My OB: Hello Dr. Jeckyll? Or Is It Mr. Hyde?

I decided to blog about my OB, Dr. Jeckyll & Mr. Hyde, over at My Best Birth.  Here’s an excerpt:

So, I arrive this morning with my husband.  After the nurse weighs me and takes my blood pressure, she tells me to unclothe waist-down.  I then notice the ultrasound machine right by the bed.  “Uh oh,” I think.  Compliant-patient side of me agrees to undress (though I know my cervix is still high and posterior).  Not-gonna-comply-patient will not agree to an ultrasound!

This week, instead of having a big baby, I have “not a very big baby” (based on external palpation) . . . “maybe 6 6.5 pounds right now.”  I’m measuring “right on” (which he didn’t say last week).  Everything looks good.  No worries.  Who is this guy!?  So, a very straight-forward appointment with Dr. Hyde this week.  At this point, I am planning on keeping my 39 week appointment, just so he doesn’t get suspicious of anything.  Suspicious of what, you might wonder?

To read the entire post, click here.

Blog it out: 38 week OB appointment

As I get ready for my 38 week OB appointment tomorrow, I feel the need to just ‘blog it out.’  Ya know . . . as a way to relieve some tension and stress from last week’s appointment.  I’m maintaining ‘shadow care’ with the only OB I know in town who would ‘tolerate’ babysitting an ill-advised VBA2C in the hospital.  Only thing – I’m not planning on going to the hospital.  However, I’ve been encouraged to keep up this disingenuous relationship just in case I do need to transfer during or following the birth.

I blogged last week about his ridiculous statement that “short, Mexican women” have the best births.  Here are some of his other de-motivating tactics:

Sketch by American artist, Ben Murphy

  • “So . . . we still doing this?”  He likes to begin my appointments with this rhetorical question.  He knows the answer, but yet, he continues to ask.
  • “You’re not gaining weight but you have a BIG BABY.”  Such bullshit.  He doesn’t share my fundal measurements with me, but I know I have been and continue to measure ‘right on’ each week.
  • “When you have a bad outcome, ________.”  He’s filled in the blank with a variety of scary things.
  • “When you need a cesarean, you can’t freak out on me.”  I told him that was way too much for him to expect.
  • I have to have a perfect Friedman’s labor.
  • CEFM, IV, yada yada.  Ok, whatever.  I’ll agree to the monitoring assuming they have telemetry.  I’ll consent to heplock but not an active IV.
  • As soon as I’m in labor, I’m to go directly to L&D.  (Yeah, right, doc.  I’ll do that.)
  • I asked him why my rupture risk is increased since they went through the old cesarean scar.  His response: “Because it just is.”  My response: “Come on, you know that’s not a good enough answer for me!”
  • When I told him that I gestate longer than 40 weeks, he said “that’s bad!”
  • Doesn’t believe vaginal delivery is best for healthy babies (?!?!?!?!!!!!)
  • Places VBAC in the “want” not need category, though he seems to understand that I have my reasons
  • Doesn’t seem to believe that the pelvis expands during pregnancy and birth?  The only way to get more room would be to break my pelvis (not that he was suggesting that route).  Does he not ‘get’ the physiology of birth?  Does he not understand the role of hormones in preparing the body to birth??
  • Seems to consider 37 weeks as term . . . not early term as I suggested.  (A newly released NIH study asserts that babies born in the 37th and 38th weeks are more likely to die before age 1 than babies born in the 39th and 40th weeks.)
  • “You know I’d prefer not to do this.”  In response to my objections over having him and an anesthesiologist breathing down my neck during my entire labor and birth.  Which is a mis-representation anyway of what would actually happen.  If I’m in labor during the day, he can continue seeing his patients.  If I’m in labor at night, he’s welcome to go sleep somewhere in the hospital or at his office.  And our hospital has 24-hr anesthesia immediately available, so he shouldn’t be guilting me about an anesthesiologist having to be there for my labor.  If a hospital isn’t safe for a VBAC . . . . it’s not safe for any birth.

Wow, when I write all of that down, I just get angry.  I’m going to crawl under the covers with my Hypnobabies tracks, strengthen my bubble of peace, work on fear cleansing, listen to my pregnancy affirmations, and call it a day.  My husband will go with me tomorrow to my appointment, so I imagine it will be uneventful.  I have a mind to bring in my “birth preferences” just to see how the doc would react, but really . . . is it worth it?  Probably not.  At this point, I’m no longer interested in his opinion because he continues to skew the ‘truth.’  I don’t want to argue about laboring in water or delayed cord clamping or any of it.

Point is – I’m not going to the hospital to have this baby unless the need arises before, during, or after the birth.  I fully recognize that at any point between now and my birthing time, that I may need hospital services.  My husband and I will decide if we agree with recommendations to abort our homebirth plans.  Otherwise, I’m not planning on needing the hospital or an obstetrician.  So the last thing I want to do tomorrow morning is have an off-putting, destabilizing, stress-inducing discussion with someone who begrudgingly is putting up with my wingnut idea to have a natural birth but very vocal about what all “will” go wrong.

You can read my last pregnancy update (34 weeks) here.

Stakeholders for the Homebirth Summit

Stand and Deliver posted more information about the upcoming Homebirth Summit called by the ACNM.  Have a look at Rixa’s post and my previous post if you haven’t already (additional links on my previous post).

Geraldine Simkins, president of MANA, sent out a message with more information regarding this “work team.”  I’d like to further break down the point that addresses “stakeholders.”

The stakeholders are NOT ANY ORGANIZATION but rather are individuals who are defined as belonging in these nine stakeholder groups:

    • Consumers (from a variety of perspectives)
    • Consumer advocates (doulas, childbirth educators, childbirth and women’s healthcare activist)
    • Home Birth midwives (CPM, CNM, LM, Amish, traditional, whatever)
    • Obstetricians and OB family practice
    • Collaborating MCH providers (nursing: L&D, neonatal, pediatrics; CNMs who provide backup)
    • Health insurers and liability insurers
    • Health policy, legislators, legal, ethics
    • Research and education: Public Health, epidemiology
    • Health models, systems, administrators

In this way, the WHOLE SYSTEM is at the table. Otherwise, we will not be able to seriously come to consensus.

Here are my thoughts on each identified group of stakeholders:

  • Consumers from a variety of perspectives – why would they invite consumers who have no understanding of or appreciation for home birth to the table?  How would an anti-homebirth consumer help improve home birth?  How are these people being chosen?
  • Consumer advocates – are these all people who currently (or have a history of) support families who desire or choose home birth?  Doulas, CBEs, and activists are not necessarily supportive of or educated about home birth.  How are these people being chosen?
  • Homebirth midwives – ok good, hopefully they will select some midwives (with solid experience & reputations) who have chosen NOT to be certified.
  • OBs and FPOBs – aside from receiving transfers in a hospital setting, what experience do they have with homebirth?  It is possible that an FPOB would be more supportive of home birth, but puh-leez, how many OBs have actually attended home births???  Additionally, how forceful will a FP be in an arena over-represented by “first class” medical participants or will they be subverted by their more ‘highly esteemed’ colleagues?
  • Collaborating MCH providers – other than practitioners who willingly back up homebirth midwives and their families, what business do these other people have weighing in on homebirth?  I have yet to meet a nurse who thinks home birth is a good idea.  This is now the second category of stakeholders that I place within the larger category of ‘back up.’
  • Health insurers and liability insurers – at this point in time, I think it will be useful to have this group participate in the discussion.  They need to “face the music” and know that women and their families expect home birth to be a viable option.  Insurance is often a barrier for people who desire home birth.  Additionally, liability insurers have stuck their big fat toes into every crevice of maternal-fetal care, so they need to know what a huge obstacle they are providing for families searching for the best options that suit their needs.  (The fact that my OB couldn’t/wouldn’t deliver a breech baby because of his stinkin’ malpractice insurance drives me INSANE to this day!)  This group should listen and learn.
  • Health policy, legislators, legal, ethics – what in the HELL kind of catch all category is this?  I can’t make sense of it.  However, representatives from state-level governing/licensing boards, like Montana’s Alternative Health Care Board, should participate.
  • Research and education: Public Health, epidemiology – please add medical anthropology to this group!
  • Health models, systems, administrators – again, too vague for my comfort.  And it is premature to invite this group to the table.

Which of these stakeholder groups are rooted in public health and/or naturopathic (including midwifery) perspectives?

  • Consumers (??!!) – maybe, but again, it depends on the “variety of perspectives” invited . . .
  • Consumer advocates (??!!) – see above
  • Homebirth midwives

Which of these stakeholder groups are rooted in allopathic tradition?

  • OBs and FPOBs
  • Collaborating MCH providers
  • Health insurers, liability providers
  • Health policy, etc. (??!!)
  • Research and education – some of these folks might have training in non-allopathic perspectives
  • Health models, systems, etc.

So SIX groups (already with institutionalized POWER) interacting with THREE groups (with hardly any power when it comes to institutional change) with two-thirds of its representation from somewhat questionable backgrounds . . .

And people involved wonder why women (like me) are so concerned?

Why oh WHY would you say that to a pregnant woman?

I’m ready to lighten the mood just a little bit, I suppose.  I found a link to this serious but cheeky post about what pregnant women really think when you say ridiculous things to them via @DarleneMacAuley on Twitter.  Ok, so maybe I should add the caveat that not all pregnant women react like this, but at least Mama Birth and I do!

Here’s one of hers:

Quote 5:
(Said when out in public with ‘gasp!’ all three kids and pregnant belly.)
“Wow. You are going to have your hands full.” ~Must be said in a voice that is a mixture of shock and horror.~

What I say:
“Oh….haha!”
(Why is my response almost always a smile and nervous laughter?! Seriously, my parents are not this polite!)

What I am thinking:
(On a bad day.)
“Are you kidding me, my hands ARE full. I am secretly freaking out, wondering if my sanity will survive and more importantly, if my kids will turn out to be functional adults. Can you get the door for me, load the groceries in the car (even after I say I don’t need help) and then help push me into my Suburban that conveniently has a four inch lift?”

(On a good day.)

“I love my kids! I couldn’t imagine life without them! They are the best thing that every happened to me and in no way a burden. Why does everybody seem so afraid of children? They are awesome.”

This is often said to me, especially when my big pregnant self is carrying a toddler twin on each hip!  (Mama Birth, I don’t have a Suburban; thankfully, a very practical Honda Odyssey!)

Here are a few more in my own voice:

Random persons: “Oh, you’re really carrying high.”

My responses:  (1) “Not really – here are my hip bones.” (2) “Really?  I haven’t thought about it.”

What I’m thinking: “That’s the last freaking thing I need to hear because what I do hear (it’s that small little nasty voice) is ‘yeah, the baby will never drop, never engage, never descend, mwhahaahahaaaa!‘”

Random persons (with my twin pregnancy): “Wow, you’re smaaaaallll for carrying twins!”

37.5 weeks with the twins

My response: “Huh, thanks?”

What I’m thinking: “I imagine she thinks that’s a compliment, but I don’t really appreciate having my twin pregnancy minimized.  I’m friggin’ huge but thankfully handle it well.”

Random persons (with my current singleton pregnancy): “Wow, you’re biiiiiiiiiiiiig!”

27weeks

My response: “Well, most women look bigger sooner when they’ve been pregnant before.”

35 weeks

What I’m thinking: “Eff you I do not either!!  I look fantastic!!!”  I also then think that people shouldn’t ever make comments about how big or small they think you are for whatever stage of pregnancy you’re in.

Various friends: “You’re not going to the hospital?  Wow, you’re brave!”

My response: “Hmm, well I think women who go to the hospital are brave.”

What I’m thinking: Unfortunately, most women take it for granted that they’ll be safe in the hospital and that their births will go normally.  I’m thinking that women don’t really consider their choice of birth venue as seriously as they should.  In my town, low risk women have access to a regional hospital (with a cesarean rate reflective of the national trend), a birth center (run by a CNM), and home birth.  Do women really know the pluses and minuses of each of these birth venues?

Random & Non-Random people: “Well, my baby would have died if we hadn’t been in the hospital because he/she was in distress!”

My response: “Wow, I’m sure that was really scary!”

My thoughts:  Normal, physiologic birth usually (sure, not always) does not lead to distressed babies.  When someone tells me their babies were in distress, I immediately wonder if they had: (1) AROM? (2) non-medically indicated induction? (3) non-medically indicated augmentation of labor? (4) epidural (which most hospital births involve epidurals).  We all usually study the “cascade of interventions” in childbirth education classes, but in the heat of the moment, lots of us forget that information and do whatever is required of or recommended to us.

These are a few of the random and usually not appreciated comments directed at me when I’m pregnant.  What are yours?

Hispanic Female Pelvises are Better?

My OB said the most bizarre thing today.  At first it didn’t really strike me as bizarre, but the more I’ve thought about it, the more I’ve realized it’s a crock of shit.

I’m not exactly sure how we got onto this topic this morning, but he stated that the Hispanic female pelvis is bigger than the average white woman’s pelvis.  The best birthers are short hispanic women according to the doc.  And then said something about a study in Southern California that I didn’t really pay any attention to.

Let’s just break this down a bit.  According to this post over at The Unnecessarean (July 2010), the cesarean rate in Mexico’s private hospitals is 70% and 40% in public hospitals.  If Mexican women are so much more physically capable of using their pelvises, then why does their cesarean rate exceed ours?  Perhaps pelvimetry is not as much a factor as OBs would like us to think?

The Unnecessarean post, an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010, further points out:

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

None of these cesarean rates support my doctor’s assertion that a woman’s genetic structure has anything to do with achieving a vaginal birth.  According to Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal, other factors are at work here.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

Aha!  I knew it.  I wonder if some jackass OB in Mexico is currently telling his patient that you need to be tall with a Nordic bone structure (my genes) to have a baby fit through the pelvis?  What do you think?

For more information on CPD (cephalo-pelvic disproportion) diagnoses (and what it probably doesn’t mean for you) and pelvises, I recommend:

The Bestest VBAC of All

So I got an epidural for my VBAC.  Get over it.”  What a great title!  You know exactly what kind of story you’re going to read and can even take a guess at the spectrum of responses to such a post.

I think this is an important post to read.  A VBAC doesn’t have to be a fully unmedicated waterbirth at home to be a ‘success.’  Yet, we run the risk of presenting a set of demands on VBAC mamas, and for many if not most this might be obstructive.

My sense of this woman’s story is that she got the epidural knowing what risks and benefits are involved.  If not, then yeah, maybe she got lucky.  My sense of other women’s stories who have had epidurals, is that even though in most women, the risks may outweigh the benefits . . . some women just don’t dilate or labor well without them.  Perhaps we can hindsight quarterback their birth preparation process, but I think that’s a fruitless discussion.

I agree with Andrea’s point that fighting about the best way to VBAC isn’t constructive.  Ideally, we wouldn’t even need to address the “best way to VBAC” if we had a medically-appropriate cesarean rate in this country.  And if “normal birth” (and I do mean natural) has a high degree of variability, so much so that we insist women be left to labor in peace without clock pressure, then we must be willing to accept variability in the way women pursue their VBACs.

Most of us, I would assume, who consider ourselves to be VBACtivists, are working so hard to re-educate women about patient autonomy, patient choice, informed consent, and participating in health care choices, that we start from the position that a woman who requests an intervention such as an epidural during a VBAC labor doesn’t know the risks.  And this is probably how the squabbles begin.

Further, plenty of “die hard” VBAC gals make “natural choices” that I find potentially risky.  I’m pretty specifically talking about the use of EPO for home induction and tonics such as 5w or PN6.  And some women say NO to induction but YES to augmentation.  And some women agree to AROM (having their waters broken).  Some women have their membranes stripped.  And I get it . . . because as soon as you get to 40 weeks, you’re treated as a ticking time bomb.

What will I do this time?  Only time will tell.  But you bet your butt that if I get exhausted laboring at home but think an epidural will help me regain the strength to birth this child vaginally, we’ll hop in the car and accept the the bad with the good.

Warning: FDA May Inspect and Destroy Your Bathtub!

I find it interesting, perplexing, ridiculous, and absurd that the FDA seized a shipment of birth tubs from a Portland, OR dock, claiming that they’ve been ordered to “inspect and destroy” them.  According to Barbara Harper, the founder of Waterbirth International, “They claim they are unregistered medical equipment, but they are not providing a way or means to get them registered. In other words, if the medical authorities can’t stop waterbirth, then just have the FDA take away the birth pools.” [emphasis mine]

feel free to reuse this image; please pingback if applicable

What’s more, the FDA believes this to be their jurisdiction because childbirth is . . . an . . . ILLNESS.  Yes, that’s right . . . I’m ill; ill with child.  VERY ill with child actually.  So ILL with child, that I might just any day now crawl into my bathtub for relief, medical relief of course, from my nearly 10 month ILLNESS.  Harper was told: “Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment.”  Now, I will say that the FDA isn’t the only institution that believes pregnancy and birth to be an illness, but that’s another story for another day.

So, when I say that the FDA may want to come into your home and inspect your bathtub, hot tub, pool, pond, toilet, sink, whatever . . . hopefully you can see that I’m not really that far off the mark for these are all things water containers that women may use to facilitate childbirth.

More info can be found on this blog as well as Barbara Harper’s Facebook notes.  Please spread the news and watch for news of a petition that Harper may be starting on Change.org.