Newsflash: Doctors Ban Bowel Movements

There is so much talk about VBAC floating around on the ‘nets lately! I was going to write a long article about all the medically sound reasons for VBAC and all of the lack of evidence for VBAC bans, etc, etc but honestly, that’s all been covered by far more qualified individuals than me. So I’m going to stick with what I’m good at: Standing on my soapbox ranting about My Opinion!

All the talk of VBAC these days is just dripping in terminology that turns my stomach. What has happened to the recognition of the mother? Feminists demanded equal rights and we got it, sort of, EXCEPT in the circumstance that we happen to be pregnant. Suddenly we’re objects (or worse, mentally handicapped idiots incapable of reason)! If a mother valiantly births her child in the back seat of a taxi cab, who gets the credit? THE TAXI DRIVER. If a woman gives birth at home and her husband happens to reach down at the last minute and catch the baby, does SHE get the credit for hours of labor and all of that immensely hard work? HA, no. Her family members will come over and congratulate DAD for “delivering” the baby (true story, my 2nd birth, first homebirth and yeah, a week of early labor and 7.5hrs hard labor and who gets a pat on the back? Yeah, my husband. He was awesome but not even he claims to have “delivered” our daughter).

It gets even worse when you bring VBAC into the conversation. Suddenly the question is whether or not the doctor “offers” VBAC or if he “allows” a trial of labor or if he will “perform” the delivery. GET A CLUE. Doctor’s don’t “perform” a VBAC any more than they “deliver” babies. Mothers give birth. MOTHERS deliver the baby. The only time a doctor actually DELIVERS a baby is when he cuts the baby out of his mother in the OR. Otherwise, it’s the mother who has grown and then births her child. PERIOD. But see, if we don’t insist that VBAC is a procedure then we can’t keep right on insisting we don’t “offer” it, can we? VBAC, people, is a normal birth. It just happens to be performed by a woman who has previously had a cesarean! There are some very good reasons why a repeat cesarean may need to be *performed* in specific cases but overall, nobody but MOM needs to DO anything when VBAC time comes around, other than offer actual, factual support. The reality is that if a doctor is saying “I don’t do VBAC’s” what he’s actually saying is “I refuse not to meddle with your birth and I AM going to cut you”. We need to get away from this idea that vaginal birth is a procedural option. Vaginal birth is what happens when you don’t DO anything! It’s the natural conclusion of pregnancy! It’s kind of like a doctor telling a patient that he doesn’t DO bowel movements! Come on!

And since when are mothers children that need permission to do something that is an inevitable given? Pregnant women give birth. It makes zero sense to me to suggest that you can’t “allow” a woman to do something she cannot help doing. Many hospitals insist on their VBAC bans because they claim to be following ACOG’s guidelines of not “offering” VBAC’s when they don’t have 24/7 anesthesiologist in house. The problem with that is that emergencies can occur, requiring cesareans, regardless of the history of the mother in question (VBAC or not) at any time of day! If we follow the logic of THAT recommendation, we must assume that only VBAC mothers go into labor at 3am OR that all vaginal births are fraught with horrible risks and therefore all mother should be “delivered (via c-section) rather than “allowed” to conclude pregnancy naturally. As this logic was has been thoroughly ripped to shreds by just about anybody with two bits of sense to rub together, I have to wonder what is keeping hospital policy makers from reversing these unethical, non-evidence-based VBAC bans. Hmmmm. There are plenty of reasons when looking at the individual cases, I’m sure, why VBAC may not be a good idea but a BAN on ALL of them? You’re telling me that it’s not safe for 32% of this nation’s women to give birth? Something’s not adding up here! Wait…adding up, adding up…what adds up exponentially when 1/3 of the nation’s women undergo surgery instead of giving birth?! *gasp* Money!

There, I said it. M-O-N-E-Y. Major sticking point. I know, I know, that makes me sound like a conspiracy theorist. I know it does and I don’t really care. Just because an idea sounds distasteful doesn’t make it automatically paranoid delusion. The reality is that c-sections make tons of money and they are convenient for doctors because they are much faster than normal birth and can be scheduled at the staff’s convenience (Mom, again, you just aren’t a person in this context and neither is your baby…except as a bargaining chip to get you to cooperate). Ok, so I know I’m over-simplifying the issues at hand here and I know money isn’t the only motivation behind VBAC bans but I can say with relative confidence that it’s the biggest motivation. Hospitals and individual practitioners don’t want to get sued. It’s expensive! It even costs them if they win because then their insurance premiums go up. Malpractice insurance is already astronomical. Here we can see that even fear of litigation comes back to the money (SHOW ME THE MONEY!!). God forbid we should be concerned about the actual outcomes of delivery! If we were then our cesarean stats would be considerably below 32% . Nobody likes to hear this but well, sometimes the truth is ugly.

Mothers? Ultimately, medicine in this country is a business. I know perfectly well that there are plenty of excellent, conscientious doctors running around. There are just as many out there, though, that think they can balance “safety” with their revenue. You want VBACS? You’re going to have to make the money talk. We have options! Give birth at home or in a birth center if your local hospital refuses to work with you. Ooops, they just lost somewhere between 10 and 25 THOUSAND dollars. The more women that choose to vote with their wallets (or their insurance carrier’s wallets) the more likely these policies are to change. It deeply offends me that we are forced in this direction. Sound reason, ethics and evidence, apparently, are not enough, though. Don’t fall for the prevailing attitude at ACOG: “Silly Mommies, only caring about your experience”. That is a bunch of bullshit. Mothers who desire VBAC desire yes, a good experience (I know, how selfish to desire one of the most important, defining moments of your life to NOT be torturous) and above that, a healthy, normal, safe experience for themselves and for their children. I reject the notion that women are less important than their children. Women and babies need each other and BOTH deserve a healthy, safe start at their lives together.

Right. *deep breath* Stepping off the soapbox, now…