Too Late for Natural Birth?

In my google alerts today, one headline stuck out: “Too late to reverse rise in c-sections?” from the Boston Globe.  It is a letter to the editor from Lois Shaevel, co-author of “Silent Knife.

Shaevel states:

For eons we females had been capable of giving birth with very little medical intervention. Then childbirth went into the hospital, and the process became a medical and increasingly surgical event.

It’s sad really.  I’m not saying that all women don’t need a hospital and that all births can be achieved non-medically, but what makes me sad is the shift in how pregnancy and childbirth are viewed by our society.  Pregnancy and birth used to be normal and expected events in a woman’s life.  Now when you tell someone that you are pregnant they ask you if you have a first trimester ultrasound scheduled yet.  When you respond by saying that you don’t plan to utilize ultrasound technology unless it becomes medically necessary, they cock their heads, look at you funny, and respond with a suspicious “huh!”

Shaevel continues: 

When Nancy Wainer and I wrote “Silent Knife” in 1983, we hoped our work would reverse the trend and give women confidence in their bodies’ innate ability to birth their babies. If this trend of surgical intervention in the natural process of childbirth continues, the only women who will birth their babies naturally 50 years from now will be those who don’t make it to the hospital in time for their caesareans.

Some women are finding ways to become more confident in their bodies.  I joined the International Cesarean Awareness Network (ICAN) which greatly increased my confidence and understanding that a repeat cesarean would likely be unnecessary.  However, the doctors will always find a way to rob us of our confidence.  One ICAN list member was told early on in her pregnancy that s/he was supportive of her choice to VBAC.  Now at 36 weeks she’s been told to schedule a repeat cesarean.  This is not an uncommon story.

Here are my thoughts on how/why this keeps happening to women who desire vaginal birth after a cesarean (VBAC).  Perhaps the doctor just wants the business and thinks s/he will be able to change the patient’s mind along the way?  Perhaps the doctor believes in a woman’s choice but loses confidence along the way?  Perhaps in losing confidence in the mother along the way, the doctor is thinking about the legal consequences of not performing an elective repeat cesarean?  Perhaps the doctor, losing confidence along the way or thinking s/he can coerce the patient into surgery, also has the $$ in his/her eyes since surgical birth costs so much more than vaginal birth?  Perhaps the doctor knows that VBAC labor can take longer, and since s/he will have to be more readily accessible thanks to ACOG directives, s/he pushes for the quicker solution – major abdominal surgery?  Perhaps the doctor is more afraid of the uncertainty of normal (as in natural) birth because s/he is not familiar with it versus that which s/he is trained to do – perform surgery?

Shaevel’s letter was formed in response to this recent Boston Globe article.  Here are a couple of important points to consider from the article:

“It’s important for us to step back and say, ‘Why is this happening, and is it in the best interest of the public?’ ” said [the state's secretary of health and human services, Dr. JudyAnn] Bigby, whose research before entering state government had focused on women’s health issues at Brigham and Women’s Hospital. “This is not a minor surgical procedure; it’s a big deal. We need to understand why this trend continues.” [emphasis mine]

She is “sufficiently alarmed” that her state’s cesarean rate now eclipses the national average of 31.1%.

Obstetricians’ fears of lawsuits may also fuel some of the increase.

“There’s no doubt about the medical-legal burden; the litigious nature of society has an impact on this,” said Dr. Fred Frigoletto, chief of obstetrics at Massachusetts General Hospital. “Very few obstetricians have been litigated because they did a C-section. But they’re always litigated because they didn’t do one.”

Fear of litigation is NEVER an appropriate motivator for medicalized childbirth.  Interventive practices are only appropriate when there is sound evidence of need.  Basing medical opinion, advice, and practices on a fear of litigation is unethical and violates the oath and creed to “first do no harm” that all doctors agree to when they become registered practitioners.

It once was popular to deliver subsequent babies [following a cesarean] by vaginal birth, but by the late 1990s the practice began to fall out of favor because of potential risks.

Potential risks – yes, it is possible that a woman’s uterus may rupture during labor.  The risk of rupture may be as low as .5%, and any doctor who puts forward a rate of greater than 1% should be asked for the research to support such a statistic.  Avoiding induction and augmentation of labor and having continuous labor support (an experienced doula and/or midwife) will help VBAC moms achieve their goals.

Anyone who doubts the importance of natural childbirth for both mother and child should register for the “What Would Mammals Do” webinar through Conscious Woman

Pregnancy bleeding scare

Yesterday I could tell that my cervical fluid (CF) was more prominent.  My midwife said my leukocyte level was elevated, indicated by a urine test.  She told me to do a “wash” twice daily of warm water and apple cidar vinegar.  I ignored her since I was a bit confused on how to do this and because the yeast wasn’t bothering me.

However, yesterday afternoon I felt a trickle.  It wasn’t completely familiar – didn’t seem like blood but didn’t NOT seem like blood either.  My heart nearly stopped when I took a look at my pantiliner.  There was a streak/string of red blood in the CF!!  I tried to stay calm and called my midwife for guidance.  She said that some women will bleed from yeast infections and suggested that I buy some Yeast Guard and apple cidar vinegar.

Luckily it was the end of my work day, so I was able to get to the store and home before my DH and DD came home.  There was no more blood, but of course I’m checking my pants every few minutes anyway.  And I’m afraid to poop.

This is what a recent history of miscarriage has done to me.  At 10 weeks I was starting to see the light at the end of the tunnel of worry, and yesterday’s blood threw me right back into the tunnel.

Today I am exhausted.  Hardly functioning at work.  Thank goodness I’m done early again today.  It’s a good thing considering that my entire office is SHAKING from the construction outside.  It’s making me feel insane.

Bad news for homebirth in Utah

From an article in the Salt Lake Tribune:

    The bill would put new limits on direct-entry midwives, who are licensed and attend home births. By defining a “normal” birth, it bans them from administering to women with a host of medical conditions, from diabetes to hypertension.
    They also would be stopped from assisting women whose babies are breech or who want a vaginal birth after a previous cesarean section (VBAC).

How is it that people who never see “normal” birth (a term that is easily usurped and unfortunately true of augmented birth in this day and age) are able to determine normalcy.  If they can determine “normal”, then perhaps they should start overtly forcing more women into induction, augmentation, and other interventions.  Medically-managed labor & delivery is certainly most common in a hospital setting.  In fact, why don’t we just get rid of the mother’s (and other vested persons’) desires altogether?  Many – if not most – OBs are contemptuous towards mothers with birth plans anyway.

I can tell you that “normal” should equate to “natural”, but it doesn’t any more.  And really the only venue for assuring natural birth is home.  Sure “natural” might not happen for everyone.  I’m not even trying to suggest that all women should give birth at home.  But these restrictions . . . why not ensure that direct-entry midwives are well-trained for breech, twin, and VBAC scenarios.  How do you ensure this?  By keeping it legal and supporting midwives who feel confident in their skill level with breech, twin, and VBAC labor.  Just as an OB should know if s/he is the appropriate person to deliver a breech baby or perform an amniocentesis (and lemme tell you, some simply are NOT), so should a CNM or direct-entry midwife.

I’ve written about “normal” and “natural” before – click here to read!

Trust Birth or Don’t?

I can’t resist.  You would think that since I am new to homebirth and haven’t had a VBAC yet that I wouldn’t bother myself with polemics regarding homebirth.  I’m obviously not that bright.  My homebirth google alert today included a post about the power of positive thinking and the homebirth movement.  I had to check it out. 

I won’t link to this weblog out of principle, but if you search for the quote using your favorite search engine, you’ll find it easily enough . . .

“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

I’d like to play with the words a bit:

“If you refuse to trust birth and insist that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

Some people, practitioners and women, simply refuse to trust birth.  Some will insist that birth is inherently dangerous.  They will likely achieve the birth experience that they desire, and it will likely be overly-managed, overly-medicated, potentially surgical, and definitely exorbitantly expensive.

“If you don’t trust birth and accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

And somewhat similarly:

“If you don’t trust birth even though you don’t believe that birth is inherently dangerous, you will likely have trouble achieving the birth experience that you desire.”

Some people don’t trust birth and have accepted the “fact” that birth is inherently dangerous.  They will likely create that reality in their birth experiences.  If women engage practitioners with this guiding philosophy, they will likely lose faith in the natural processes of life and end up dissatisfied with their birth experience even if the outcome is positive.

Some women know that birth isn’t dangerous most of the time but lack the trust needed to achieve particular outcomes.  Perhaps this was me once upon a time.  I never really considered that birth might be dangerous.  Why would I be created for a particular skill if it were inherently dangerous to me or my offspring?  However, I’m not sure that I trusted myself enough last time.  I didn’t trust my body.  I didn’t trust my instincts.  That’s probably the worst part of it . . . I didn’t listen to my inner voice.

“If you trust birth and acknowledge that birth is inherently natural to our species, you will likely achieve the birth experience that you desire.”

If you trust birth you are fortunate enough to understand that certain life events are natural and far less risky than some of the every day activities in which we engage.  Things like riding in cars.  That single activity is far more risky (statistically speaking) than giving birth.  If you trust birth you may not be “rewarded” with a particular birth outcome but understand that complications and poor outcomes are possible.  Trusting birth is not about sticking your head in the sand.  It’s about understanding that most of the time women can achieve normal birth when given appropriate support, time, and space.

Going back to the original quote:
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

“Trust” – in the original text, the blogger puts the word “trust” in quotes; this diminishes the validity of “trust” in relation to childbirth
“Refuse to accept” – ultimatum . . . polemic
“Inherently dangerous” – emotional scare tactic
“Reward” – as if there’s a prize involved???
“Desire” – as if all that matters for homebirthers is what the woman desires

Do you see yourself anywhere in my “play on words” section?  Where do you want to be?  Do you want to be afraid to be pregnant?  Do you really want to go into labor and delivery afraid?  Do you really want to go into labor and delivery lacking trust?  What is positive and proactive about being fearful and lacking trust?  What do you as a pregnant and/or laboring woman gain from that perspective?  I would say nothing.  You have lost your power and are no longer an active participant in your care when you are afraid and can’t trust.  Perhaps you (and your birth experience) are more manageable that way.  How do you feel about that?  Do you want to be managed?

I can’t really define homebirth for you.  Everyone comes to homebirth from different paths.  Some women always know that they’ll have their babies at home.  Some women are involved in social structures that are more inclined to promote homebirth, homeschool, extended breastfeeding, attachment parenting, and the like.  Some women are disgruntled consumers.  Some women aren’t given the choice to have a vaginal hospital birth and turn to homebirth as their only choice.  Some women who give birth at home don’t fall into any of these generalized categories.

For me homebirth is about safety, sanctity, Faith, Trust, natural life processes, achieving physiologic birth, what’s best for me and baby, avoiding an unnecessary cut, vaginal birth after cesarean, comfort, family, community, and a whole host of other things that I haven’t even discovered yet!

BFP Sturm und Drang

BFP = Big Fat (or your favorite “f” word) Positive; used on TTC (trying to conceive) and birth loss boards on the internet.  Women who use this terminology tend to record BBTs (basal body temps) and other fertility signs.

Sturm und Drang = German for “storm and longing” or “storm and stress”

From Wikipedia:

” . . . the name of a movement in German literature and music taking place from the late 1760s through the early 1780s in which individual subjectivity and, in particular, extremes of emotion were given free expression in response to the confines of rationalism imposed by the Enlightenment and associated aesthetic movements. The philosopher Johann Georg Hamannis considered to be the ideologue of Sturm und Drang, and Johann Wolfgang von Goethe was a notable proponent of the movement . . .”

And since Goethe was one of those poets who was set by “everyone and their dawg” in the Classical musical period, I’ve come across the theme quite a bit.

What does Sturm und Drang have to do with BFP?  Here I type, “barely” pregnant, bearer of the positive pee stick (home pregnancy test), being pulled by my rational mind and wild emotion.  I have been pregnant 3 times in the past 5 months.  My June cycle led to pregnancy and a 5 week miscarriage in early August.  We waited a full cycle and conceived again, but I miscarried between 5 and 7 weeks in early October.  We waited 8 weeks for my menses to return, and in the third cycle following the miscarriage I “accidentally” got pregnant again. 

The rational mind says: (1) miscarriage is a possibility, and a higher possibility now that I’ve had 2 back-to-back miscarriages; (2) although miscarriage is a possibility, I am statistically MORE likely to carry the pregnancy successfully to term; (3) there’s nothing I can do to cause a miscarriage; (4) there is nothing I can do to necessarily prevent or treat a miscarriage; (5) that I’ll survive another miscarriage should that be the journey.

The emotional heart says: (1) Trust God; (2) God won’t necessarily spare me from another miscarriage; (3) I can’t bear another miscarriage; (4) I’ll survive a miscarriage if I have to . . . my family needs me; (5) Bond with this pregnancy; (6) Stay emotionally detached from the pregnancy . . .

Another aspect of Sturm und Drang as it applies to BFPdom is guilt.  I have guilt on two levels.  First, I didn’t intend to become pregnant this cycle, so I am a bit embarrassed about being pregnant so soon and feeling foolish for having “accidentally” gotten pregnant in the first place.  My herbalist wanted me to be on a particular herbal regiment for about 3-6 months before TTC.  Second, I participate on a birth loss forum.  Some of the women in my group have been trying for months if not years to become pregnant.  Some have been trying for months if not years to become pregnant and see a pregnancy through to term.  Some have suffered multiple losses.   So I sometimes feel guilty and petty because I do have one beautiful daughter and have at least experienced pregnancy now 4 times.

As happy as I am for me, I grieve for these kind women on my board.  It’s hard to see one of them go on to a pregnancy board and continue with their pregnancy and birth.  It’s hard to see them return after a pregnancy was lost.  It’s hard for all of us to be excited about possibly being pregnant and scared that the inevitable (menses, miscarriage, stillbirth, etc.) will fall upon us.  It’s rough waiting for the next hcg or progesterone test or ultrasound that assures us that the pregnancies are moving forward. 

I love these women dearly.  I wish the circumstances that brought us together were different, but I learn something new every day.  Someone posts something heart-felt every day that touches me.  These hopeful grieving women have marked me and I them. 

Musings on Birth Safety

Which is it – childbirth is safe, normal, natural or dangerous, wild, and unpredictable?  Do we really need to draw a line in the sand like that?  Isn’t childbirth all of that – normal, natural, wild, unpredictable, sometimes just fine, sometimes not?

No, childbirth is not always safe.  I work with a gal who has nearly died in childbirth several times.  She lost one child along the way.  She birthed at hospitals under the care of a high-risk obstetrician, and that was a necessary reality for her.  A friend of mine recently birthed a baby still.  They don’t know why the baby died during birth.  Another friend of mine suffered an uterine rupture.  Her smart baby was blocking the artery that was compromised, and that is why she is still alive today.

But often pregnancy and childbirth is normal and uneventful.  (Well, it’s always a big life event, but it’s not nearly as dramatic as Baby Story would have you believe.)  It seems like it is more fun for people – some natural birthers and some who want all of the technological bells and whistles – to hype up childbirth.  “Ugh, it was SO PAINFUL I just HAD to have my epidural.”  “No one is going to take away my VBAC.”  “Oh my gosh if I hadn’t had that c-section, I’d have died in childbirth.”  “I’ll have to be dying before I let anyone take me to the hospital again.”  (For what it’s worth, I said that last statement following my October miscarriage.)  Drama drama drama.  Me me me.  I want I want I want.  I’m being a bit extreme here, but I read so much selfishness and self-indulgence and self-glorification on both sides of the proverbial childbirth fence.  Does this help women?  Does this empower women to make informed choices that “make” childbirth safe?

Let’s come back to that term “safe” as it applies to childbirth venue.  If you don’t believe homebirth is a safe choice, then it’s not . . . for you.  If you don’t believe that you can have a natural non-interventive birth in the hospital, and that’s important to you, then you probably won’t have a good experience in the hospital.  If you don’t trust anyone but your self and perhaps your partner in childbirth, you will probably prefer unassisted childbirth.  We’re only “safe” when we believe we’re safe.  I honestly don’t believe that MOST women are safer in the hospital or safer at home or safer at a birth center.  They perceive a level of safety and psychologically, and even physiologically, respond to that way of thinking.  Certainly there are plenty of “yeah, but” scenarios out there, but I very clearly wrote “MOST women” above.

Be afraid to birth at home.  That’s fine.  But don’t call a woman crazy for choosing to feel safe at home, especially if she is surrounded by well-trained and caring support.  You can be afraid even when someone else isn’t.  Be afraid to birth at the hospital.  That’s fine.  But don’t criticize the woman who chooses to deliver at a hospital, especially if she is surrounded by well-trained and caring support.

It is an unfortunate reality that babies die in childbirth . . . that women die in childbirth.  I think doctors, midwives, and other childbirth support providers are all interested in reducing negative outcomes in childbirth.  I just wish, hope, and pray for the day when these parties can meet and work from a point of mutual respect.  That’s when we’ll have a maternal-child healthcare system that is woman-baby centered and certainly safer for all involved.

We can’t make changes if we don’t talk.  Debate is not talk.  People who debate don’t listen.  I think people who get caught up in debating issues without stopping to listen and learn are afraid.  They are frightened sad unhappy people.  I have my own set of fears just like anyone else, but I strive to run my life from a place of power and trust.  I don’t want to pass fear along to my children.  I don’t want to be remembered that way.  I don’t want to approach God that way.

May you find power, faith, and love, now and forever.