Several hundred years ago, having a C-section meant almost certain death for the mother because there was a common belief that a uterine incision could not be sutured.
You sound like an excellent doctor. Thank you for seeing women and caring about our outcomes.
My poor daughter is a second-generation cesarean; my mother was told I was too enormous to birth normally. I was about 7lbs. I then had a primary section for a “huge” 8lb2oz baby. My VBAC with a larger baby helped, but didn’t heal those wounds.
I recently heard a lecture from Rachel Somerstein (author of a new book about cesarean) and comments from an OB followed. He was young, and reflected on the first half of his residency being spent doing sections; the second half “preventing” them. As if a cesarean were an inevitable or naturalistic outcome! He seemed to have no sense of irony.
In fact, there seems to be no sense of *shame* in deskilling among the younger generation of OBs, especially those who take to TikTok and Instagram; a sense of pride, in fact, that if the silly mother does not want to consent to major surgery for frank breech, for instance, she will simply have to go freebirth in a field somewhere because anyone who doesn’t believe in science deserves to have her baby die. The contempt is palpable, unfortunately. What I read here is your compassion. The world needs more of it.
You have raised enough questions to write a book to answer them. I would like to listen to Rachel Somerstein's lecture and to read her book. I've been doing VBACs and vaginal breech births since 1978 and never had cause to regret doing them.
My attitude comes from respect for moms, dads and kids. Our book is called Pregnancy Your Way: Choose a Safe and Happy Birth. The first half of the title derives from respect for your (plural) sovereignty, and the second half stands for my support for your autonomy. This book is a course on how to exercise autonomy from 6000 births.
Today even ACOG recognizes your sovereignty and your autonomy. ACOG is the American College of Obstetricians and Gynecologists. So, at least we have the words coming down from on high. Whether and to what degree those words hit close to or land on the rank and file is anybody's guess. At least we are being told to respect you.
I am very familiar with contempt. Even offering patients vaginal breeches or VBACs and respecting their autonomy has brought contempt from my peers. I was available for breeches from many family practice docs. All deliveries went well, but one lady who had a very nice breech birth told me that the wife of one of the OB docs in town said that the complications from a breech vaginal birth can occur even decades later. There is no proof of that, but one DOES need to know how to do a vaginal breech. It's NOT hard to do, but there are some things which MUST be done and some which MUST NOT be done...like everything else in life. What must be done fro a successful vaginal breech birth is a chin tuck, called "neck flexion" in medical parlance.
And finally, if the teachers don't know, they can't teach. So rather than just telling you the truth that the doctor doesn't know how to do a vaginal breech or a VBAC, they might cover their weakness with contempt. That's common.
Thanks for your thoughtful issues. I'm genuinely sorry for the contempt you've seen.
Sorry about the disgusting "belief in Science bit." I bristle when I hear that, especially from Fauci, who I don't think understands science very well at all.
You sound like an excellent doctor. Thank you for seeing women and caring about our outcomes.
My poor daughter is a second-generation cesarean; my mother was told I was too enormous to birth normally. I was about 7lbs. I then had a primary section for a “huge” 8lb2oz baby. My VBAC with a larger baby helped, but didn’t heal those wounds.
I recently heard a lecture from Rachel Somerstein (author of a new book about cesarean) and comments from an OB followed. He was young, and reflected on the first half of his residency being spent doing sections; the second half “preventing” them. As if a cesarean were an inevitable or naturalistic outcome! He seemed to have no sense of irony.
In fact, there seems to be no sense of *shame* in deskilling among the younger generation of OBs, especially those who take to TikTok and Instagram; a sense of pride, in fact, that if the silly mother does not want to consent to major surgery for frank breech, for instance, she will simply have to go freebirth in a field somewhere because anyone who doesn’t believe in science deserves to have her baby die. The contempt is palpable, unfortunately. What I read here is your compassion. The world needs more of it.
Thanks Liz!
You have raised enough questions to write a book to answer them. I would like to listen to Rachel Somerstein's lecture and to read her book. I've been doing VBACs and vaginal breech births since 1978 and never had cause to regret doing them.
My attitude comes from respect for moms, dads and kids. Our book is called Pregnancy Your Way: Choose a Safe and Happy Birth. The first half of the title derives from respect for your (plural) sovereignty, and the second half stands for my support for your autonomy. This book is a course on how to exercise autonomy from 6000 births.
Today even ACOG recognizes your sovereignty and your autonomy. ACOG is the American College of Obstetricians and Gynecologists. So, at least we have the words coming down from on high. Whether and to what degree those words hit close to or land on the rank and file is anybody's guess. At least we are being told to respect you.
I am very familiar with contempt. Even offering patients vaginal breeches or VBACs and respecting their autonomy has brought contempt from my peers. I was available for breeches from many family practice docs. All deliveries went well, but one lady who had a very nice breech birth told me that the wife of one of the OB docs in town said that the complications from a breech vaginal birth can occur even decades later. There is no proof of that, but one DOES need to know how to do a vaginal breech. It's NOT hard to do, but there are some things which MUST be done and some which MUST NOT be done...like everything else in life. What must be done fro a successful vaginal breech birth is a chin tuck, called "neck flexion" in medical parlance.
And finally, if the teachers don't know, they can't teach. So rather than just telling you the truth that the doctor doesn't know how to do a vaginal breech or a VBAC, they might cover their weakness with contempt. That's common.
Thanks for your thoughtful issues. I'm genuinely sorry for the contempt you've seen.
Sorry about the disgusting "belief in Science bit." I bristle when I hear that, especially from Fauci, who I don't think understands science very well at all.
Alan Lindemann MD, previous FACOG