Security

Birthing Beautiful Ideas recently posted a transcribed copy of a "patient safety update" sent to all patients at an OB practice in her area. The letter focused on VBAC, and essentially served as a notice to that practice's patients that VBAC was not an option offered by some of the practice's providers.

BBI was concerned about the flawed information being sent to those patient about the safety of VBAC. I can't blame her. Read her explanation and you'll see.

For the better part of last year, I found myself thinking about the mothers who choose to allow someone else to control their birth experience. I was baffled. Why are some moms more at ease in a 'technocratic' birth environment, and why are some moms afraid of it? So, I set out to have as many conversations with moms as I could about birth experiences, a sort of informal poll, in an effort to understand their decisions. All of my talks with moms have been interesting and enlightening.

The constant theme in these conversations was this: everyone wants a healthy baby. That may seem like a 'duh' statement of the obvious, but it was actually a very important fact. Remembering this helped me keep their decisions in perspective. Some mothers look back on their birth experience and point out things that could have been better, but as long as their child benefited (or at least, wasn't harmed in any perceivable way), then the choices made were just fine.

Another theme was the way moms returned to the value judgement, 'Does this choice bring me a sense of security?' For some moms, there's a sense of security gained from working with a care provider who calls the shots. I had women express how much they liked their care provider because s/he seemed to always know what was best for her, and following his/her advice resulted in a healthy baby.

A very close friend, whom I consider one of my three heartsisters, discovered recently that she's pregnant again, and is now facing the challenges of deciding whether or not to pursue a VBAC. I'm watching from the sidelines as she's faced with the same situation that's been posed to the patients of the OB practice who wrote that letter, because the provider she used for her last birth has a no-VBACs policy. Her choices are even more limited due to another set of policies followed by nearly all of the care providers in our area which label women of size as high risk mothers. I know she'll weigh her options carefully, but in combination with the level of struggle she believes she can endure to get what she wants, these policies may cause her to choose an elective repeat cesarean.

Dr. Bradley wrote, in Husband Coached Childbirth, about his observations of laboring mammals on the farm where he grew up. Animals need specific things to make them feel safe, and engage in behavior which ensures safety. They often hide in darkened barn stalls, and need to be undisturbed; their instincts tell them that any disruption of the birth process could be an opportunistic predator attacking. For humans, our understanding of what security means can be influenced as much by our personal experiences and the cultural collective from which our experiences stem as by what's written into our genetic code as instinct. And we're social animals who rely upon our interactions with others of our kind in order to function and evolve.

Mothers are put into a unique decision making position by our culture and individual care providers who exist today. Mothers are asked to trust everyone and no one at the same time, to make decisions based on the consensus while appeasing their individual and instinctual needs. What an overwhelming expectation to have to fulfill. Is it any wonder, then, that some mothers find security in placing the safety of themselves and their child in the hands of something or someone else?

I understand that sometimes, the decision is more about what is safest than what seems safest. No one can argue with a choice made to save a life or prevent irreversible harm, especially one which is made in an emergency situation. That being said, in cases where the research evidence says that certain options are reasonable and should be available to mothers, it's concerning that care providers will not support their patient's decision. If you read the evidence report from the recent NIH VBAC conference, it's clear that the risks of cesarean section (which is a major abdominal surgery) are higher than the risk of uterine rupture during a VBAC attempt.

I have so many other thoughts about this, I may have to do another post.