Wednesday, September 30, 2020

Cesarean: Is It the "Conservative" Choice?

     I had an interesting conversation the other day; one that left me thinking for days. A friend who works in a local hospital was talking with me about VBACs.  We have few obstetricians that will perform VBACs, and he was telling me about how scary it was for them to be willing to do these. He poked fun at the physicians who were stupid enough to let women try for a VBAC. I tried to just listen and see where he was coming from. Now, I know that my community is years behind some of the larger cities in the United States, but he used a word that I was not expecting in this conversation. The connotation of this word and its relation to the birth community left me perplexed for weeks. His word was “conservative” and he spoke of this community being “conservative” in medicine as well as other things.

     To him, this was an honorable trait, but to me I thought it was a misuse of the word. You see, I consider myself to be a conservative, which in my eyes means that I relate to ideas of old and don’t accept change easily. In my search for understanding, I looked up the definition of the word.

Conservative – “holding to traditional attitudes and values and cautious about change or innovation, typically in relation to politics or religion”

     Where I had difficulty with this was in his thought that having repeat cesareans was a “conservative” way of thought. After all, the original way of birthing a baby was vaginally and not surgically. The change and innovation came when cesareans were first used. Don’t misunderstand me. I believe that some cesareans are necessary, but too many times women are not given a chance. Especially in my community, where this “conservative” way of thinking leads to repeat cesareans and VBACs are considered to be just too dangerous.

     As a doula, I once attended a homebirth transfer in which the obstetrician encouraged the couple to have a cesarean when they came in. Now, the mother was not in labor and was looking to have an induction. The physician was tired and said it had been a long weekend and he had lots of patients to see on Monday. He asked the couple to opt for a cesarean as it was a “non-invasive procedure”. I was flabbergasted and so were the parents, who argued and asked how he thought a cesarean would be considered non-invasive. I know that for the doctor, he is used to doing this procedure, but in no way does that make it non-invasive or lacking in risks or complications.

     I find that the risks are stressed more when women are requesting a VBAC and yet when a cesarean is decided, rarely will a woman be told what complications could come. Whether a vaginal birth, cesarean, or VBAC, all come with risks, but should be decided by the mother and based on her preference after she has been given all the information and all her options. VBACs should not be restricted as an option just because a community is “conservative”, no more than cesareans should be favored in a “progressive” community.

Sabrina Elliott