It is virtually impossible for anyone who was raised in a white colonialist country – like the United States – to come into adulthood without racism in their heart and mind. This is where implicit bias comes from. So if you have heard people say things like, “All white people are racist,” that’s what they are referring to. It’s not using the N-word or going to a KKK rally. It’s not listening to Black women when they report pain in the hospital and missing a potentially deadly complication as a result. That is one way implicit bias presents. So what can white birth professionals do about it? How can they identify and face the implicit bias in their own heart, and systemic racism within the health care system, so racial disparities can improve?
“I need to ask a favor from anyone who 1) had a vaginal breech birth in the hospital, 2) had one at home because that was your only option, or 3) was pressured into a cesarean because it was not an option due to hospital policy or lack of experience of attendant. I am getting a lot of pressure to stop attending breech and despite my best efforts to get privileges at a tertiary care hospital with neonatology, it is not happening. Please send your impassioned pleas and experiences to Sutter Davis Hospital 2000 Sutter Pl Davis CA 95616 Thanks!”
I have thought about AB 1306 for so many hours since I initially opposed it last Friday and I’m feeling really conflicted about it. Let me share with you why. Removing physician supervision will improve the ability of CNMs to practice autonomously including offering VBAC in the hospital setting (where hospital policy permits) and in birth centers (provided the CNM opts to offer VBAC). This could be a good thing for VBAC families and a great thing for all the other people CNMs serve. And so it’s really tough because it could negatively impact the small number of women who plan home VBACs by requiring them to have a VBAC consult with an OB. So, what is the right decision?
A woman who had four cesareans, after planning VBACs and home births, recently contacted me. She didn’t know where she fit into the birth community. My heart went out to her because there have been periods in my life when I have felt isolated and alone. And it’s a crappy feeling. I replied to her, “A vaginal delivery is not required to participate in the birth community. There are many cesarean moms just like you who are seeking compassion, connection, and understanding. You could be a soft place for other women to land as they mourn (or celebrate!) their cesarean deliveries.”
I’m in an online group for labor & delivery nurses where the discussion of vaginal birth after cesarean (VBAC) at home came up. While some understood the massive VBAC barriers many women face, others simply said, “Find a hospital that supports VBAC.” I left a late-night comment stating that “finding another hospital that supports VBAC” is just not a reality in many areas of the country. It’s literally not possible. Not even in the highly populated state of California. I also suggested rather than calling women stupid or debating the validity of the decision to have a home VBAC , we should consider why women make this decision.