The Trial of Labor

I was catching up over at the True Face of Birth and was immediately drawn to a link about a successful hospital VBAC.  The story posted at Bellies and Babies is awesome and inspiring, and how wonderful to read the woman’s narrative and that of her doula!

I was tremendously impressed with the two obstetricians mentioned in the story.  The first OB ultimately told the woman that he wouldn’t allow her to VBAC.  (At 36 weeks this was BAD FORM.)  She found a provider who was supportive of her choice to have a vaginal birth, and it “sounds” like this OB really knew how to stay out of the way and let the mom do the work.  He also was educating his nurse about the whole process - how normal it is to be in water during the late stages of labor, how normal it can be to birth a baby in water, how normal it is to push at will (as opposed to pushing in 10 count blocks), how normal it is to birth the placenta when it is ready to release from the womb.  I am also impressed with the first OB - the one who told her “no.”  He evidently did some research after she left his practice and changed his mind about VBACs.  It takes guts and humility to be able to change your ways and be open to new practices (as if vaginal birth or even VBAC is a new practice).

Anyway, I hope you will enjoy reading these stories as much as I did.

Tags: waterbirth, hospital waterbirth, waterbirth VBAC

As you can tell, I am back to reading my google alerts.  I came across a post titled “Cesarean vs. VBAC - Birthing Story” and decided to read it.  It seems to me that this is the very type of woman who needs the support and resources that ICAN, CIMS, Childbirth Connection, Conscious Woman, and the like provide.  Women are understandable very protective of their birth stories, so I didn’t post a comment.  However, she may come across my post if she tracks her pings.

I’d like to address specific details of her story.

1. “I was instructed to read through the risks of VBAC and give in my consent in writing…. this during my first visit to the doctor.” She wisely decided to wait to “consent” to the mode of delivery.  Understandably she had concerns and questions due to the manner in which the information was presented to her in her first visit.  Furthermore, she states that her doctor never seemed to discuss the benefits of normal birth.
2. “No mommy would want to carry a healthy baby for 9 months only to risk the baby’s health during delivery.”  Absolutely!  And natural birth advocates believe that every woman deserves the right to weigh the risks and benefits of cesarean versus normal birth for herself.  OBs are not upfront about the risks to both baby and mother from cesarean delivery much less the harm that occurs once mom and baby are home.  Doctors suggest procedures and tests that have not been proven to aid the birth process yet may have a negative impact on normal birth.  These include continual fetal monitoring, artificial rupture of membranes, induction, vaginal exams, IV, episiotomy, and the list continues.  These interventions usually only benefit the doctors and nurses.  And did you know that amniocentesis carries a substantial risk for pregnancy loss?
3. “My mid-wife advised me to wait till the 35th week before I made any decision. But the doctor would not wait till such time. Even before I gave my written consent on my preference I got a call from doctor’s office about scheduling my C-section for the 13th May. (my due date was 26th May).  This irritated me to great levels. While one of the major benefits I was going to get by opting for C-section was a date of my choice, the doctor had deprived me of the same by just giving me one option.”  OBs suggest that it is safer to perform a cesarean before Mom goes into labor.  However, scheduling a cesarean 2 weeks before a due date is risky.  It is sad that this OB was intent on taking this woman’s last “choice” away from her.
4. “Besides, I knew that I was making good progress and could go in for VBAC.”  Women should trust their instincts about birth and surround themselves with people who support their needs and desires.
5. “During my 40th week appointment, the doctor examined me and said that I had made no progress at all since 37th week. The baby’s position and the cervix measured the same. She also scared me that the baby was big and it could be a very hard delivery for me.”  The next day at the hospital she began labor on her own. 
6. “The nurses who were monitoring me repeatedly started asking me if I really wanted to go in for C-section which was scheduled at 11:30am.”  Hooray for her nurses!!  It seems like they wanted to encourage her to have a normal birth!
7. “I got a call from the doctor immediately … I must say it almost sounded like a threatening call. She said if I didn’t go for C-sec at the decided time, she was not going to be available for the entire week and that some random doctor from the hospital.”  Yes, that was a scare tactic.
8. Her “big” baby weighed just over 7 pounds.

The reason I’ve quoted and listed these points from her story is that this story is all too common.  When are we going to stop this abuse, this subversion, this last form of modern sexism?

My sister-in-law’s birth experience came up in discussion this week when we were home visiting.  We knew at the time of her cesarean that the baby was likely premature - even at 41+ weeks - because of the thick coating of vernix on her when she was extracted from my SIL’s body and based on her mother’s gestational pattern.  Her OB of course recommends repeat cesarean for future childbirth.  Perhaps some of the reasoning is valid, but personally, I think she’s being misinformed and discriminated against.

My husband asked her if she was interested in a VBAC or would go with the OB’s recommendation, and she said “I don’t care.”  She doesn’t care?  How can that be?  How can she say that in front of me knowing damned well that I DO CARE!

Because I do care!

Telling a woman like me that you don’t care is offensive.  I do care.  I care that my baby likely was unnecessarily removed via major abdominal surgery.  I care that the physical and emotional effects of this surgery may not be seen in and by my daughter until later in life.  I have just this year (at age 34) begun to learn about and remedy some of the ill effects of my own cesarean birth.  I also care that my brother’s wife was subject to interventions that lead to cesarean birth.  I really care that she was subjected to a surgery that could have prematurely ended her own life.  Stories of maternal death during or shortly following cesarean surgery are working their way into the mainstream media.

We know that this is not the best way for babies to be born unless it is an emergency situation.  We know that babies who are born via cesarean section risk breathing issues, spinal issues, being accidentally cut, being seperated at birth from his/her mother, needing NICU support, as well as emotional and chemical problems in the future.

Because of what “I don’t care” implies

She said she doesn’t care to my husband and me knowing full well that we do care.  She knows about my work with ICAN.  By saying “I don’t care”, she made me feel like she doesn’t believe in the work I am doing or honor my birth philosophy.  Instead of saying “I don’t care” so bluntly, she could have said something much more tactful.  Try “I’m not sure which path I will take, but given my reproductive health history I will likely do as my doctor recommends and schedule a repeat section.”

My whole being in invested in two very important personal issues: (1) cesarean awareness and advocacy through ICAN; (2) miscarriage - cause, prevention, “treatment”.  By saying “I don’t care”, I am left feeling like she doesn’t care about me.  (Now, I recognize this as a bit extreme.  I know she does care about me, but she didn’t care to think about how this statement would hurt me.  This happened days ago and I still hurt.)

Because of who says it

I’d imagine that you or I are more likely to hear something along these lines from someone we care about - a close friend or family member.  This makes it all the more painful.  If some idiot woman I don’t know or like said this to me, it would roll right off.  But the horrible things our family members and friends say to us are really tough to forgive and forget.  I know that I must forgive and forget, and that’s partially why I am writing this post. 

Because she should care

I recognize that I have no power over another person’s decision to care about health care decisions made for them.  However, does that mean that I back off and let a family member be led to medical decisions that could adversely affect her family?  This is tricky for sure.  I have no desire to badger her and don’t want to negatively impact my relationship with her and my brother, but it is really hard to stay silent when your family chooses to stick its head in the sand.  They’d just rather I stick my head in there with them than have to endure one of my “rants”, as I am sure they see it.

I don’t want to negate anyone’s birth experience.  I don’t want to tell another woman how she should plan childbirth.  However, I believe it is my Calling to advocate, support, and educate women (and their families) with regard to safe and ethical health care decisions specific to prenatal, childbirth, and postnatal care.

What is so offensive about that?  Why should my caring be taken so poorly or treated as trivial?

‘Tis the Season to be Reminded Why My Family Drives Me Nuts . . .
Fa la la la la!

Clip clop, clip clop, clip clop sound the donkey’s hooves.  Mary & Joseph and the baby in her womb are on a long journey.

“Joseph, would you please stop for a moment.”

“What’s going on, Mary?”

“Uhh . . . ohhh . . . . .

Ow!”

“Joseph, I think this baby wants out.  I’m in labor, dear.”

“Criminy, Mary!  We’re in the middle of nowhere.  Let’s try to make it to Bethlehem at the very least.”

Mary focuses on her deep breathing and uses the rhythmic motion of the donkey’s stride to her advantage as she labors.  She notices that the sky is a deep blue color and the stars are out.  The evening is quiet and warm.  Her trusty steed plods along patiently.  Her steadfast husband who guides the donkey looks back often to check on his laboring bride.

“You hangin’ in there, Mary?”

“Uh huh.  OOOOWWWWW!” she groans.

“We’ll be there soon.  Look, I can see the outline of town ahead on the horizon.”

Soon they arrive in Bethlehem.  It is quite late, and it is clear that their entrance into town was an imposition.  They request lodging and are turned away several times.  Finally, they are at least offered a spot in the barn.  Mary & Joseph are weary and happy to have any shelter in which to rest.  Mary is able to rest between her contractions, and even Joseph catches a bit of shut eye.  They are lulled by the sounds of cows, horses, and chickens in the stable.

“Joseph.  JOSEPH!  I think it’s nearly time!!”  Mary cries out.  Joseph is startled awake.  He rubs his face and gets ready for the birth of his child. 

He encourages her.  “Mary, I am seeing his dark hair.”  And soon there after he exclaims, “You almost have him out!”  Joseph is so proud of Mary.  He can hardly fathom how she instinctually knows what to do. 

“Can I do anything for you, Mary?”

“Please hold my hair off of my neck and out of my face.”

“Ah much better, dear.  Thank you!”

Mary continues to push with Joseph assisting in any way he can.  After what seemed like an eternity (but was more likely two or so hours), Mary birthed a son.

Mary & Joseph’s son was to be called Jesus.  He is the Son of God.  Shepherds and wise men alike knew of his birth and were guided to his birthplace by the brightest star in the sky.  They brought him gifts and honored his parents, especially Mary who was brave and faithful enough to endure the physical and social burden of carrying this particular precious child.

“Behold!  A virgin shall conceive and bear a son. 
And shall call his name Immanuel.  God with Us.”

Last week a fellow ICAN leader posted a video of numerous women who had been previously diagnosed with CPD (cephalo-pelvic disproportion).  CPD is a fancy way for a care provider to say that your baby was too big for your pelvis or that your pelvis was too small to birth your baby vaginally.  Most of the time, that’s simply NOT TRUE.  True CPD is quite rare, actually, and usually results from a deformation or injury.

Resources 

• Kmom’s information on malposition
• Cesarean myths “exploded”

And here is how ICAN (International Cesarean Awareness Network) “explodes” the diagnosis of CPD that so many women receive.

Click here to subscribe to ICANvoices.  I’m sure there will be more videos added regularly!  If you are pregnant or considering becoming pregnant, I highly recommend you subscribe.

What in the world do I mean by “forced motherhood”.  This isn’t something I gave much thought to until more recently.  It’s been nearly three years since my cesarean, and yet I find new ways to process that experience.  I simply mean that motherhood doesn’t always come naturally to women who have undergone cesarean surgery.  Some days we have to force ourselves to trudge onward.

I was able to force myself to mother my son when my mind kept telling me he wasn’t really mine. On a very animal level, I felt no connection.

The quote above (used with permission) from a real live mother friend of mine, and it’s quite a profound statement in my opinion.  I’ve questioned my own disconnect from my daughter and still feel like I’m missing an important link to her somehow.  On days like today, this really breaks my heart

I was told that I would crave my baby after she was born.  I didn’t have that strong “mothering instinct” after my cesarean, and I felt like my baby girl was a foreigner.  Huh.  Wow, I feel like crying just for even writing this.  Oh God, how horrible and tragic is that.

I had a quick and easy physical recovery from the cesarean . . . not the norm, I know.  I still felt like I had done the MOST IMPORTANT THING EVER by having a child and caring for her.  But it didn’t feel natural.  I wasn’t viscerally connected to her when she came to exist outside of my body.

I was able to send her to the hospital nursery with only a bit of guilt (more because I felt like I was supposed to feel guilty not because it was too hard to be separated from her).  She took well to breastfeeding, no problem.  On the other hand, I didn’t have trouble letting her feed from a bottle either.  I didn’t feel weird about leaving her with her dad or grandparents or trusted friends.  Even now, nearly 3 years later, I can travel for a few days without my husband and my daughter and enjoy myself.  Am I that cold stone bitch?  Am I an animal who rejects her young?  Maybe.  I don’t think so.  But many nights after my husband & I get home and get her from daycare we just can’t WAIT for her to go to bed.  We only get to be with her for 2 or 3 hours a day during the week, and all I want to do sometimes is put her to bed.  Am I that stone cold bitch?  Am I that animal who has rejected her young?  Yes, I feel incredibly selfish and I hate it.  So then I have to ask . . . am I damaged and is my relationship with my daughter damaged from “cesarean  disconnect”???

And how am I going to feel if I fail to VBAC in the future?  How will I forgive myself if I fail at a hospital VBAC?  Will I beat myself up and especially my husband for not going the HBAC route?  If I choose a HBAC and have to transfer or have an emergency, will I be able to forgive myself for failing?  I won’t have a hospital or medical care provider to blame . . .  only myself.  If I die or if my baby dies, will my husband forgive me and how will we/he move on???

Oh, today is a sad day, a low day in my motherhood journey.

In a recent post I mentioned Ricki Lake’s movie, The Business of Being Born, which will be hitting select theaters across the country this Fall.  I was pleased to hear back from the film’s managing group, so I am currently looking into scheduling a viewing of this movie in Missoula.  The Wilma would be a great location for such a film, but since the theater is in the middle of being sold . . . it might not be a possibility.

I just found out about another movie on this topic, Pregnant in America by Steve Buonaugurio.  I don’t think WordPress allows embedded code, but please click here to view the movie trailer!  Here is a bit of information from the “about” page:

Pregnant in America examines the betrayal of humanity’s greatest gift–birth–by the greed of U.S. corporations. Hospitals, insurance companies and other members of the healthcare industry have all pushed aside the best care of our infants and mothers to play the power game of raking in huge profits.

His wife pregnant, first-time filmmaker Steve Buonaugurio set out to create a film that will expose the underside of the U.S. childbirth industry and help end its neglectful exploitation of pregnancy and birth with help from producers Betsy Chasse and Straw Weisman.

One of the people interviewed in the movie claims that 66% of all hospital revenue is from childbirth!  So you can see why hospitals are interested in making sure that women come to the hospital for birth and that they are willing to pay for equipment, drugs, procedures, and surgeries that take place in hospitals.  And hopefully, then, you can see why doctors and hospitals have an interest in keeping birth away from midwives, especially “lay” midwives.

It doesn’t look like they are ready to say WHEN and WHERE this movie will be released.  That’s terribly frustrating!  But do keep your eyes peeled for it!

On August 14 I became aware that a woman in Maryland was dropped by her OB at 8 months pregnant.  She was abandoned by the practice (Simmonds and Simmonds in
Frederick) because she challenged protocols that do not necessarily improve the outcomes for women and children in childbirth.  You can read the news story here.

Good news came today via Barbara Stratton, Baltimore’s ICAN Chapter Leader.  The family decided to have their baby at Holy Cross Hospital (DC area), and their daughter was born via VBAC.  The attending staff doula, Marialuz Castro-Johnson, received special recognition for her part in helping the family with their goal of avoiding another cesarean birth.

We live in a culture of fear that resides closer to home than most people realize.  Women’s health care has been hijacked and abused for nonsensical purposes.  In this case, a woman with a reasonable and prudent desire (to avoid an unnecessary repeat cesarean) was dropped by her provider for “unreasonable demands”.  The idea is that if you threaten a woman late in pregnancy when emotions are high, that she’ll inevitably succumb to pressure and do what she’s told to do.  It might be her body and her baby growing inside, but she has no right to demand anything with regard to how the baby will exit her body.  (Plus what does it matter as long as the baby - and mother - are healthy.  Does it really matter if it’s a vaginal birth or a cesarean?  Bet your a$$ it does.)

I hope there will be many more stories about courageous women who demand humane care.  I applaud this family for their courage and perseverance.  Late pregnancy is a stressful enough time without the added aggravation from people who should be there to help you and advocate for your needs.  But it’s often not that way.  We the consumers are at the bottom of the healthcare foodchain.  Our desires are brushed aside, ignored, and overlooked.  And we foot the bill.  We spend more money than just about anyone for health care, and yet our outcomes (at least with regard to childbirth) are not better. 

And then what about the LAW?  The Your4State article states: “According to an opinion issued in July by the Maryland Attorney General’s Office, a doctor cannot force a woman to have a c-section against her will unless the baby’s health is in jeopardy, and ultimately the decision lies in the hands of the patient.”  I encourage us all to find out what the law says in our home state.  The VBAC path is not always easy, and we must all arm ourselves with as much knowledge as possible.

Congrats to the Ecker family and thank you for sharing your story.  Yours will give many women hope!

I moved to my current location two years ago.  I’m on a quest to find the right provider, whether she be an OB, CNM, PA, or lay midwife.  I have yet to find a comfortable fit, but if and when I get pregnant again, I know I’ll find her.  I say “her” because I’m less likely to go through this process with a male provider.  Actually, I love our family practice doctor, and if he still delivered babies . . . I’d be a happy gal . . . or at least a hopeful one!

I talked to my CNM from my 2004 pregnancy and discovered that I have reason to be disappointed . . . I reminded her that she had told me I had a good pelvis for birthing.  She told me that you never know what a pelvis will or will not do until it’s put to the trial of labor.  Which at first was comforting . . . until she said that I am the example of someone who looks like they should be able to vaginally birth a child and didn’t.  Then again, I had so many things working against me that day.

I told her that an OB here in town said that my pelvis may not be adequate for natural childbirth.  It’s wide enough but not long enough (anterior-posterior).  My former CNM said that this pelvis shape (platypelloid) is rare and contraindicated for vaginal delivery.  I was so surprised to hear that from her.  I guess because my daughter never ever engaged into my pelvis (and I was fully dilated), perhaps she buys into this possibility.  I wish she didn’t buy into the whole contraindicated pelvis idea at all.  A truly contracted pelvis is extremely rare and is usually due to some sort of physical trauma.

I was disappointed by her advice to me regarding repeat c-section.  She told me it was ok to want to schedule a c-section in the future.  I guess she’s never had a c-section herself.  I doubt she’d be telling me to be ok with it otherwise.  Of course I am thankful that my daughter and I are both here and healthy.  I am thankful that my scar is minimal.  I am thankful that my c-section recovery was super easy.  But there are so many horror stories out there - I know women who have had their incisions burst open after the fact.  I know women who have atrocious-looking scars.  I know women who had excruciatingly painful recoveries.  I know too many women who have regrets - whether immediate or retrospective - regarding their cesareans.  Many women who have had cesareans don’t even feel like they ever truly birthed their babies.

Of course no OB or CNM is going to admit that actions they took may have caused the need for a cesarean section.  I believe the OB did her job - by the time she was called in, my daughter was stuck and just not coming out vaginally.  I didn’t think I’d need a doula, and I have no way of knowing whether or not after the hours of pushing that anything else could have been done.  I believe that my CNM offered me bad choices.  She knew that I didn’t want any intervention.  I shouldn’t have let her break my water.  Damnit!  I knew better.  That choice was the beginning of the trail to cesarean.  I regret that choice with every ounce of my being.

I hope my readers understand where I’m coming from.  I don’t believe cesarean to always be unnecessary.  I’m sure that by the time I had the cesarean that it was necessary.  I know some women do fine with ruptured membranes and induction and epidurals.  I knew that route wasn’t for me, but I succumbed to pressure.  I strongly believe that a woman’s body is built for childbirth, even if they’re not able to vaginally birth all of their children.  I believe that a woman must trust her instincts above everything else, because she and she alone is connected to the child within, and no doctor or midwife can possibly know more about that connection than the woman.

Discussing a c-section with well-meaning family members and friends can be difficult.  The over-medicalization and institutionalization of pregnancy, labor, and delivery makes it hard for some people to understand why we mourn our c-sections.  (Sometimes these people are not-so-lovingly referred to as “sheeple”.  Baaaaaaaaa!)

I didn’t initially mourn.  I think my first response to the spinal was “why don’t women ALWAYS have one of these!”  (Oh, geez, no I din’t!)  My CNM looked crest-fallen.  My OB (who did a beautiful job with my c-section, by the way) laughed . . . and knew that she had won that time.  I don’t mean that my CNM was disappointed in me or that my OB was some saw-crazed freak; it just kinda “happened”.

So now I have a scar.

Oh, and NOW you’re telling me that I’m at an increased risk of uterine rupture if I choose to VBAC.  (My OB has had a VBAC go very wrong, and I know she carries that pain very deep in her heart.  It was obvious when she told me about it.)  But how had I been so oblivious to the serious risks that were presented by the medical community about VBACs?

So, here I have the VBAC/HBAC supporters saying one thing and interpreting data one way . . . and the medical community saying something very different and using the data in a very different way.  Gawd I hate that.  Can’t a fact be a fact be a fact . . . basta!  Genug!!!

But I digress . . . this purpose of this post is to inform you of the “helpful” things people say to those of us who endure (notice present tense) cesarean section:

• At least you have a healthy baby (yes, true)
• At least the c-section was an option for you (yes, true again, I suppose)
• Maybe you’re just not built for natural childbirth (bullsh*t!)
• Well at least you won’t have incontinence issues (not always true; true for me)
• Well at least you didn’t have your vagina ripped open wide; gee vaginal birth really hurts (you’re kidding, right?)
• Huh, so and so had a section and was really pleased (well good for her; notice, I’m not her?)
• So are you gonna get a tummy tuck with your next one? (are you insane?!!!)
• Huh, c-sections are quite common these days (?!?!?!?!?!?!?!?!!?!?!?!!!!^*&#@*!)

Here are a couple of tasty ones that an OB tried on me:

• I don’t know why you wouldn’t just do a repeat.  I mean you won’t even have to go into labor.  (are you as dumb as you look?)
• Well, ya know, we could tie your tubes while we’re in there.  They’ll just be flopping around down there anyway.  (ok, I only said I “think” I want 2 kids)

Please feel free to comment below and add your “favorites”.