you know not the day nor the hour
Tuesday, May 15, 2007
I've been pondering freebirthers for the past week, having read the Grauniad article and then Crippen's response to it. And brewing up a post that, if I don't get it down now, I suspect I will never post it with mere a week to go before Beelzebump arrives and a calendar that is still, ridiculously, covered in scribbles. All I can say is that here's what I've got down so far, and that any lapses of coherence/into rantiness might be most charitably ascribed to pregnancy hormones:
I had a post-partum haemorrhage when I had Rebecca. It happened on the operating table, shortly after she had been delivered by an emergency c-section that followed a long and fruitless labour. My current midwife Margaret recently went over my UK surgical notes for me, line by barely legible line: it turns out that haemorrhage occurred when the incision in the thin and distended uterine wall extended suddenly and rapidly into several neighbouring blood vessels, resulting in a succession of hasty tyings-off and the consultant being summoned in rather urgently to help repair the damage. While I have vivid memories of Becca's birth; of feeling my belly suddenly lighten and hearing her very first aggrieved squawk, I don't remember the haemorrhage itself (although I do have a vague memory of one of the doctors tersely barking 'Get [So-and-so]!' to a colleague.) I have no memory of the hasty debriefing that followed being stitched up, during which they may or may not have explained what had just happened. Jack remembers that there was such a conversation, but funnily enough the poor lad was a wee bit shellshocked at the time too, so doesn't remember what was said. I do remember being faintly confused by the circle of upside down (and in retrospect, relieved) smiles above my head and the repeated 'Congratulations!' (Why are they congratulating me? What have I done? Oh yeah, I just had a baby...')
Would I have had the haemorrhage if I hadn't had the c-section? Who knows? Had I laboured longer, would Rebecca have emerged naturally? Possibly not: her position, and especially the position of her head, in the birth canal, was what was preventing her from coming out in the first place. By the time the c-section was deemed necessary, she was in distress, and I had a temperature and I was advised by doctors and midwives alike that the c-section was the safest option at that point. Heavy-hearted, I added my very wobbly signature to the consent form. Mere minutes later, a healthy little girl was hauled, protesting vociferously, out of me.
But who knows how it could have gone otherwise? If a c-section hadn't been a readily available option, what would have happened? What if I'd been living in the Sudan, with restricted access to medical intervention? What if I were a freebirther, and had decided to persist without intervention? Would Rebecca ever have come out? Would I still have haemorrhaged? Who can say? And that's my point: you can't know these things. You can't know. You just can't.
Begging the question of the, to put it mildly, unhelpful part played in the politics and rhetoric of childbirth by the naturalistic fallacy
(pain relief is cheating, or worse, weakness; the word 'intervention' must be spat out through twisted lips) I think there's another dangerous fallacy at work here, and it's the fallacy of control. We Westerners live in societies in which modern medical care is widely available; for all the problems that bedevil the NHS or the New Zealand health care system, compared with our grandparents, compared with people in, say, sub-Saharan Africa, we have it pretty good.
And it is this that allows us to feel entitled to everything going our way (and aggrieved when it doesn't). The fallacy of control: nothing could possibly happen to me, and even if it does, someone will sort it out and it will all be fine. We think we know what will happen to us.
And what if something goes wrong? If it happens to me, I'm at best indignant, at worst – well, I hardly like to think about it. To someone else? Well that's different: they probably did something wrong. Baby in the wrong position? Ah, well you should have spent the last months on all fours over a birthing ball, like we recommended. Epidural instead of gas and air, which was no longer enough? Well that'll be what slowed your labour then. C-section? Well there you go. Perhaps you'll 'succeed' in having a natural labour next time. Breastfeeding sapping your will to live? Well if it hurts, you're doing it wrong.
So here I am, a week from my scheduled c-section but there is still no guarantee that it will happen on the 22nd: I could still go into labour in the next week and a notionally elective procedure could become, as the obstetrician put it, 'semi-elective'. It is, as Valmont keeps on repeatin' in Dangerous Liaisons, beyond my control. I asked my midwife what were the chances of another haemorrhage on the operating table. Far less likely, she replied, as they'll be aware of my history, I (hopefully) won't be in labour, and they'll be able to proceed in a more studied fashion, avoiding cutting near all the scar tissue. Chances are that things will be fine this time around, and I am not actually worried. But that doesn't mean that I am certain that nothing will go wrong. I don't believe I have that much control over the process. And I accept this. And actually, I'm fine with it.
So what of autonomy? With such an eventful history, even without seeing my surgical notes (which we requested from the UK when I was six months gone) there was never, according to Margaret, any question of my attempting a home birth. 'Being allowed' was how she put it, I think. And once they'd actually seen my notes, no question of my being 'allowed' to attempt a vaginal birth. Allowed by whom? By the obstetric consultants at Wellington Hospital to whom she's ultimately responsible. So effectively any freedom of choice I might have hoped for concerning the way I will give birth has been pretty much removed. Do I consider this to be paternalistic control of my birth 'experience'? Not in the least. I suppose in theory I could refuse the surgery. Hell, I could refuse all medical intervention and 'freebirth' at home. I'd risk killing the baby and bleeding to death myself, which I suppose would be rather hard on Jack and Rebecca, but I'd be reclaiming my autonomy, exercising my freedom of choice. Hell of a way to prove a point though.
And even if you don't have a dodgy history like mine; even if you're a first-time mother in perfect health who has enjoyed a trouble-free pregnancy (me last time, actually) there are still things that can go suddenly, horribly, awry. And this is why I am deeply disturbed by women, and the midwives who encourage them, who, convinced that if they only believe hard enough they will have the perfect, fulfilling birth experience, eschew medical intervention. (And who, it seems to me, appear to scorn those of us weaker souls who are compelled by circumstance, by our very lack of control, indeed, by our admission of our lack of control, to accept it.) Because it's a hell of a way to prove a point. Especially if it all goes wrong.
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