This is a trick question. Its just not helpful to think of fetal position as being anyone's fault.
In a long labor, a mother may ask “Why doesn’t this baby come out?” A helper might joke, “This is a stubborn baby.” Midwives have been known to say,
"This mother is too much in her head" or "She's too uptight."
A mother does her best given the the baby's position and the time and support available. So, while emotional or mental tension can certainly lengthen a birth, midwives and doctors seldom realize how much a slight malposition of fetal position plays in labor progress.
Mothers are often blamed for birth complications when the lack of support in a birth-phobic society has left her neglected, lacking in the knowledge she desires to have and from access to wise care. The mother, too, is doing her best in the situation she lives in.
After a long labor ended in a cesarean, a mother asks, "Am I broken?" Sometimes its a matter of the baby's head being wrong way in. The pelvis would have birthed the baby with the chin tucked and crown first, but perhaps couldn't fit a baby whose chin was up or head was tilted.
Baby is trying to accomadate the space available the womb. Muscle tension or laxaty pulls on the lower uterus making less room. The womb may not aim into the pelvis smoothly. A baby will take the most optimal position possible.
Some providers know how to help reposition baby and some do not. The same solution doesn't work for every variation, so the cause and effect can seem random. When Understanding anatomy of the soft tissues with angle of the head and pelvic shape, the light comes on and a pattern emerges.
"But, Gail, my friend's doctor [it could have also been a midwife or nurse] didn't let her get out of bed, and she had a cesarean for a long labor. Isn't that the doctor's fault?"
It isn't the doctor's wish to have a mother suffer. Doctors also practice in a dynamic interaction of hospital administration, colleagues, and limits to training in natural birth solutions. Perspectives in what makes a cesarean necessary or acceptable may differ.
A woman who feels that she had a cesarean for a less than absolute necessity sometimes comes to feel mislead by her sense of trust in routine medical care. Assumptions are exposed painfully. Anger is an appropriate emotion when we are forced to change our plans beyond our expectations, especially without our voice in the decision.
We all do the best we can given the variables of the day.
We can prevent the blame and shame spiral if we take time to find three things,
- Empowerment: Information about best maternity care practices is important, and so is serenity. Relationships of trust within the birth team are helpful but not always mandatory.
- Equality: A care provider who is comfortable in a cooperative relationship sharing responsibility with the woman giving birth. Women have a dynamic role in thier own maternity care (and society's!).
- Voice: The clarity and the courage to state needs and desires in a way that recognizes the worth and roles of those needs and desires as well as each individual in the birth team.
A mother may be told her baby is in a good position for birth only to find out later that head down is not enough. Learning about fetal position is something the mother, herself, must pursue. Relying on medical and midwifery helpers, even body workers, who are so praised in this website, may not serve every mother's needs.
As humans we are, well, human. Everyone is doing the best they can with the knowledge, emotional safety, and time they have within the culture they live and move in.