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

I happened upon an interesting self-ascribed feminist post about “medical rape” and the “medicalization of childbirth.”  I’m certain that I have written about being an empowered patient, since that is one of my goals as a childbirth activist - to help empower women to participate in their health care, ask questions, get second opinions, etc.

I’m not sure the original author has much knowledge of the socio-political dynamic in part responsible for the current state of modern medicine.  However, she makes some good points.  For instance:

The male medical establishment - even with female practitioners - tend to subvert women and suppress their decision-making ability, especially in the reproductive health sector.  Why?  Well, it is easiest to exert power over a woman when she is on her back with her feet in stirrups, her butt hanging over the edge of a paper-clad table, and a speculum shoved into her private parts.  Who hasn’t felt vulnerable and less powerful in that position?

I’m not suggesting that all obstetricians are bad or that men make sucky gynecologists, not any more than I’d suggest that cesareans are completely unnecessary, or that the safest place to have a baby is at home.  Then again, statistically about half of the cesareans performed in this country are not necessary (and don’t improve our infant mortality rate), and actually staying home is the best way to ensure that unnecessary interventions aren’t performed on you when you’re only 2cm dilated at the hospital.  Unfortunately, a growing number of women are dissatisfied with the services their obstetricians provide, are disgusted by medico-legal decision-making when it comes to women’s (and babies’) physical and psychological well-being during the childbearing year, and suffer poor childbirth outcomes.

Something has to give.

Tags: obstetrics, gynecology, medical rape, medicalized childbirth, awareness, advocacy, childbirth

I just talked with my regular OB.  He was under the impress that I had a Mullerian Anomaly (such as a septate uterus) and a major contributor to my recurrent pregnancy loss.  I’ve seen a Reproductive Endocrinologist recently who came up with his own recommendation.  He suggested that my 1-1/2 inch fibroid was distorting my uterine cavity and causing the recurrent pregnancy loss.  He said that he would be “very concerned” about that fibroid.

I double-checked my obstetric records from my 2004 pregnancy.  The fibroid was discovered during a 10-11 week ultrasound (a first-time mom, I was nervous that the midwife didn’t find my baby’s heartbeat).  The fibroid was roughly 4.5 cm then and is therefore about the same size now.  However, I don’t believe it to be a cause of my recurrent losses.  Rather, it is a symptom.  It is a symptom of imbalanced hormones, usually too much estrogen.

Anyway, my OB’s nurse called me today to say that he (my OB) would NOT recommend a myomectomy for a non-symptomatic small fibroid.  I don’t bleed without stopping; I don’t have unmanageable pain.  Since I already have a cesarean scar, he sees no reason to add to that.  Phew!

So, if anyone tells you that you definitely need a myomectomy, please do seek other opinions.  Your uterus may just say “thank you.”  In my case, it should be thankful that I’m saving it from at least two more uterine surgeries.

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?

Today I have the luxury of time and relaxation.  After walking (yep, that’s right) my daughter to daycare, I returned home and swept out the garage.  I finished at 9:30am and have the entire day ahead of me.  I digress.  As I was sitting on my bed checking my e-mail, I discovered that CNN was discussing how women make mistakes with regard to healthcare.  This does not apply to soft-spoken women alone; in fact strong women like me have a hard time demanding the care that we deserve.

This article at CNN discusses resources for various health issues that women face.  Dr. Christine Northrup shares a few gynecological resources.  I hope that the media continues to reach out to female consumers and remind them to be proactive and empowered in their health choices.

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 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.

Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean surgery on mothers, babies, and families worldwide.  Cesarean birth is major abdominal surgery for women with serious health risks to weigh for both moms and babies.  Cesareans may be safer now than they ever have been, but this surgery is being conducted more frequently than is prudent or safe.  The acceptable rate established by the World Health Organization (WHO) is 10-15% - what is your community’s cesarean rate?

The blogosphere is atwitter about Cesarean Awareness Month.  Here are some posts I found today that deal directly with CAM:

• Instinctual Birth’s post
• No Womb Pod’s post
• Strain Station’s post
• Cesarean Awareness’s post
• CT Birth Experience’s post
• She Got Hips’s post
• CT Doula’s post

If you have blogged about Cesarean Awareness Month and don’t appear on my list, please leave a comment so we can read your post.

To learn more about cesarean awareness, support, and education, visit the Internation Cesarean Awareness Network (ICAN) website and/or look for a chapter in your area.  Another great resource to consult when weighing the benefits and risks of intervention in chilbirth is Childbirth Connection.  Also, I recommend looking at and considering the Mother-Friendly Childbirth Initiative.

How do you plan to honor Cesarean Awareness Month?  How can you let people know that natural birth is an important issue for you and for them?  I promise that there is some way, no matter how small it may seem, that you can have a positive impact on your birth community.  Even wearing a cesarean awareness ribbon several days this month will help.  If you need ideas, feel free to ask.

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed - via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed - we treat them. We don’t judge the obese who come in with MI’s. - we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis - we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading - we treat them. We don’t judge many other behaviors which really ARE obviously poor choices - because they are just that - choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

I was glad to find this post today.  Sherry Payne is a self-ascribed homebirth enthusiast, and I think it’s wonderful that she brings this enthusiasm to her blog, her other writing, and to her profession.  She is a labor & delivery nurse!!!  Her article is entitled “Consumer First, Patient Second.“  Here is an excerpt:

“Receivers of health care must adopt a more pro-active consumer role in their own healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent guide through the process. He or she is not your daddy.”

This is certainly my goal as an ICAN leader and as a woman who now ”knows better” than to let another person take charge of her body - to empower women and their families to take on a more involved role and equal position in their health care.  I don’t think there’s a harder “place” to do this than obstetrics, unfortunately.  However, if one woman in my community learns something from me in this regard, I will be thankful.