Women have long fought for their rights: to vote, to own property, to education, equal pay, rights to hold certain jobs, marital rights, legal rights and others. More recently, the fight is around abortion. The latter controversy is still in lively discussion, as anyone reading the news can attest to. Elections are won and lost on that issue alone, and emotions run high. Few are without a passionate opinion on the matter, and the battles are still being fought.

Yet – where is the outcry from women and men – and from both the vocal pro-choice and pro-life movements – about what happens after a woman becomes pregnant? Both sides agree that a woman can get pregnant and keep her baby, but then neither seems to care what happens next.

What often happens is that the pregnant woman is thrust into a world where she has high stakes (the health and very life of her and her baby) and lots of conflicting information. Her mother, aunties, friends, work buddies and internet support groups weigh in with experiences and stories which either support her, pressure her or scare her, her partner suddenly urges her to be careful and will “protect” her, the natural birth crowd says how wonderful it is to have unmedicated labor or how important it is to do things the natural way implying all else will cause harm, and her doctor is usually friendly, caring and offers medical opinions based on experience, research, policy and litigation concerns.

Many women lean toward what their doctor says, which might make sense until they realize that it may or may not be something that is supported by the medical literature, might be based more on facility policy, insurance underwriters, or lawsuit exposure than on that particular woman’s health or even on whether that doctor personally supports that option. Many practices today say they are low-intervention and don’t do “unnecessary procedures,” but how do you know whether that scheduled c-section for a “big baby” is unnecessary or necessary?

So how does a new family sort this all out? Underneath all of this is the underlying message: do what you’re told or anything that does go wrong will be your fault. In the end, many women surrender and simply follow along – and deal with the consequences later. It’s ironic that this happens right before she becomes fully responsible for her new baby. “Give up and follow along, we know best.” How exactly does that help create an empowered, confident, strong parent?

Think about the dizzying array of options that a birthing woman is unable to make. Perhaps the choice is simply denied due to policy (such as VBAC/vaginal birth after cesarean, water birth in a hospital or even something like eating or drinking during labor). Maybe there is strong pressure against it (such as homebirth, which requires strong commitment just to choose it and put up with all of the nay-saying – look at this homebirth post for some of the hot controversy.) Or, maybe a doctor doesn’t allow the choice and once she finds out, she’d have to switch doctors to get what she wants, making it costly, inconvenient or downright impossible.

It starts right after that pregnancy test turns positive. Insurance companies get involved and decide what is and isn’t covered. Maybe a woman finds insurance or Medicaid will cover an obstetrician at a particular hospital but not another one, or a midwife in the local university hospital but not a midwife in a birthing center – so that decision is made for her. Even the decision whether to receive prenatal care can be made based on things such as finances. The further a woman progresses in her pregnancy, more and more choices begin to disappear: Can I go into labor naturally? Can I avoid an IV? What do I do if my breech baby doesn’t turn? How about electronic fetal monitoring? How about mobility during labor, or something as simple as the ability to eat or drink? How am I allowed to push this baby out? What am I allowed to do postpartum?

Different caregivers enable women to have more choice, or less choice, according to their own philosophy, experience, and policies. Yet when it’s averaged out, over a third of normal, healthy women and babies in this country require major abdominal surgery to have their babies! There is something deeply wrong here.

The other day, the New York Times ran an article that has been making it around the birth circles: New Guidelines Seek to Reduce Repeat Caesareans. C-sections are a hot topic for sure. How is it that the medical literature says that vaginal birth after cesarean is safe in many circumstances (even with twins!), medical guidelines permit it and still a woman’s right to choose it is in many cases outright denied?

The panel reaffirmed that vaginal birth was safe for many women with past Caesareans, and urged the obstetricians’ group to reassess its guidelines.

It is followed by things such as this:

Dr. Sandra B. Reed, an obstetrician at Archbold Memorial Hospital in Thomasville, Ga., which does not offer trials of labor after Caesarean, said, “I do not think this bulletin is strong enough to change the current policy in our facility.”

and this:

Dr. Waldman said he still hoped the new guidelines would encourage more hospitals to allow trials of labor after Caesarean, but, he added, “the big issue is liability.”

When it’s liability – the legal system, not the medical system – that starts deciding what can happen to you and your baby over your objections (and if you don’t believe it, read this about coerced and forced c-sections), then there’s something vastly wrong. Women aren’t stupid. Women make choices for good reasons, and they and their babies, not the doctors or lawyers, live with the consequences. I have to believe (want to believe) that the care providers don’t like this either. It even isn’t good from a cost-saving perspective – many of the unnecessary procedures add thousands to medical bills. If decisions are made to protect from lawsuits or for the financial benefit of hospitals and not for health reasons, then I really can’t see this situation is tolerable for anyone but malpractice attorneys.

Women deserve the right to have a safe birth, free to respond to their bodies without interference, free from humiliation, shame and punishment, and to make informed choices for themselves and their babies.

I hope that more and more people see that reproductive rights are broader than simply contraception and abortion. Women must insist on being fully informed and then take responsibility for their decisions (and not then sue a doctor for not having forbidden the option) before anything is going to change. It is also going to require a change in the culture of fear around birth.

Personally, I am hoping that this is the generation of women that will take this on. What do you all think?

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