The Beginning of the End of the Beginning

I am sad (and relieved) to announce that ICAN of Greater Missoula is officially closed.  I really don’t understand why it wasn’t sustainable in this community.  Here are a couple of thoughts . . .

1.  The homebirthers and homebirth midwives are doing their part for sure, but unless you know someone personally who has birthed at home or who has used a midwife or is a midwife, you just won’t know much about how that works here in the greater Missoula area.

2.  The traditional birth culture prescribed by the medical community does not want to change.  Sure they built a “birth center” at the hospital, but all that really means is that women now have private bathrooms, tubs (I wonder if women are even allowed to use them?), and nicer accommodations.  I don’t think anything has fundamentally changed to make birthing healthier for women and babies at our hospital.  If I’m wrong, I’m happy to update this post at any time.  Our docs participate in a town-wide on call group.  What this means is that if you don’t birth your baby during office hours or during your doctor’s on call duty, you’re not likely to have your doctor help you birth your baby.  There are a few doctors that this does not apply to, and the key is to be with one of them.  Our medical community “killed” the birth center established by Dr. Montgomery, but kudos to Jeanne Hebl, CNM for establishing a successful homey birth center after Dr. Montgomery’s untimely death.  By November 15, 2011 Hebl’s birth center had assisted with 100 births.

3.  Women (families) in this town don’t know that they are “allowed” to have an opinion about birth much less how to have the birth experience that best suits their needs and wishes.  This is where I feel like I failed.  For example, when I was planning my HBA2C I ran into an acquaintance whose wife was getting ready for her 3rd cesarean.  They were told they weren’t allowed to do a VBA2C in Missoula.  I didn’t birth my baby at home, much to my surprise and chagrin, but I did have a most unlikely and uncommon VBA2C at the local hospital with a very good OB who did his best to scare the shit out of me during my appointments.  However, when push came to shove (literally) – HE WAS THERE.

Support for women and families in this community will always be there.  I hope families continue to seek out the best birth experiences that fit their needs and their dreams.  I will continue to offer support when and where I can.  And VBAC/CBAC support in Missoula does have a Facebook presence.  Click here to reach our page.

Here’s a recent picture of my amazing VBA2C baby:

My precious VBA2C baby at age 23 months

Against All Odds: Gillian, VBA2C

I have neglected to post an announcement about my daughter’s birth.  I was thinking that I would have a birth story ready to post within a few days of her birth, but clearly that is not the case.  Actually, in addition to her birth story, I will be drafting additional posts related to this crazy birth experience and a couple of guest posts for other blogs.  Stay tuned!  For now, here are some stats for your enjoyment, and a picture of my latest love bug.

Gillian, day 2

  • Gillian, born Tuesday, July 12 around 5:30 am
  • 8 lbs, 14 oz
  • 21.5 inches long
  • 15.5 inch head!
  • HARD labor commenced at 7pm on Monday, July 11, about 5 hours after a second dose of castor oil while pumping, at 41w4d gestation, the same day I cancelled the ‘required’ 41.5w cesarean (scheduled for 1:30pm on July 11)
  • About the only thing that was physiologically NORMAL about all of this is that she came out of my vagina and I was not given pitocin (well, not until stage 3)

I must give particular thanks to the women of ICAN and Birth After Cesarean for lifting me up, particularly during the last trimester of this pregnancy.  The last week of my pregnancy was sheer emotional hell, and I wouldn’t have made it through without these networks of amazing women.

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:

What I Gained from My (Cesarean) Birth Experiences

Today’s CAM task: Number a sheet of paper from 1-10. Now write ten things you have gained from your cesarean (or birth experience). If you can’t get to ten, it’s ok. Start with one… via ICAN

I have learned so much . . . and so little from my birth experiences that I can hardly decide what to list.  Here’s what is coming to my prego brain at this moment!

  1. We can’t take our childbearing years for granted
  2. We must participate in our health care decisions – this is hard for a lot of women to do when we’re pregnant and/or laboring in a hospital with stringent guidelines!
  3. That first cesarean changed my childbearing years in a profound way . . . profound ain’t always good
  4. I gained knowledge about my body
  5. I gained knowledge about our health care system, particularly the inadequacies of maternal/fetal care (treatment)
  6. My pregnancy losses (partially due to adenomyosis which was caused by the 1st cesarean) taught me a lot about the brokenness, resentment, trauma, depression, and heartache women can experience when they have cesareans
  7. I’ve learned a different way of interacting with my health (not that I am particularly good about practicing what I preach)
  8. I’ve gained a whole international network of friends (ICAN & BAC) – I can call these women, text them, Facebook them (ah, FB as a verb), IM them, and sometimes even meet them face to face.  I’m sure one of them would travel to support me through this birth if I needed.  <sniff!>
  9. I’ve gained the knowledge and courage to help other women in labor, and I can’t wait to learn more about being a doula!
  10. That most babies should be born normally, and that homebirth can be a great choice for families!  When I was pregnant with DD1, I was vaguely familiar with homebirth, but that was way too “granola” for me.  My hope is that women (and their friends and families) will at least research this childbirth choice and decide (based on more than a preconceived notion) if it’s right for them. 

Pissed! but Accepting?

Wednesday was a banner shite day.  My midwife had been encouraging me to maintain a relationship with an OB, and I knew this necessitated a change.  Friends and L&D nurses urged me to try this one doc, Dr. A (we shall call him), stating that if anyone was going to give me a chance at VBA2C, it would be him.

So, I naively went to my 9:50am interview/appointment with Dr. A.  I was nervous – didn’t really sleep the night before – but hopeful.  The staff was very nice; the nurse was nice.  (I had previously talked with her.)  I had previously met this doc, so at least I wasn’t worried about that.

He was interested to know why I was there since obviously I had been seeing another OB for the 1st three-quarters of my pregnancy.  I told him I had 4 reasons:

  1. I am very motivated for a VBA2C

He interrupts . . . “Don’t do it.”  Shaking head.  Patronizing tone.

I cry.

The rest of the appointment was him trying to scare me out of it, and by the time I told him I’d been diagnosed with a thin lower uterine segment (LUS) during the RCS, he was certain that I am a nut.  Actually, he recognized that I had done a lot of thinking and researching, but he didn’t think I had given enough thought to permanent damage to the baby and permanent damage to me.  (Like, DUH!  What else have I been thinking about the past 7 months.  FFS!!!!!!!)

What was scary is that he’s familiar with the same research I’ve studied.  He mentioned the Cochrane library.  He refuted the opinion of the NIH VBAC Consensus Panel (because most of them don’t deliver babies).  The research doesn’t point to maternal death from uterine rupture but he’s seen it.  Fetal demise begins within 8 minutes of the onset of bradycardia associated with rupture which is too short a time to get a cesarean performed.  Yada yada.

Terrifying.  And I’ve done my research.  I’ve been researching this since 2007.  I have a PhD.  I have fantastic research and analytical skills.  And I was still terrified.  And I still doubted myself, my support system, everything.  And I resented my baby.

And I freaked the hell out.  Couldn’t go to work. 

So, you probably see the “pissed” part.

Here’s the “accepting” part.

Of course he’s going to do “his job” and dissuade me from VBA2C.  In his experience, it’s too  risky to justify.  He’s not going to understand why I disagree.  I’ll never be able to “educate” him here either.  When I don’t rupture and have this baby at home without incident, he’ll assume I got lucky.  I accept that he views birth with a completely different lense.

However, he’s agreed to take me and said he won’t drop me either even if I go forward with the VBAC.  He’d rather babysit me through this poor choice than turn me away.  I’ll have to sign an AMA (against medical advice) waiver just to cover his butt.  Fine; whatever.  So, for now . . . I’m planning to continue my concurrent care with him.  If it becomes a regular thing for him to try and terrorize me, then I’ll drop him.

Although he really shook me to the core on Wednesday, thanks to the amazing support of ICAN and Birth After Cesarean, I’m back on track and actually feeling more solid about my birth plans.  I just don’t “see” the hospital figuring into this experience.  Perhaps God or my baby or some 6th sense will change things, but for now, I’m back to planning a peaceful birth at home.

Day 2 Pt 1 Impactful ICAN Conference Tweets

The working subtitle of this post is . . . you can lead an OB to the table, but can you keep him/her from cutting??

some rights reserved - thetorpedodog @ Flickr

Here are some of my favorite tweets from the Saturday morning sessions.  (And as I look at the 300+ conference tweets paused in twitterfall this morning, the day after, I realize there may not be a part 2 . . . kind of like History of the World!)

Disclaimer: Since I collated these posts from a public feed reader, I have not asked permission to repost them.  OPs may request their tweets be removed and are welcomed to clarify their tweets in the comments section.)

Regarding breech:

BirthingKristen “Women should have the right, the support, and the resources to choose their own set of risks.” #vaginalbreech #ICAN2011
I do believe this, but gee, it’s hard to achieve especially when you involve birth attendants, regulations, insurance, hospitals, even birth centers, etc.  I’m afraid to say that the fact is that women will never fully have the right to choose their own set of risks unless they birth on their own.

DeepSouthDoula Vaginal breech birth is in our reach but it’s up to the parents to make it happen. Like the parents who walked out 1 hour prior. #ICAN2011
Again, somewhat idealistic.  In my case, I knew I’d be trying to fight my provider’s malpractice insurance . . . me . . . alone.  I’m not saying there aren’t things we can’t and shouldn’t do, but realistically many, if not most, families are not going to fight the system one hour before giving birth.  And they shouldn’t be made to feel like failures because they didn’t fight this overwhelming machine.

ShannonMitchell GT: breech birth is a part of the traditions midwifery #ican2011 #breech
Yes it is.  Isn’t it a shame that it’s often not in the current scope of practice for traditional midwifery?

DoulaMari: “Mama loves you enough to have you at home even though you were breech!” #ican2011
This just hurts my feelings.  I know the statement had nothing to do with me or my choice to consent to a CBAC for double footling breech twins and that it’s excerpted from an emotionally powerful experience, but it still cuts like a knife.  Actually, it feels like a repetitive cut to the same wound that refuses to heal.

drpoppyBHRT When docs tell midwives, “you can’t do that” is it really because THEY can’t do that? #vaginalbreech #normalbirthignorance #ICAN2011
Nice.  Yes, I think a lot of the time it does mean that.  They haven’t been trained to trust the body’s wisdom; they’ve been trained to search for pathology and treat that pathology.  Even the NIH VBAC consensus report indicates that younger doctors may be more resistant to VBACs because they were trained during a time when VBAC was (is) so highly contentious.

heathertom Tully: the question may be Is the attendant safe? #ICAN2011 #vaginalbreech
Absolutely.  I personally would be more afraid to show up at the hospital pushing out a breech baby if I didn’t know that the doctor on the receiving end was experienced with breech.  In fact, I’m of the opinion that in my community it may be irresponsible to show up at my hospital with a vaginal breech.  It hasn’t been part of the local practice – obstetrics or midwifery – for more than 10 years.

poderyparto Breech: 80% no intervention needed at all, 20% need maneuvering. #CAM2011 #ICAN2011
In other words . . . HANDS OFF THE BREECH!

drpoppyBHRT OBs in Germany and Israel are working to unite midwives and OBs to increase vaginal breech birth. I love that! #kneechest #ICAN2011
This is wonderful to know.  We should be pointing to these case studies every chance we get.  This will help us as we advocate for evidence-based care.

Other awesome tweets: (before I fell off the wagon)

drpoppyBHRT: Midwives told to stop doing #VBACs, they responded “when you stop doing cesareans.” Gail Tully #ICAN2011
AWE.SOME.

MamaBear1326 Why am I lucky enough to live where I achieved a vba2c and some people dont have that option #breaksmyheart #ican2011
Many women don’t feel they have the option to birth their babies.  This is so sad.  The fact is that women have fundamental rights.  No one can force you to consent to a surgery.  And even ACOG’s 2005 committee opinion supports protecting these rights:

Efforts to use the legal system to protect the fetus by constraining pregnant women’s decision making or punishing them erode a woman’s basic rights to privacy and bodily integrity and are not justified.”  (via birthaftercesarean)

Unnecesarean Dr. Poppy Daniels: “Women who really want a vaginal birth can go to extremes to get it.” (No kidding) #ICAN2011
And we will.

ICANofAtlanta How many ob-gyns have not read the latest ACOG practice bulletin on VBAC, not to mention the NIH consensus? #ican2011 #hcsm @drpoppybhrt
. . . and won’t acknowledge that local practice should change to reflect the bulletin and NIH findings.  This is why I’m sending letters to all local OBs.  I’m done with their fear mongering and lies.

RobinPregnancy T-shirt spotted: Keep your politics out of my vagina on @shannonmitchell #ican2011
Nearly snorted my coffee when I read this.  And I want one.

mollytoba I keep hearing about better integration of midwifery and OBGYN care. Who is actually doing this? Any successful models? #ICAN2011
Someone did respond to this, but I can’t find the tweet.  She mentioned some place in LA (which I can’t remember if refers to Louisiana or Los Angeles!).  But that was the only ‘successful model’ response I read.

DeepSouthDoula Exploring birth trauma in mamas AND with birth professionals. What we witness can be traumatic for us too. #ICAN2011
I may have to dedicate a post to this.  Birth professionals who experience trauma need to be treated!!!  Please refrain from bringing your trauma into future births.

babydickey “I’m not a uterus walking into an operating room.” I’m a pregnant woman with a family. #ICAN2011
<le sigh>

blairlovesjason Glad @drpoppybhrt discusses the harm in shows like Deliver Me, A Baby Story, etc. Means a lot coming from a professional. #ican2011
Totally!  I didn’t know any better and was watching these shows in 2004 when I was pregnant with DD1.  It made me afraid of the cesarean, but it didn’t do anything to help me (or encourage) me to prevent it.  It was like watching a car wreck in progress, over and over and over again.  Dammit, and then I wrecked my ‘car.’

ShannonMitchell Acnm says they are working on revised vbac statement addressing “immediately available” #birthaction #ican2011
Very good news.  The ACNM needs to step up and not hide behind ‘big brother.’

babydickey Midwives Alliance of North America (MANA) has a c-section rate of 5.03%. YEA! #ICAN2011
I trust this to be true, but it would be so helpful if MANA would release the data.  People want to see it.  I want to see it.  MANA hold plenty of statistics that to my knowledge are not publicly accessible.  It’s a shame.

mollytoba Ida Darreagh of NARM: the safest place for a woman to give birth is where she feels strong, supported and capable. #ICAN2011
Absolutely.  This is why I try to be super careful when talking with mamas who have different ideas about where to birth.  Everyone should feel safe giving birth.  It doesn’t ensure a perfect outcome, but it’s still important to respect one another’s decisions.

DeepSouthDoula Don’t feed the trolls! Seriously not worth it. As @unmarketing says – you are not the jackass whisperer. #ICAN2011 AND seeKJtweet Ok who said Beetlejuice? #ICAN2011
Oh my.  There is a persistent non-practicing OB with too much time on her hands who just hates natural birth advocacy.  She has quite a cult following.  I used to go to her blogs thinking there was something possibly to learn there . . . but it’s just so polemic that I realized I was wasting my time and scaring myself in the process.

RobinPregnancy Every state needs to look at the safe transport bill for home births. #ican2011
And where do I go to find that?  Over to Google.  Searched [“home birth” “safe transport” legislation] which didn’t come up with much.  But I did find that a bill is working its way through the Illinois General Assembly.  Have a look!  I found this as a result of reading this action alert from the Chicago-area homebirth meet-up group.

Impactful Tweets (pt 3) ICAN 2011 Conference

I tried to catch as much of the Henci Goer chatter on twitter as I could tonight.  We have a full house tonight (our 3 plus 2 neighbor kids spending the night, oy!) so I’m playing with less than a full deck.  Ha!

Disclaimer: Since I read these tweets on a public hashtag channel, I’m not asking permission to repost.  If anyone wants their tweet removed or wants to clarify a tweet, please let me know.

anderzoid #ICAN2011 henci goer: how much we have over medicalized birth? IV drip- not allowed to eat or drink – induction- cord clamping- etc
I assume this was a slide of the topics used to justify the point that birth is over medicalized.  My previous research leads me to concur that these are some of the ‘biggies.’

poderyparto Ineffective & harmful practices: sonograms to estimate fetal weight, planned cesarean for breech,not supported by research. #ICAN2011
Ultrasound is such a poor diagnostic tool for assessing fetal weight in the 3rd trimester.  I can’t recall exactly ‘when’ ultrasound is more accurate for predicting due ‘dates,’ but it’s very early on – I’m thinking 8-12 weeks gestation, but don’t quote me on that.  Only one mom out of the many I know personally that were told they were going to have a big baby actually did have a big baby.  Friends and family members who have had 3rd trimester estimates done with specialists have birthed babies 2 pounds lighter than predicted!!!!  Regarding the no-questions-asked cesarean for breech – a flawed Canadian study is what dictates current US practice.  Thank goodness Canada is taking the lead to restore breech as a version of normal.

bbybirthingmama Scheduling a section for breech, twins, “big baby” and slow labor are not supported by research! #ICAN2011
I was sad to discover that 75% of twins in Montana are born by cesarean.  I imagine all breeches are born by cesarean except for the rare surprise breech or unattended breech births.  Many docs aren’t ‘allowed’ by their insurance companies to deliver breeches naturally – how convenient for them.  Slow labor – yeah!  Most women just DON’T dilate 1cm/hr.  I REPEAT – MOST WOMEN AREN’T GONNA DILATE ACCORDING TO FRIEDMAN’S CURVE.

tconsciousdoula The way to get a VBAC? Tell the Dr you are planning on having 10 children! #ican2011
Now that’s a good one.  I’ll have to add that one to my list!

babydickey: Perinatal death from csec scar uterine rupture is 6 in 10,000. But did you know pregnancy loss from amniocentesis is 60 in 10,000? #ICAN2011 AND Unnecesarean 6% of scar ruptures—> perinatal death (3 per 10,000). Compare to excess risk of pregnancy loss from amniocentesis… 60 per 10,000. #ICAN2011
Here’s what was stated in the NIH VBAC Report: “Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent.”

tconsciousdoula planned VBAC should be the norm (87%) actual rate is 9% (2007) #ican2011
Add this information to your notebooks in case you need to make the case for VBAC to a doctor, a nurse, a hospital administrator, or a friend.

tiffrobyn A 41 week pregnancy is not only normal, it is AVERAGE! #ICAN2011
Like . . . duh.  Why have care providers forgotten that?  Well, statistically that may not be the exact average for all childbearing groups (i.e. primip vs. multip), but it’s absolutely ridiculous to pressure a woman into inducing at 41 weeks.  Some providers will start pressuring you at 39 weeks, especially if you let them anywhere near your cervix!

bbybirthingmama WHO Recommends no more than 10% induction rate. I didn’t know that. #ICAN2011 BUT poderyparto US induction rate 2005: 47% (babydickey tweeted 41%) of women planning vaginal birth! #ICAN2011 #CAM2011

shedenka So hospitals and docs tell ALL women “you can’t eat/drink” during labor. Total CYA: aspiration risk is 3.2 women out of 10 million #ICAN2011

nashvillebirth Henci Goer makes my head hurt in a good way. She always melts my face off. #ICAN2011
*Giggle*  This really made me smile.  I love having my brain hurt in a good way.  It’s invigorating!!

bbybirthingmama Early Cord Clamping can take up to 40% of newborns blood volume! #ICAN2011
I had no idea!  All of my babies have had their cords clamped immediately.  I will definitely add this to my notebook – I had decided a while back that I wanted delayed cord clamping.  I know it’s not really a strange thing to ask of a CPM but may be strange for an OB.

anderzoid Henci Goer still on ineffective & HARMFUL practices: Care by an OB for LOW-risk & MODERATE-risk women #ican2011
This point was made by a NYC OB in “The Business of Being Born.”  It’s overkill, and generally speaking, normal birth just isn’t exciting enough for them.  Plus, most of them have never seen a normal birth – especially the younger OBs.

anderzoid: #ICAN2011 #ppdchat Henci Goer: it’s hard to get #PTSD on radar bc TRAUMA is centered in Institution. DEPRESSION is centered in women.
This is a very interesting statement and one that I’d like to have fleshed out for me.  I can almost grasp it but not quite.  I will say that people seem to be aware of PPD and acknowledge it but are less able to grasp PTSD as it relates to childbirth (or pregnancy loss).

Want to read more conference hi-lights?  Here is part 2 and part 1 of my Impactful Tweets “coverage.”

DH & I have a big to do list for the weekend, so I don’t know how thorough future posts will be.  Enjoy the weekend!

EDITED to add “Birthing Beautiful Ideas’s” wrap-up of the day’s presentations at the ICAN 2011 Conference.  Have a look!