Birth Justice or Justified Actions?

The birth world is filled with lots of information, perspectives, and opinions. Even with all the angles on a topic, thorough research or evidence, and experienced care providers, sometimes things take an unexpected direction. When a baby is showing signs of distress, or a mom is having difficulty enduring labor, these challenges need to be met with interventions in order to see things through for the best possible outcome. These solutions can be discussed ahead of time, and offered in a gentle, serene manner. When a provider is doing everything to honor a woman’s desire for vaginal birth, despite complications, is this going too far? Is avoiding a cesarean resulting in extensive perineal injury a better option? Is this a case of obstetric violence, birth justice, or is it a justified action? I have seen it all, and some I did not want to see.

As a doula, I do whatever I can to advocate and educate during the labor and birth process. I want to recognize each woman’s vision of birth and help each birthing team carry out their desired wishes. Many times, different factors can come into play which can change the course of this vision. Sometimes this means weighing the pros and cons of real time information or having hypothetical conversations about potential situations. This could be a result of mom’s health, baby’s health, interventions, and other catalysts. Whichever scenario presents, I am always transparent with facts, eager to research and find more resources, and willing to consult with nurses and doctors in order to establish a true sense of what is going on and how I can maximize my efforts.

In an effort to improve outcomes for infant and maternal survival rates, new measures have been introduced to avoid lifelong impairment, injury, or death. Since the early 1900’s when infant mortality rates were approximately 100 in 1000 births, there has been a marked decrease to today’s statistic of 5.4 per 1000 births for an 80% drop. Paralleling this is the maternal mortality rate which was around 850-1000 per 100,000 births in the early 1900’s compared to today’s numbers of about 10-20 mothers per 100,000 births for a nearly 98% drop.

Episiotomies have decreased 73% to 3.4% from 2012. According to ACOG (American College of Obstetrics and Gynecology) the use of episiotomy was not recommended as new research demonstrated that natural tearing promoted better healing. Vacuum assisted rates are about 2.4% and forceps rates account for about .5% of deliveries. They are less common than the use of vacuum as a result of phased out training and lack of familiarity. As an alternative to cesarean birth, vaginal assist methods are approached with great caution and reserved for circumstances where vaginal birth appears promising but needs a little extra finessing! When push comes to shove, or in this case, push comes to pull, special actions are sometimes needed. It is projected that additional perineal injury could occur as well as injury to the baby, but exact outcomes are difficult to predict accurately. 

In a fleeting moment, things can escalate and become very frantic but is this always necessary? In my experience, an alternative to the planned birth vision can be just as wonderful. This can be achieved through a gentle bedside manner in a controlled environment with clear explanation and informed consent. An alternative outcome does not necessitate blame. While many of us do whatever is possible to achieve vaginal birth, a cesarean birth is also birth and sometimes the safer method. Every birth story is written as the tale unfolds, leaving chapters to be filled with unique details. We all want a positive emotional outcome as well as a positive physical outcome.