I wish I'd written this!

This is one of the best bits of birth writing I've come across in a while. So check out Looking glass Alice examines birth and parenting in our culture. Her other stuff is good too -- I like the fact that she's not afraid to "offend" and seems to have a good handle on why we shouldn't be afraid of "offending".

After all, which one of us ever changes if we aren't offended to begin with?

Cesarean Rate Rises. Again.

So I'm a bit behind in the blogging (what's new?). But I will add my voice to all the others expressing our outrage and grief (though not surprise) that the National cesarean rate for 2006 was reported by the CDC to be 31.1%, a 3% rise from 2005. Given what I see in the stories from just the women who join the ICAN email list, I'm not surprised at all. What with VBAC bans, early inductions and cesarean surgery becoming the "treatment of choice" for suspected macrosomia....I knew the numbers would be bad.

You want to know what's really bad? These numbers are very likely lower than the reality. Why? Well, because some states (Florida is one) exclude "high risk" cesareans from their data -- so if a woman has a cesarean and she was carrying muliples, or the baby was breech or the baby was premature....that doesn't "count". I'm trying to wrap my brain around why this would be a reasonable thing to do....and honestly, the only reason I can come up with is that it keeps the "official" number lower. The argument that these are "necessary and unavoidable" cesareans doesn't make sense to me (and isn't true anyway since all of those pregnancies can end with a vaginal birth)...and excluding breech alone has to raise the cesarean rate by at least 3%...what I am sure has not had any real effect on the numbers are the "patient choice cesareans"....because they really are very rare. You wouldn't know it from the popular press but anytime anyone has tried to get a handle on how many non-medically indicated cesareans are done by maternal request....a very small number is generated. Add to that the fact that most likely, some proportion of hospitals are just plain lying about their cesarean rates (we have a few cases where we know for sure it happens, I'd assume its not limited to those few hospitals) and you get a number that's higher than 31.1%.

So in my state, Michigan, the cesarean rate was 29.8%. About the only good thing I can say about that is that it isn't 37.4%, which is where New Jersey, the state that cuts more women than any other, falls. You know things are getting bad when you see a rate below 25% and want to celebrate (or move to that state). Look up your state -- and then look at the Press Release from ICAN...and then send it to all the media outlets in your area you can find, and to your state and national legislators. Let them know that you are tired of your healthcare and tax dollars being pocketed by the medical and insurance industries, while the U.S. suffers one of the worst maternal and infant mortality rates in the developed world. Let them know that you are tired of women's legal rights to informed consent and refusal being systematically trampled on.

And then, put your money where your mouth is. Join ICAN. If that doesn't appeal, join Lamaze Intl., or CIMS, or Citizens for Midwifery or birthNETWORK or ANY organization that's trying to make a difference.

If you want to get personally involved, email me -- I've got a big project just about ready to launch and I'll need people who are willing to donate time and phone minutes. The problem is huge....but you know what else? If even a quarter of the women who've been through the medical establishment while having a baby got involved....we could make a big difference. So how about it?

N*A*T*U*R*A*L* spells....

vaginal? boy, I thought new math was strange, this new spelling is WAY out there. I'm getting really old....

Seriously, though...it seems (I've noticed this myself, I'm not just hearing it from other women) that "natural birth" is the new way to say "vaginal birth". Well....ok? Yes, a baby coming out of your vagina is an integral part of a natural birth...and admittedly, having a baby come out of your vagina is a HUGE accomplishment in this day and age....but natural?

So how do we decide to define a word....strictly, as in by the dictionary or by traditional usage? By current cultural usage? What are the consequences of allowing (either actively or tacitly) definitions to shift? How important is a word, anyway....I'd say words are very important, even more so because most people don't recognize how important they are!

Let's use the word "choice" for example. I could very accurately be described as someone who is pro-choice when it comes to birth options (what did you immediately think of when you read that? My stance on the "other" choice issue? Now you are probably wondering). The minute I use the phrase "pro-choice", the minute an organization like ICAN uses the phrase "pro-choice", even if we are clearly using it in the context of birth options, not abortion...people assume that we are "PRO-CHOICE". That phrase has gained a certain specific cultural definition that then restricts how I can use it in a different context.

So, if a "natural birth" has come to mean a "vaginal birth" and has no relationship at all to the circumstances of the labor with regard to drugs and other interventions...so what? Why in the world do we care? Are we truly "natural birth nazis" out to make any woman who has any intervention feel guilty, forcing women to suffer needlessly in childbirth through the strength of our criticism, reveling in our obvious moral and physical superiority because we pushed a baby out our vaginas without drugs or assistance? Given the diversity of humans, I'm sure there are some women who feel like that, I've experienced my share of birth elitism when the fact that I've had a cesarean becomes known...but honestly, most women who plan a drug-free birth aren't like that at all. And certainly, the women I know who plan drug-free births don't do it to prove anything...they just want to maximize their chances for a safe vaginal birth and its clear that using as little technology as is safely possible is the way to do that.

There was a time when "natural birth" absolutely meant drug-free and implied free of other interventions too. It was certainly something that many women strived for, and I don't think they wanted a natural birth in order to get their natural birth merit badge. I mean really, if the majority of women would like to have a natural birth, meaning no drugs, realistically it just doesn't mean that the majority of women think they are superior to other women. It means that there's an underlying cultural assumption that a drug-free birth is a good idea. But now we have this situation where its really hard to know what women truly want (and the benefits of a drug-free birth are no longer understood) -- there's the "epidural in the parking lot" crowd (who I think might say that as much because they think its trendy? funny? inevitable?), there's the "oh, nobody gets a badge for not using drugs" group (which I suspect is more about personal "failure issues" than anything) and of course, there's the "let me tell you how bad it really is" group (which I think is human nature -- we like to top each other's stories and talking a lot about something does take the mystery out of it....its just too bad we are replacing the mystery of "what's it going to be like" with false "facts" about what its going to be like). A pregnant woman surrounded by these statements is going to have a hard time believing she's capable of a drug-free birth and she's going to wonder why she should bother?

I don't know. I can't help but think about a study done in Brazil. Its been common belief that a big part of the reason the cesarean rate in Brazil is something like 80% is because women want to have cesareans (to save their vaginas I've been told). Well gee, someone actually went and ASKED...and guess what? The vast majority of pregnant women in Brazil say they want a vaginal birth, when asked at the beginning of their prenatal care. Look at that....we were wrong, it doesn't seem like its the women who are driving the cesarean rate after all! So, I have to wonder if we are wrong about women just not wanting a natural (drug-free) birth anymore....I think a lot of women do. Its just that by the time they get to the end of the pregnancy, they've been pounded with horror stories of how torturous labor is, they've been told (at least implicitly) that they are crazy or elitist to plan a drug-free birth, they've been told quite explicitly that they can't do it and they might as well not bother (you don't have to be a martyr, after all, you wouldn't get a filling without anesthesia. Actually, I would and have but that's neither here nor there since its an apples to oranges statement anyway) and they certainly haven't gotten a bit of support from their OB. If you set someone up to fail, well, most of the time they fail.

Ah, failure. A word that is very loaded in the context of labor and birth. But see, I don't have to tell a woman she's "failed". I really don't think of it in those terms anyway, to be honest. I know women are failed by those around them all the time when it comes to pregnancy and birth. That's where my criticism falls. Women tell themselves that they've failed, all the time about all sorts of things. I think that's where a lot of the stuff about not being a martyr comes from....because we DO judge ourselves based on what other women do (not just in pregnancy and birth). I don't think its a conscious effort to make another woman feel bad in order to feel better....but I do think that's some of it. Some of it is probably a (misplaced) desire to save your friend/sister/sister-in-law/cousin from the feelings of failure that you struggle with. It does make for a pretty damn touchy topic, especially when we are talking about "natural birth", a thing that most women "fail" at.

The question of whether one should "correct" the definition of "natural birth" when used to mean "vaginal birth" came up on the ICAN list. Boy oh boy, that was heated (though polite). It also showed up the limitations of email for discussing something that is going to be extremely nuanced and depend strongly on the context of the conversation that might need to be "corrected". For the record, I don't like the term "corrected" here -- birth is a tender topic...corrected implies "did it wrong" and honestly, there's a difference between the wrong use of a term and a "wrong birth". Do I believe that we need to fight against the trend making natural equivalent to vaginal? Yeah, I do. Its yet another erosion in safe birth....because it takes the very idea of a drug-free birth out of common language. If you don't hear it talked about, you don't think about it, you assume it doesn't happen. But for me, that doesn't mean stopping a woman in the midst of her telling her birth story for the first time and correcting her, when she says she had a natural birth with an epidural. It might mean asking some questions...if she's part of a group and everyone is swapping stories around, I might say something like "hey, that's so cool you had a vaginal birth, they are getting rarer and rarer, especially with all the stuff they do to you in the hospital these days" or depending, I might just ask "hey, did you say natural or did you say vaginal, I missed that part" or any number of more indirect ways to point out what I see as a disconnect. As long as they aren't threatened, for the most part, women LIKE to talk about their experiences. I like women to talk to me about birth because then I can share my experiences too. And then we can all think harder about pregnancy and birth and the state of things and what it should be like rather than what it is like. Because ultimately, that's what it is all about -- helping women fully understand what choices they have and what those choices mean -- giving women all the tools to make safe choices for their babies and themselves, something that most women just don't have the knowledge or confidence to do. And I believe that the vast majority of pregnant women will do whatever it takes to have the safest birth they can...they just don't know what a really safe birth looks like, and the only people telling them are us -- the crazy, hysterical natural birth nazis....

So yeah, let's make sure we are clear on terminology. But let's mix that with a healthy dose of empathy and compassion for the women who've never had a chance to hear about a really natural birth.