The Trial of Labor

Today I was in class trying to follow along in a fast-paced discussion of voice pathologies.  One such pathology discussed was the Human Papilloma Virus which can attack the vocal folds.  Colds and other viral infections can manifest as papillomas (small harmless epithelial tumors) on or near the vocal folds (membranes of the voice box).  This is called Recurrent Respiratory Paillomatosis (RRP).

RRP shows up in children, and the suspected cause is a HPV-infected mother.  When a baby descends through his/her mother’s birth canal, the baby can contract HPV if the mother carries the virus.  Adult onset RRP evidently is becoming more prevalent, possibly due to changing sexual practices.

In the course of teaching us about HPV and the respiratory equivalent, RRP, the instructor stated that pregnant women with HPV have have their babies “delivered” via cesarean section.  The instructor was given this information by . . . you guessed it . . . a DOCTOR!  I couldn’t hold my tongue.  I wanted my colleagues to be sure to know that although a doctor may suggest that a pregnant woman with HPV should have a cesarean, that it’s not a mandate.

I wish I had told my colleagues that uniformly recommending cesarean delivery due to HPV is not an evidence-based practice.  Why is this important?  What if a pregnant woman enters this practitioner’s speech & hearing clinic complaining that her voice is hoarse and weak, and upon further investigation, it is discovered that she has RRP.  This practitioner may tell her that she’ll have to have a cesarean because she has RRP.  That may be one more woman who, heeding the advice of her care providers, would be cut.

Let’s look at some of the literature on the net about both HPV and RRP. (See sources at the bottom of this post.)
Frequency:  According to the RRP Foundation, there are maybe 20,000 active cases of RRP in the U.S., and the CDC estimates that less than 2,000 children contract RRP in a year.  HPV is quite prevalent - approximately 20 million Americans are infected.
Transmission.  Active condyloma during pregnancy or HPV can cause a baby to become infected, but occurrence is deemed RARE.  As stated previously, RRP is becoming more prevalent in the adult population possibly due to changing sexual practices, and HPV has a strong connection to sexual practice.
Childbirth recommendations:  Cesarean delivery is not completely protective from RRP though recommended for consideration when visible condyloma is present in a primaparous pregnant patient.  Cesarean delivery is not protective against RRP in mothers with genital warts.

Well-meaning practitioners from other unrelated fields can and do contribute to the cesarean problem.  However uncomplicated a cesarean may seem when presented antiseptically from a medical provider or behavioral clinician, important questions are not being asked:

1. How likely is transfer of the presumed pathogen
2. How is cesarean delivery protective against the transfer of specific STDs and other viral infections
3. What physical complications can arise for the mother with a cesarean
4. What physical complications can arise for the baby due to a cesarean
5. How does cesarean delivery affect the mother-baby dyad
6. What psychophysical or emotional complications can arise after cesarean delivery (or after traumatic birth experiences); how and when do they manifest
7. What complications may arise (at birth, in childhood, during puberty, in adulthood) from possible RRP transfer
8. How should the patient/client prioritize the risks/benefits of vaginal or cesarean birth
9. What does the mother (and her support team - partner, family members, close friends, etc.) desire
10. Who is more important - the mother or the baby

This last question is the most perplexing, it seems, for the medical community.  Babies are born innocent and vulnerable.  They are unable to advocate for themselves.  In protecting the rights of the unborn or barely-born (not that I oppose that ultimately, I might add), care providers knowingly and unknowingly subvert the rights of the mother.  The mother is here right now.  She is hopefully a positive contributor to her community.  She may already care for other children.  She may have a life partner.  When her health and happiness is compromised for the well-being of her innocent child, is our society really any better for it?  Which is more important - kinetic energy, a life in process, a current contribution . . . or potential energy, a life about to begin, a possible contribution.

I hope readers will take to heart the broadest implications of this post.  First, medical doctors and insurance companies are not the only ones adding to the increasing cesarean rate.  We find well-meaning contributors in some of the most unlikely places.  Second, questions beyond “how easy is it to fix” must be asked when the life and well-being of the mother-baby dyad is at risk.

For more information on cesarean delivery, please visit the International Cesarean Awareness Network (ICAN) and Childbirth Connection.

Sources Consulted:
CDC information on HPV - http://www.cdc.gov/STD/HPV/STDFact-HPV.htm
Condyloma in Pregnancy Is Strongly Predictive of Juvenile-Onset RRP - http://www.greenjournal.org/cgi/content/full/101/4/645
Course notes
eMedicine - http://www.emedicine.com/med/topic2535.htm
Genital HPV Infection Learning Module - http://depts.washington.edu/nnptc/core_training/clinical/PDF/HPV2008.pdf
RRP Foundation - http://www.rrpf.org/
Women’s Health, HPV and Genital Warts - http://www.womenshealth.gov/faq/stdhpv.htm

Tags: genitalHPV, HPV, papilloma, recurrent respiratory papilloma, RRP, cesarean rate, cesarean epidemic, cesarean awareness, ICAN, protective cesarean

I wish I was kidding.  I’m not.  I was insensed to read that a woman in Colorado was denied coverage because of a prior cesarean.  I hope you’ll read Navelgazing Midwife’s post.  It’s a good summary of the situation.

Ick.

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?

I skimmed an interesting article from the Guardian this morning that suggests that whereas art often depicts life events, childbirth has not been well-represented by artists.  I hadn’t really thought about that.  Women have been regularly depicted in art as domesticians, as sexual beings, as dancers, as objects of beauty.  What is not domestic, sexual, dance-like, or beautiful about childbirth?  Why is the image of a slim naked woman (commodified) so desirable in contrast to the burgeoning of life from a woman’s body (abjectified)?  What is not attractive about a body blooming from pregnancy?

I decided to look for [childbirth art] and ["childbirth art"] via Google and was surprised by the number of irrelevant hits.  A few things that piqued my interest included:

• A Childbirth and Breastfeeding Webring (who knew those still existed!?!)
• Artwork available via CafePress (such as this piece) and other poster sites
• A post from 1994 mentioning the lack of childbirth art
• Making your own birth art during pregnancy (which is still not exactly what “qualifies” since this act is usually a private or semi-private experience)
• And most intriguing, a book - The Art and Ritual of Childbirth in Renaissance Italy

Childbirth in Renaissance Italy was encouraged, celebrated, and commemorated with a wide range of objects, from wooden trays and bowls and maiolica wares to paintings, sculpture, clothing, linens, and food. This groundbreaking book examines for the first time the appearance, meaning, and function of these childbirth objects. It also describes the social and cultural context in which they were created, purchased, and bestowed. In doing so, the book offers many insights into Renaissance daily life.Jacqueline Marie Musacchio draws on surviving works of art as well as contemporary and largely unpublished inventories, diaries, and letters, to illustrate the strong bond between the art and rituals of childbirth in Renaissance Italy. She describes a family-centered society seeking to rebuild itself in the wake of the catastrophic population decline wrought by the Black Death. Birth objects were symbols of fertility that encouraged pregnancy. But they were also rewards for procreation that congratulated the new mother. To demonstrate this, Musacchio investigates how objects were given, lent, bought, or commissioned as part of marriage and birth rituals, and how particular images and objects were regarded as aids to pregnancy and birth. For a variety of reasons, she concludes that childbirth objects served as necessary mediating devices between the real and ideal worlds.

In contrast, women who have suffered cesareans (not to suggest that all women who have had a cesarean feel like they suffered) have created some incredible artwork.  Click here to find related images.  I assume that cesarean art falls into the “abject” arena.  Furthermore, pregnancy and the birth process haven’t become mainstream depictions of the female body in art.  I hope more artists will be interested in changing that.

Anomoly.  Congenital.  Rare - in my case occurring in 0.1-0.5% of women or possibly as high as 10% in women with recurrent pregnancy loss[1].

On Monday I had a hysterosalpinogram (HSG) done to check the lining of my uterus for abnormalities potentially caused by a cesarean section in 2004.  My doctors and I are not finding good reasons for repeat pregnancy loss.  My lupus anticoagulant panel came back clean, and the only test left to do in my current OB’s mind is an ANA.

As a result of the HSG, I was diagnosed with uterus didelphys, one of several Mullerian Anomalies.  The OB is certain that this is the cause of my recurrent losses though still recommends the ANA blood draw.  He doesn’t think I need to proceed with a thrombophilia panel.  He didn’t offer any course of action for this issue, suggesting that we should just “keep trying.”  He was surprised that this hadn’t been diagnosed sooner.

Of course, being the curious person that I am, I performed internet searches for “double uterus,” “didelphic uterus,” and “uterus didelphys.”  I also chatted with an internet friend who put me in touch with a couple of other people who have been diagnosed with anomalies.  I have joined a yahoo group that deals specifically with these anomalies.  Even a couple of hours after the procedure, having looked at many pictures on the internet, I began to have doubts about my diagnosis.

I will obtain a copy of my HSG “picture” hopefully today from the radiology lab.  When I compare what I remember seeing on the screen at the hospital with what I see on the internet, I think it’s more likely that my uterus is bicornuate (heart shaped) and/or possibly contains an uterine septum.  A septum would be most problematic for maintaining a pregnancy because if the baby implants on the septum, it will not have enough vascular support to grow.  (This just breaks my heart.)

What next?  I am going to be in Denver for a couple of months studying vocology (vocal science).  (I need a calculator and to remember my college physics class from 1990, eek.) I am looking for a reproductive specialist there who will do a thorough investigation of immunological, endocrine, and structural causes for my losses.  It is possible that the immunological path has been exhausted, but with my mother’s history of autoimmune disease, I’m not so sure.  Endocrine/hormone issues haven’t been addressed to my satisfaction.  Neither OB group I have worked with in town believe in progesterone deficiency.

So, that’s my story in a nutshell for now.

[1] Müllerian duct anomalies are estimated to occur in 0.1-0.5% of women. The true prevalence is unknown because the anomalies usually are discovered in patients presenting with infertility. Some women carry babies to term with anomalies, so it could be more common, possibly as high as 3% of all women.  Sources: http://www.emedicine.com/Radio/topic738.htm; http://www.seattlefertility.com/treatmentOps_UterineAnomalies.htm

I was irritated to discover that Time magazine published an article entitled “Choosy Mothers Choose Cesareans” in their special Environmental Issue. Since cesarean surgery is an over-used procedure[1], it is quite inappropriate for this type of article to appear along-side articles dealing with the Presidential candidates’ climate change positions and how the US can be more green.  Needlessly consuming medical services is anything but green, and Time magazine should take responsibility for its poor choice in content.

According to the article, more women are choosing cesareans, a trend doctors expect will continue.  I do not know nor have heard of anyone actually choosing a cesarean, save the stories I read or hear about through the media.  I believe that the media is creating this belief that women choose cesareans, and that this is a trend we should expect to see continue.  But perhaps it is true that women are choosing major surgery for reasons cited, such as (1) fear of ripping/tearing the perineum, (2) fear of incontinence, (3) fear of pain, (4) fear of birth, (5) or fear of having a stretched-out vagina.  Time’s article feeds into the misperceptions of birth generated by Hollywood blogs and reality shows like A Baby Story.

Fear of ripping/tearing:  from what I have learned over the years, women rarely rip or tear during childbirth if they push following their body’s signs, are given appropriate time to labor and birth their babies, and/or have the perineum massaged or supported during pushing.  Episiotomies can cause more damage to the perineum, vagina, and anus than a natural tear anyway.  I wonder if this fear stems from botched episiotomies?

Fear of incontinence: cesarean delivery does not prevent incontinence.  Sorry!

Fear of pain: I wonder why so many women are taught to fear the pain of childbirth.  Granted labor was one of the most challenging things I have ever done, but I think my exercise habits and outdoor enthusiasm (road biking, hiking, backpacking, running) had prepared me for childbirth.  I don’t look back on my labor and regret the pain - I regret the fact that a cesarean became necessary.  Anyone who has done a little bit of study on the purpose of pain in childbirth can tell you that it is actually beneficial - it can indicate problems that need attention as well as provide important feedback to the mother and her careproviders regarding her progress.

Fear of birth: there actually is a term for women who have a fear (phobia) of childbirth - lockiophobia.  If a woman is not phobic, then she should work with a psychologist or psychotherapist to determine the root causes of her fear and overcome those.  Pregnancy can bring up psychological pains of the past, but they are not avoided through cesarean surgery.

Fear of a stretched-out vagina: do I really need to address this?

The title of my post suggests that cesareans will limit future choices.  This is true - women who have had a cesarean are at risk of being pressured into repeating surgery for future births, have a slightly more elevated risk of uterine rupture and other poor birth outcomes, are unable to have normal birth at most birth centers [2], may not be able to have a normal birth at their local hospitals [3], will be pressured to comply with hospital protocols that may lead to interventive birth outcomes for future births, may have difficulty finding providers who will support their choices in future births to name a few limitations.

Other things you may not know about cesarean aftermath [4]

1. Risk of post-partum depression and post-traumatic stress disorder
2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
3. Stillbirth, miscarriage, infertility
4. Pain, adhesions, slow recover, unsightly scaring
5. Negative impact on relationships with other family members, particularly partners/spouses
6. Rejection of birth - some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape“

Thankfully I have come to learn about the viability and appropriateness of vaginal birth after cesarean.  I was encouraged to subscribe to the ICAN Yahoo list where I learned much of what I know now about birth that I didn’t know before my daughter was born.  I know the dangers of choosing cesarean for the first, second, or fifth time.  I have experienced stress, depression, and other tangible and intangible outcomes related to cesarean surgery.  I worry that my current trouble with recurrent pregnancy loss is related to the cesarean.  I resent that I have to consume more medical services to rule out uterine defects caused by the cesarean.  Tomorrow I will have a hysterosalpinogram performed.

It is regrettable that women such as Ms. Chung are led to believe and accept that cesarean birth is risk free, complication free, and consequence free.  It is simply not the case, and it does not take more than 30 seconds with an internet search engine to learn that much care should be taken when deciding if cesarean surgery is right for a woman and her baby.  The March of Dimes states that cesarean surgery should only be performed when the mother’s life or baby’s life is at risk.  Cesarean surgery is a blessing when used appropriately, but its safety is not justification for indiscriminate use.

[I sent a slightly abridged version of this post to Time magazine's Editor.]

[1] The World Health Organization maintains that an acceptable rate of birth via cesarean surgery is 10-15%.  When the cesarean rate exceeds this range, the risks outweigh the benefits.
[2] To read the AABC’s recent statement on VBACs at birth centers, click here.
[3] Go to http://www.ican-online.org to see if your hospital allows VBACs.
[4] See also http://www.childbirthconnection.org/article.asp?ck=10166; read ICAN’s book, Cesarean Voices to learn how cesareans have impacted real women and real babies.

In about an hour I will be interviewed for a local news station regarding Montana’s cesarean rate.  I don’t know much more than that.  The reporter has a young child.  The reporter is supposed to be meeting with a local hospital official.  Other than that, who knows what her focus will be.  In anticipation of this interview, I decided to review some things that I have read and wrote regarding cesarean rates.

With regard to rates, it is important to consider that the US cesarean rate (2006, preliminary) is 31.1%.  The rate has increased by 50% since 1996.  The rate recommended by the World Health Organization is 10-15%.  Once the cesarean rate exceeds 15%, the risks (statistically speaking) outweigh the benefits.  The Montana cesarean rate (2006, preliminary) is 28%, nearly a 3% increase from the year prior.  According to a source at the local hospital, our local rate is around 31%.  I was told that only 16 VBACs took place in 2006 at my hospital.  (A local CNM questioned the accuracy of the VBAC figure, suggesting that VBACs were under-reported.)

I can list many contributing factors to the continued increase in the cesarean rate:

• Medico-legal concerns on the part of doctors, hospitals, and insurance providers (it’s HUGE, actually)
• “So and so had a cesarean . . .”
• Hollywood stars having elective cesareans
• Young and underpriviledged mothers are more at risk for cesarean surgery
• An unchecked trust in care providers - most women do not seek second opinions when it comes to maternity services
• Sensationalization of birth - Baby Story and OR Live come to mind
• Society - our view of birth has changed; the culture of fear has spread to childbirth
• Cesareans ARE more safe now than they ever have been

Of course I’ll direct the reporter to resources such as:

• ICAN
• The Mother-Friendly Childbirth Initiative
• Childbirth Connection
• Conscious Woman

I just received my weekly “cesarean awareness” google alert.  I find it interesting what is included and what isn’t.  I blogged about Cesarean Awareness Month posts I found and found additional ones here.  Some of these are not mentioned in the alert copied here below.  Also, I find it interesting that my posts didn’t show up in the blog alert but did in the web alert.  HuH!

April is Cesarean Awareness Month
By timothydeanmills.com(timothydeanmills.com)
In the United States in 2006, 31.1% of babies were born by cesarean section–a 50% increase since 1996. In Georgia, that number was 31.3%. The World Health Organization recommends a maximum c-section rate of 10-15%.  Tim’s weblog - http://timothydeanmills.blogspot.com/

International Cesarean Awareness Month
By Kathy
April is International Cesarean Awareness Month. Please check out my C-section posts by clicking on that category. In addition, here are some other C-section related links. The International Cesarean Awareness Network Pushed Birth …
Woman to Woman Childbirth Education - http://womantowomancbe.wordpress.com

Cesarean Awareness Month!
By doula_char(doula_char)
April is Cesarean Awareness Month What is Cesarean Awareness Month? An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the …
whatzadoulado - http://whatzadoulado.blogspot.com/

April is Cesarean Awareness Month
… and let them guide you and help you, is it up to you to ask the right questions, is it up to you to make sure you get the right answers… Here is the website to learn more about ICAN, and Cesarean-Awareness-Month …
Boriquita’s WebSite - http://boriquita.multiply.com/

April is Cesarean Awareness Month
By Boriquita(Boriquita)
I wish I knew half of what I know now for my first birth. I guess I can use this information now for this birth and any other experience in the future… I have learned that I must take responsibility for my learning, not one person in …
Boriquita Comments - http://boriquita99.blogspot.com/

Google Web Alert for: “cesarean awareness”

National Cesarean Awareness Month - Topix
April is National Cesarean Awareness Month! Over 50% of the C-Sections taking place in this country TODAY are deemed unnecessary by the World Health …

International Cesarean Awareness Month — Blogs, Pictures, and more …
James KG wrote 2 days ago : Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean …

April is Cesarean Awareness Month - Associated Content
Check out April is Cesarean Awareness Month - Submitted by WD at Associated Content.

KentuckianaMoms :: View topic - April is Cesarean awareness month
April is Cesarean Awareness Month! 1 in 3 Louisville women gives birth surgically, and the number is rising every year. Join us Monday, April 7 to learn …

Cesarean Awareness Month — Blogs, Pictures, and more on WordPress
James KG wrote 2 days ago : Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean …

I wish I understood how all of this web aggregator stuff worked . . .

Why has today been such a tough day?  I really can’t explain why I am so down in the dumps.  I think there are enough “reasons,” but I must not give in to them.

This morning I woke up somewhat disoriented because DH’s alarm clock is CRAZY.  So, I thought I was already late for the brunch we scheduled with friends, and somehow that set the tone for the rest of the day.  On our way to our friends’ home we stopped at a local bakery.  I ran into a midwife/herbalist who had been helping me before her mother fell ill.  It was the first time we had talked since my miscarriage.  That continued to establish the tone for the rest of the day.

We proceed onward to our friends’ home.  These are our best friends in town.  My girlfriend is now 11 weeks pregnant, and it’s really really tough.  Of course I am thrilled for her and relieved that all is well with her pregnancy.  But I’m also mad as hell.  It’s a hard place to be - for both her and me.  We had invited another couple to brunch who are considering a move to our town.  They have 2 kids, so of course there was lots of talk about kid-related issues, and my friend’s pregnancy, and whether or not we were going to have another baby.

I had a good conversation today with a friend of mine who has been down a different but no less significant miscarriage path.  She forwarded some threads to me that she thought would be helpful.  I decided to put them off until later.

We returned home from brunch and all decided to nap.  I couldn’t.  My brain started processing MISCARRIAGE MISCARRIAGE MISCARRIAGE again.  It wouldn’t stop.  My heart was breaking all over again right there in the bed where my DH & I have tried and hoped for three babies.  We were planning our upcoming homebirth just days before my last miscarriage.  We believed.  We trusted.  We were deceived.

I went upstairs to my computer to work on some outstanding projects.  Instead, I turned to the multiple miscarriage threads that my friend recommended.  I was quickly overwhelmed.  I am meeting with a different OB (one who spends 2 days a week seeing fertility patients) on Tuesday.  I am starting to panic.  There is so much that can contribute to recurrent miscarriage that is not easily found.  It’s also quite possible that no definite cause will be found.  Then what do I do.

I cried.  I cried more than I’ve hardly allowed myself in the past 6 weeks.  Tears were streaming but I was silent.  Don’t want to wake up my slumbering family.  And what might happen if I actually let loose?  I’m terrified to go there.

I stepped into a nastly little debate on-line today about whether or not women who have had cesareans have actually given birth.  It grieves me that women can be so mentally and emotionally damaged from their childbirth experiences, and while I am empathetic, I can’t relate.  Especially not on a day like today when I have been reminded over and over again that other people get pregnant and carry babies to term just fine.  No, cesarean surgery is NOT an optimal way - even when a life-saving mechanism - to have a baby.  But I’d take another cesarean over the madness and hell I’ve been in for the better part of a year.

I feel like I am starting to lose ground.  Perhaps this upcoming visit to the OB is stressing me out.  Perhaps my professionally-insane April is starting to weigh on me already.  Perhaps being behind on so many projects has more than caught up to me.  Perhaps I’m starting into a new phase of grieving.  Perhaps I’m afraid to get over these losses.  But one thing is for certain:  I am not who I want to be right now.

I found this on ICAN’s eNews (www.ican-online.org/community/eNews/) and want to share it with those who maybe aren’t (yet) subscribers!

Cesareans Affect Lives. Real women, real babies. Lives changed.

How has your cesarean impacted you? Come to www.ican-online.org and blog about your experiences in 100 words or less, tell us your story.

Cesarean Awareness:
is not only about the “bad” cesarean and recovery
is not about guilt for not succeeding at VBAC
is not about not attempting VBAC
is a state of being, whatever that may be for you or me - hope, fear, acceptance, sadness, depression, thankfulness
is about doing the research to understand the reality of the risks taken on every time another mother has another surgery

ICAN is about all birthing women having access to that information.  Cesarean Awareness Month is about encouraging the spread of that information.  We want to encourage you to find a way to spread the awareness in your community. Wear your ribbon. Write on your car. Buy brochures to drop off in the library. Put up a poster at your work. This is about open communication about the health of our women, babies and families.