Hospitals are not supportive of unhindered birth, there’s no denying it the statistics speak for themselves. Less than five percent of women leave hospital after an intervention free birth, and given the prevalence of the managed third stage and premature cord clamping it’s most likely even less. The definition of Normal Vaginal Delivery (NVD) is very loose, it can mean an induced labour, an augmented labour, an epidural, or any other number of interventions that are not natural however under the hospital’s definition of NVD it’s all perfectly normal. Women and hospitals frequently have different ideas about what “normal” and “natural” are.
Despite the outrageous lack of unhindered births that occur in hospitals, women still plan them. They do things like learning as much as they can on birth and interventions, hiring a doula, and planning to “go in pushing”. The latter is a very common plan for women who are planning a vaginal birth after caesarean but the anecdotal evidence shows that this is not often successful.
*****TRIGGER WARNING: THE FOLLOWING CONTENT CONTAINS STORIES OF EXPLICIT OBSTETRIC VIOLENCE******
Karen B: (US) My local hospital had a vbac ban but I was told that they couldn’t cut me without my consent. I planned to go in pushing and just not consent and after labouring at home all night I thought I was close, my body was doing some pushing. When I arrived at the hospital I was 2cm dilated and they said they were taking me to the operating theatre. I tried to discharge myself and go home but my husband was very worried something might go wrong so I stayed and ended up with a caesarean after three more hours of fighting the staff. One thing’s for sure, if your hospital or doctor say they don’t allow vbac, they probably mean it.
Karen’s story is not uncommon and nor is the advice she was given about “going in pushing” but when we tell women they can not be cut unless they consent are we telling the truth? Whilst it’s true that legally the hospital can not physically force you into an operating theatre without your consent, they are not afraid to gain consent using underhand methods as evidenced by the following stories.
Evie Vorstadt: (US) During my final antenatal appointment my doctor asked me to sign some paperwork, he was very dismissive of its nature and just told me they were standard forms. I was busy with my toddler so I quickly signed just so I could get home with Ethan in time for his nap. When I arrived in the hospital pushing I was admitted straight away and then taken to the operating theatre. I thought they were taking me to L+D. I still can’t talk about what happened then. What I will say is that my doctor showed me and my husband the forms that I had signed and told me he has already billed the insurance company so I had to have a caesarean now or I would be in trouble for insurance fraud. I didn’t know any better and I felt powerless. Now I have two scars, both completely unnecessary and I have to have a UC because no one will attend me in labour now.
Ayla-Jean Smith: (US) I stopped attending antenatal appointments at 38w because they were such bullies. I arrived at hospital 40+3 and the nurse said I was 8cm and my dr was coming to see me. He said to me through grittet teeth that I was going to have a caesarean or he would have a judge declare that I was unfit and I would lose my children. I asked for an epidural so I could be awake but that was denied. As the anaesthetist put the mask on my face the doctor bent down and whispered in my ear that he might take my uterus as well, just to be sure I didn’t “pull anything like this again”. He didn’t do that but I have had three unassisted homebirths since then rather than face the fear of what could happen at the hospital.
Allanah Weston: (Australia) I was over tired after labouring for three days at home. When I arrived in the hospital I’d been pushing for half an hour. They took my husband aside and told him that I was rupturing and needed another caesarean, they told him I was deranged so they needed him to consent on my behalf. He didn’t know what to do so he signed the consent. Then they put something in my IV line to make me sleep and I woke up in recovery all alone. I didn’t know what had happened. it was the most terrifying and violating experience of my life.
Adarsh Bhattacharyya: (India) I decided to go to hospital when my womb was pushing but I was feeling frightened at home so I went earlier. When I got to the hospital they told me I was 6 fingers dilated and I needed a caesarean because my cervix was getting fat and my baby’s head was getting water in it. I agreed to have the caesarean so they put me to sleep (I didn’t want an epidural). When I woke up I didn’t feel like I had had a caesarean and I realised that they had not cut into my abdomen. My legs were tightly bound together and the nurse told me that I had been 9cm dilated so they had manually dilated my cervix to a 10 and used a forcep to bring my son out from my body. They cut my perineum very badly to do it and they did it all while I was sleeping, thinking I was having a caesarean operation. The doctor said I should be glad because he had let the baby come as God intended but I don’t think that was God’s plan at all. I was changed by this experience forever.
Tara Weiss: (US) When I showed up in hospital I was pushing. They threatened to call child protective services on me if I didn’t consent to a fourth caesarean. I consented pretty quickly.
Some women will succeed with this plan but their births are rarely the satisfying and peaceful experience they long to share with their babies and families. Success under hostile conditions is exceptionally rare because the conditions that mammals require for safe, successful birth are that they be warm, in a darkened environment, and that they feel safe.
Victoria StJohn: (UK) When I arrived at the hospital I was forced to sit in a wheelchair even though I needed to be upright. It was excruciating. When I refused a vaginal exam because I knew I was 10cm and I had been pushing for a little while the midwife rolled her eyes at me and said she would send the doctor in to tell me I needed one. By this time my body was pushing really hard and my husband and doula were trying to keep me in my own little world. The doctor came in when I was pushing and without even introducing herself she started yelling at me about how I was making their jobs hard and that after two caesareans I was going to kill my baby. She kept yelling at me and my husband repeatedly asked her to speak politely. Two male security arrived as my baby’s head was emerging and escorted my doula from the building. We didn’t know that the doctor had called them, and my doula hadn’t even spoken to them except to introduce herself. I gave birth in the hospital but it was very frightening. I had a truly horrible birth, I wasn’t safe in that environment.
Debbie Bestmark: (Australia) I live in what could be classed as the outback of NSW. My local hospital refused to take me on for vbac because they said they didn’t have the facilities for an emergency caesarean. I thought this would be perfect because I wasn’t planning an emergency! When I arrived there I was pushing gently, I was very calm. I thought I still had a long time to go. The hospital refused to admit me and instead said to go to the larger hospital an hour and a half away. From there on things went crazy fast. My baby was born in the carpark twenty minutes after we were refused. It wasn’t what I planned but I got my vbac. The hospital were awful to me and have told me that if I ever do anything like that again they will report me to DOCS. But all I did was give birth, I would have thought I was legally allowed to do that.
Our bodies are designed to stop labouring in the presence of hostility and danger, this allows women to flee from bears if they are labouring and one tries to eat them but our mammalian brains don’t know the difference between a bear and an aggressive registrar.
Chelsea Aurora McBride: (US) I arrived in the hospital thinking I must be close to fully dilated but I was only 5cm, two more than I had been a week prior. I feel like such a fool. I don’t know why I consented to the RCS. I didn’t need it but all the bright lights and disturbance stalled my labour and I thought there was something wrong. I was also really disheartened because I thought I was more dilated. I probably shouldn’t have let them check but you never know these things until it’s too late. When I stopped contracting I should have gone home but they kept on at me about rupture and how I wouldn’t know it was happening and how my baby would die so I agreed to the caesarean. I don’t think I was in any position to agree to anything, I know I was just bullied into it and it makes me really angry. Next time, if there is one, I will have a homebirth.
Beth Kiriakos: (Ireland) I felt like I couldn’t go on labouring at home anymore, I wrongly assumed I was in transition. I was 4cm with a posterior baby but I hadn’t been having the typical back labour. I refused to consent to a fifth caesarean, it was the first time I had ever refused medical advice but I did it after a lot of research. I never got past 4cm so I was told I needed a caesarean and I was tired of arguing and fighting over every little thing so I gave in. I wish I hadn’t given in but they were just so persistent. I don’t think it was a well thought out plan to “go in pushing”. When they told me a vba4c wasn’t possible I thought I would prove them wrong but I underestimated their commitment, and I over estimated my ability to fight in labour.
Often women are fooled into thinking they have found a supportive surgeon or hospital but towards the end of their pregnancy they encounter what is commonly referred to as “the bait and switch”. They bait you by saying they support vbac to get your business, then gradually or sometimes quite suddenly they change tactics. They might give you arbitrary dates that you must give birth prior to, or tell you how enormous your baby is for example.
Trina Pinkman: (US) A friend told me her doctor was vbac friendly and she had had her vbac with him. Another friend told me to ask lots of questions because what works for one woman might not work for us all. I wish I’d listened to that friend. I had two caesareans previously. My doctor seemed like a lovely man. There were a few things I didn’t like, for example he was always in a hurry and he would brush my questions off with things like “we will only do a caesarean if it’s necessary” and one day he even told me to “go home and focus on decorating the nursery, don’t worry about that stuff, I’m an expert so I’ll do the worrying for you”. But the nursery was fine, it was his expert ponderings that should have given me pause for thought. I hit 38w and he told me he had scheduled my caesarean for 39+2 because I was showing no signs of labour. I said I was happy to wait. So he gave me a scan that showed low fluid and a big baby. Then he said he wanted to move the caesarean date forward. When my caesarean happened my baby was only tiny and his lungs were obviously not ready. He spent days in NICU struggling to breathe. My wound was infected for months. I will never trust another doctor.
Jessica Blackthorn: (Australia) My first baby was born in the public system, it was a dreadful experience so I decided to go private for my second. The private hospital my obstetrician delivered at refused to reveal their vbac statistics to me but my doctor told me she saw lots of vbacs there under her care. She said I could refuse anything I wanted. I planned to refuse constant monitoring, an IV and only to get an epidural if I needed it. When I arrived in the hospital they were unable to get in touch with my doctor so they said I had to go with their rules until my doctor said otherwise. I spent hours strapped to the bed with monitors unable to move. It was horrible but when I tried to move the nurse shouted at me and said “YOU are one of those mothers who just wants a flowery birth and doesn’t care about the baby. If you kill your baby the only flowers will be the ones at the funeral”. By the time my doctor arrived I was stalled at 5 and labour never picked up again so I had a caesarean. I cried through it and I haven’t stopped crying in the seven months since. Later on I learnt that the vbac stats at that hospital are 3% success.
Stories like the ones compiled here shouldn’t be a reality but of all the stories received during the submission period, the overwhelming majority of them highlight a culture with a frightening lack of compassion for women and babies, a willingness to break the law, the use of coercion and manipulation, and outright threats to frighten women into consent. Although it’s not really consent if a woman is afraid to say no and many women are far too afraid to say no and are not given adequate information to even cover the hospital’s recommendations for “informed consent” let alone the medical board’s definition. It’s a testament to obstetric culture that we are so fearful of birth that we rely on the law to protect us from openly hostile surgeons and venues when statistics clearly show how unlikely a birth is under those circumstances, and science shows how impossible it is for our mammalian brains to labour with fear. This design is actually one of the safety features of birth, we must stop expecting ourselves to give birth without it.
We do women a great disservice when the best advice on birth after caesarean we can give is “just go in pushing, they can’t give you a caesarean unless you consent”. Expecting ourselves to turn into great warriors in pregnancy and labour is highly unrealistic. It’s time for women to take our business elsewhere, it’s time for midwifery and out of hospital birth to become the norm, and for midwifery (NOT to be confused with medwifery) to be available to all women in all venues, furthermore access to midwifery must be determined by women in consultation with midwives and not surgeons. The obstetric model of care has driven the caesarean rate through the roof, it has had a good chance to show that it can work well for women and in many instances it has failed miserably. Women must be able to trust their care provider, they must know that they will be supported with kindness and compassion and that every choice they are presented with will be clearly explained as either medically necessary or hospital protocol. Surgeons and hospitals must no longer hold the power in the birthing market, this power belongs to women and women alone.