Friday, June 18, 2010

Fire & Rescue

Here's what we're talking about.

You're on the second floor of a burning building. Fire completely blocks the door of the room you're in. Your only chance of surviving is by jumping out the window, despite risk of some injury. Of course you're going to jump. This is absolutely a lifesaving action.

Bruises or a sprain are a probability, a broken bone is quite possible. Other major injuries are a lower risk, but still real. Once in a great while you could even be killed by jumping out the window, but the chances are very low, and it's absolutely worth the odds and the healing time to recover from the fall. After all, staying inside the house means facing certain death. THANK GOD we have the option to jump.

Now take the fire out of the picture. The house is perfectly fine.

Is jumping out the window still an equal choice to going down the stairs and walking out the front door?

It happens almost every time the cesarean epidemic is discussed these days. The most recent skirmish that I know of, which motivated this post, was, relatively speaking, a very minor one (a site rating blogs was discussing our mighty friend The Feminist Breeder). Sometimes the conversations go on for days, comments numbering into the hundreds. No matter the specific conversation, whether it's a story on how significantly the risks increase with multiple c-sections, or the possibility of increased likelihood of various lifelong problems for children born surgically, or simply talking about ways to avoid it, someone - and often multiple someones - posts defensively about their own cesarean experience, pointing out how it saved their life, their baby's life, or the live of a loved one or a loved one's baby. In many cases this is clearly coming from an emotional place, often quite a raw one, and very understandably so.

I would never argue the validity of someone's else's birth, and there is NO doubt that cesareans are lifesaving miracles when they are necessary. No doubt whatsoever. And I believe I can safely say that I speak for the vast majority of birth advocate types on this. I am so thankful that cesareans exist - they truly are a wonder of modern medicine, and we are lucky to live in an age where they are available. Sometimes it gets tiresome to have to preface any discussion of cesareans with this lengthy disclaimer, though, as genuinely as I mean it (and I do really mean it).

Once and for all (maybe): It is the unnecessary ones we are talking about. We know that houses do sometimes catch fire. And we know that sometimes it happens even when the house had been at low risk of catching fire, even when precautions are taken. It is when the house is NOT on fire, and a combination of factors pushes women - and their babies - to jump out the window anyway.

I realize that this analogy is a simplification (as all analogies do eventually break down). A house being on fire is a pretty absolute, concrete situation, whereas the reasons for cesarean are definitely a judgment call much of the time. But there is a core truth there, as well as other ways to stretch the metaphor.

A la: A toaster catching fire CAN, in fact, lead to the house catching on fire, which could then lead to jumping out the window. But does it then follow that as soon as we smell smoking bread, we should jump out the window? I would submit that we try to put out the toaster fire itself first, and further point out ways to avoid the toaster catching on fire in the first place. And we should also give thanks that modern technology has made jumping out the window safer than ever, if the fire department has assembled and is holding a good quality safety net*.

I could go on like this for way too long -but you catch my drift. So once again, when we ("we" being rather broadly defined here) discuss our myriad concerns about the growing cesarean epidemic, we are not denying the truly life-threatening situations that have indeed saved many lives, or criticizing the mothers in those life-threatening situations, or suggesting that she would be a better mother/woman/human if she had refused the lifesaving cesarean. We just don't want other mothers to be pushed out the window for no good reason.

* Thoroughly off-topic aside: one of my best friends was a firefighter and paramedic, working for a time on a campus-based volunteer service. Once year the batch of new trainees was learning how to hold a safety net, and was having some trouble organizing their group to do so effectively. One rookie piped up, "Well, can't we just lay it on the ground?"


  1. I'm glad to see you writing! No reasonable person disputes the data; there are too many unnecessary surgeries being done, not only c sections, but all sorts and kinds. Medicine is aggressively defensive on all fronts. What changed for me, over the years, was my willingness to assume that those "emotionally based" stories from women about their surgical births bore the colors I painted on them. All birth stories are coming from "an emotional place" that is, inevitably, "raw". Birth is always raw, it doesn't matter how or where it occurred. Women who give birth surgically feel, rightly so, that they have to defend their experience to "natural birth advocates" and unfortunately, "we" have set up a situation where a woman who crows with joy about her c section birth is assumed to be either deluded or in denial, both of which are insulting and demeaning positions to take towards anyone. We assume, often wrongly, that these women simply don't "get it" or, that given all the information and tons of support, they would choose something else. My own experience as a midwife and a mother have taught me otherwise. Years ago, in the midwifery community, we used to say that "women birth the way they live" and we believed it and took it mean that the way a woman does anything is also how she will likely give birth. Women in our culture are overwhelmingly attached to technology, like this particular media-box we're utilizing right now. They (we) ignore the potential risks of exposure to radiation, the assault on our neo-cortex due to our constant multi-tasking and other "potential" risks because this technology suits our needs and we want to use it. "We" would hotly defend our choice to use this technology, touting it's wonders and benefits, even in the face of a lot of evidence (and there is a lot of evidence) that long term overuse of any technology impairs various human capacities and well-being. Women do not exist in one context when pregnant/birthing and another the rest of the time. For a group that uses the word "holistic" as often as we do, we make a real hash out of actually applying it. Women are not walking wombs! Women are whole persons who make their decisions about everything, including birth, based upon their own values and perceived needs. Women make their birth choices in the same way they make their other choices. If you really talk to a woman about her life and lifestyle, you will find a consistent thread that will, inevitably, determine how/where she chooses to birth most of the time. That reality is played out very clearly in our statistics including the demographics of who chooses home birth or midwifery care, and the percentage of women who choose what is still considered an "alternative"; about 2%. They choose what suits their cultural, educational, social and emotional "background" and the primary reason more women don't choose natural birth, or midwifery care, is that it doesn't fit the current high-tech cultural paradigm we all live in.

  2. Very well-put! I quite agree, really.

  3. Agreed. It's disheartening to live in a day and age where adults decide to deliver a baby early for convenience. Where women are scared into thinking that their bodies are somehow so defective that they couldn't possibly have a natural birth. And one in which they are not made aware of the very inherent dangers of major surgery (it's just a c-section, after all). It's sad to see people put so much faith into the "powers of technology" forgetting that the power of nature is what got them here to begin with.

    I'm not against c-sections, or a woman's right to choose a c-section...but I would hope that women put as much time, thought and research into her birth choices as she does in to shoe shopping.

    Sadly, though, that rarely happens.

  4. Anne I just wrote a post on cesarean and choice. I read this right after I hit publish. The topics were so similar I linked to your post. Here's mine

  5. I am going to use your fire analogy. It explains it perfectly... I had no idea what was going on until you started talking about cesareans. :)