March 11th, 2010

Once a Cesarean, Rarely a Choice

This week the National Institute of Health held a consensus conference on the topic of Vaginal Birth After Cesarean (VBAC.) The purpose of this conference was to present and explore the current available information about the risks and benefits of both a vaginal delivery, and a repeat cesarean delivery, whereby the panel may ultimately present a consensus statement on the safety, efficacy, and availability of VBAC.

With the current national cesarean rate of 31.8%, a VBAC rate of only 7.8%, and nearly 40% of US hospitals banning vaginal birth after cesarean, many women are finding they have no choice but to undergo major abdominal surgeries for the delivery of their children. However, many women, alongside providers and educators, have stood in opposition to this forced surgery as a fundamental violation of the mother’s right to choose what happens to her body and her baby. When the NIH announced the VBAC conference, many activists, mothers, and providers, felt this was an opportunity to beseech the researchers to look at the information available and see how the lack of choice has been harming mothers, their families, and even their providers. In a show of solidarity, birth activists from all over the world came to witness the conference, ask questions, and share the stories of the ways that forced cesareans have affected their lives or their practice.

Much to the surprise and delight of the concerned activists, the resonating tone throughout the NIH VBAC conference was that of maternal choice, patient autonomy, and informed consent or refusal. While in recent years the relatively small risks associated with VBAC labor have driven providers to restrict access to VBAC, the NIH speakers presented clear evidence that there are serious risks associated with repeat cesarean delivery as well. Dr. Howard Minkoff even pointed to the 2002 Smith study showing the risk to the baby in a VBAC labor is about the same as any other full term, normal vaginal delivery. Consistently, the speakers stated that VBAC is a reasonable option, elective repeat cesarean is not a risk-free delivery, and that ultimately, it is the mother’s choice which of those risks to accept. None of this is new information to anyone interested in maternal and fetal health, but these revelations in this type of forum validated the feelings of the many mothers and activists who have spent years pleading for supported access to VBAC.

Though most of the conference speakers focused on the statistical medical data on vaginal or cesarean birth, one speaker illustrated the more personal side of the story. USA Today reporter, Rita Rubin, brought the audience on an emotional journey as she presented stories of families across the country who have picketed, battled, or even birthed unassisted in the name of preventing an unwanted and unnecessary cesarean. Throughout the conference, speakers and audience members made the NIH panel aware that many mothers demand access to vaginal birth, and that the VBAC issue will remain a contentious topic until hospitals and providers start respecting, and honoring, the mother’s right to choose.

Unfortunately, the language about informed consent and patient autonomy did not make it into the final NIH consensus statement, and when panelists were pressed on the issue, they failed to recognize that pregnant women have the same right to choose thier course of care as any non-pregnant person. Says Susan Jenkins, legal counsel for The Big Push For Midwives,

“The panel refused to take a position on whether a pregnant woman has the same constitutional right to informed refusal as any other adult in the U.S. This is unconscionable and I wonder what this administration’s take is on an HHS panel questioning whether pregnant women are entitled to the full benefits of U.S. citizenship in regard to patient autonomy.”

Time will only tell if the more positive points made by NIH consensus will have an impact on VBAC access in this country. From a birth activist’s point of view, the statements made by many of the conference speakers were a huge leap in the right direction. However, our cesarean and VBAC rates will not be reversed overnight, and in the interim, scores of women are left without a choice but to either fight the system for their VBAC, or submit to a surgical birth. To these women and their families, this is really no choice at all.

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This article was written for, and cross-posted at RH Reality Check.

March 6th, 2010

VBAC Access is a Human Rights Issue

Despite mounting medical evidence to the contrary, women around this country are being told that if they want to have a child after they’ve had a cesarean, they must undergo another cesarean delivery for the birth of their next baby.  Though the cesarean may be unwarranted and unwanted, these women are often left without any choice but to have this major abdominal surgery for no other reason than a paper policy written by a hospital administration who has never met, nor treated these women.  However, according to the AMA, the ACOG, and the letter of law, forcing a woman to have repeat cesarean is unethical, unprofessional, and unlawful.

How is it, then, that some hospitals have found it within their right to “ban” women from birthing babies through their own vaginas?  Why are some hospitals telling women they will not provide them with treatment unless they agree to a cesarean delivery, as opposed to a vaginal delivery? According to the Emergency Medical Treatment and Active Labor Act (EMTALA), any hospital participating in the Medicare and Medicaid program (which is most) cannot refuse treatment to a woman in active labor, even a woman refusing surgery.   The law simply does not support bans on vaginal birth.   Women do not forfeit the right to make their own medical decisions when they become pregnant.  On the contrary, they carry the responsibility of making medical decisions for the benefit of themselves, and their unborn child(ren.)

Aside from the medicolegal problems with forcing a woman into surgery, one must wonder about the ethical and moral significance of denying a women her own basic biological function.  Many women feel a tremendous sense of loss, violation, or defeat if they are unable to experience the birthing of their baby on their own terms.  These women can develop such a fear of repeating that experience that they stop having children.  Many women choose to birth future children outside the hospital to circumvent the system all together. Whatever their decision, many mothers felt they had little say in the matter because their hospital or provider could not be trusted to respect their wishes.  Some mothers say their choice might have been different if they knew a hospital could support their basic human right to bodily integrity.

Our Supreme Court upholds the right for a woman to choose whether or not she carries a pregnancy, and that same autonomy should be afforded to the manner in which she delivers her child.  At the end of the day, the woman (and her baby) live with the outcome of any delivery.  It is her body.  Her baby.  Her choice.

In a civilized society like ours, no woman should feel that she has been forced under a knife.  Women are human beings, and human beings in this country have the right to keep people out of their body.  If providers want to be taken seriously, they need to start taking their patient’s human rights seriously as well.

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If VBAC access is important to you, call in to The Feminist Breeder & Friends Radio Show Sunday night at 10 PM Eastern time to have your voice heard.  Special guests Desirre Andrews, President of ICAN, and Michele Demont, creator of Birthcut.com, will help me kick off my coverage of the National Institute of Health’s conference on Vaginal Birth After Cesarean.

February 10th, 2010

I’ve Been Annoyed with Feminists This Week

Perhaps you don’t follow a million feminists* on Twitter like I do, so you may not be aware that they/we are all pissed about the Tebow Super Bowl ad.  If you’re like me and you weren’t watching Super Bowl 44 either, then you really have no idea what I’m talking about.

Let me set the stage:

The notoriously anti-choice organization calling themselves “Focus on the Family” paid umpteen millions of dollars to run an ad during the Super Bowl that depicted Pam Tebow (the football player’s mom) being faced with the choice to either abort Tim, or keep the pregnancy.  Um, you can guess which she chose.

Now, the reason this is pissing feminists off is that CBS has never allowed this kind of controversial ad during the Super Bowl before, and we believe that a sporting event is no place for abortion politics.  But CBS decided to scrap their previous anti-advocacy ad policy and took the paycheck from Focus on the Family — a paycheck, as so many feminists have already noted, that could have gone to HELP women faced with unwanted pregnancies.  You don’t see Planned Parenthood generating Super Bowl ads because they use the money they get to help women.  What a novel concept.

So, the feminists and the Women’s Media Center were all over this one — even sending in the President of WMC, Jehmu Greene, to make an appearance on The O’Reilly Factor.  Unfortunately, as much as I think O’Reilly is a jackass who never lets anyone talk, I also think Jehmu lost the argument.  By the end of his stupid rant, he even had me thinking “Yeah, what’s the big fucking deal?  It was her choice.”

Now wait, I still know what the big-fucking-deal is — I am a pro-choice feminist after all — but it got me thinking that we had a whole lot of other feminist fish to fry this week that the mainstream feminists, and the Women’s Media Center, seemed to flatly ignore.

Yeah, I get it.  We’re pissed that some organization shelled out millions of dollars (making them poorer, btw) to put out some vague ad on the Super Bowl that probably didn’t influence anybody to do anything except go,

“Hey look — it’s Tebow.  And his mom.  That’s sweet.  But I’d rather see Danica Patrick’s tits in another Go Daddy commercial.  Now pass me the nachos.”

Meanwhile, elsewhere in the influential media last week…

There’s a woman strapped to an operating table, live on the Today Show, undergoing a cesarean delivery with no medical indication to warrant this major abdominal surgery, which the Today Show Talking Heads falsely touted as “medically necessary” for reasons that the ACOG do not even support.

And the feminists uneducated about cesarean awareness issues will say,

“Who cares if she had a cesarean!  It’s her choice!”

To which those of us educated on cesarean awareness issues would respond,

“It’s not an informed choice when someone tricks you into it. Talking a woman into major abdominal surgery for your own convenience and without any true medical indication is deplorable.  And selling your viewers that same snake oil is even worse.  That surgery just compromised that woman’s uterine health and patient autonomy forever, and probably for no good reason. THAT is why we care.”

And then the woman’s doctor told her on national television that she was free to birth vaginally next time, and what he must have meant by that is that she’s “free” to have a VBAC as long as she can find one of the few doctors or hospitals left that will truly support her decision to birth vaginally after a cesarean.  And if you’ve ever been a mother looking for a supportive VBAC provider, you know what an impossible task this can be.  My OB also told me I could have a VBAC when I was strapped to that OR table.  What he meant by that was,

“as long as you don’t try to birth vaginally during my daughter’s birthday party, because if that happens, I’m going to try to force you to have a cesarean, which you will spend 38 hours fighting off, and eventually you will birth vaginally, but I will have ruined your birth experience in the process — so yeah… birth vaginally on my terms, and on my schedule, or suffer the consequences, lady, because now that you have a nice uterine scar, all I have to do is say the words ‘uterine rupture’ and I can get you to do pretty much whatever I want.”

Oh, and then on Good Morning America, Giselle Bündche’s graceful, natural home birth in a tub has some talking heads over there spouting off all the “risks” associated with water birth — you know… the “risks” being that if you’re birthing comfortably in the water, then you might have a less painful childbirth, and the hospital then will not get to poke you with all their pharmaceuticals and non-evidence based, non-woman-friendly policies.  Water birth is very bad for hospital business, you know.

So all the while that women’s reproductive choices are being trampled on in mainstream media outlets last week — where are all the feminists? Where’s the Women’s Media Center?  Where, Where, Where?!?!

I’ll tell you where — they’re busy paying more lip service to a Super Bowl commercial than it deserved.  They’re busy pretending that most women would elect a major abdominal surgery even if they truly knew the risks involved, and that abortion is the only reproductive justice battle we have to fight.

Well, I’m one feminist who will spend my fight on the women who are being cut into without informed consent, and on the women who want to give birth where ever they need to even if it won’t make the local hospital a nickle.

I just wish the Women’s Media Center would report on these crimes against reproductive rights.  They can start by sending a letter to NBC.

Tell me, if you’re a feminist, what have you done to help birthing women retain their legal rights to patient choice and informed consent?  If all you’re fighting for is abortion access, think about moving a step beyond that every once in awhile, and helping the women who choose to continue the pregnancy.  They need justice too.

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*oh, and don’t get all nit-picky with me, I know there are some wonderful feminists fighting for birth choice — you know who you are, and so do I, so I didn’t mean you.

January 25th, 2010

Women Hating Women on the Metra Train

Each month, the Metra Rail (which is our Chicagoland commuter train) publishes a newsletter called “On the Bi-Level.” Each newsletter contains travel notes, service information, and a special section called “Sounding Off” where commuters write in to compliment or complain about the service they receive, or their fellow travelers.

In December’s issue, a very pregnant woman named Kate wrote in to “On the Bi-Level” to complain that her fellow Metra passengers weren’t offering her their seat, even though they could clearly see she was pregnant. If you’ve ever been a pregnant woman on public transportation, you’ll probably understand where Kate is coming from. I cannot think of anything more uncomfortable, and potentially dangerous, than standing on a moving vehicle that’s flying down the tracks at 50 miles an hour while trying to hold something that feels like a bowling ball in your bladder, as your 25 lb uterus pulls at your back while simultaneously pushing down on your swollen ankles. To put it lightly, it sucks. There are really only 3 things a woman needs when she’s pregnant; food, gallons of water, and a place to sit.

But instead of understanding Kate’s frustration, her fellow passengers took the time to write in for the January newsletter to tell Kate to go fuck her whiny, pregnant self.

In response titled “No Sympathy Here,” Liz writes:

A big BOO HOO to Princess Kate, the pregnant passenger who was very upset that no one offered their seat. My my, since when was pregnancy such an enormous disability issue?

You seemed to be able to muster the strength to walk two full car lengths to take note of the seating situation; and you sound a little irate that nobody literally jumped up to rescue you by offering their seat. Sorry, toots, this was a situation you chose to be in… there are people out there who can’t have kids, such as me, and I’m NOT going to give you my seat. Tough out the discomfort for nine months. Some people will never experience it.

And Liz wasn’t the only one. Here Adrienne writes:

This is for Kate and all the other pregnant women who whine about not being offered seats on public transportation. They somehow feel they are more entitled to a seat than anybody else, and every seated passenger should feel guilty for not jumping up and falling all over each other giving up their seat. Yes, it would be courteous, but it’s certainly not mandatory. How are we supposed to know you are pregnant and don’t just have a large stomach? Perhaps you should either walk through the car with a sign, make an announcement when you enter a car or simply walk up to someone and tell them to get up. Also the handicapped seats are designated for “customers with disabilities.” As far as I know, being pregnant is NOT a disability or a handicap. It’s also very possible the seated passengers might have a disability that is not obvious.

If the roles were reversed and you saw a woman you thought was pregnant, how likely would you be to offer your seat?

Thankfully the Metra took this opportunity to put their $0.02 in and offered the following:

We got a few letters in response to Kate. All of them were from women. All of them were entirely unsympathetic to her plight. Be we don’t think Kate was wrong to expect a little courtesy. We should all expect it, and give it, too.

Knowing that women, and only women, wrote in to rag on Kate makes me really sad for the political state of my gender.  Just sad.

Listen Liz and Adrienne, get off your ass and give Kate your seat, or you will have more bad karma than you can shake your nasty attitude at.

Do you have any stories like this to share? I’m sure they’re out there.

January 8th, 2010

Mean Girls Grow up to be Mean Women

My feminism aches from the nastiness I see women throwing at other women, especially on the internet. People say things to other people they would never dream of saying to their face. And I’m not just talking about the disagreements – it’s okay to disagree, healthy even.

But WHAT is with the name calling?!! Seriously, are we 12? The name calling starts when you disagree (whether directly or indirectly) with a person’s sentiment, and they turn around and hurl insults and expletives at you instead of formulating a respectful (or at least mature) response.

And the bullying? The bullying occurs when someone doesn’t like something you’ve said, and they write entire blog posts dedicated to what a horrible, stupid person you are, then post links all over any relevant site in an effort to persuade their network of “friends” to come to your blog and harass you along with them.

And my god, the stalking?! Stalking occurs every time we hang around someone’s space who we do not like at all, and have no business even reading. I mean really – if you don’t like the author, what in the world are you doing reading her thoughts? That’s just twisted. Either you’re looking for ammo or you’re a masochist. Either way, not good.

I’ve seen this behavior out of females from early on in my childhood. Attending 26 different schools between K-12th grade meant I was always the new kid, and we all know how new kids get treated.  Being poor as hell, having bright, firey red hair, and developing quicker than the other girls made me an especially obvious target.  I left school crying many days over the torture I received.  One day, after the bullies told me I smelled bad, I shoplifted a stick of deodorant from the local convenience store because my grandparents didn’t have any money to buy me any.  And because thievery is not in my nature, I cried the whole way home and promised myself I’d never, ever steal again, no matter what bitch said I stank.

As a result of that treatment, and the nightly beatings I got growing up, I have always been an outspoken advocate for people who are getting treated like crap.  When I was in high school, I often came to the aid of girls getting bullied. While the other Mean Girls would stand around the locker room yelling insults at the poor freshmen girls for nothing more than the crime of being younger, I’d stand in the middle and tell those Mean Girls that their behavior was hurtful, and I’d tell the freshmen girls that the Mean Girls were just jealous and immature.  Veronica Arreola recently described me on twitter as a feminist who “supports mamas w/a vengeance!”

Damn straight.

Some people – people who don’t know me well – assume that my firey, outspoken nature means that I’m one of those Mean Women.  But people who know me see that’s the furthest thing from the truth.  I am a compassionate, empathetic, loyal, caring person who simply cannot tolerate the injustice I see in the world.  There is a major difference between being the Bully, and being the Person who fights back ferociously on behalf of the victim.   I don’t like this Mean Girl behavior, and I won’t take it laying down, whether it’s directed at me, one of my friends, or even a total stranger who I’m merely sympathetic to.

But of course that comes with a cost. This makes some people think that it’s okay to say hateful, awful things to me.

When I stuck up for a homebirth mom who lost her baby, @JessicaGotlieb called me a “raging asshole” and implied that I was stupid.  I’m not surprised after the article she wrote about the poor, homebirthing mother.  And you guys know how I feel about women who deny that birth rape can exist. *shaking my head*

When I told Elita @blacktating on twitter that I wasn’t going to let her bully me, she called me a “nasty bitch” and a “racist” in response.  I guess it really upset her that I wasn’t going to participate in her attack on me.

But I’m just embarrassed for them.  No matter how many double birds I’ve thrown at my computer, I don’t make it a habit of publicly attacking a fellow woman like that, especially without any direct provocation.  Especially not someone in my tiny, close-knit community of mom bloggers, activists, or advocates.

This infighting has GOT to stop.  I’m not saying we should all agree, because we most certainly should not.  As responsible, thinking women, it is our responsibility to debate the issues and work on the scary solutions.  But, please, if you’re hanging around the blog of someone you hate, close the damn window and walk away now.  Or, If you’re tempted to repost somebody’s words all over the internet in order to drum up hatred for some person who couldn’t care less about you, just cut it the fuck out.  That’s nutcase behavior.  And, if you’re one of these women who thinks that name calling on Twitter (or your blog, or a comments section) won’t come back to haunt you – I’d like to let you know I’ll be at BlogHer ’10 this year.  Come say that shit to my face. I triple dog dare you.

Let’s get it together, ladies.  We are grown ass women.