Monday, March 8, 2010


I just finished a conversation with a friend who recently found out she's pregnant with her third baby. This baby will be born via planned c-section (her first was born by cesarean after she got stuck at 7 cm, her second a planned c-section). She also mentioned an insensitive comment one of her acquaintances had made about cesareans, and it got me thinking. We are all guilty of misunderstanding each other once in a while. Unfortunately those misunderstandings and hurt feelings abound in the birthing world. It reminded me of this post from a year ago where I angrily lamented the rising cesarean rate and unwittingly hurt a reader's feelings (and felt awful about it).

It got me thinking about how tricky it is to balance advocacy and compassion. An advocate is, by nature, a fighter. We aren't content to accept the status quo. We feel driven to change things. But we can't change things unless we raise awareness about the problems we see. And, it seems, we can't raise awareness about the problems we see without pricking a few hearts here and there. Or can we?

Is it possible to talk about unnecessary cesareans without hurting the feelings of those who have given birth by cesarean? Is it possible to talk about the beauties and bliss of normal birth without those cesarean moms feeling that we're telling them their experiences were "less than" or failures? Is it possible to balance advocacy and compassion in such a way that everyone feels heard and validated and no one takes offense?

What do you think?


Fig said...

When you find out, let me know.

This is a tough one.

Linda said...

I don't think you can ever be sure you won't offend anyone, because the person being offended gets to choose how they interpret your words. You may try very hard not to offend, but someone can still choose to be offended by it.

kamille said...

this is so, so hard. with every post i make on my birth blog or every time i talk about childbirth, i am so afraid to offend or hurt someone's feelings. birth, by nature, is a sensitive subject because it is so personal. it is hard to find the balance of wanting to share to uplift and inspire and not wanting to offend. it's a constant inner struggle, for me.

Carlie said...

I havent had any chilren yet but when I do I have felt impressed to have a home birth. I have found that people feel like its there ever living duty to tell me that Im nuts and Im irresponsible and bla bla bla but I have felt the promptings and can not deny them therefore I will do what I feel is right. What I have found really ammusing is that people find it ok to say that stuff to me but if I ever breathed a word or my opinion its not welcomed at all. Its very confusing and annoying to me. I just came across your blog and thought I'd look around. Thanks for letting me word vomit on your blog! ha.

Tianna said...

This is tricky, for sure. But it makes me wonder. (And, ironically, I'm really hoping I can say this in a way that doesn't offend, because that's not my intent.) You're an advocate for avoiding unnecessary cesareans (which is remarkably hard to type, but fun to say), yet you don't want to offend those people that are doing the very thing you're advocating against.

I guess the question is where exactly you stand on the issue. How against it are you? Let's look at extremes. If you're against murder and actively advocate against it, you're not going to feel guilty if a murderer hears your plea to lower the homicide rate. On the other hand, if you don't like the color yellow, you probably would feel pretty rotten if you started ranting about the hideousness of it to someone who has spent years carefully decorating her kitchen in yellow.

Obviously, this falls somewhere between the two. And I'm pretty sure you're not frustrated with those women who didn't realize they had a choice and just went with what their doctor told them they "had" to do. And I think you do a pretty good job of being tactful. I think the eggshell ground here comes with those women who actively choose to have a cesarean. You're advocating against those. You don't want to offend those that choose them.

Where do you stand? Are you one that says, "Unnecessary cesareans are wrong and we should do everything in our power to avoid them! Oh… er… you had one? Ummm… I didn't mean that personally. I just meant the world at large; let's still be friends." Or are you saying, "It is a tragedy that there are so many unnecessary cesareans. I want to do my part to lessen the number of them. However, if you choose to have one, I will still respect you."

So, how much of an advocate are you? What are you actually trying to accomplish with your fighting?

JackJen said...

I don't normally comment, but I wanted to here. Your post got me thinking...

From what I've read on your blog (and on other blogs that advocate for normal, physiological birth), it's very clear that your views on unnecessary c-sections and other interventions are rooted in wanting the very best, safest options for women.

In my opinion, to advocate in behalf of lowering the c-section rates, elective inductions, or even simply the practice of defensive medicine during birth is to advocate for the protection and well-being of women.

When the majority of maternal mortality in birth in this country is connected to medical interventions, it's clear that to reduce those interventions is to save more women.

Looking at it through that lens, there's nothing offensive at all.

Buscando la Luz said...


I don't know how much of an advocate I am. But I see advocacy much the same way I see missionarywork... you aren't going to do a very good job sharing the truth if you start out offending the person you want to help.

When I say I'm "fighting" to prevent unnecessary cesareans, I don't mean I'm fighting with the women themselves. (This was the same misunderstanding I encountered in the post I linked to a year ago.) My anger is directed at the faulty maternity care system that perpetuates sub-par care.

The eggshell ground I'm referring to isn't actually the women who choose elective cesareans with no medical indication. I believe that those women are a small drop in the bucket of unnecessary cesareans and my understanding is, despite the media and the medical establishment's efforts to blame those women for the rise, they're actually few and far between.

The tricky part is trying not to offend the women who were cranked through our sub-par maternity care system (the cascade of interventions) and ended up with a cesarean (or who were pressured or misled into second or third cesareans). It's almost certain that half of those cesareans were unnecessary. But it's impossible for me, as an outsider, to know which half a particular woman falls into. Is she one of the necessary ones (and thank heaven we have cesareans available for women like her!)? Or is she one of the unfortunate victims who could have given birth vaginally under different circumstances or with adequate support or freedom of movement or a number of other midwifery-style practices? I can't know, so it would be risky to make assumptions.

And regardless of whether or not a particular woman's cesarean was necessary, most of the women who've had cesareans believe that they're one of the necessary ones. Sometimes because they really were necessary. Sometimes because their doctors told them their bodies weren't made to give birth or their pelvis is too small or they would have died without their cesarean, etc.

I worry about offending the women who are already hurting, already feeling "broken," and who are trying desperately to defend their cesareans because it's too painful to consider the possibility that their cesareans may have been unnecessary. They're already hurting and vulnerable... so the last thing I want to do is hurt them even more. The questions that plague me are... how can I help THOSE women? Is it even possible to help them without hurting them? Do they even want to be "helped"? What really is the best way to show my love for them?

I think this comment might turn into another blogpost... :-)

Danielle said...

I think this is the hardest part of being a birth advocate. I struggle so much with what I can/should say and how to word it to try and minimize any offense. I'm trying to come at it from the point of view that I am just trying to educate and get the info out there so women can make informed decisions.

I think you hit my frustrated nail on the head about women who've had unnecessary c's but believe their c-section was necessary. How do you help someone who is content to sit back and believe what she's told, despite the evidence? Most of my friends like this have had awful experiences and they are terrified of going through it all again just to have it end in the C anyway. They'd rather just sign up for the butcher block again.

I'd love a way to be able to discuss the new studies coming out, the new evidence supporting the decreased risk of a VBAC versus a repeat C.. My husband says I shouldn't be afraid to offend people, but as you say.. the dumbest way to try and 'save' someone is to start by offending them.

Katy said...

So think about the conversation about macromasia on my Facebook page yesterday. (Thank you for taking part.) And think about the lady who talked about her "vaginal cesarean" after only being allowed two hours to push. And then blaming the jaundice on head compression rather than a slowed system due to a medicated birth and thus, a medicated baby.

These are exactly the kinds of situations that I use for advocacy efforts. I will have a mom who posts something about how here baby was resuscitated immediately after the birth and I will then gently include something about delayed cord clamping and how that can further optimal outcomes, especially when a baby isn't breathing from the start.

The other thing that seems to be funny to me is that when I post things about elective cesareans, the women who seem to comment about that being a wildly outrageous idea are the women who get roped into a second, third, or fourth cesarean with no medical indication.

I have a friend who had a carb overload at lunch and then went to her prenatal, only to have the bp cuff reveal a high bp reading. The doc scheduled her "emergency cesarean" for six hours later, stating she needed one now, but he had to wait until her stomach was empty. When she went for pre-op, her bp was normal, just as it had been her entire pregnancy. They still did the cesarean and delivered a preemie baby.

It's situations like these. Where you know the outcome was completely unnecessary. Like there are those who you can definitely help prevent being killed in a homicide, but this advocacy work seems to be preventing stray bullets or drive-by shootings. You can run around and cry wolf with advocacy work, but until weeks like this week (where the articles on maternal death are shooting out of the AP chutes) we end up with these really great advocacy tools that scream, "I'm not kidding here, listen to me!" And maybe, just maybe, you prevented one unnecessary cesarean that could have ended in maternal death.

I have the one in a million factor going on. If I helped one mom get her VBA2C or another decide not to have a cesarean, it probably *was* worth ruffling the feathers of a few. Because is it really ruffling feathers, or planting the concept that these women REALLY DO HAVE A CHOICE! And how amazing is that?

The Winn's said...

I think everyone has their opinion on what the right way to birth is. Opinions can be so strong that we don't realize that expressing them can be harmful. I think the objective of birthing is to have a healthy baby. The thing that we need to focus on more than how we choose to birth is how we choose to mother. Otherwise who cares if you have a natural birth, or a C-section. If you are a crappy mom it really doesn't matter. The way you choose to birth does not determine your parenting skills or ability.

OrganicMama said...

Busca, the fact that you're already sensitive to this issue makes it possible for you to preface your remarks against unnecessary c-sections with understanding and love. I think you do a pretty good job of this already. :)

Sara said...

There are going to be hurt feelings. People who are the exception and that fall in that 15% or less of c-sections that were truly necessary are often defensive. Often that group of people that feel that they are part of that "exception" group are really actually not, and they're even more defensive.

The same thing happens with breastfeeding. Only 1-5% of women truly cannot breastfeed, but another 25% or so are sabotaged with bad information, by doctors, etc.

It doesn't matter. They're proof that the intervention is necessary.

I tend to say "While infant formula is wonderful when it's medically necessary, it's a medical intervention like any other medical intervention and it has risks as well as benefits. If the benefits do not truly outweigh the risks, and if the care provider has not tried to remedy the problem without resorting to the intervention, the risks drastically outweigh the benefits." or something like that.

C-Sections are not evil. Infant formula is not evil. But they ARE medical interventions and medical interventions should be used when there is a situation that needs intervening in, and after someone has tried to resolve the situation.

We don't put moms on insulin if their blood sugar levels test high. First, we try daily monitoring and dietary adaptions to manage the gestational diabetes.

C-sections, inductions, epidurals and infant formula are often used too much like something that is NOT an intervention. They're treated as a choice instead of what they are: A medical intervention that has risks and benefits.

It's the inappropriate use of the intervention that we object to, not the intervention itself.

Honestly, I think that moms that undergo surgery necessary to save their babies, or that doctors have told them is necessary to save their babies.. are amazingly wonderful and strong and that they're giving birth in a way that I can't even imagine. The procedure used to bring their baby into the world doesn't make them less of a woman. Birthing vaginally doesn't make anyone more of a woman.

It's not about that. It's about the misuse of a medical procedure that can and will risk the lives of women when used inappropriately.