Pam Candelaria: My Birth Hero!
Today’s “Birth Heroes” post features Pam Candelaria, the moderator of the BabyCenter VBAC Support Board, the blogger at Natural Birth for Normal Women, and the author of the “Woman’s Guide to VBAC” piece on VBAC success rates and prediction models. Her kind and empowering way of informing women about their birthing options was one of the things that influenced me most during my second pregnancy. As you read through my interview with her, it should be easy to see why!
1. Tell us a bit about your birth experiences.
Each of them was so different! I’d always planned and hoped for a natural, drug-free, low-intervention delivery, and since my mom and grandmother had easy deliveries I just assumed mine would be as well. My first son, though, ended up being born by cesarean after a miserable 27-hour induction. While my c-section wasn’t bad, and my recovery was easier than I expected, the emotional fallout was pretty rough and I struggled with feeling like I’d failed. I went on to have 3 VBACs, including one NCB, one incredibly long labor with an early epidural, and one 3.5 hour labor that included an epidural about 10 minutes before delivery. None of my births matched my vision, but each of them- yes, even my c-section- was perfect in its own right, and each was critical to shaping my views on birth and how women should be treated when we are having babies.
2. What have each of your births taught you about yourself? What wisdom have they given you that you now share with other women?
The biggest thing my births taught me was to expect the unexpected. I never expected a c-section. I never expected that my NCB would not be my best birth- that I would tear significantly, pass out, not get to hold or nurse my baby for 4 hours following delivery. I never expected my third baby to give me a long, difficult labor that was more painful than my pitocin induction. And my fourth baby, well, by then I’d learned that nature was bound to throw me a curveball so of course that labor and delivery were essentially picture-perfect. I’m so grateful to have had such wildly different births! I really think experiencing so many of the things we talk about in the birth community has given me insight that just talking about it can’t duplicate. I learned that when you’re actually in a situation vs. talking about it hypothetically, your whole thought process changes. Logic goes out the window because it is your life, your baby. My third birth fundamentally changed my views toward other women in regard to their births. I made a laundry list of decisions I swore I would never make, from scheduling an induction to getting an epidural before I was even dilating to finally consenting to pitocin. And you know? While it was sort of difficult for me from a personal standpoint (I felt so hypocritical!), it was really a good thing for me from an activism standpoint. After living that situation, I fully realized that the decisions we make in our births are the very best decisions we can make at the time, and they aren’t made in a vacuum. I think it’s somewhat instinctive to second-guess our decisions, pick apart our births, wonder what we could have- should have- done to make things better if they didn’t go perfectly, but over time I have started to think that’s just a distraction. Instead of looking back and saying “I wish I had done XYZ” I think it’s far more valuable to say “If I am ever faced with this situation again, I will do ABC.” It’s okay to learn from our experiences, but we shouldn’t devalue them simply because we would make different decisions the next time around.
3. What resources (books, websites, support groups, etc.) have helped you most throughout your pregnancies, births, and experiences as a birth advocate?
BabyCenter’s VBAC support board was critical to my VBACs and my journey toward birth activism. It was amazing to have such a strong community of women who really understood why VBAC mattered to me, and why I was struggling emotionally after my c-section. And they were informed! Oh my God were they informed. The information, the research, the data—it was overwhelming at times, but once I started digging in to it, I couldn’t get enough. I was coming at this from a relatively mainstream point of view, and I was shocked at how big a deal VBAC was. Unsupportive OBs? Bans? Seriously? All I wanted to do was push a baby out of my vagina, just like millions of other women. Finding out that I might have to fight to be able to do that… it changed my perspective so much. Once I started to realize how modern obstetric practice treats birthing women as accidents waiting to happen, I started to get mad, and I stopped taking my own births for granted.
I was always fairly self-motivated to feel strongly about VBAC, but my passion for birth in general came a bit later. It wasn’t until my third pregnancy that I finally decided to take everyone’s advice and read Ina May’s Guide to childbirth. I’d read some of Ina May’s writing online, and I thought it was great- but her book? Oh! It was amazing! The birth stories, the chapter on sphincter law, and just the overwhelming faith in women and our innate ability to give birth was so empowering. I also came late to the movie The Business of Being Born, and while my husband termed it “pretty good for a propaganda flick” it confirmed everything I’d started to believe about the state of maternity care in the US. I think that movie, and Ina May’s Guide, really opened my eyes to the fact that women everywhere- not just VBAC moms- are being damaged by modern maternity care. More recently, the book Pushed by Jennifer Block made me want to jump up and shout “YES!!” about every page or so, and I was highly impressed with the NIH Statement on VBAC and Amnesty International’s report “Deadly Delivery” which discusses the human rights aspect of the atrocious maternal mortality rate in the US.
I also have to give a HUGE nod to women like you, Kristen, who take this ball and run with it. I’ve been incredibly lucky to meet people who are active in the birth community and have the time and resources to actually get out there and start fomenting change. You all help me stay motivated to keep caring, even when it seems completely overwhelming. While I do realize I have touched countless women’s lives through BabyCenter, there’s something incredible about seeing women- normal women! women I can relate to!- getting a head of steam and taking this battle to the places where it can actually bring some policy-level changes. The NIH conference was just huge for that, and I can’t tell you how much I admire everyone who went to the conference and made sure the voices of the birth community weren’t lost in the cacophony of existing policy and questionable data.
4. You moderate the VBAC Support Board on Babycenter.com and do a remarkable job of keeping it relatively drama-free and maintaining a non-judgmental and empowering tone. In that same vein, you also create a safe space for women who choose VBACs or repeat cesareans, and for women who end up having VBACs or unplanned repeat cesareans. How do you accomplish this, especially with a topic that can bring up so many heated emotions?
First and foremost, I have to say we have an incredible community of women on the board, and without all their support the group wouldn’t be what it is. On a personal level, being consistently empowering and nonjudgmental isn’t always easy—my flair for diplomacy is often pushed to the limit and there are times I’ve had to take brief breaks from posting because I just can’t handle the misinformation, the manipulation, the outright lies women are told to get them to comply with an OB’s wishes. But I always come back to my own experiences, how judged I felt when I posted my third birth story on a natural childbirth board I’d been going to for advice, and NOT ONE SINGLE PERSON replied, not even to say congratulations. I mean, hey, it was about as far from NCB as you can get, but I brought a child into the world and that was still a triumph! Right? So, when women come to the board and they end up having c-sections- either by choice or by necessity- I really understand that their births are still triumphs. When women come to the board and ignore our advice, I have to understand that in their lives, they had compelling reasons to choose what they chose. It’s not my place to judge them or their decisions, and I try to gently guide other posters away from making judgments as well. I think it’s absolutely okay to offer information, encourage women to ask questions of their providers, suggest doing more research. Ultimately, though, we all have to make our own decisions. I’m not afraid to take that stance very strongly if I need to, and I will argue just as passionately for a woman who is making an informed c-section decision as I will for a woman who is making an informed VBAC decision. A while back someone posted this on the board: “I can’t want a woman’s VBAC more than she does.” What a simple and elegant way to sum it up. I can’t want it more than she does, and as long as I keep that perspective, I can offer my support to women regardless of where they are or what they choose.
5. If you could make just one immediate transformation in maternity care in the United States, what would it be? How do you think that birth advocates can best work to make this particular change?
This is so difficult to answer. Every time I start, I realize how everything is connected, a big spiderweb of social messages and fear and money and guilt and finger-pointing. I think a good starting point, though, would be to stop blaming women for their births. I can’t think of any other medical specialty where routine procedures are not evidence-based and sometimes directly cause harm, yet when a patient has a poor outcome and seeks support she’s told she should have been better educated, should have questioned her doctor, should’ve been a stronger advocate for herself. While I can’t discount the role women play in their own care, I just don’t think it’s fair to tell women- or even imply- that they somehow deserved a bad birth experience because they didn’t do enough to try to have a good one. As an advocate, I’m surrounded by doulas and midwives and VBAC moms and homebirthers; it is incredibly easy to forget that most women give birth in hospitals, most women get epidurals, most women have OBs providing their care, and most women are not familiar with the pros and cons of the medical model of maternity care. I might even go so far as to say most women don’t know there are alternatives to the medical model of care- I sure didn’t when I got pregnant the first time!! I truly believe we have to stop putting all the responsibility on women, have to stop expecting all women to have the level of knowledge we do about birth, have to start giving it more than lip service: “Of course women aren’t solely to blame, but…” Let’s start putting the blame where it belongs: with a system that insists all women fit the same mold, with doctors and hospitals putting their financial bottom line above the health and safety of their patients, with a society that views women’s bodies as sexual objects to the exclusion of our biological realities. To do that, though, we have to stop blaming women for their births. Such a simple starting point, don’t you think?