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Some people think I’m anti-this/ pro-that: My advocacy style

The way I do things

VBAC Facts communicates differently than many others who speak or write about birth. Rather than advocating for a specific decision, we advocate for access to information. Specifically, the mission of VBAC Facts is to close the gap between what the best practice guidelines from ACOG and the NIH say about VBAC and repeat cesarean and what people generally believe.  In meeting this goal, VBAC Facts makes hard-to-find, interesting, and pertinent information relative to post-cesarean birth options easily accessible to the people who seek it. VBAC Facts does not advocate for a specific mode of delivery, birth attendant or birth location. Because of this stance, sometimes people are a little confused. They are accustomed to outspoken advocates (arguing for either the pro or con) urging them to have a certain type of birth at a prescribed location with a specific type of birth attendant – or none at all.

VBAC Facts is occasionally labeled as pro-this/ anti-that because I periodically will not agree with someone, even if we have made similar birth choices.  If someone supplies incorrect statistics, uses faulty logic,  or uses the dreaded terms “always/never,” I pipe up and give my perspective and a source corroborating my stance.  You may (or may not) be surprised how often this interjection is interpreted as anti- or pro-[insert method of birth, place of birth or type of birth attendant here.]

Balanced Rock

“Error, error Will Robinson!”

Let me give you the most recent example. The other day on Facebook, someone posted this:

A Canadian study has found that homebirth is safer …. yes EVEN FOR VBAC!
http://www.cmaj.ca/content/181/6-7/377.full.pdf

Naturally I was curious to read it as the number of studies on out-of-hospital (home or birth center) VBAC is really limited. So I did and noticed two key points which I shared because in her country, and mine, this study would not be applicable in all situations:

“It should add confidence to the safety of home birth in a context such as ours in which registered midwives have a baccalaureate degree or equivalent and are an integral part of the health care system. Our findings do not extend to settings where midwives do not have extensive academic and clinical training.24″

HBAC [home birth after cesarean] sample was too small to make any conclusions about HBAC: 88 women.

Questioning my personal choices

Then she basically accused me of being anti-home birth.

I had a home VBAC, but my personal choices are pretty irrelevant in terms of my work, since I’m not advocating for all moms to choose home birth or VBAC. But this fellow home birthing mom, since I questioned how she interpreted this study, came to the conclusion that I must be against home birth. What other reason could there be? So I replied,

This is an interesting study, but I think it’s important to be clear about it’s findings and how it was conducted. 88 HBAC moms is not a significant sample size because it’s simply too small to accurately measure complications/ outcomes.

This study also intentionally excluded any TOLAC [trial of labor moms] moms from the hospital comparison group. So this is not so much a HBAC vs. hospital VBAC study as it is a study on home vs. hospital birth among unscarred moms.

“Lots of your posts come off as opposed to homebirth.”

Her response is telling:

Thank you for clarifying that. I can’t tell you how many times I’ve been asked if you’re against homebirth and I say you aren’t and in fact you ARE a homebirther. Lots of your posts come off as opposed to homebirth.

And there it is.  You don’t tow the party line, you don’t appear to be in constant agreement with those who make similar birth choices, and people don’t know what to make of you.  It’s as if life has become so polarized that people can’t imagine someone who really isn’t on one end of the spectrum or the other advocating for everyone to make the same decision as them.  I am an advocate for information.  Plain and simple.  I reply:

Perhaps people interpret my realistic/ practical approach to things as anti-homebirth. And because I like to debunk myths and this frustrates people because these myths give them (misplaced) confidence. I acknowledge the various risks and benefits that come with our birth choices.

I do this because I think that women are intelligent enough to hear “these are the risks and benefits of XYZ” rather me dictating “make XYZ choice” or giving the (often hollow sounding) “it will all be fine” or “I had an HBAC, so should every woman!!!”  To some people, that comes off as anti-this/pro-that… but for me, it’s a fair look at our choices.

I think sometimes people start to look at a specific mode of birth/ birth location/ type of birth attendant with rose-colored glasses.  They try to minimize the risks associated with their “choice of choice” in an attempt to advocate for others to make similar decisions whether that is VBAC, repeat cesarean, home or hospital birth.  (Everyone has an agenda!!)

But minimizing risks deprives women of their right to informed consent and that is really no different than individuals who exaggerate risk. I don’t advocate for women to birth a certain way in a certain location.

My frank discussion of the risks sometimes angers people because they think it’s scare tactics anytime someone brings up a bad outcome or risks. I write about the difference between scare tactics and informed consent here after I received a comment from an OB saying I’m anti-OB/anti-hospital.

A big part of my philosophy is based on the fact that I have a website and a large readership.  I don’t want anyone to ever come back to me after a bad outcome and say, “You misled me.”  I feel an obligation to be honest and truthful about the pros and cons of options as well as the quality and quantity of research available to us.  Women often feel misled by their HCPs [health care providers].  I don’t want to be part of that misinformation machine.

My mission is simple: to make hard-to-find, interesting, and pertinent information relative to post-cesarean birth options easily accessible to the people who seek it.

I do this because I think the information speaks for itself.  It doesn’t need a cheerleader!  It doesn’t need someone to stretch the truth!  Just someone to say, “Read this!”

My tips for birth advocates

Later that same day, someone posted in the VBAC Facts Community asking how they can get involved with birth advocacy. Other VFC members and myself directed them to a variety of organizations like ICAN, Improving Birth, the National Advocates for Pregnant Women, the ACLU, Legal Advocates for Birth Options and Rights (LABOR), and Human Rights in Childbirth. I also supplied a few tips for anyone interested in becoming a birth advocate based on my own journey:

  1. Share info, don’t persuade.
  2. Offer options, risks, benefits.
  3. Be OK with people making different choices than you.
  4. Point to reputable sources so it’s clear that you are the conduit of information, not the source.
  5. Always verify “facts” before forwarding.
  6. Don’t get emotional, swear, belittle, insult, name call, bully, etc. I know that may sound obvious, but I’ve met many people whose aggressive and angry passion totally turns people off. If you isolate, insult, antagonize, or annoy people, they are not going to listen to you and what could have been a teaching moment, is gone. And once they write you off as a crazy, hysterical loon, it will be unlikely you will be able to change their perception.

There are many roads to the same destination. You can advocate right now by going on message boards and simply pointing people to accurate information when they ask questions. Sometimes all they need is to see a little bit that suggests what they have accepted as “truth” is the opposite of what major medical organizations, public health professionals, and medical researchers support and recommend.

Take home message

VBAC Facts advocates for access to information, not a specific decision.

Yes, I had a home VBAC. But just because I made that choice doesn’t mean:

  • I believe home birth has zero risk (it doesn’t)
  • I think everyone should have a home birth (they shouldn’t)
  • I think everyone should have a VBAC (they shouldn’t)

I have said many times, “Birth is not one size fits all.” As ACOG says, two women can look at the exact same information and make very different choices. And I’m ok with that because there is not a Right or Wrong decision for all women, just a right or wrong decision for that specific woman, and that is hers to make based on information, not bullying or hysteria.

Supporting the mission of VBAC Facts

If you like my style of advocacy, you might really enjoy:

  • the class I created and teach targeted to parents, health care providers, and birth professionals entitled, “The Truth About VBAC: History, Politics, & Stats” offered on-line as a webinar or in a city near you,
  • the VBAC Facts Micro Brochure, a folding business card to be used by professionals and advocates that provides a brief overview of post-cesarean statistics, or
  • the “VBAC Facts Community,” a Facebook group that I created in response to other groups that I found very polarizing.  Our whose membership includes post-cesarean moms, health care providers, and birth professionals.

 

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7 comments to Some people think I’m anti-this/ pro-that: My advocacy style

  • TLK

    I really appreciate what you’ve written here. My first baby was a hospital induction turned emergency c-section. When we found out we were expecting baby number 2, we did a lot of research. We didn’t merely look at data or statistics–although that was an important part of the decision–but we looked at our specific circumstances:

    -my overall health, including surgical records from the cesarean
    -the health of our baby
    -the various hospital birth options available to us. (including a visit to an OB at a large city hospital an hour away)
    -our free-standing birthing center options
    -our homebirth midwife options
    -UC was completely off-the-table for us because of my husband’s personality, feelings about birth, the train-wreck that was our first birth experience, etc

    We interviewed the midwife we chose extensively before making our decision. My husband was very skeptical (having been raised by an RN who had 3 c/s herself), and he asked a lot of *tough* questions. If she had glossed over his questions with an “it will be okay” attitude, I never would have had my homebirth. She never flinched, though, and was very matter-of-fact with him, while still being compassionate toward me. She even assisted us in looking at our non-homebirth options! However, after talking with her on several occasions, looking at her track-record (which she was open and honest about), her training, experience, and knowledge, speaking with other mothers who had birthed (and transported) with her, and our various other birth options, the question answered itself:

    Having a homebirth with *this midwife* would be the *safest* option for *me* and *our baby*.

    There never is a guarantee that all with be well, but at least we were confident that we had made the best decision we could with the information we had. I went on to have 3 safe and successful HBACs with her. :)

    At this point, I am faced with the reality of navigating another pregnancy without my beloved (retired) midwife. Although I can’t believe I’m doing it, I’m interviewing an OB/GYN in 2 weeks. I have no great hopes that my hospital options have improved much, but I at least want to be able to say that I looked into it. I also have a long list of midwives to talk to–none of whom are as local to me or as experienced as my former midwife was.

    In some ways, the decision will be easier this time. I have a “proven pelvis” and a “proven scar”. I know, for example, that I go into labor naturally at around 41.5 weeks, and that none of my babies were “big” despite their “old” gestational age. I know I have long labors with little “progress”, followed by very quick dilation and short 2nd stage. My less-than-textbook labor quirks may scare a few folks off. On the other hand, hopefully whoever we decide to go with will not be surprised that I vomit the whole time or that I go from 2-10 in an hour.

    All that to say that I totally agree with you: every woman is different, and each one of us needs to consider our own circumstances when making the choices as to how, where, and with whom to birth. In general, I do think that homebirth with a qualified midwife is a safe option for most women…including many of us with scars. However, I would never pretend that it is the perfect, risk free option for every mother. If a mother lives in a community with a wonderful hospital birthing center that has a low c/s rate and a high vbac success rate, but no homebirth midwives, her decision would probably be completely different from mine, in a community full of hospital vbac bans/almost bans and several reputable midwives to choose from.

    Again, thanks for your work! I often refer friends who are interested in knowing their post-cesarean birth options to your site. Many Blessings!

  • Marla

    I appreciate your style of advocacy very much. In my opinion, one of the biggest injustices women who face birth choices after a c-section is that so many care providers only provide information supporting the choice they want women to choose. Too often, that amounts to exaggeration, scare-tactics, and bullying. If birth advocates resort to the same methods to “promote the cause”, the result will be the same – women making choices based on misinformation, fear, or frustration instead of making decisions based on what they feel is best for them and their families. Thank you for consistently seeking to share the truth as it is.

  • Amanda

    Thank you so much!! I really appreciate you standing up for the truth regardless of how it may or may not appear to others. To be honest I feel tossed two and fro with my previous births and trusting the system but I dont want my feelings to dictate to me and make me see something that is not there. Ultimately I want what is best for me and my babies. Your facts let me see past my feelings and make informed decisions in the face of any future VBAC or HBAC. Thank you :-)

  • I always love your post. I love how well reserched they are and how much information you really provide to allow moms to make an INFORMED decision. While my blogging is no where near as referenced 0_o LOL…. my advocacy style is similar. I often have to start off saying “I am NOT for everyone having a natural birth…” I just want women to get the information…most importantly TRUTH so that they can make good choices for themselves. Thanks for all you share and write. Forget those that dont get it ;-) and keep up the good work!! Love it!

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