Feminism and Medically Managed Childbirth
By Danell Swim
January 14, 2008
Let’s face it. Most elective cesareans are not the “I don’t want a stretched out vagina” types that we hear about from celebrities. Most are for medically indicated reasons, which are different from medically necessary. A medically indicated elective cesarean is one where a vaginal birth may be safer, but carries more risk than most vaginal births. Such as in the case of breech presentation, previous cesarean section, macrosomic (large) baby, past the due date, etc. In these cases, a woman is often given the choice to schedule a cesarean.
Women are told that their babies will be too large to fit through the pelvis, which is an extraordinary assumption for a doctor or midwife to make. In labor, a woman’s body produces relaxin, a hormone that softens the pelvis and allows it to open. Until a woman is in labor, there is no way to accurately measure how far her pelvis will open. Also, ultrasound has been shown time and time again to be a poor indicator of fetal weight and size. In these cases, a woman is told to schedule a cesarean rather than suffer through a long and difficult labor, only to end up with a surgery in the end despite her troubles.
Women are told that they have to schedule a repeat cesarean if they’ve already had one or more previous cesareans. Often, this is because their doctor or midwife won’t attend, and because many hospitals are banning them. Again, VBAC (vaginal birth after a cesarean) has been shown to be as safe, if not safer than a cesarean section. I’ve known doctors to tell women that the uterine rupture rate for VBAC is 5-10% for a lower transverse incision (the real number is about 0.5%), and that by scheduling a cesarean, they will save themselves decades of urinary incontinence that comes from vaginal deliveries (evidence has shown that it is pregnancy, not birth, that leads to urinary incontinence).
Women are told that they must be induced if they go beyond 40, 41 or 42 weeks (depending on the policies of their care providers). It is said to be for the welfare of the mother and baby, though numerous studies have shown that induction does not improve the outcome of mother and baby in an otherwise normal pregnancy. And shouldn’t new mothers be told that the average natural gestation is more than 41 weeks? Instead, women are excited to learn that they’ll be meeting their baby soon, oblivious to the added risks of an induction (fetal distress, uterine rupture, etc), or with the knowledge that induction significantly increases the risk of an emergency cesarean.
In cases such as these, is an elective cesarean really empowering to women? I don’t believe that it is. I don’t think that a woman can be empowered and satisfied with their childbirth experience unless they feel that it was truly their choice; and lies and coercion do not lead to empowerment or satisfaction. Except, perhaps, in the pocket of the person performing the cesarean.
Elective cesareans can be a wise choice for some women, who know all the risks, complications and alternatives to the procedure. But the fact that so many women are denied access to this information, and are made to feel secure in this falsehood. There is no encouragement to seek out further information, to educate oneself, or to find practitioners who will attend vaginal deliveries with a slight increase in the risk of complication.
Feminism and childbirth will not merge into one, until more women begin to educate themselves. We need to stop taking someone else’s word for it when it comes to our births, and start taking command of the situation. We need to research doctors and hospitals instead of arbitrarily choosing one. We need to feel secure in our decision to say “no” to a doctor who recommends a procedure that we are not comfortable with. In the end, that is all doctors do for us: they recommend. And they are not always right. It is up to us, as modern feminist women, to look into the realities of what our doctors tell us.
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I think this doesn’t take into account the mind games that doctors play on women. From always talking to women when they’re on an exam table and undressed, to managing every bit of care. I mean, I don’t know why I can’t go to a prenatal appointment at a doctor’s office and pee on my own stick. Why do I have to pee in a cup and let the nurse do the dirty work? They must be afraid that I’d lie about the answers. It’s all insane.