Friday, April 23, 2010

Self-righteousness and Superiority

There is a woman from church that I am assigned to serve with. I visit with her once a month; she's 31 weeks pregnant and has a son a few months younger than mine. She's having an induction, the date is already set. The reason? Her first labor went so quickly that she never had time for an epidural and the pain was unbearable- sounds pretty reasonable, right?. Her first baby was "large" (8 pounds) so the scheduled induction is fairly early- I think 38 weeks.
I'm very proud of myself, I bit my tongue. I didn't say "did you know that an elective induction is almost TWICE as likely to cause fetal distress (where the baby isn't getting enough oxygen for extended periods of time)?" I did say "I can imagine how scary it was to not have an epidural when you had planned on one- that kind of pain takes a lot of preparation and when birth doesn't go according to plan it can be hard to adjust". That's as preachy as I got about NCB (natural childbirth). I was proud.
The reason for me moderating myself? Days prior on facebook, a friend had mentioned being all for epidurals, another friend (NCB-friendly, though perhaps a bit colorful) went off a bit on him, so I found myself private messaging him my views on epidurals in an effort to smooth things over. Even then, he felt attacked and judged and I felt horrible because that hadn't been my goal. It made me re-examine how I view other women's birthing choices.

I have a problem not judging mothers who take unnecessary interventions in their labors. Unfortunately, that means I'm judging 90% of women out there- including many good, dear friends. It's not so much judgment as confusion. HOW could you NOT research the possible side effects of a scheduled induction or c-section? If they knew that the induction greatly increased the odds of fetal distress, the pain of childbirth, and the risk of emergency c-section, they wouldn't choose it, right? Surely if they knew that a c-section QUADRUPLED the rate of maternal death, they would at least try labor, right? And that doesn't even bring in the dangers of subsequent cesareans.

My passion around natural childbirth is not just from fuzzy feelings about the power of women, it's from real evidence of better outcomes! How can I soften that to not make it sound like women who haven't been exposed to that evidence are somehow remiss? How on earth can I phrase it so I don't sound like I think MY way (that is, only allowing interventions when they are truly medically necessary) is the only right way (when in fact, I guess, that is how I feel). How do I convince them that I don't have some huge ego to think I know better than their OB (When I do think that for normal, uncomplicated pregnancies, the mother, if she keeps herself informed, does know better than most OBs- who the statistics show take unnecessary risks and have worse outcomes than if the labor is led by a midwife or the choices of an informed mother).

But then I remember back to my own birth, and how, even after all the research and studying, I was willing to trust my OB. I remember when my OB wanted to break my water at 36 weeks because I was dilated to a 6, I thought it sounded like a good idea. She made it sound so urgent. Heaven knows I wanted to meet my baby and I was SO sick of not knowing when I would go into labor. It was so easy to justify that intervention for the small amount of control it would give me. I was going to go home and think about it.
So I did. I asked my sisters (older and wiser) and I asked my online Natural Chilbirth forum what they thought. My sister couldn't figure out why I would consider it, why I would take that risk. I felt judged for even thinking about it. Even after my labor, I felt judged for the interventions I allowed. I can never go back and change the way I did things, so why should I feel guilty about it? My baby and I were both healthy, so why the guilt? Unfortunately, I will always have to wonder how the labor would have gone without those interventions. Would I have torn so bad (not likely)? Would Daniel have had jaundice if he had baked longer (not likely)? Would he have turned around if I had waited for his cue for labor, so I wouldn't have had such painful back labor? I'll never know. But I certainly don't need external sources make me regret those decisions more.

So why am I now judging others? Well, a lot of it is the information I have. I'm currently reading Pushed by Jennifer Block and I just want to shout from the rooftops that EVERY woman should read this book before giving birth! Every page or so I read some jaw-dropping statistic about the things that go WRONG with interventions and the things that go right when labor is allowed to progress at its own pace. Worse yet, page after page shows that OBs simply don't know what to do with a labor that goes right- they have to "manage" it, they have to speed it up, they have to intervene, often ignoring the evidence and international recommendations against it.

And really, it's not judgment. It's wanting to insert knowledge into their heads that THERE IS A BETTER WAY. So... if it isn't coming off as self-righteousness, it's a superiority complex. Great. And NCBers often come off that way- they think they know more, they think their way is better, and they often shame women who have had unnecessary-intervention-ridden births (And often, regrettably,  the women who had NECESSARY interventions feels shame as well). No one wants to hear that there birth was "wrong". And no woman wants to feel guilty for believing a trusted birth professional when he said there was no risk for the epidural/induction/c-section.
But the fact of the matter is this- the NCBers I know DO know more- indeed, I would say of the women I know, that the more research a woman has done, the more likely she is to plan an intervention-free childbirth (and by research I don't mean "finding out which OB has the happiest clients"). And it sounds wrong to say it because it is so "superior", but a planned intervention-free birth IS a better way of birthing.
A few of these informed NCB women DO end up with interventions- surely less than the average rate, but it does still happen- but they can rest assured that they CHOSE those interventions because the risks of not having them (medical necessity) outweigh the risks of having them. There is no guilt in allowing an intervention when the mother knows it really is necessary, rather than when the OB (who wants to clear out a bed or get home for dinner) says it is necessary.

So the moral of this long post? I do not judge any choice a mother makes in childbirth- so long as it is an INFORMED one. 


  1. I completely understand how you feel. People tend to get really defensive about their births, and it doesn't do anyone good to make people feel bad. I often don't say anything in situations like the one you described and then later I complain to my husband about how frustrated listening to it made me. He always asks why I didn't say anything--with as strongly as he knows I feel about NCB, why don't I promote it more? It's because it's hard to find a balance between sharing information and offending people.

    I fully respect the rights of women to make birth decisions different from my own, but I also have a hard time respecting any choice I see as uninformed. The problem is, most people who are uninformed don't realize it. If they did they'd get informed. They think they are informed (I certainly used to) and find any insinuation that they're not, insulting.

    That is not to say I don't think there aren't fully women who make fully informed birth choices different from what I would choose, think I would choose, or see as ideal.

  2. Hi, I don't know you and stumbled across your blog...hope it's ok I comment. I had a natural child birth with my first at a hospital and plan to do the same with our next. I had a hard time sometimes with people that use excessive intervention, but here is something i came up with and perhaps it will help you. I loved my birth because I did it natural, but my sister loved hers because she had a great epidural that she didn't feel a thing. Birth is such a spiritual experience that I decided if someone needs intervention to think and remember birth as a beautiful thing then it's ok (for them). (although in my opinion inductions are ridiculous earlier than 41 weeks, great blog by the way)

  3. I don't think I could have written this post any better. It has so many of the things that I think about ALL of the time. It is a fine line that we walk, but I think you are right, we know more about birth then most Dr. Thank you for this post.

  4. When I was in my third trimester with my last baby, it seemed EVERYONE around me was having inductions (at 37-39 weeks). It was kinda hard to bite my tongue, but I wanted very much to be respectful of other people's pregnancies and experiences. It got even harder when my best friend was fighting tooth and nail to keep her baby inside for every additional day she could get (ended up giving birth via c-section at 25 weeks, the baby was 15 ounces . . . her baby is doing AMAZINGLY now, still in NICU but nearly 6 lbs. now). When I'd hear people talk about wanting to just be done and how early could they talk their doctor's into inductions, I wanted to grab 'em by the shoulders and shake them and tell them they should be thankful for every day their little one spends inside until the baby & Mom's bodies decide the baby is done. When I went 6 days overdue, people thought I was crazy, and I was hounded daily why I wasn't getting an induction. It was hurtful and obnoxious to hear the comments. Which is why I tried to keep my own mouth shut about their experiences -- nobody wants to hear they're doing something 'wrong', especially about something like birth. But, at the same time, without people sharing their experiences, I would've had a third epidural birth this time around, rather than the AMAZING natural birth I experienced. So, I guess it's a fine line. That I wish I knew how to walk! :-)