated (only in
a different form) if she so desperately wants a VBAC that
she will use any intervention to achieve it.
True healing, and a return of faith in their body's
ability to birth a baby, can only be achieved through
natural childbirth... This is so easy to say, isn't it? So
many things go wrong during pregnancy, or labour, that
necessitate interventions and I thank God for the ability to
use technology in those instances. What I am trying to say
is "Technological interventions shouldn't be used if not
necessary, or if they can be damaging, as using them to
achieve a vaginal birth really defeats the inner purpose of
the woman attempting a VBAC." To truly KNOW that you pushed
your baby out by yourself would be the most empowering gift
any woman could receive. Their faith, their womaness, cannot
be returned to them if interventions achieve this aim for
them.
I was tossing some terms around at a meeting I was
attending the other day (with a wonderful GP, some midwives
and a psychologist). It was a sub-committee to discuss the
VBAC situation, called the 'VBAC sub-committee' I think! I
was suggesting 'Natural Birth after Caesarean' would be more
appropriate, when the doctor suggested...
EMPOWERING BIRTH AFTER CAESAREAN
Isn't it a wonderful title??????? That's what I want to
call the journey women take after a c/section from now on,
though I know I will confuse a heck of a lot of people.
EBAC! That's what women need to aim for. A vaginal birth is
no guarantee of healing, especially when we focus on it so
much that we are willing to put up with any intervention to
birth our babies this way. This is just too traumatic, not
healing.
Women shouldn't need to shun technology totally to
achieve EBAC births. That's just too sad. Technology should
be there if necessary, but not used unnecessarily. Our fear
of the unnecessary use of technology encourages us to turn
to homebirths and alternative therapies in our search to
regain faith and trust. Wouldn't it be wonderful for women
to be able to calmly, and confidently, walk into hospitals
with no fear of policies forcing them to endure procedures
that may ultimately lead to a loss of empowerment. These
policies have created the biggest 'catch 22' situation the
medical establishment has ever produced. They believe VBAC's
need extra monitoring and preparation for birth, yet the
women attempting an EBAC would love extra 'human' monitoring
without all the technology that attends them within the
system. They need empathy, encouragement and support, not
machines, drips and starvation.
Anyway, back to EBAC... Women need to actually birth
their babies by themselves, if it's a vaginal birth, or in
the way they decide if it's otherwise. It's all about being
involved intricately in the birthing choices and decisions,
and having faith in their bodies and in the people they have
chosen to care for them. When they recover the trust and
faith, in the process and in the people they surround
themselves with, then they will have an Empowering Birth
After Caesarean. Much more healing, and infinitely more
satisfying, than a VBAC, both in name and in nature.
Birthing Beautifully,
Jackie Mawson.
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