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Part One: “But your child might die” the right to defy doctor’s orders

by Genevieve Tait
08 April 2015
HEALTH AND MEDICINE

This is the first of a two-part debate by different members of the medical community on the topic of what is natural and what is reasonable when it comes to birth and a mother’s right to choose her delivery method. In part one, Genevieve Tait worries that many mothers who insist on vaginal birth against medical advice are competing for a fraught badge of womanhood at the risk of their life and the life of their baby.

I recently spent some time working with an obstetrics team at a Melbourne hospital.
 
I just might have witnessed a new and unexpected Vagina Liberation movement – where women are so proud of their vagina’s capacity to deliver children that the organ has taken on an identity status all of its own.
 
I frequently saw women wax lyrical, and sometimes even territorial, about their vaginas and vaginal birth.
 
It would seem that vaginal birth has gone from a functional use of anatomy to a source of competitiveness and entitlement that can be life threatening for expecting mothers and their unborn babies. And birth has become some kind of holy experience, rather than the mechanism by which another life enters the world.

 

Vaginal birth has gone from a functional use of anatomy to a source of competitiveness and entitlement that can be life threatening for expecting mothers and their unborn babies.

 
I saw many expecting women assert their desire for vaginal birth, even when that birthing method posed particular risks for themselves and their baby. Some women refused to allow for any blood tests or examination in case the result triggered the doctor to recommend induction, early epidural, or C-section.
 
Every woman should have the right to make a choice about her birthing strategy and her body. This right is inalienable. But sometimes I worry that women get so concerned about how they are going to deliver the baby that they forget about the actual welfare of the baby.
 
I worry they forget that the obstetrician is trying to manage the health of two people, and so any recommendation coming from that doctor is intended to benefit two lives. Whether a baby first glimpses the light of day via the stomach, in a pair of forceps, or via the vagina, what matters is that the baby arrives alive and the mother stays alive.
 
If I had a dollar for every time I heard that “vaginal birth is the most natural thing you can do” I wouldn’t be suffering such crippling debt from my medical degree.
 
I hear it in the hospital, I hear it on the bus, I hear it from my clucky friends.
 
To me, this statement is absurd.
 
Vaginal birth is the best option for some mothers. If we were all to live only as nature intended it, we need only look as far as those less privileged parts of the world where medical intervention isn’t available – nature kills mothers and babies. If these women are so opposed to medical advice (a specialized body of knowledge that is naturally evolving over time), then when they next get pneumonia they should just cross their fingers and hope to get better, or press their palms together and pray.
 
The capacity of the female pelvis and vaginal canal to accommodate the passage of an enormous fetal head leaves only millimetres to spare – if you try to add 1cm of width by inserting a pair of forceps, you more often than not end up with a tear.
 
Attention base jumpers and other thrill seekers: try giving birth.

 
Every woman is different – so it doesn’t follow that every birth should be the same.

 
Every woman is different – so it doesn’t follow that every birth should be the same. And yet, somewhere along the line, these women seem to have internalised the pervasive and pernicious notion that without a vaginal birth they are less of a mother and less of a woman.
 
Where did they swallow this misinformation?
 
I point the finger in a few directions but I poke it at parenting blogs and forums. Not all of them. Some of them are great. But so many of them spew up little else than gossip mongering, anti-intellectual, fad-driven peer pressure for grownups.
 
And don’t get me started about the current trend for home births and all the YouTube videos they inspire. Here are women so desperate for low-intervention, non-clinical deliveries in settings where incense burning won’t set off the fire alarm, that they are willing to flout the fact that home birth doubles the neonatal death rate.[1]
 
Women are demanding natural births but often those women have bodies and health issues that are a long way from the idealised body type discussed in natural birth forums. Pregnant women today are often very physically different to the pregnant women of a few decades ago. Today’s expecting mothers are more likely to suffer from: high blood pressure, obesity, gestational diabetes resulting in very large babies, mental illness, drug addiction, age complications, and domestic violence. All of these factors complicate birth.
 
For a number of women I saw, their insistence on vaginal birth had very serious consequences that could have been avoided by way of an alternative birthing method.
 
I attended the prenatal visits of a severely obese forty-one year old woman who refused any prenatal care other than ultrasound as she clearly saw the obstetrician as some evil agent seeking to suck her baby out of her navel with a vacuum cleaner.

 

The obstetrician suffered this hostility with dignity and followed through with this worryingly well-rehearsed advice: it has been found that more than 50% of mothers who die giving birth are obese, and 30% of stillbirths or neonatal deaths were born to obese mothers[2]. She didn’t budge.
 
Another woman had been sent to the ICU after suffering eclampsia – she refused any tests that may have identified such a complication because she was adamantly opposed to undergoing C-section or induction.
 
Another woman’s baby suffered brain injury and renal failure due to the delivery delay attributed to her violent defense of her right to vaginal birth – despite her baby having a dangerously low heart rate in-utero.
 
These were not the only examples I encountered. And I worry this particular Melbourne hospital is not the only one where the Vaginal Liberation movement is gathering pace.  
 
Ladies. Some of you will choose to push a baby out of it. Some of you will choose to smuggle cocaine in it. There’s no need to get lyrical about it. Good mothering in the lead up to and during the birthing process should be measured by the judiciousness of decision-making based on professional advice – not the diameter of your vagina.   

 

 

Genevieve Tait is a medical student based in Melbourne. Image Credit: Wikihow.

 


This article is part of a debate on the right to defy doctor's orders. Click here to read the opposing argument. 
 


[1] American College of Obstericians and Gynecologists, Committee Opinion: Planned Home Birth. Accessed 9.3.15.
[2] Women and Newborn Health Service, King Edward Memorial Hospital, Management of Pregnancy and childbirth in women with a body mass index above 40. Accessed 9.3.15.