Fall 2004 in The Feminist Psychologist
Feminism and Childbirth: Part 1 of 2
by Jill Kuhn
Pregnancy, labor, and delivery are feminist issues. This was never so obvious to me as during my recent 2nd pregnancy. On leap day of this year, my daughter was born via vaginal birth after a cesarean (VBAC). In spite of 37 ½ hours of labor and delivering my 10 lb baby in a freestanding birth center (midwife assisted), this was not the most difficult part of my birthing experience. As hard as all this was, it was nowhere near as grueling as trying to find someone who would support me in having a VBAC. Not a single obstetrician (OB) or hospital that I contacted would allow me to deliver by VBAC. They all wanted to schedule me for an elective C-section to occur during my 38th week of pregnancy because of their so-called fear that my uterus would rupture, along my prior Cesarean scar, during labor.
In an attempt to sort out fact from fiction, I reviewed numerous medical journals, midwifery journals, and policy statements of the American College of Obstetrics and Gynecology. I quickly learned that only 10-15% of women in the United States have VBAC’s, although over 90% of women can be successful at it if given the opportunity. I also discovered that the feared liability of a “uterine rupture” was highly exaggerated. When a low-transverse uterine scar does “rupture” (less than 0.22% of the time), it is rarely fatal to the mother or the baby. Conversely, elective C-section has a higher risk of maternal and fetal death, of anesthesia complications, of injury to other organs, of infection, and of respiratory distress in the infant when compared to VBAC. Even in the best of circumstances, the recovery from a C-section is arduous and fraught with pain and with difficulty caring for a baby and other children. After all, it is major abdominal surgery!
Certainly C-section has its place. It can be a life-saving surgery for a laboring woman or her baby. Unfortunately, women are rarely informed of all the risks of C-section. Moreover, 26.1% of pregnant women are sectioned in the United States, with some hospitals cutting as many as half of their pregnant patients. In spite of these statistics, infant and maternal morbidity and mortality rates in the U.S. are no better than countries with much lower section rates. Liability is only a small part of the reason that OB’s do not “allow” VBAC’s. The reality is that C-sections bring in more money and also allow the physician more control of the delivery.
Many OB’s paint themselves as the victims of a litigious society. So, in response to their fear of a lawsuit, they take away women’s child birthing choices. They are quick to intervene with machinery for fear that something may go wrong and unwittingly create a self-fulfilling prophecy. OB’s seem to see birth as abnormal and thus every normal turn of labor as a potential problem. Furthermore, OB’s are surgeons. As a result, surgery is often their solution to conjured up dilemmas. However, for the vast majority of women, pregnancy is healthy. A baby is not a tumor that needs to be excised, nor is it a disease that needs a cure. This patriarchal system ignores the supra-role it plays in pathologizing pregnancy and medicalizing every step of labor. The reality is that with rare exception women’s bodies will give birth to their babies in their own time and in their own way. This can be done without an OB over-medicalizing each step of labor, without inducing, constantly monitoring, and keeping labor on a clock.
Most women are not connected to a birthing community in which they have grown up seeing birth, talking about birth, and becoming aware of the range of birth experiences. Thus, we are justifiably fearful and turn to OB’s to help us with our fear. However, when men wrested control away from the long tradition of midwifery, they discarded women’s knowledge of how to birth. They in essence threw away the reality that a woman who is supported with care and love will almost always give birth without medical intervention! They effectively disconnected communities and generations of women who could support one another. This isolation places the OB in the role of the expert in charge of women’s bodies. Plus, OB’s do not believe that women are capable of making decisions for their babies and themselves. Thus, the arrogance on the part of the obstetrical profession of ignoring women’s rights and acting out of their own self-interest can be added to the list of assaults done to women in the name of good medicine.
As a feminist, I would not want to take away another woman’s right to an elective C-section or to determine the course of her birth. However, too many women are not given the information with which to give a true informed consent. My next column will continue with this topic by discussing ways to prepare for and have a feminist birth. I invite you to e-mail me with your thoughts and ideas for future columns (kuhngale@earthlink.net)
*For more information on Cesareans please contact the International Cesarean Awareness Network at: www.ican-online.org