Going on the Offensive
I was twelve weeks along with my third child when I was told that I was a “good candidate for vaginal birth.” A candidate? I was in good health, and had had two previous pregnancies, with two vaginal deliveries - why was I merely a “candidate” instead of it being assumed that I would birth vaginally? Two words: defensive medicine. Defensive medicine is when a provider acts for reasons other than the health or well-being of the patient, for fear of being sued or subject to other punishments or penalties. In my case, I have big, fast babies, giving healthcare providers nightmares of shoulder dystocia in the middle of the highway.
First, let me state that I am not a small woman. I am, according to the BMI charts, obese. Whether I think the BMI charts are accurate, well, you’ve heard from me before on that. I am well-pleased with what my body can accomplish (both in pregnancy and general physical feats), so I’m not too worried about it, especially given that all test numbers are “brilliant!” as my primary care provider says. On the other hand, I’m a Fat Mama. From a long line of Fat Mamas. Therefore I must be: 1) lazy, 2) stupid, 3) diabetic, 4) pre-eclamptic, or 5) ALL OF THE ABOVE AHHHHH! I happen to be none of these (yes, I’ve checked, thanks). Nonetheless, I began my birth history with the Fat Mama tag.
My first child was born as a result of a “successful” induction. Towards the end of my pregnancy, my midwife (whom I had chosen because that’s the best way to a natural birth, right?) began to become concerned about the size of my baby. I was over nine pounds at birth (and breech and sectioned two weeks after my mother’s due date, if we’re counting), and come from a family of larger people. Combined with a lack of vaginal birth in my family generally, she was concerned that allowing me to go full-term would mean an almost certain C-section. Besides, at 37 weeks, he was “ready,” right? After talking to my midwife, I agreed to the induction (for which I was told there were no risks, as opposed to almost certain injuries for a later term vaginal birth) and my son was born at what is now referred to as a “late pre-term” baby. He was a good size (borderline macrosomic) but was not ready to be born and suffered a lot from his early birth. Ten years later, he has finally overcome most of the physical issues, although he still suffers from growth and behavioral issues that his providers believe are connected to his birth and the years of treatment after for prematurity-related problems. In addition to the guilt from consenting to the induction, I now had the Big Baby tag attached to me.
My second child was born in a spontaneous vaginal birth at just over 40 weeks. I had decided to decline any interventions like those I had agreed to in my first birth, primarily because I was scared about the same complications arising. Therefore, I chose a very naturally-minded midwifery practice but also considered and planned for an unassisted birth (we did not know of any legal home birth midwives in our area), and we weren’t sure whether these midwives would switch into Intervention Mode towards the end, like my last. In an example of “the baby will tell you what it needs,” our daughter (a little over nine pounds) arrived after a precipitous labor of half an hour - there was no time for anyone to show up even if we had wanted them to do so. However, we did choose to transfer to the hospital after her birth to make certain that the speed of her birth was not related to a problem with either of us. At the hospital, we were personally attacked and the hospital’s desire to cover themselves legally led to demanding testing and procedures that were absolutely not called for, as my medical records would attest.
Rather than looking at us individually, we were viewed as a dangerous unit, a potential liability, and they felt they needed to attack us as totally unknown entities. I was told that I was either dumb or lying, and that they wanted the name of my homebirth midwife because they were “not going to be responsible for whatever she had done.” We were told that they would not allow us to leave, even though my daughter checked out perfectly (they did not examine me, other than attempting to provide cord traction, and did not request to do so) because “we do not want to be responsible for that.” We finally agreed, after nearly 12 hours of being told that would could only leave AMA and without out child and on the condition that they would not call CPS, to allow the chief pediatrician to examine our daughter; if she gave a clean bill of health, we could leave unimpeded. After a brief examination, the pediatrician said “unfortunately, [she] could find no reason to keep us in the hospital.” We received a nice call from Child Protective Services anyhow and had to spend the first few weeks of our daughter’s life proving our worth as parents. I also then received the Fast Laborer tag.
My third baby, my secretive little baby who pretended he wasn’t there for so long and then BAM! baby…he was conceived by someone with three big tags: Big Baby and Fast Laborer and Fat Mama. After weeks of testing and concern that I never, ever wanted in a pregnancy (or had received before), we confirmed that the pregnancy was viable, despite heavy bleeding. That’s when, at 12 weeks, I was told that I could “try” for a vaginal birth. Try? “Well, you have larger babies, and those are hard to deliver and we don’t like to let you try and end up having problems.” Really? A nine-pound baby came virtually flying out, and that’s really a worry? The plan was to closely monitor me throughout and induce - or maybe even schedule a section? - as soon as the baby was “ready” - much like my first. When we ended up moving cross-country in the middle of the pregnancy, I chose more naturally-minded midwives…I thought. My first appointment with them led to the suggestion of early cervical checks and “induction as soon as you are the littlest bit ripe.” See, they didn’t want to risk it. “We don’t like people having babies that fast. We don’t like people potentially having their babies outside of the hospital. And with as big as you make them…we should deliver you early. We don’t want to be responsible for a baby born at Target, or getting stuck.” Despite the fact that my body clearly makes nice, large, late but fast babies…I was told I should kick them out early and on schedule. Again. No thanks. Instead, my fat little third baby was born a little over 8 months ago, at home, weighing not-quite ten pounds. He did cause a little fuss, choosing to be born with his hand up instead of tucked neatly down, but he was born on his own time (almost a week late - why do they keep getting later?) and his own speed (fortunately with more notice than his sister) and perfectly healthy.
Defensive medicine not only affected how I birth my babies (no chance of finding me in a hospital short of a major issue), but also affected what I do for a living. After the birth of my second child, I knew that something needed to change. I was tired of hearing stories about what happened to women in labor, as well as hearing about the restrictions placed on providers by hospitals and states for fear of being sued. I went to law school, after previously teaching high school, not to sue people (although I will if necessary) or to make the giant bucks (although that’d be nice, if my fairy godmother is listening), but to defend choice and the ability of women, and families, to make their own, educated decisions regarding their care. In doing so, I also will defend providers who desire to make evidence-based and autonomy-respecting decisions, not litigation-based decisions, and allow their patients the ability to make informed consent and refusal. because everyone - physician and client alike - is hurt by defensive medicine.
ANaturalAdvocate is an activist, a soon-to-be attorney, mother of a small herd, hoarder of books, and self-described “techno-crunchy.”