Impactful Tweets (pt 2) from ICAN Conference

Looks like @DeepSouthDoula is the winner of cool tweets, part 2.  I’ll have to tell her the amazing news, LoL!  Looks like there will have to be a part 3 tonight.  Henci Goer has already made some great points, and she’s only just gotten started!  w00t!!  Here’s the link to part 1 if you missed that post.

DeepSouthDoula Abdominal scars can change your overall body mechanics for the worse. #ICAN2011
Interesting how people don’t consider what happens to the muscles and especially the connective tissue as a result of this major abdominal surgery.  I’m a professional opera singer and rely on the entire abdominal complex to support my sound.  This includes the pelvic floor.  This entire structure has been permanently altered.  Have you considered how your cesarean might (will) affect you physically?

poderyparto Herrera: People should see a c/s. Once they ser it they’ll start asking more questions. #ICAN2011
This is an interesting statement.  I just don’t imagine your average woman would be interested or even willing to watch a cesarean surgery.  And really, it’s different being in the room when one is happening versus seeing it on TV or YouTube.

Preparing4Birth: #ICAN2011 @ICANtweets Insurance company should not mandate how doc works. Write congressman. A state issue
This is HUGE.  I was aggravated to learn from my OB that his malpractice insurance doesn’t cover vaginal breech delivery.  He’s an older doctor, so of course, he knows how to do it.  I think it is incredibly unfair that my second birth was dictated by someone else’s friggin’ insurance!!!

Ethologicmom #ICAN2011 amazing that dice didn’t realize that women choose or are forced into hbacmom by bans and lack of support!
Dice?  I have no idea.  But yes, women increasingly choose homebirth and unassisted birth because they ultimately feel unsupported by some (or all) careproviders.  A woman who feels forced into homebirth or unassisted birth are not ideal candidates for those settings.  A woman should have access to the care she desires.  We’re the ones paying for it!!!

DeepSouthDoula The only true way to know if you will have a successful VBAC is to try. #ICAN2011
I just can’t imagine not trying . . . even though people would try to scare me out of it.  Fearmongering is not the way to go, folks . . . studying the evidence is!

drpoppyBHRT How do we “grow” supportive providers? #VBAC @BirthingKristin #ICAN2011 #NIHVBAC
I imagine that since newer docs are typically less willing to recommend VBAC (based on NIH VBAC consensus report), that now that the ACOG recommendation has been revised, perhaps the new generation of OBs will be less resistant.  This doesn’t mean we shouldn’t be doing everything we can to positively affect our local birth culture!

DeepSouthDoula Any person pregnant or not has the right to refuse medical treatment – even in an emergency. Goes for refusing CS. #ICAN2011
One of my friends is having her 3rd VBAC after cesarean.  We were performing out of town, and she thought the local hospital didn’t allow VBACs.  She was relieved to learn (from me . . . yay me!) that she did NOT have to consent to a cesarean if she had the misfortune of going into labor in that town.  On the other hand, it would have been an opportunity for us to ‘educate’ that particular hospital on the rights of childbearing women! ;)

DeepSouthDoula Have the NIH & ACOG statements ready & use them to our advantage. #ICAN2011
Great advice!  I’m on Spring Break right now, and honestly, I’m just now getting around to reading the NIH VBAC Consensus report.  Eye opening, really.  I’ve “clipped” out the conclusion summary and points within the detailed section of the statement that directly apply to my situation or to issues that seem most critical to me.  I will be bringing some of this information with me as I interview an OB regarding VBA2C.

DeepSouthDoula SHARE – ORGANIZE – PROMOTE – CHANGE. Make connections through social media. #ICAN2011
Following the #ICAN2011 channel has shown me that a lot of birthies are now quite active on twitter.  I guess I’ll pay more attention to twitter . . . at least for a while.  Birthies and moms are welcome to request to follow me – @labortrials.


Impactful Tweets (pt 1) from ICAN 2011 Conference

I’m taking a break from my “Emotional Clutter” post that I’ve been working on.  Ahhh, nice to take a breather from that topic.  My friend, L, pointed me to http://twitterfall.com as the best hashtag (#) reader out there.  And well, she would know!

So, I’ve been reading the #ICAN2011 channel and want to share some of the tweets that I’ve seen that should make an impact on VBACtivists as we do our important work!  (Since I’m pulling this content from a public channel, I am not asking permission to repost.  I will remove tweets if the OP requests.)

@DeepSouthDoula: [Macones] Be patient and keep working on us (OBs). Things will get better but it will take time. #ICAN2011
This is encouraging to read.  Other tweets indicate that consumers should be addressing hospital administrators.  However, from personal experience I can tell you that our hospital’s CEO said he can’t make the OBs change.  It’s easy for folks to displace and deflect in this business.

@Preparing4Birth: VBAC candidacy – low vertical incision 98% are this type. 1 or 2 prior ces should have access. Birthweight not a predictor. #ICAN2011
I read another tweet that indicated he supports VBA2+C but that it takes the right patient with the right provider in the right hospital.  I’ve also read that the steepest increase in rupture rates is between 1 (.5%) and 2 (1%) cesareans and then begins to level out.

@Unnecesarean: Macones: We’ve all focused so long on uterine rupture but need to also focus on the consequences of multiple cesareans #ICAN2011

@babydickey: We are underestimating the risks of multiple c-sections. #ICAN2011
A great site for weighing the risks of VBAC and repeat cesarean is Childbirth Connection.  Also have a look at the NIH VBAC Consensus.

@ShannonMitchell: When vbac rates CAN be 60-80% Don’t ask me to wait for ten years for a 20% rate #ican2011 #birthaction
I love me some Shannon.  She’s absolutely right, so we all need to get off of our duffs and DO SOMETHING!  Or do MORE!!

@ Unnecesarean: Macones: If hospitals can’t respond to emergencies, they probably don’t have any business doing obstetrics. (attributed to Landon) #ICAN2011
This is a very important point and should be addressed any time a facility with a maternity ward imposes a VBAC ban.  People who live in towns with VBAC bans in place should write letters to the paper, picket the hospital, and set up an on-line petition at the very least.  The average family doesn’t know that a facility that can’t handle a VBAC is unsafe for childbirth.

@ShannonMitchell: From 30 to 32% is 40,000 cesareans #ican2011 #birthaction
Wow, 30-32% is not nearly as offensive as knowing that 40,000 more women were cut open . . . many (most?) unnecessarily!  And other tweets indicate that the 40K cuts refer to the increase from 32-32.9% (our current national cesarean rate).  If that’s the case, how is that not perceived as a national crisis????

@tiffrobyn: Dr Macones: ECV, CVS testing, carry 1-2% risk, greater than vbac. #ICAN2011
Tests and procedures (including cesareans) that OBs may offer are sometimes riskier than what they refuse to do (attend VBAC).  I will say that I’ve never been offered an amnio, ECV, or CVS even at my advanced maternal age. ;)

More later, I am certain . . .

Cesarean Awareness Month 2011

© Amy Swagman, 2010 -www.themandalajourney.com

© Amy Swagman, 2010 -www.themandalajourney.com

So another year has passed, and I’m back to wondering where we are with our cesarean awareness ‘campain.’  I’m somewhat ‘skirting’ the loop (not really inside or outside of it, just around), so I’m not your most up to date source.  For truly outstanding resources related to cesarean awareness, read Unnecessarean and VBAC facts for starters!

A couple of things that have my attention lately:

  • Our national cesarean rate is staggering, and some predict that by 2020, 1/2 of our births will be done by cesarean.  We must be vigilant!
  • Montana needs a Friends of Montana Midwives group
  • Montana’s cesarean rate is 29% just below the national average.  However, some counties in MT have super high cesarean rates.  Why is that? (Carter County had a 65.4% c/s rate 2005-08 according to the March of Dimes!!!!)
  • Birth activist are working so hard – it’s just awesome!  Thank you to all who are gettin’ it done!!
  • According to Childbirth Connection, “A high-quality, high-value maternity care system is within reach, and childbearing women are the most important stakeholders to drive system change.”  Have a look and see what you can do!
  • Also, through Childbirth Connection, I’ve learned about relevant legislation that has been introduced.  This legislation needs our support!!
  • ICAN is getting ready for the 2011 conference – wish I could be there . . .

Because I’m pregnant I’m in a great position to find out even more about what is being done locally and what still needs work.  I have found – contrary to what my OB told me – that a few OBs will consider VBA2C on a case by case basis.  I have discovered that our only independent birth center, run by a fantastic CNM, does VBACs (even primary!) but not VBAmC.  I have lots of friends who are pregnant these days and have learned a lot about local practices.

Because I’m pregnant with #4 and work a full time job (one that often has me out of town on weekends in the Spring and has me out at night), I haven’t had the time & energy to get more aggressive.  This too shall change, and when it does – LOOK OUT!  ;)

In the meantime . . . what can you do?

The Few Minutes I Remember

I was just reading A Day They’ll Never Forget from the Giving Birth with Confidence blog.  It’s wonderful to read stories like those – truly beautiful, uneventful (in a good way), unencumbered births.  I can’t relate to them at all, but I still have hope.

In stark contrast to these four womens, my children have been cut out of me.  I don’t remember all of the details of their births, and I never will.  Is it because of the anesthesia?  Is it because a cesarean section is a traumatic experience for the body . . . and the mind?  So many people just don’t seem to understand that it should be fairly uncommon for a woman to need to have major abdominal surgery as a result of trying to birth her babies.

My water broke just short of midnight one night in August 2009.  I was trying to get comfortable enough to sleep, but Baby A had been making that quite difficult for some time.  This night was no different.  I piled pillows up and tried to lie down in a modified child’s pose.  No sooner had I settled, Baby A started moving vigorously and with a swift kick, obliterated her amniotic sac.  I cried out – “They’re going to cut me open.”

I had hoped that Baby A would turn back from breech before they were born, but breech presentation was confirmed at the hospital.  I was prepped for surgery.  This is the end of what I remember clearly.

You Know You’re a Homebirther When

  1. you find yourself zealously defending the CPM/DEM designation and probably come off as a bit of a wingnut!
  2. you get pissed off just thinking about the horrible things that OBs and nurses (for God’s sake) have said to women who have had to transfer from home to the hospital
  3. you get even more pissed off thinking about the birth that screwed everything up for you (not altogether in a bad way) and your childbearing years
  4. you have this idea to become a doula . . . or worse yet, a homebirth midwife
  5. you have this even crazier idea to leave your day job with full benefits to become a homebirth midwife
  6. you have this even more insane idea to move to Canada or some other country with a better health care system to (a) have your babies and/or (b) become a homebirth midwife
  7. you recognize that malpractice insurance does NOT make birth more safe
  8. you realize that you have to take responsibility for your own choices in pregnancy and in birth – from the Costco dipped icecream extravaganza I ate for dinner tonight (oops, not one of my finer moments) to where you’ll have a baby and with whom and what you’ll allow this person to do for (t0) you as your birth; all of these choices have consequences (hello reflux) . . .
  9. you want everyone to know about homebirth for what it is . . . not what mainstream America assumes it is (been there, done that)
  10. you want families to understand that their choice of careprovider(s) is such an important decision (OB doesn’t mean superior to CNM superior to CPM/DEM; these are very different designations with very different training requirements and very different mindsets; know what you’re getting yourself into!)
  11. you can no longer ignore the voice inside that says . . . “the last thing I want to do is leave my bed and go to the hospital” – I ignored that voice six years ago; now that the option is presenting itself to stay home, I must listen to my inner Truth, pray for God’s blessing and protection, and trust that His Will will be done.

edited to add a point and adjust some “tone”

Supplementing Pregnancy with Progesterone

It amazes me that OBs can still be resistant to testing for progesterone deficiency and treating it.  After two consecutive losses and a clean blood panel, I begged my OB to test my progesterone levels.  I was pregnant again.  Not only did she refuse to test, but she also said that even if I tested low for progesterone, she wouldn’t supplement.  Her “brilliant” idea to treat pregnancy loss was Clomid!  (You can read tons of stories about women taking Clomid and suffering miscarriages as well as being blessed and challenged with multiple gestation issues.)

I lost that baby at 10 weeks gestation.  It died a few weeks earlier.  I was devastated and so angry.  I’m still angry at that nutjob OB.  For numerous reasons I transfered to a more compassionate OB who had been through infertility with his wife and also seemed to enjoy thoughtful discussions with his patients.  Although he misdiagnosed my problem, he supported me in seeking a second opinion with a reproductive endocrinologist (RE).

The RE discovered low low low progesterone.  The RE also found adenomyosis in my uterus that was distorting the shape of my uterus.  He believes that my cesarean caused the adenomyosis.  He removed as much as he could.

I received the all clear to TTC and quickly became pregnant again.  (Becoming pregnant was never my issue.)  I began supplementing with progesterone via 17-hydroxyprogesterone shots.  An early ultrasound discovered that I was carrying twins.  (Recall the one OB’s suggestion to give me Clomid?!??!!!!!!!)

I continued the progesterone injections and weekly progesterone tests during the first trimester of that pregnancy.  My progesterone levels seemed ok on their own, but it was prudent to continue especially since specialists don’t know what a good level of progesterone is for multiple gestation.  After three consecutive losses, I carried my twins to term. :)

I accidentally became pregnant during my September 23, 2010 cycle.  I suspected it almost immediately after conception, so I began early testing.  By CD 28 I tested positive for pregnancy.  I contacted my OB’s office (my previous lovely OB died the day he cleared us to TTC in 2008) on a Friday, and was frustrated that it took until the end of the business day on Monday to get a script.  In the meantime, I contacted medical friends and even the RE’s nurse.  I was amazed that she got back to me and was still willing to advise me . . . 2 years later and from out of state.  What a blessing.

Your typical OB isn’t always well-equipped to deal with early pregnancy issues.  My OB recommended 100mg oral progesterone.  I double-checked this with the RE’s nurse, and she did NOT recommend this treatment.  My SIL also told me some sketchy stuff about oral progesterone supplementation.  The RE’s nurse said the best thing to do is either go back on the shots or do 200mg prometrium vaginally.  Since prometrium is so accessible and doesn’t require a stick in the bum, I went that route.  I also want readers to know that it took a while to straighten out the script, but by Tuesday I had what I needed thanks to a lovely independent pharmacist, the RE’s nurse, and the OB’s office following through with exactly what I requested.

I just want to offer this information up for those who are struggling to make sense of their losses.  Really, if you think you suffer from low progesterone and/or a short luteal phase, you need a medical script for progesterone supplementation.  It is unlikely that natural supplements will do the job . . . maybe for marginal progesterone?

Someone on one of my advocacy lists said that taking prometrium vaginally seemed “iffy” to her.  I must admit that irritated me, but she doesn’t know anything about me or how seriously I consider my health decisions.  Had I not been directed to this reproductive endocrinologist in 2008, I would probably not have my twins or be 16 weeks pregnant with my fourth and final baby.