The way I do things
I have a little different method of advocacy with which you may be unfamiliar. Rather than advocating for a specific decision, I advocate for access to information. Because I take 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.
I’m 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, makes mathematical errors, 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-[insert method of birth, place of birth or type of birth attendant here.]
“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!
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 to small to make any conclusions about HBAC: 88 women.
Questioning my personal choices
Do you feel the … anger? Animosity? Confusion? I don’t even know what the right word is. 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,
It’s not this study’s fault that it came out 2 years after my HBAC. 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 to 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, *which is great.*
I had a HBAC for the reasons that many of us do: I felt like my odds of VBACing were greater at home. I felt like my body would labor normally in my familiar environment with supportive people. I felt like the odds of emergency transfer had to be weighed against the risks of hospital birth. I have written extensively, and frankly, about the risks of home vs. hospital birth as well as the limitations of research when it comes to comparing our birth location options. I also have publicly shared my HBAC birth story.
“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 (6 months old and 1,000+ members strong) 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:
In general, I think the most important things to consider when talking to anyone about post-cesarean birth options are,
- Share info, don’t persuade.
- Offer options, risks, benefits.
- Be OK with people making different choices than you.
- Point to reputable sources so it’s clear that you are the conduit of information, not the source.
- Always verify “facts” before forwarding.
- Don’t get emotional, swear, belittle, insult, name call, bully, etc. I know that may sound obvious, but I’ve met many advocates 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 whackadoo, 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.” Two women can look at the exact same information and make very different choices. And I’m ok with that. After all, it’s not my body, baby, or birth. It’s the mom’s. And she is entitled to decide how she wants to give birth, where she want to give birth, and with whom.
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
- the “VBAC Facts Community,” a Facebook group I moderate whose membership includes post-cesarean moms, health care providers, and birth professionals, or
- supporting the mission of VBAC Facts through sponsorship or advertising.