First the disclaimer. This essay is aimed at the woman with a previous cesarean, who had something about her cesarean experience that was "unsatisfactory". Something that didn't resolve when her baby was finally placed in her arms. Something that she doesn't want to repeat if she has another child. If there weren't something unsatisfactory about the experience, she wouldn't be worried about planning her next birth and what I have to say here isnít applicable to her.
What that "something" is varies widely -- it ranges from women who experienced their cesarean as an incredibly abusive act to women who simply recognize that a subsequent birth is safer as a VBAC -- women who suffer from Post-traumatic Stress Disorder because of their cesareans and women who have no real negative feelings at all about the cesarean itself. But that "something" exists for each of them, exists beyond the birth of that cesarean born baby, exists to keep these women searching for a different birth the next time.
Why is this important? Itís interesting (at least to me) because of a tendency we unconsciously fall into when planning another birth. Most of the time, birth plans include people other than the mother and the baby. Medical professionals, spouse, family members, friends. I suppose that birth plans wouldn't really need to exist if it weren't for "other people" being involved in some way with the birth. And I've seen, over and over, conflict between what the mother of the baby wants and what these "other people" want.
Obviously, there's a huge disconnect between modern obstetrics and what many women want in a birth after a previous cesarean. There are all sorts of strategies for women to deal with this disconnect. This really isn't the hard part about creating a birth plan (although the agenda of the medical profession is monolithic and very hard to resist, birth plan or no). There's something about pregnancy and protective mother love that seems to make many women that I have contact with at least willing to try to "stand up" to the medical professional without a lot of fear of offending that person. However, itís a very different story when we are talking about family or friends.
Now, I'm not going to go into theories about marriage dynamics or mother/daughter psychology. Let's just say that for many reasons these are not cut and dried, black and white relationships. The same is true regarding a relationship with a good friend, or a spiritual advisor. What these people think about the choices we make when planning a birth matters to us. The degree to which itís reasonable that their opinions really matter varies a lot but that's not the issue. The fact is, we take into account what these other people "want" when we plan our births. The fact is, we make compromises because of what other people want.
Why in the world do we do this? Well, sometimes we have to -- I'm not going to suggest that a woman leave her spouse because he absolutely refuses to agree to a homebirth. (I might suggest that it doesn't have to come to that, that there is more going on here than just ďmy husband wonít let me have a homebirthĒ, because usually in the end, it isn't a simple yes/no problem but you do have to work hard at it to figure out what is really going on). Very often, we compromise our plans because we don't want to "offend" or we worry about "straining" the relationship. Or because we are just plain afraid to stand up to someone about what we know is right for us and our unborn baby. Afraid to not be "nice". We want to preserve the relationship in question and so we compromise, believing that it will be worth it to maintain the status quo.
What does this have to do with the previous cesarean? Well, why in the world would it be reasonable to assume that the compromises you make in your "birth plan" aren't going to matter anymore when your baby is placed in your arms? (Iíve heard too many women say ďI just want my baby to be here, I know itíll be ok once the baby is hereĒ.) I know we unconsciously assume that it won't matter after the baby is here (remember, ďall that matters is a healthy babyĒ), we don't see beyond the birth, we just see the relationship dynamics at work during the pregnancy and up to the birth. What we forget is it didn't work that way the first time. "Something" continued to matter, long after the birth. And if we make compromises the second (or third or fourth) time around to try to keep everyone else happy, and that impacts how the birth unfolds, it is going to matter and those relationships that we comprised ourselves for are going to be negatively impacted anyway.
Sometimes the compromise is worth it -- sometimes itís worth it to take the chance that a relationship will be damaged in a different way after the birth, in the event of an unwanted outcome, to preserve a comfortable relationship before the birth. (Important to note that most likely, it's comfortable only for the person who demands the compromise. Not so comfortable for the woman doing the compromising.) But does every relationship with every person who has an opinion about your birth deserve a compromise? Iíd say absolutely not. I'd even go so far as to say that most relationships, friend, family or otherwise don't warrant compromise. Compromise doesn't preserve the relationship. Iíll repeat myself: compromise will not preserve the relationship. It is very likely going to matter a lot if the compromises you make for your spouse/friend/mother/mother-in-law end up getting you another "unsatisfactory" birth, whatever that means to you specifically. I believe you have to ruthlessly decide which is worse -- offense and possibly hurt feelings before the birth or ongoing and possibly intense resentment after the birth. Because honestly? That's what it comes down to a lot of the time. When there are other people in disagreement with what you know is best, there simply isn't any way to make everyone happy. It simply can't happen.
We have to decide. Who makes the sacrifice? The other ďconcernedĒ person or ourselves and our unborn children? Someone will, that's the only sure thing. Will it be the person who has some variable degree of interest in the birth (and may not be there afterwards, in any real sense), depending on who they are or will it be the two people who have everything invested in a safe birth? You get to decide. You have to decide. There is no one else to whom it matters more.
Revised June 12, 2006