Having a healthy baby is why I care about birth advocacy
“At the end of the day, it doesn’t matter how the baby came out. All that matters is that you have a healthy baby.”
It’s that dreaded “healthy baby line.” The one I’ve written about before. The one that others have addressed with admirable sensitivity and eloquence.
And I’ve been thinking about that line in a relatively new light lately.
My general position on the “healthy baby line” hasn’t changed. I still think these sorts of statements are hurtful and demeaning and insensitive to women’s experiences. To be fair, I also don’t think that people generally intend for these statements to be taken as such.
But in addition to the aforementioned response that I’ve given to the “healthy baby line”–a response that focuses on the emotional aspects of birth and new motherhood–I’d also like to add this point: Healthy babies do matter. And that’s why I (and others) care so much about how they come out.
This is because unnecessary birth interventions that interfere with how babies “come out” can pose additional risks to moms and their babies.
This is not to say major birth interventions such as induction of labor or cesarean section are so risky that they should never be used. To the contrary, when these interventions are necessary and/or medically indicated–for example, when a woman has a cesarean section for placenta previa, or when a woman’s labor is induced because of preeclampsia–they are wonderful and even life-saving uses of the medical technology that is currently available.
But when these interventions are used in the absence of necessity or medical indication, some parents may decide–and have the right to decide–that the possible benefits of these interventions might outweigh their risks.
Notably, some of these risks are relatively small. Some of them may even be risks that moms and/or their partners examine and pore over and say to themselves, “You know, I think that the convenience of having an elective induction still outweighs the risks that it presents, and I am willing to take on those extra risks.”
And in these sorts of cases, they’ve made an informed decision. And informed decisions–informed consent–are something that I not only respect but also champion as a fundamental right for all medical patients.
But before a parent can make an informed decision about unnecessary induction and/or cesarean section, they should know the following:
According to Childbirth Connection’s systematic review of the comparative risks of cesarean section and vaginal birth, cesarean section poses the following extra risks* to both mothers and babies:
- Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
- Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
- Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
- Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.
- Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
- Health of babies: Babies born by cesarean are more likely to:
- be cut during the surgery (usually minor)
- have breathing difficulties around the time of birth
- experience asthma in childhood and in adulthood.
- Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:
- ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
- reduced fertility, due to either less ability to become pregnant again or less desire to do so
- placenta previa: the placenta attaches near or over the opening to her cervix
- placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
- placental abruption: the placenta detaches from the uterus before the baby is born
- rupture of the uterus: the uterine scar gives way during pregnancy or labor.
- Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
- be born too early (preterm)
- weigh less than they should (low birthweight)
- have a physical abnormality or injury to their brain or spinal cord
- die before or shortly after the birth
And in addition to the general risks of induced labor (such as an increased risk of NICU admission, forceps and vacuum-assisted delivery, and abnormal fetal heart rate), the use of synthetic oxytocin (or pitocin) itself carries a number of risks of which parents should be aware. As reported in the RxList Drug Guide, pitocin can lead to the following adverse reactions in a mother:
Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Hypertensive episodes
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterusExcessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
And according the same RxList Drug Guide, the pitocin can lead to the following adverse reactions in the fetus or neonate:
Bradycardia
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures have been reported with the use of Pitocin (all due to induced uterine motility)
and:
Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage (all due to use of synthetic oxytocin in the mother)
It should go without saying that none of these lists are meant to frighten anyone about labor induction or cesarean section. To reiterate, these invertentions can be wonderful, life-saving uses of medical technology. What’s more, there are ways to make the experience of these interventions more mother-, baby-, and family-friendly.
Nonetheless, the risks that these interventions pose to mother and baby demonstrate just why it does matter how a baby “comes out.”
And that’s because how a baby comes out can have a significant affect on how healthy that baby is.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
*Worth noting is that the Childbirth Connection’s systematic review of cesarean section and vaginal birth did find the following increased risks of vaginal birth (as compared with c-section): an increased incidence of perineal pain and incontinence for mothers, and increased risk (though still low risk) of nerve injury in babies.
I want desperately to reconcile my feelings on this issue.
Full disclosure: I am a mom who had a medically necessary cesarean, but lost my son after at 2 months old because of his severe CHD. He never left the hospital.
I *want* to respect others feelings over their traumatic or disappointing births, but as a mom who did *not* have a healthy baby, that does not have a baby at all with me, it’s really difficult.
I understand that being told “a healthy baby is all that matters” is incredibly dismissive when you’re hurting over your birth experience. I can’t see myself ever telling anyone that, but at the same time, the backlash by some mothers against such statements hurts me when I know how much it hurts to have not-the-birth-you-wanted, AND lose your child.
I am completely on board with avoiding unnecessary medical interventions, and the risks they pose.
Melissa, first let me just express my sincerest condolences over your loss. I cannot even imagine the depths of what you have felt emotionally, and, as a mother, my heart just breaks for you and your son.
I also want to apologize for not being as clear as I should have been about the fact that not all women are lucky enough to say that they do, in fact, have healthy babies. And that women who are this lucky should be (and the vast majority of the time are) grateful to have healthy babies. And I’m deeply sorry if my response to the “healthy baby line” inadvertantly seemed as if it were obscuring your own and others’ losses.
From an admittedly non-professional standpoint, I honestly don’t think that you need to force yourself to reconcile any of your feelings on this matter. I’ve said before in my “Scars that Run Deep…” post that we humans can feel complex and even contradictory emotions all at once.
So thank you for adding your voice here. For what it’s worth, I think it is a good reminder that responses to the “healthy baby line” should be careful not to slip into the insensitive backlash that you describe.
Melissa, I’m so sorry to hear this. I can’t even imagine the feelings you have on this issue. And it was so generous of you to share your viewpoint.
I had a medically necessary caesarean, and while it was disappointing to miss out on the birth I wanted, I felt comfortable making the decision because I had a wonderful OB that I trusted, I was very educated on the birth process, and I had actually planned for a c-section up until my 33rd week of pregnancy, because I had a had a complete previa that eventually moved away from my cervix.
My second pregnancy (my first ending in a first trimester miscarriage) ended around 18 or 19 weeks, right on the edge of miscarriage/stillbirth. And even though I did everything right–good prenatal care, eating, exercising–my son still died. And it hurt a lot. What stuck with me was the reality of bearing children–it’s never a sure thing. No matter what, new life is always tenuous. And I think it’s irresponsible for any doctor to wave the healthy baby flag in order to pressure a mom into an potentially unnecessary surgical birth. As Melissa’s story so poignantly shows, it’s never a sure thing.
Bethany, please accept my heartfelt condolences over the loss of your son too. The loss of a child, whether through miscarriage or stillbirth or illness or accident, is heartbreakingly sad in every instance.
I actually think that part of the reason why the “healthy baby line” irks me so much is that it seems to be using other mothers’ losses–mothers who have not been lucky enough to have healthy babies–to obscure the feelings and experiences of other mothers who feel traumatized or even “just” disappointed in their births. And these losses–losses like yours and Melissa’s–should not be used in this way. Or in any way.
And I what I wish for both you and Melissa and any mother grievign over the loss of a child is the peace and the love and the support to experience your grief in the way you personally need to experience it. However that needs to happen, and for however long that needs to happen.
-Kristen
I had an unnecessary cesarean section. I was led to believe one thing by my OB only to discover that my official medical records said something very different. I struggled for a long time with feelings of sorrow and anger over how it all came down. I felt duped and the numerous times I was told “at least your baby is healthy” certainly didn’t do anything to ease that discomfort. If all I had done was focus on the fact that he was “healthy” I know I would have missed out on the great many changes it brought about in my life.
My other issue being the concept of “health.” When babies are born by primary cesarean section, without the benefit of labor and all that entails they are at risk for health issues much further down the road. There are some we’re aware of (asthma, food allergies), but I suspect there are others we don’t yet know about. I wonder what kind of impact it will have on my son and on his children as well (epigenetically speaking). Humans have delivered vaginally for a great many years before this – as the c/s rates rise I can’t help but wonder what the results will be of this particular social experiment.
Ultimately I think the issue being that the “healthy baby” comments simplify the issue and try to make it very much a black and white type thing with no room for shades of gray.
Dear Melissa and Bethany,
Thank you for sharing your stories. These are truly terrible stories of loss, and I by no means intend to compare my own worries or situation to your own.
Beautiful Birth, I am grateful that you bring up this important topic- it’s one I was only able to put into concrete thought just yesterday! Thank you also for your thoughtful reply to the NursingBirth post today, too: http://nursingbirth.wordpress.com/2009/10/21/the-ol-bait-and-switch-or-finding-out-your-ob-has-been-leading-you-on/, …I have been feeling very empowered reading your VBAC scare tactics!
Yesterday I was worrying out loud that if I do have a second c-section that everyone will say, “well at least you have a healthy baby” (assuming of course I am so blessed), that everyone will judge my body to be a failure, and just say “I told you so”. The whole weight of the “failure” will be on me, the MOM, not shared by my doc, my husband, my doula, my medical staff. That Mom bears this burden of loss all alone. And more importantly that everyone will diminish my own feelings and emotions about the experience.
OB’s constantly reinforce this idea that Mom’s emotions don’t matter at all, the separation of mind and body, and that if you go against their medical advice you are being selfish because you care more about yourself than the baby. All of these statements seem likely to snowball into mom being overwhelmed with a newborn and suffering from postpartum depression because noone cares about mom, it’s all about baby. Should we plan an appointment with a shrink ahead of time?? It’s enough to make any mom go crazy!
As well intentioned as these statements are, I still think it’s important that ALL MOMS have at least a few people around them that can be *more aware* and insightful to their sensitive emotional and mental needs. This is one of those “unspoken birth topics” that has been long overdue for open discussion.
Kelly, I think that many women planning for a VBAC have some of these same worries and concerns. I know that I did as I was planning my VBAC. And this is why it is so important to surround yourself with women–whether in real life or online–who have shared this “VBAC journey” and who have experienced the full range of VBAC outcomes. While no one’s experience is exactly the same as someone else’s, there is definitely comfort in finding other people who can say, “I know, I’ve been where you are right now, and I’m here for you.”
When you mentioned the “few people around [moms] that can be more aware…,” it should come as no surprise that I immediately thought of doulas. We are trained to “mother the mother,” after all! (And if I recall correctly from your post on Nursing Birth, I think that you have already hired a doula!)
I also have a post “brewing” right now about how mothers deserve better support and celebration before, DURING, and AFTER labor. It’s based on an analogy I made between birth and a marathon that my husband recently ran.
Pampered Mom, my heart definitely goes out to you right now. I don’t know if you’ve already read it, but you might want to check out my post from a while back, “Scars that Run Deep: All that Matters After a Cesarean.” (You can search for it on the site.) I’ve been told by a few people–including those who have never even had cesareans–that it helps to explain why the “healthy baby line” can be very hurtful to moms grieving over their birth experiences.
And I’m totally with you on wondering (and worrying) about the “unknown effects” of cesarean sections on children of current and future generations.