Monday, May 7, 2012

Reflections on Unnecessary Things

Women who choose cesarean absent a medical indication for cesarean in North America are often portrayed in a negative light. They are deemed a drain on the medical system (at least in Canada). They are called "too posh to push". They are called vain. There are those who would even deride them as being somehow unworthy of motherhood - after all, giving birth vaginally is the way "nature intended". Some people might even declare that women who gave birth surgically, have not "given birth" and are somehow "lesser women". Any woman who has had a cesarean or is planning a cesarean, feels compelled to defend her choice or the reason for it, as there seems no bigger travesty than an "Unnecesarean". Even Canadian policy makers feel as though a worthy goal is to "reduce the rate of cesarean births" and "increase the rate of attempted VBACs".

This situation generates many Unnecessary Things, far worse than surgery among a group of women who could have had a "normal birth" if only they let "nature take its course", but freely and with informed consent opted out of "normal birth".

This situation "unnecessarily" legitimizes the denial of patient autonomy - a woman denied a cesearean absent a medical indication for it has no recourse. She often does not even have the empathy of others - after all she has only been subjected to what is considered "normal".

This situation makes finding sympathetic care providers "unnecessarily" difficult for those who would prefer an elective cesarean birth. Many women are forced into a situation that lacks continuity of care, or may have to travel to access the care they need.

This situation "unnecessarily" generates feelings of inadequacy among those who through no fault of their own were unable to "achieve" a vaginal birth.

This situation "unnecessarily" increases the risk of truly traumatic outcomes for mothers and infants. Many mothers believe that if they just push a little longer, labour more, or refuse an epidural that they can avoid a cesarean birth. Many might delay to the point of an emergent situation which then risks being "unnecessarily" unconscious for the delivery of their child, "unnecessary" complications, "unnecessary" disability, and "unnecessary" death.

Other "unnecessary" things that result from this situation are "unnecessary" pain, "unnecessary" vaginal tearing, "unnecessary" sexual dysfunction, "unnecessary" post-natal mental health problems, "unnecessary" reconstructive surgery, "unnecessary" incontinance, "unnecessary" bias in the information given to women planning on giving birth and "unnecessary" guilt.

In sum, the situation as it is today, "unnecessarily" jeopardizes quality maternity care. It puts process ahead of outcomes, and that is what necessarily needs to change.


  1. I love this post. I opted for a maternal request c-section with my first and second children after seeing what vaginal deliveries did to my family. Every single women who has given birth vaginally in my family suffered from incontinence, sexual dysfunction, and more. I was only granted this request because I was a first time mom at 36 and considered high risk. Otherwise I would have had to pay a private doctor out of my own pocket to have it done. It's also crazy how many people thought I was putting my baby at risk to have a c-section, not realizing that it's the safest way to be delivered for the baby. This is controversial information, but it's true. The majority of c-section risks are to the mother, and they are sometimes less than a vaginal delivery depending on the woman and her family history (as in my case).

    It's crazy how women aren't told about vaginal delivery risks until afterward! I had a friend who thought I had delivered vaginally who mentioned how much it sucks that she couldn't have orgasms anymore after giving birth like it was a normal thing. After talking to friends, it turns out it's more common that you would think. While I know that many women deliver vaginally with no ill effects, and c-sections also carry their own risks, we need to make sure women have ALL the information and not a one-sided view of risk so they can make better decisions about their own bodies.

  2. Jennifer - I fully agree that the information given to women making choices about their bodies and their babies needs to be more complete and up-to-date. It might also help if some of the things weren't quite so taboo.

    Part of me thinks that having a private option (note: I have reservations on this) might actually improve accessibility in Canada. Right now the situation is find a provider to perform the c-section in Canada under the public system or leave the country (at a cost of about $15,000 or more to access a c-section in the US). Patients undergoing cateract surgery have more choice - with the ability to pay out of pocket for the difference between a more advanced lens and a standard lens and the ability to access a private facility to get faster access (note the government still pays what they would have paid for the cataract surgery in the public system).