By Jane Hardwicke Collings
The important thing to remember about the so-called high risk situations (and there’s many more situations usually included in the list than the three here) is the role of fear. Fear clouds the mind, fear has us revert to basic survival instincts – fight or flight. Fear stops labour. Risk brings up fear, if it’s risky then it’s not safe. But we need to put that into perspective, everything has its risks, everything.
“Breech birth, vaginal birth after caesarean (VBAC) and twins birth can carry additional risk. The risk must be measured rationally however. The risk of uterine rupture for example after a primary c/s is not quite 1%. The vast majority of Obstetricians do not support women to achieve a VBAC. Many paint a picture of fear and death citing uterine rupture as a compelling reason to elect for a repeat caesarean. The risk of spontaneous abortion after amniocentesis is 1-2%. This test is routinely offered to women over 35 without any of the trappings of death and injury.” Justine Caines
If you are in a so-called high risk group it doesn’t mean that you have to give away your decision making to someone else. Rather, you need to be sure that you are making informed choices about everything. What tests you’ll have or won’t have, what kind of birth you plan for, who your primary care giver is etc.
Once you have ALL the information, and you are clear that you are not handing away your decision making to someone who says words to the effect of:
- “Don’t worry about all that, trust me, I’ll look after what’s best for you and your baby”
- When you’ve confronted all your own fears about your situation,
- When you weigh up the actual data,
- When you take responsibility and
- When you listen to your intuition,
- Then you can be sure you are making an informed choice.
- Not objective – informed and subjective.
VBAC, Twins and Breech births require the level of trust that is possible, that you are capable of. Trust that everything will be perfect, that you will make the perfect choice for you and your baby. You are not separate. What’s good for the mother is good for the baby. Let go of your fears and expectations and trust in your life’s journey and your baby’s life journey.
Maybe you want to ask yourself these questions:
- How does this situation serve?
- What is this teaching me/showing me about myself?
- Why is this happening?
- How does the fact that this situation is occurring make sense in my life?
- What beliefs and patterns of mine does this situation reveal?
- What is this situation bringing up for me? What fears?
- What am I feeling?
- Is this familiar?
- What memories come up?
- Is there healing required from past experiences to enable me to move forward here and stop repeating patterns?
Journal the answers to these questions and any others that arise for you in the process. There are no right or wrong answers, it’s simply a process for you to come to know yourself more fully and understand your life journey.
When I thought about why my first birth had ended up a caesarean I could see how it reflected my inner belief that I was not safe and that under no circumstance should I surrender. I didn’t realise I felt this until I went hunting within, a good while after I ‘surfaced’ from being immersed in Sam’s newborn time. Further in depth exploration took me to my experience as a four year old when I was in hospital with pneumonia and ‘nearly died’. My soul searching revealed that in my decision to live, back then when I was four, I decided I wouldn’t give in to anything, especially if it was bigger than me. This gave me strength to ‘live’ through adverse or threatening situations, but when it came to surrendering to the ‘birth force’, I couldn’t or wouldn’t – and without consciously even realising that. Bringing this self awareness to my next pregnancy and birth enabled me to tend to my terrified four year old self and make new choices that suited my current situation. I learned that surrender is safe and preferable in certain situations, especially in making love and giving birth.
Know that if a doctor performs a caesarean section, from a medico-legal perspective, it will be deemed that he has done all he could.
There has been case in Australia where a mother refused the obstetrician’s recommendation for a caesarean section following her two previous caesareans. When she didn’t turn up to her next antenatal appointment, the doctor reported her to the law enforcing arm of the government responsible for the safety and wellbeing of children. The officials arrived at the woman’s home to question her and she was in labour! The Mother had found another hospital supportive of her desire to give birth vaginally and was on her way there. She had a vaginal birth after two previous caesareans.
You won’t make a friend of your obstetrician if you go against his recommendations.
Would you rather be told that you’re a good girl or know that you are a powerful woman?
“What I have learnt via research and through practical experience is that ‘risk’ is a conjecture from practitioners who have little if any understanding or faith in normal birth. Unfortunately birth in Australia is dominated by medical practitioners. These practitioners create labels of ‘risk’ often with little regard for research evidence. On the whole these practitioners only believe in the safety of birth after the event. To me this is most telling and explains our huge rates of intervention, and resultant morbidity.” Justine Caines
The range of experiences women encounter during birth are so varied. This is a clue to the need for you to get all the information available and make an informed choice about the care you will have and the birth you will plan for.
Vaginal Birth After Caesarean (VBAC)
“A cesarean delivery can be a life-saving procedure for the mother and her child. However, it is also major abdominal surgery that puts the mother and her infant at increased medical risks. These include infections, hemorrhage, transfusions, and injury to other organs, anesthesia complications, and a maternal mortality two to four times greater than that for a vaginal birth. Long term complications in subsequent pregnancies and labors include risk for uterine rupture, and placental problems such as placenta previa, placenta accreta, and abruptio placenta*. Studies also show that a cesarean delivery, particularly when it was unexpected, may put some women at increased psychological risk for depression and post-traumatic stress. Taking a closer look at these risks may help women to make an informed decision.”
With the caesarean section epidemic at a rate that is currently 1 in 3 births and rising every year, the medical community has had to really look at what they are doing and why.
In many cases, as stated in the media – where our culture debates its rights and wrongs -women have been blamed for the increasing rate of caesareans. Women, it is claimed, are becoming “too posh to push”, preferring a controlled birth rather than whatever Nature had in store. And women are demanding caesarean births to fit in with their schedules. The real reason is that doctors have been promoting caesarean sections for decades and women trust them.
“Once a caesar, always a caesar” has been the well known phrase spoken to support the ongoing practice of repeat caesarean sections. Although a repeat caesarean for no reason ie no ‘medical indication’, is known to be more dangerous for the mother and the baby than a VBAC , it is still what many women are told during their antenatal care and is still the dominant medical practice.
Women have been led to believe that caesarean sections are safer than normal vaginal birth. Safer for the baby, safer for the woman, preventing damage to