Commentary Maternity and Birthing

What My First Pregnancy Taught Me About Birth Justice

Ruth Jeannoel

The medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a vaginal birth after cesarean.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

After discovering I was pregnant for a second time, I had concerns that my previous cesarean section would keep me from having a vaginal birth. But what I learned after speaking with medical professionals and reading up on vaginal birth after cesarean (VBAC) is that it is possible, with the appropriate resources. I also came to realize that the medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a VBAC.

All across the country there has been an injection of #BlackLivesMatter in our decades-long Black liberation movement, and reproductive justice, including birth justice, is a critical part of those efforts. Birth justice includes making sure Black moms have full control of their own health and birth process through proper childbirth education and community resources.

It was around 9:30 p.m. on October 22, 2008, when I began to have contractions and I went to the hospital. I was about 32 weeks into my first pregnancy, which was well before my “safe period” of 37 weeks, which in 2008 was described as the stage when the fetus has fully developed. (The “safe period” has since changed to 39 weeks.) Within six hours of labor I developed preeclampsia, which is a pregnancy condition affecting as many as 8 percent of all pregnancies and can be deadly for Black women.

At about 10:30 p.m., the doctors explained I would need an emergency cesarean or else I could lose the little one I had been carrying.

I was scared: At the age of 21, I had to have major surgery.

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The nurses quickly changed my gown, gave me an epidural, and moved me from my hospital room to surgery. I kept thinking about how I didn’t want any of this, because I wanted to give birth naturally and without any pain relief medication, but it sounded so urgent. It sounded like I needed to really have a cesarean for both my safety and the health of my baby. And so on October 22 at 11:59 p.m. I had a c-section.

C-section rates are declining in the United States, but Black women continue to have them more frequently than their white counterparts. According to 2014 data from the Centers for Disease Control and Prevention, the cesarean delivery rate “declined for non-Hispanic white women for the fifth consecutive year, down 2% from 32.0% in 2013 to 31.4% in 2014 and 4% from the 2009 peak. Rates declined 1% for both non-Hispanic black (from 35.8% to 35.6%) and Hispanic women (32.3% to 31.9%). For the second year in a row, non-Hispanic white women had the lowest cesarean delivery rate; non-Hispanic black women continued to have the highest rate.”

Throughout my pregnancy I saw a midwife at a birth center, who ultimately was not with me when I developed preeclampsia and had to go under the knife. I felt disempowered because everything happened so fast and it seemed as if all of the decisions were made for me.

After the surgery, my family and close friends were glad that the baby and I were both safe. But beneath their concern for our safety I could see there was an underlying stigma around having a cesarean birth. Even though the c-section was not planned, I would get looked down on as if I wasn’t “woman enough” because I didn’t have a vaginal birth. I felt ashamed and didn’t know how to share my birth story because in a way I had lost decision-making control over it. I was unprepared to deal with the stigma that was attached with having a c-section.

A couple years after having my first child, I began to have a different understanding of what reproductive justice is and began to reflect more on what it would look like in my own life. SisterSong Women of Color Reproductive Justice Collective describes reproductive justice as, “the human right to have children, not have children, and parent the children we have in safe and healthy environments.”

During that period between my two pregnancies, after having more conversations with other mothers and hearing different birth stories, I began to understand that what I was attempting to deal with wasn’t about vaginal birth vs. cesarean birth; it was about women having the bodily autonomy to make their own decisions. I told myself that if I ever got pregnant again, I would make sure that I had all the necessary information to ultimately decide how my birth went: I would do everything in my power to have a vaginal birth. For example, had I known in advance that I may be susceptible to preeclampsia, I would have looked into methods to lower the risks of complications.

While telling everyone who asked (or didn’t) that I would have a vaginal birth, I ran into several myths. The main one was that you can’t have a vaginal birth after c-section. It just didn’t make sense to me because I knew that birthing was a natural process, meaning that I needed to trust my body and know that every pregnancy was different and that my body could handle a vaginal birth.

At that point I had a lot more questions than answers.

I began reading and asking my OB-GYN about vaginal births and she described the risks and benefits of having a VBAC and emphasized that it was very possible. And she, of course, was right.

As research from the National Institutes of Health explains, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean.” The American College of Obstetricians & Gynecologists (ACOG) agrees, adding that “most” women with one prior cesarean and “some” women with two prior cesareans are candidates for VBAC.

The main problem a woman seeking to have a VBAC might encounter, I found during my research, was a potential uterine rupture. However, a report published in the Obstetrics & Gynecology medical journal found:

Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

My research helped me to better understand that the risks associated with a VBAC weren’t as high as I thought.

When I found out that I was pregnant five years later, I moved forward with my plan to have a VBAC. By that time I had moved to another state, and VBACs were not as common or accessible in Florida as they were in Massachusetts.

I quickly learned that not every OB-GYN I encountered performs VBACs. In South Florida, I had only three doctors to choose from. With help from my doula, I was able to find the right one and a hospital where VBAC was an option.

Unfortunately, in Black communities, not everyone may have access to doctors who do VBAC. Because of the higher risk of uterine rupture, many hospitals, especially in low-income communities of color, are not able to make this accommodation. Also, I found that doctors often do not promote VBACs; therefore, many women who may want to have one may not know that such an option exists.

In 2014, at 37 weeks, I was able to have a successful VBAC and give birth to my second born. I was proud of myself that I was able to have a vaginal birth under my own terms in a hospital room with an amazing team of doctors.

It’s important to dispel the myth that you can’t have a vaginal birth after a previous c-section. Doctors and the medical community have a responsibility to make sure that all women have the appropriate information to make an informed decision over their body. It will always be a woman’s right to choose how she wants to have her child, and where she wants to have her child if her local hospital doesn’t offer the services she requires.

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