This essay was submitted to APPPAH for the Pre and Perinatal Educator certification and discusses Ethics within this field. Specifically, the paper addresses C-sections and VBACs and the ethical situations we run up against with the birthing rituals established in the westernized world. Upholding natural birthing practices versus technocratic models would be a huge step in implementing the paradigm shift to conscious parenting. We must be mindful of how these conversations are approached and be ethical in our mannerisms and principles.
As a pre and perinatal psychology educator, my greatest ethical challenges revolve around the principles of respect and responsibility to do no harm. APPPAH’s core mission is to bring consciousness to birthing practices, parenting skills, and psychology in a world that is for the most part unconscious to the scientific process of human development and how these processes provide the foundation for health and joy or disease and misery. The irony of this educational mission lies in the path of obtaining consciousness, which is littered with subconscious triggers that set off imprints and patterns laid out by a person’s autonomic nervous system during their earliest periods of development. In order to tackle such a jarring journey, I have to uncover my own patterns and states of being within my own autonomic nervous system (ANS). In turn, I can then recognize how neurophysiology governs the mind, body, and spirit of another person’s ANS.
Along this journey of self-discovery and training, I have found the most difficulties in adhering to these two ethical practices of respect and “do no harm” when addressing health care providers such as OB/GYNs, their support staffs, and pediatric dentists on the topic of supporting normal, natural birth processes during pregnancy, birth and breastfeeding. Currently, the majority of these healthcare providers do harm to mothers and babies by practicing non-natural techniques. When trying to educate them on the benefits of supporting natural processes, I must remind myself to respect how they were birthed, raised and educated in order to form such practices. My own personal experience of birthing my second child exposed me to how the current medical modalities practiced violate the Lamaze code of ethics and the Ten Steps of Mother-Friendly Care.
When I learned I was pregnant with my second child, my OB/GYN insisted that I opt for a cesarean delivery. I wanted to attempt a VBAC, and if I had been allowed to, I would have also sought out a midwife or doula to help me through the pregnancy. Whether he was aware of his tactics or not, my doctor scared me into a C-section by informing me of the risks I would incur if I attempted to deliver naturally. Namely, he said my uterus could rupture and if that happened my child would surely die and most likely me as well. I spoke to a few other mothers who had tried VBACs, but their doctors refused to attend VBAC deliveries. According to the American College of Obstetricians and Gynecologists (ACOG), a mother’s uterus has less than a 1 percent chance of rupturing at the site of a C-section scar if a vaginal birth is attempted (Enking). My doctor said the odds were low, but why would I want to take the chance because the consequences would mean sure death. My husband was so concerned about this statistic and the doctor’s recommendation that I felt my only option was to follow through with a C-section.
Hospitals list different reasons for why repeat C-sections take place, including that doctors can become more efficient with their schedules versus waiting for a patient’s labor to progress naturally. A new review suggests doctors may choose C-sections to guard against malpractice lawsuits (Enking). Providing better education to doctors and hospitals regarding the importance of VBACs and respecting women’s inherent abilities to deliver children naturally is one way to decrease the staggering rate of C-sections around the world. The best way to fight back is with science itself.
Many studies have been conducted on how to lower risks involved with VBACs. These studies should be shared and included in curriculum for OB/GYNs in medical school and condoned by governing boards such as the American Board of Physician Specialties. These studies observed women who received continuing midwifery care during pregnancy, labor and postnatal care and compared them to women who only received standard maternity care. What they consistently found is VBACs pose less threat when handled with a continuing midwifery model of care. C-sections can bring benefits for women in labor, but they result in more risks, including more pain, longer and difficult postpartum recovery, higher maternal mortality and morbidity, difficulty in conceiving, as well as high rates of stillbirth and miscarriage in subsequent pregnancies (Zhang, T. & Liu, C.).
When I returned to my doctor to explain some of the things I had learned from my studies with APPPAH, he became very defensive and was not willing to hear what I had learned about midwifery as a support model for VBACs. I wondered what triggered him so much, but I have no knowledge of his past experiences or what it is like to be an operating physician with such huge responsibilities on my shoulders. I resisted the urge to emphatically insist that he did me harm and he held no regard to my body’s capabilities to birth a child naturally. I could have badgered him with my anger and lack of respect for the medical community overall.
I know now I could help reduce his stress if I approached him in a different way by using Michael Josephson’s Seven-Step Path to Better Decisions. By following the steps he outlines, I would gather a number of peer-reviewed studies on how midwifery care supports women who choose VBACs. These studies could be presented to medical boards and governing boards of the hospital that oversees his employment. I could even introduce the steps of Mother Friendly Childbirth Initiative to nurse coalitions in the area of his practice to better educate them on how to best support natural processes during labor and delivery. I could develop multiple relationships within his own professional community to increase my chances of impacting his opinions in a positive, influential manner (Josephson Institute of Ethics). By working on my own self-regulation of my autonomic nervous system, I can train myself to stay in a focused state of mind and communicate with medical professionals on this topic in a calm, regulated manner with my overall objective constantly in mind. Ray Castellino’s Principles are also extremely useful for how I can conduct myself ethically when trying to educate people on VBACs. His use of frequent eye contact and self-care are extremely important in establishing a safe container for people when speaking of such controversial issues as VBACs (Castellino).
Mutual support and cooperation takes a great deal of time and effort and if communications can be kept intentional, calm, and backed by facts and scientific studies, we can bring people’s awareness to how VBACs should be embraced rather than shunned. By practicing the principles outlined by Castellino and Josephson, I can avoid doing harm myself or disrespecting the professionals in this field who have come a long way with their own education and experiences.
Castellino, Ray. The Principles Interview. Retrieved from APPPAH’s Ethics Module 2 Curriculum.
Enking, Molly. (2018, August 12). After a C-section, women who want a vaginal birth may struggle to find care. Health. Retrieved from https://www.pbs.org/newshour/health/c-section-vbac-vaginal-maternal-health
Josephson Institute of Ethics. “The Seven-Step Path to Making Ethical Decisions.” Retrieved from http://josephsoninstitute.org/med-4sevensteppath/
Zhang, T. & Liu, C. (2016 May-Jun; 32(3): 711–714). Comparison between continuing midwifery care and standard maternity care in vaginal birth after cesarian. Pakistan Journal of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928428/