The Politics of Pregnancy
So I'm almost 42 weeks pregnant. I've had a lot of time to think about the rather strange state of childbearing in this country.
On the one hand, since the decision Roe vs. Wade in 1973, every woman is guaranteed the right to decide whether or not to carry a pregnancy to term, at least through about 20 weeks or so. To be honest, I can think of no circumstances under which I'm likely to take advantage of this. I think, though, that there are a lot of reasons that people feel the need for such a provision. Arguments are made about the difficulty of caring for severely deformed or mentally deficient children; about victims of rape; about women who have been abandoned by the child's father. Many people have the sense that pregnancy can be an unbearable burden for women, particularly those who do not have a partner or access to resources such as good health care and child care. Along with this is the sense that men should not be able to tell women what they can or cannot do with their own bodies. (Most of these discussions leave aside the personhood of the fetus, whose fate is being decided. While I think this is a vital consideration, I have to acknowledge that I'm in the minority in this country.)
On the other hand, having decided to carry a pregnancy to term, women find themselves very much at the mercy of rules and policies about which they have little say and which may not be very well supported by medical research.
For example: my first child was delivered via c-section. There were a lot of reasons for this, which I won't go into here. Suffice to say that my obstetrician felt that the reason for this was not any deficiency in my body, but the fact that Mr. A's soft spot had already grown together, which gave him a rather strangely shaped head that was not going to mold to go through the birth canal. Since this is not a genetic defect, any subsequent children would not be at a higher risk for the same problem.
However, because my first delivery was a c-section, when I got pregnant this time around, I found that many hospitals, including the one where I had delivered Mr. A, did not allow women with a previous c-section to attempt vaginal delivery. (This is called VBAC--vaginal birth after cesarean.) This is because it is widely believed in the medical community that the risks associated with VBAC are too high. The main risk is uterine rupture, which is between 0.5% and 2%, depending on when the child is delivered and whether or not oxytoic drugs are used to begin or augment labor. This seems an extremely small risk to me, especially given other risks associated with c-section, such as infection of the incision and lesions in the scar tissue. At many hospitals it would not be a decision I would be allowed to make, at least not without a very big fight. I'm fortunate to live in a large enough metropolitan area that there are hospitals that will allow VBAC without a fight.
The difficulty of finding a practice that supports VBAC is perhaps one of the more extreme examples of the way that women are denied real choice in the way that they give birth. The root of all of this, it seems to me, is that birth is treated as a pathology instead of a normal event in a woman's life. The insistence on constant monitoring (which does not improve outcomes for babies and mothers); the rules against eating and drinking during labor, despite the fact that it's work and can go on for hours; the treatment of women who want a non-interventionist labor and birth as wierdos; time limits placed on labor before the doctors begin to insist on c-section--most of this is not supported by research that says it's helpful, but by a medical profession that treats pathologies instead of human beings. It is supported by the loss of a trust relationship between patients and doctors, since there is so little time spent going over health decisions because doctors are pressured by insurance to have huge practices.
Of course, there is always the home birth option, but that is often made difficult because of insurance companies that don't cover home birth midwives. It's rather bizarre, in this era when health care costs are often said to be out of control, that it's much easier to obtain a $13,000 c-section rather than a $3000-$5000 home birth. Equally strange is that birth preparation classes (which can run up to $300) and doulas (women who take care of the laboring woman throughout the process, whose services average about $600 where I live) are rarely covered by insurance, despite the fact that a woman who is well-prepared for labor, who knows what the process is likely to entail and who is well-supported throughout is much less likely to need expensive interventions and much more likely to recover quickly.
I've often wondered, as I researched the pros and cons of VBAC, where feminism was in all of this. Nowhere, as far as I can tell. Of course, a lot of us are fighting for the right to give birth without so many major decisions made for us, and in some ways things are getting better. It's rather strange, though, that when the debate over abortion is so often framed in terms of 'choice' that so few prominent women will fight for real choices for women who do decide to give birth.
On the one hand, since the decision Roe vs. Wade in 1973, every woman is guaranteed the right to decide whether or not to carry a pregnancy to term, at least through about 20 weeks or so. To be honest, I can think of no circumstances under which I'm likely to take advantage of this. I think, though, that there are a lot of reasons that people feel the need for such a provision. Arguments are made about the difficulty of caring for severely deformed or mentally deficient children; about victims of rape; about women who have been abandoned by the child's father. Many people have the sense that pregnancy can be an unbearable burden for women, particularly those who do not have a partner or access to resources such as good health care and child care. Along with this is the sense that men should not be able to tell women what they can or cannot do with their own bodies. (Most of these discussions leave aside the personhood of the fetus, whose fate is being decided. While I think this is a vital consideration, I have to acknowledge that I'm in the minority in this country.)
On the other hand, having decided to carry a pregnancy to term, women find themselves very much at the mercy of rules and policies about which they have little say and which may not be very well supported by medical research.
For example: my first child was delivered via c-section. There were a lot of reasons for this, which I won't go into here. Suffice to say that my obstetrician felt that the reason for this was not any deficiency in my body, but the fact that Mr. A's soft spot had already grown together, which gave him a rather strangely shaped head that was not going to mold to go through the birth canal. Since this is not a genetic defect, any subsequent children would not be at a higher risk for the same problem.
However, because my first delivery was a c-section, when I got pregnant this time around, I found that many hospitals, including the one where I had delivered Mr. A, did not allow women with a previous c-section to attempt vaginal delivery. (This is called VBAC--vaginal birth after cesarean.) This is because it is widely believed in the medical community that the risks associated with VBAC are too high. The main risk is uterine rupture, which is between 0.5% and 2%, depending on when the child is delivered and whether or not oxytoic drugs are used to begin or augment labor. This seems an extremely small risk to me, especially given other risks associated with c-section, such as infection of the incision and lesions in the scar tissue. At many hospitals it would not be a decision I would be allowed to make, at least not without a very big fight. I'm fortunate to live in a large enough metropolitan area that there are hospitals that will allow VBAC without a fight.
The difficulty of finding a practice that supports VBAC is perhaps one of the more extreme examples of the way that women are denied real choice in the way that they give birth. The root of all of this, it seems to me, is that birth is treated as a pathology instead of a normal event in a woman's life. The insistence on constant monitoring (which does not improve outcomes for babies and mothers); the rules against eating and drinking during labor, despite the fact that it's work and can go on for hours; the treatment of women who want a non-interventionist labor and birth as wierdos; time limits placed on labor before the doctors begin to insist on c-section--most of this is not supported by research that says it's helpful, but by a medical profession that treats pathologies instead of human beings. It is supported by the loss of a trust relationship between patients and doctors, since there is so little time spent going over health decisions because doctors are pressured by insurance to have huge practices.
Of course, there is always the home birth option, but that is often made difficult because of insurance companies that don't cover home birth midwives. It's rather bizarre, in this era when health care costs are often said to be out of control, that it's much easier to obtain a $13,000 c-section rather than a $3000-$5000 home birth. Equally strange is that birth preparation classes (which can run up to $300) and doulas (women who take care of the laboring woman throughout the process, whose services average about $600 where I live) are rarely covered by insurance, despite the fact that a woman who is well-prepared for labor, who knows what the process is likely to entail and who is well-supported throughout is much less likely to need expensive interventions and much more likely to recover quickly.
I've often wondered, as I researched the pros and cons of VBAC, where feminism was in all of this. Nowhere, as far as I can tell. Of course, a lot of us are fighting for the right to give birth without so many major decisions made for us, and in some ways things are getting better. It's rather strange, though, that when the debate over abortion is so often framed in terms of 'choice' that so few prominent women will fight for real choices for women who do decide to give birth.
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