No-BS Book Reviews--Choosing Cesarean: A Natural Birth Plan

No-BS Book Reviews: Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull

When I was informed that my baby was still breech at 38 weeks and that a cesarean section was required, I knew that I was supposed to feel angry, saddened and cheated of the chance to have a “normal” delivery; instead, I felt secure, in control and—let’s be frank—pretty relieved. Anyone who wants to know why should read Choosing Cesarean: A Natural Birth Plan by Magnus Murphy, M.D. and Pauline McDonagh Hull. In this important book, the authors make a convincing case for cesarean delivery on maternal request as a valid form of birth and as the best choice for some women.

Hull is a journalist who blogs at http://cesareandebate.blogspot.com, while Murphy is a urogynecologist (essentially, someone who spends his time propping up busted pelvic floors), and their book reflects this mixture of the medical, the personal and the political. It is a comprehensive guide for anyone considering choosing cesarean or interested in learning more about the issue, discussing not only the case for cesarean but also the practical and emotional aspects of planning and recovering from a surgical birth.

After a personal intro by the authors, Choosing Cesarean starts off with a look at the safety of panned cesarean, doing an excellent job of puncturing the sloppy science and media hysteria which has blighted popular discussion of this type of birth. Stats surrounding cesarean safety are usually based on “mixed” data which combines planned and emergency sections; if you look at the data for planned sections alone, the safety record of this birth type is generally at least as good as that of spontaneous vaginal delivery. Furthermore--and this is another important point which comes up several times in the book--an emergency cesarean is usually the result of a planned vaginal delivery. The book goes on to look at birth satisfaction, noting that satisfaction levels are high and birth trauma almost non-existent among women who choose cesareans. There is a detailed discussion of the pelvic floor and things that can go wrong in vaginal births—all the things which your Lamaze class won’t tell you (one quibble: a diagram of the pelvic floor might have come in handy here). Just a warning, but this part can make disturbing reading, and if I’m honest, I came out of this section feeling like I had dodged a bullet. 

This is followed by a discussion of cesarean rates around the world and the intensely politicized debate which surrounds cesareans. An entire chapter sets out the risks of planning a cesarean in detail; Murphy and Hull never gloss over the details of surgical birth or make it out to be a superficial or cosmetic procedure. The final section of the book focuses on the “how-to” aspects, describing the surgery itself in detail and giving advice on how to plan and recover from a surgical birth, interwoven with stories, hints and tips from real women who have had maternal request cesareans.

We all have our biases when it comes to birth and Murphy and Hull are unabashedly fans of planned cesareans; nevertheless, they are clear at all times that this is only an appropriate option for women who are suitable candidates (committed to having a small family, sure of their conception dates, and fully informed about the risks and benefits of the procedure). They also state emphatically that the fact that chosen cesarean section is a valid choice does not in any way invalidate the desire of other women for natural childbirth and VBAC. The book is well-written, well-edited and clear; in the sections on pelvic floor health in particular it does a good job of explaining some complex ideas in language any layperson can understand.

Any quibbles? Well… one objection which is invariably raised whenever the idea of maternal request cesarean comes up is “The cure for the problems of vaginal delivery (pain, trauma, pelvic floor injury) is not surgical birth, but natural childbirth. These terrible problems are basically caused by women giving birth on their backs in hospital; if we all went without drugs and squatted in labor, they wouldn’t happen.” The evidence supporting this is, well… dubious, to say the least, although there is some evidence that the use of epidural anesthesia may increase the risk of a forceps/vacuum delivery; anticipating and discussing this objection might have increased Choosing Cesarean’s persuasive power. (In my own case, feeling that I had to choose between either unmedicated labor—i.e., hours or possibly days of blinding agony—or an increased risk of an instrumental delivery and all the physical and emotional trauma which that can cause, merely increased my own desire to avoid vaginal delivery if possible… neither of these options sounded very appealing!) I’m also unsure about the book’s title “A Natural Birth Plan”; cesarean birth is certainly valid, but it isn’t natural… and there’s nothing wrong with that. “Natural” isn’t always better.

These are small quibbles about what is fundamentally an intelligent, courageous and important work. I’ve recommended it to more than one person, and my own copy is now well-thumbed. Whether you are planning a cesarean, know you will have to have a cesarean anyway, are not sure either way, or are simply interested in birth politics, you’ll find this book a terrific resource. It’s worth a read.

Becoming "the framework of support that we want to see"

I have just added a page of No-BS Breastfeeding Resources to the site, which I'll be updating from time to time. It's based on my previous post, but I added the following paragraph, which I'll just post again here:

A  while back, the Fearless Formula Feeder wrote a blog post in which she expressed disappointment in the way a certain breastfeeding website had behaved--all the more so because this was a website which the FFF had previously considered to be one of the better breastfeeding resources. The site in question had previously been seen making efforts to bridge the divide between breastfeeders and formula feeders and to express respect and support for all mothers, so it had come as something of a surprise when the site (a) ran an interview with a breastfeeding celebrity which had come across to many readers as rather smug and provocative, and (b) deleted comments by some posters (including the FFF) which had expressed criticism of the interview.

When the FFF blogged about this, she drew the following comment from a follower of her blog:

"I cannot conclude anything other than that BFB has gone over to the dark side. It's unfortunate, but it seems that a lot of lactivists, in order to maintain their core readership, find themselves being pushed more and more to the extreme, leaving those in the middle (who are probably a very large majority) marginalized. Breastfeeding bullies–which BFB seems to be increasingly leaning toward–do not just harm bottle-feeding parents. They harm breastfeeding ones, and potential breastfeeding ones too."

while another commented,

"I have always liked Best for Babes as an organization that was “supportive” to all mothers... I just think that at the most basic level, moderate attitudes and being supportive of everyone just doesn't get readers and ad impressions. Showing your ass and leaning toward militancy does."

There's an important lesson here for us all. Sites like Best for Babes, Kellymom and all the others are the way they are because that's their core readership--that's who hangs around these sites and posts the most. As a result, more moderate voices tend to be drowned out, and will continue to be drowned out unless these more moderate people get more proactive about speaking up and expressing some alternative viewpoints... in a sensitive, respectful and non-trolling way, needless to say. Meanwhile, the small number of breastfeeding-related Facebook pages and sites which are committed to discussing breastfeeding in a sensitive and non-extremist way have tiny followings compared with the big lactivist resources. There's an Evidence Based Breastfeeding Facebook page, sure--but maybe people need to start being more proactive about posting on it and inviting people to it (and by "people" I'm including myself, by the way). We need to keep an eye out for good resources, comment on them, share them with others, link to them and bring them into discussions at our mother's groups and due-date-clubs. It's a case of "Use them or lose them."

If anyone reading this page feels, like me, that we need better breastfeeding resources... less antagonistic, more moderate, more representative of the full range of mothering styles, and well, just.... saner... then it's all very well complaining about this amongst ourselves, but the current situation is not going to change unless we all step up and "become the framework of support that we want to see." And that's something which we all need to get behind.

Baby regrets... "I wish I'd..."

For some reason, I have all these regrets about her little newborn hands and feet. They were so tiny and precious. I wish I'd made prints of them in ink, gradually getting bigger over the weeks and months. And I wish I'd taken some film footage showing the way she used to move her little hands about when she was a newborn... they were always fluttering and opening and closing and spreading like little starfish in the sea, as if they were marveling at the freedom of the open air. In fact, I wish I'd filmed all sorts of things when she was tiny... like the way she used to make suckling movements with her lips when she slept, and how floppy her head was. I didn't even discover our new camera had a film button until she was two months old (yeah, I know). Now all those little newborn movements are long gone and I only have my memories.

Like all parents, I wasted a fair bit of money on things she didn't like. I spent a fortune on a beautiful Mio baby hammock. She hated it, and I was too nervous to use it what with the earthquake aftershocks and all (I gave birth on 12 March in Tokyo, about 16 hours after the earthquake). Oh well, at least I got a couple of beautiful pictures of her in it. She didn't like the mesh feeder or the swaddle blanket either.

I wish I had actually packed my hospital bag well in advance. The morning my waters broke I still had half my stuff scattered all over the living room. "No need to finish packing it just yet. Everyone knows first babies are always late," I had thought. Ha.

Oh, and I wish I'd depilated my legs beforehand--or rather, got a proper all-over waxing job at a salon. God knows what my obstetrician thought of me.

I wish I'd given Little Seal Vitamin D drops. She has never had any signs of Vitamin D deficiency, but still it might have been a good idea.

I wish I'd bought a proper camera as soon as I got pregnant and taken lots more bump shots. I don't regret not getting a belly mould though... that's just weird.

I wish I hadn't flipped out so badly when she had colic between 5 and 10 weeks. I did and said some very silly things which I am extremely embarrassed about now (so embarrassed that I'm not even going to say what they are). Turns out Mum was right. They do grow out of it.

I think my choice of pram (a Maclaren XT) was basically a very good one in almost all respects, but I wish I'd chosen something with a rear-facing option. I remember Little Seal being quite frightened of the pram sometimes when she was little and was being wheeled about in busy, crowded city streets, unable to see my face, and I'm sure it's contributed to her dislike of the buggy even now. It would be lovely to be able to go for a walk together and communicate face-to-face while I also get a bit of much-needed exercise. I actually use the sling a lot, even these days, but it would be nice to change it up and use the pram too. (And anyone who wants to snark on mothers who want to put their toddlers in a rear-facing buggy can go jump in a lake. Seriously. Some of us have jobs, and face-to-face time with our toddlers is a precious commodity).

I wish I'd bought more slings while Little Seal was tiny. I had no idea just how much I was going to be using carriers... a lot, as it turned out. While I think my chosen carriers (Beco Gemini and Beco Butterfly) were really, really good ones, I think it would have been fun to have a couple of mei tais in there as well. And a ring sling! Buckle carriers like the Beco aren't really ideal for a newborn, in my opinion. And it might have been fun to get into wrapping. Yes, I know wraps are really granola-looking, but they are also really pretty and interesting.

Oh, and I wish I'd bought a babywearing coat too. Turns out it would have been a good investment. I hate having to walk around inside an overheated shop in winter with my coat on because Little Seal  is strapped on on top.

Knowing what I did now, I wish I'd been just a little more conscientious about getting a tad more solid food inside her. I was pretty good about choosing iron/zinc-rich foods for her for the most part (even then I was highly suspicious of the breastmilk-is-all-they-ever-need mentality prevalent online), but I do also remember lots of lazy days when I just plugged her into the boob and surfed the web, and at mealtimes just chucked bananas and rice cakes (which she didn't always eat) in her general direction. Hmmm. Oh, and I wish I'd been a bit more careful about oral hygiene and not passing on dental-caries-causing bacteria--I cringe now to think that I actually prechewed some meat for her once or twice. I know they all get colonized by these unpleasant bacteria eventually, but it surely makes sense to keep it away from their mouths as long as possible.

I wish I'd had Little Seal's cord clamping delayed. At the time, the benefits were in doubt and there was some concern about an increased risk of jaundice (which now appears to be unfounded).

I wish I'd tried Baby Sign. Not because of any of the (dubious) benefits that are sometimes claimed for it, but because it would have been so cute. And cool. And interesting. I've heard of babies as young as four months signing "milk" in their sleep... magical.

I wish I hadn't driven both of us crazy with trying to get her to accept a bottle, when in retrospect it really wasn't necessary at all (note: this was for me in my situation. For most breastfeeding mothers, life will be a lot easier and pleasanter if the baby will drink from a bottle). If I had another baby in similar circumstances--i.e, working from home and using at-home childcare for the first nine months at least--I would probably not even bother with the bottles, and just go straight to cup-feeding and start solids at 4-5 months.

I wish I'd kept a more detailed account of the pregnancy and birth and the first year.

And just briefly... a few things I'm glad I did:

I'm glad I didn't spend money on little clothes and toys, because people give them to you anyway, and I needed my money for other things (like the hospital).
I'm glad I read baby books during my pregnancy rather than pregnancy books (pregnancy takes care of itself, mostly; if it doesn't, you need to see a doctor, not read a book about it. But babies.... well, you don't have so much time for reading once you've got a newborn, let's face it).
I'm glad I prioritized sleep from the start, and that I got tough and nightweaned at 8 months.
I'm glad I started the potty early, since this is now really starting to pay off.
I'm glad I chose a really good hospital, with nice food and nice nurses and great breastfeeding support. Even though it was damned expensive.

And I'm really glad that I breastfed, even though I was slightly ambivalent about the idea when I was pregnant. I know that the pros and cons of different feeding methods work out differently for us all, but for me, breastfeeding has turned out to be one of the best mothering decisions I ever made--largely problem-free, healthy, convenient and cheap, not to mention emotionally fulfilling, empowering and just plain cool (my body producing life-sustaining food for an infant... how amazing is that?) And it's that feeling, ultimately, that keeps me passionate about the subject and blogging about it here.