ICAN:  A Report of the 25^th Anniversary Conference…Sort of

by Barbara Behrmann, Ph.D.

A Slide Show

I am sitting in a conference room with dozens of women, watching a montage of images of mothers recovering from c-sections.  If I were to create from them a single representative snapshot, you would see a woman lying in a hospital bed clad in a white, hospital gown.  She is hooked up to an IV, unable to walk around, a vacant expression in her eyes.  Still under the influence of medication to reduce pain at her incision site, there is no joy on her face, no sense of wonder, no deep eye-to-eye soul connection between her and her baby.   In fact, her baby may not even be in her arms.  Knowing the inherent power of birth, the image is one of defeat, resignation, and pain. But while her physical pain will likely heal; her emotional pain may not. 

To be fair, this image is not descriptive of all women whose babies are born via cesarean section.  And not all women who end up with c-sections are traumatized.  But many are.  And by the time the slide show is over, I don’t see a dry eye in the room.

Sharon Storton, a marriage and family therapist who specializes in perinatal mental health and trauma recovery, says, “Sitting down during the slide presentation, was the exact energy of sitting in a room of rape and sexual abuse survivors.  It was heartbreaking.”

An Airplane Encounter

A number of weeks have passed since then and I am writing this at 30,000 feet en route to Colorado.  My seatmate turns out to be a lovely man, 31, whose wife, he tells me, is eight months pregnant with their first child.  Patrick could not be more excited.  They have a web-site to keep their friends and family up to date and have all the baby paraphernalia eager first- time parents are quick to buy:  a bassinet for beside the bed, a crib, a bouncy seat.  Patrick has happily accompanied his wife to the their child birth classes and is attending “Daddy Boot Camp,” six hours of classes specifically for dads to go over much of the information new dads need:  how to hold a baby, how to help mom, how to feed a baby (an “objective presentation on breastfeeding and formula feeding), along with information on sleep deprivation, shaken baby syndrome, and how to use a car seat, The future dads even spend time with two “vets,” previous boot camp participants who have crossed over to new fatherhood.  In short, I’d be hard-pressed to find a more supportive, earnest, and enthusiastic dad-to-be.

Patrick and his wife have also read a lot of birth-related books and have hired a doula (albeit one inexperienced) to help them have the natural, drug-free birth they desire.  His wife is not adamant about refusing an epidural, he explains, but wants to avoid one, if possible.  We chat a while longer and eventually Patrick returns to his book and I to my writing, hoping to draft a report of the ICAN conference, where the above-mentioned slide-show took place.

A Big Mess

As I reread my notes, I feel my blood pressure rise.  The cesarean rate continues to climb.  For almost 1 in 3 women, birth has become a surgical event.  If you live in Lousiana or New Jersey, you are about 70 percent more likely to have a c-section than if you live in Alaska, Idaho, New Mexico or Utah.   Over 300 hospitals around the United States no longer even offer women the option of a VBAC (vaginal birth after cesarean).  In 2005, 56% of women who wanted a VBAC couldn’t get one. 

Lactation consultant Diane Wiessinger was one of the speakers.  A biologist in a former life, she looked at animal behavior to see how far removed we are from our normal, biological selves.  I think about Patrick and his wife when I re-read her rhetorical question:  “How many mammals,” she asks, “read books, take classes, have clocks, and worry about hindmilk?

For many mammals, she explains, if the birth is too disruptive, they don’t bond with their babies after the birth.  Yet the majority of U.S. births are managed in ways that inhibits the development of normal mom-baby relationships, she says, “Try this with any other mammal and see what you end up with. No other mammal would accept the baby.  It would run screaming from the room.”

Other speakers including Dr. Marsden Wagner and Henci Goer (author of Obstetric Myths vs. Research Realities and The Thinking Woman’s Guide to a Better Birth) spoke passionately about topics ranging from cavalier attitudes toward abdominal surgery, a long list of risks to moms and babies, many of which accumulate with each successive surgery, and the myth of elective c-sections (no medical indication is not the same thing as maternal request).  They also addressed issues ranging from faulty research upon which childbirth policies are based; unfairness in birthing politics (many doctors advocate for maternal choice when it comes to a c-section, for example, but not when it comes to where and with whom to give birth), and other problems with obstetrical practices in the U.S.

I become angry.  Furious.  Not simply at the fact that millions of women each year will be cut unnecessarily, but at a system and standard of care that is downright harmful to mothers and babies.  And I am reminded that while it is important to be well-informed and have a birth plan or doula, these are often no match for the pressures of a hospital. 

A Statement

For 25 years ICAN volunteers have worked tirelessly and passionately to improve childbirth.  Nancy Wainer, long time midwife, activist and author of Silent Knife, explains that they started their work before the dawning of the age of the Internet, (in case you missed it, this last phrase should be sung to the tune of the Age of Aquarius), before cell phones and computers, working constantly because their emotional health depended on it.  And women continue to join for their emotional health.

Many of the voices heard, in fact, were those of women sharing their stories.   Some choose to have unassisted births at home, rather than going back to a hospital.  At least one such mom declared that she would rather die and bury a baby rather than go back to the hospital to give birth. 

That may seem extreme, but it speaks to how much birth matters to women.  Sporting pins that declare “VBAC mom” or “VBAMC mom” (vaginal birth after multiple cesareans), women for the first time in history are defining themselves in terms of their birth history. 

“It’s deciding there is power in being able to stand up and say I did something not a lot of women get to do,” says Anita, a member of ICAN who lives in Kansas.  “I’m proud of my scar because of who it made me.  If I hadn’t had a c-section I wouldn’t be where I am today….I would not have sought or known the truth if I had not been angry.” 

A Mission

ICANs mission today is this:  “to improve maternal and child health by preventing unnecessary c-sections through education, providing support for cesarean recovery, and promoting VBACS (vaginal births after cesarean).   And its main, underlying message is that how we give birth matters.  To babies.  To moms.  To families.  In the daily life on an obstetrician, a woman’s birth is one of many, easily forgotten at the end of a demanding day.  But a woman will remember that day forever.  And babies don’t have a second chance to be born. 

As the conference drew to a close, I saw a second montage of slides titled, “She would have been cut.”  Images of one positive, affirming birth after another, from women who had VBACs, some traveling from around the country, even from around the world, to be able to birth vaginally.  They depicted the powerful and highly personal quality of birth.  In one slide, the father and pre-school aged son were wearing helmets, clearly playing some sort of game, while supporting the mom through the work of birthing.  Another photograph showed a woman giving birth while her dog simultaneously birthed puppies under the bed.   Another image depicted the birth of twins; the first one born wouldn’t stop crying until the second one emerged.

The contrast from the first set of slides is striking.  Esther Booth Zorn, who launched the Cesarean Prevention Movement, encouraged women to listen to each others’ birth stories, get informed, inform others, and become activists within the community.  “If it is to be,” she reminds everyone to say, “it’s up to me." 

A Conclusion?

As I read through my notes and wonder how to convey a weekend’s worth of material in 2000 words or less, I think about the conversation I just had with Patrick.  I wanted to offer encouragement, faith, positive energy, not dire warnings to labor out of the hospital for as long as possible.  Instead I asked if they have read Ina May Gaskin’s book (Ina May’s Guide to Childbirth),  Henci Goer’s book (The Thinking Woman’s Guide to a Better Birth), Barbara Harper’s book (Gentle Birth Choices). 

Nancy Weiner, puts it like this: “If you don’t want Chinese food, don’t go to the Chinese restaurant.”  But what do I say to someone who has already made the reservations?  I wanted to reassure Patrick that his wife will be awesome, that they will have their dream birth and emerge transformed by the empowering journey of welcoming a new life into their arms.  But I didn’t know how to tell them what’s possible in an environment that makes it improbable. 

I still don’t.  And I’m open to suggestions.