Impactful Tweets (pt 2) from ICAN Conference

Looks like @DeepSouthDoula is the winner of cool tweets, part 2.  I’ll have to tell her the amazing news, LoL!  Looks like there will have to be a part 3 tonight.  Henci Goer has already made some great points, and she’s only just gotten started!  w00t!!  Here’s the link to part 1 if you missed that post.

DeepSouthDoula Abdominal scars can change your overall body mechanics for the worse. #ICAN2011
Interesting how people don’t consider what happens to the muscles and especially the connective tissue as a result of this major abdominal surgery.  I’m a professional opera singer and rely on the entire abdominal complex to support my sound.  This includes the pelvic floor.  This entire structure has been permanently altered.  Have you considered how your cesarean might (will) affect you physically?

poderyparto Herrera: People should see a c/s. Once they ser it they’ll start asking more questions. #ICAN2011
This is an interesting statement.  I just don’t imagine your average woman would be interested or even willing to watch a cesarean surgery.  And really, it’s different being in the room when one is happening versus seeing it on TV or YouTube.

Preparing4Birth: #ICAN2011 @ICANtweets Insurance company should not mandate how doc works. Write congressman. A state issue
This is HUGE.  I was aggravated to learn from my OB that his malpractice insurance doesn’t cover vaginal breech delivery.  He’s an older doctor, so of course, he knows how to do it.  I think it is incredibly unfair that my second birth was dictated by someone else’s friggin’ insurance!!!

Ethologicmom #ICAN2011 amazing that dice didn’t realize that women choose or are forced into hbacmom by bans and lack of support!
Dice?  I have no idea.  But yes, women increasingly choose homebirth and unassisted birth because they ultimately feel unsupported by some (or all) careproviders.  A woman who feels forced into homebirth or unassisted birth are not ideal candidates for those settings.  A woman should have access to the care she desires.  We’re the ones paying for it!!!

DeepSouthDoula The only true way to know if you will have a successful VBAC is to try. #ICAN2011
I just can’t imagine not trying . . . even though people would try to scare me out of it.  Fearmongering is not the way to go, folks . . . studying the evidence is!

drpoppyBHRT How do we “grow” supportive providers? #VBAC @BirthingKristin #ICAN2011 #NIHVBAC
I imagine that since newer docs are typically less willing to recommend VBAC (based on NIH VBAC consensus report), that now that the ACOG recommendation has been revised, perhaps the new generation of OBs will be less resistant.  This doesn’t mean we shouldn’t be doing everything we can to positively affect our local birth culture!

DeepSouthDoula Any person pregnant or not has the right to refuse medical treatment – even in an emergency. Goes for refusing CS. #ICAN2011
One of my friends is having her 3rd VBAC after cesarean.  We were performing out of town, and she thought the local hospital didn’t allow VBACs.  She was relieved to learn (from me . . . yay me!) that she did NOT have to consent to a cesarean if she had the misfortune of going into labor in that town.  On the other hand, it would have been an opportunity for us to ‘educate’ that particular hospital on the rights of childbearing women! ;)

DeepSouthDoula Have the NIH & ACOG statements ready & use them to our advantage. #ICAN2011
Great advice!  I’m on Spring Break right now, and honestly, I’m just now getting around to reading the NIH VBAC Consensus report.  Eye opening, really.  I’ve “clipped” out the conclusion summary and points within the detailed section of the statement that directly apply to my situation or to issues that seem most critical to me.  I will be bringing some of this information with me as I interview an OB regarding VBA2C.

DeepSouthDoula SHARE – ORGANIZE – PROMOTE – CHANGE. Make connections through social media. #ICAN2011
Following the #ICAN2011 channel has shown me that a lot of birthies are now quite active on twitter.  I guess I’ll pay more attention to twitter . . . at least for a while.  Birthies and moms are welcome to request to follow me – @labortrials.


Today’s Notable Reads

Today is a banner day on my Facebook news feed.  Here are some things that piqued my interest.

  • Owen Wilson and his girlfriend welcomed their baby into the world at home!  I’m not providing a link – I figure you can go to your favorite celeb site if you’re curious.  ;)
  • Did you know that nearly 100% of us parents use car seats incorrectly.  Here’s a 5-minute video featuring “The Car Seat Lady.”
  • I haven’t read this yet, but check out this New Yorker article regarding the decline effect and the scientific method.
  • Homebirth: A Midwife Mutiny is a great blog.  I first read Risk, homebirth, VBAC and am now on to her take on a BBC News article about “womb tearing.”  Next, I think I’ll read Blaming Women, because HELLO it happens all the stinkin’ time.
  • I’m also curious to read a new-to-me blog today, particularly the article on “No, Actually, You Did Not Turn Out Ok.”  We’ll see – I’m a fairly mainstream mama, so I don’t know how I’ll respond knowing that this is one of the blogger’s perspectives: “Where I Post . . . And Kick Your Lily White Arse For Making Your Baby Cry-It-Out.”  We ended up doing CIO with our oldest.  Is she ok – not completely.  Is it because of CIO – not necessarily.  Are we ok – no completely.  Is it because of CIO – not exactly.  But hey, let’s blame ourselves (see blaming women above) and each other (a favorite past-time for some on Facebook) for our kids becoming assholes or freaks as if THEY have nothing to do with it.
  • DEEP BREATH
  • My favorite spot on the internet for sound pregnancy & birth related advice – Childbirth Connection

Thinking Through Birth

You may be surprised to discover that I’m pregnant again!  I’m due in late June or early July 2011, and this means that I’ll have three babies under the age of 2.  I’m excited and terrified, let me tell you.

I’ve been back on the ICAN yahoo list, the ICAN forums, and Mothering’s forums getting back into the swing of things.  This has forced me to really look at my birth experiences, my fears, and my hopes for this future baby’s entrance into the world.  It’s quite uncomfortable.  I’m a huge fence sitter.  Which means that I do poorly on multiple choice tests.  Which means that I can see both sides of political situations and most conflicts.  Which means that I am afraid to let go of the medical birth model that I claim to so strongly resist.

Why wouldn’t I be afraid.  My first birth ended with medical interventions and a cesarean.  I suffered three consecutive losses that couldn’t really be explained until I saw a specialist.  I naturally conceived twins and had to have early pregnancy supplemented with hormones which led to other interventions.  I was risked out of homebirth.  My OB was in love with his ultrasound machine which means that I had a ton of baby pictures.  I didn’t really have a viable choice for homebirth care.

Even this pregnancy has been medically supervised and supplemented beyond the norm.  First trimester progesterone supplementation and already two ultrasounds to check viability and growth.  How am I going to sever this link?  Even though I am planning a home birth, I am now so used to medical intervention, that I’m having a hard time ripping off the bandaid, so to speak.

Here is the link  to the twins’ birth story for anyone interested in reading it.  It’s not terribly thorough, but I guess that’s because what can I say about it really?  I had double footling breech twins which was a no go for vaginal birth at the hospital.  (Twins and breech are not in the scope of practice for homebirth midwives in MT.)  So, I got cut.  It sucked.  Recovery was long.

What I’m noticing this time around is how many women are UCing their twins, even breech twins.  I was not brave enough for that even though I talked as thought I could be.  Honestly, I didn’t see how I could be prepared to UBAC twins, and I didn’t want to put that kind of pressure on myself or my husband.  I think it’s a real failure of the “system” that I couldn’t be attended by a capable midwife at home.

These stories are great to read and make me feel so much better about my own plans to HBA2C, but they also make me sad.  It’s another slice of the knife reading that other women successfully birth breech twins in the comfort of their own homes.  My good ICAN friend, L, rightly challenged me on my belief that I had no choice.  These stories are proof of this.

But then I think back on the fear mongering . . . the claim that my lower uterine segment is too thin at the end of pregnancy to VBAC safely.  And I think of the statistically significant higher rupture rate with VBAmC – why wouldn’t it be higher for VBAmC than it is for VBA1C?  Considering how many bizarre statistics have applied to me during my childbearing years, the fear flag is raised regarding my potential to rupture.

And then I remember that the risks of repeat cesarean and the risks of serious complications with a VBA2C are about even.  And I realize that it’d be hard for me to have a successful VBAC at the hospital even if there was a provider who would attend me, which there isn’t.  And I think about my recent conversation with my family practice doctor who reminded me that my midwife will transfer me to the hospital if anything goes wrong, and that emotionally/mentally it would be hard for me to be successful to birth normally in a hospital setting.

So this is the snapshot of where I am right now with it all.  And in case you’re curious, here’s my current reading list:

And I’ve placed holds on a couple of Ina May Gaskin books to read during my winter break.  I’ll also review Simkin’s The Birth Partner.

Undue Burden and Access to Evidence-Based Maternity Care

I’ve been reading Jennifer Block’s Pushed and really enjoying what a journalist can bring to childbirth advocacy.  I’ve learned many new things – what a nice surprise.  It’s not that I’ve learned everything there is to know about childbirth, but I think I got “stuck” in reading books that basically said the same thing but in different ways.

A new term for me is “undue burden.”  Wikipedia’s definition falls short, in my opinion, but between Block’s discussion of it and other internet sources, I’ve come to understand it better (at least from a layperson’s perspective) and how it might apply to a LOT of women in the childbearing years.

I’ve learned that undue burden has been applied to reproductive rights issues, specifically abortion.  However, I don’t think we advocates have worked this “angle” enough in terms of childbirth choices.  Abortion rights activists have advocated for “morally agnostic undue burden standard[s]” [1]  Likewise, I would call for an “agnostic” undue burden standard applied to childbirth.

The undue burden standard is utilized in American constitutional law and historically has been applied in such areas as abortion rights, affirmative action, tax laws, and more.  The Supreme Court applied this concept to abortion, ruling that a state can’t put up so many obstacles to abortion procedures that a woman’s individual rights are violated.  [2] An undue burden is created when obstacles are severe and/or not justified.

Do you see where I’m going with this?  I feel like I am a victim of undue burden.  I have no reason to believe that I can’t successfully birth my twins naturally.  But the state has deemed that my preference of birth venue is not valid – women with breech babies or multiples are not allowed to birth at home with a licensed midwife.  My choices are to (1) birth unassisted at home, (2) go to the hospital against my will, or (3) enlist the services of an illegal midwife.  Additionally, the only services that would be covered by my insurance are hospital services.

In most states women with breech babies have no choice but to go to the hospital for a cesarean section even though breech presentation has traditionally been referred to as a version of normal.  We’ve lost access to vaginal breech birth.

In most locations women with multiples are pressured to succumb to cesarean surgery.  A number of folks have voiced their concern for my choice to birth these babies vaginally.  They simply don’t know any better.  Luckily I have found an obstetrician who is not afraid of normal birth.  However, I realize now that he may not be there for me when it comes time to go to the hospital.  He takes a week of vacation each month of the summer and is out of town twice next month, my birth month.  I found this out accidentally from his reception staff.

It is possible that I will show up at the hospital and some OB whom I’ve never met will show up and start pressuring me into surgery or ignore (or at least be unaware) of my birth preferences.  So because the state has deemed that twins should not be birthed at home, and because my insurance company won’t cover home birth anyway, I can either “choose” to go to a hospital that doesn’t practice evidence-based obstetrics or go eff myself, I guess.

Isn’t this an example of undue burden?  Lack of access to the care of my choice?  Paying for health care that doesn’t support evidence-based maternity care and forces me to go to a specific hospital in my town with a high cesarean rate and low VBAC rate?  Unjustifiably restricting scope of practice for midwives?  Not offering alternatives/access to the type of care I require?

I don’t want to be a patient.  I don’t see any need to expose myself or my newborns to the hospital environment.  Even my 4 year old doesn’t understand why I would go to the hospital to have babies.  “Mommy, are you sick?”

Don’t get me wrong, if I or the twins needed emergency medical services, you bet we’d go to the hospital.  I’m thankful to have access to obstetrics when necessary, but I resent being forced to utilize services that go against common sense, research, and are expensive and wasteful as applied to the great majority of laboring women.

I hope natural birth advocates, women’s studies researchers and writers, and lawyers will work together to expand application of the undue burden standard to the women who don’t have access to ethical, evidence-based care in childbirth, and are forced instead to incur great expenses to access the care they desire, to hire “illegal” or “under the radar” practitioners, to utilize unwanted services and support the over-payment of those services, or to go at it alone.

Please, give me back my right to birth.  Give me back my body.

1 – “Destacking the cards…,” Gender & Sexuality Law Blog, accessed 7/18/09.
2 – Jennifer Block.  Pushed. p.262.

Things Do Change or Welcome to Waffling

I had my most recent ultrasound a couple of weeks ago.  I was pleased to find out that both babies are guestimated to be roughly the same gestational age and size.  In fact, at 28-29 weeks pregnant, they were measuring 2lbs15oz!  They’re keeping up and even slightly ahead of the average singleton of the same age!

The other piece of great news is that they are both head down . . . or at least they were during that ultrasound.  This means the likelihood of a natural birth in the hospital is more likely.  It means that hospital birth is back on the table.

A midwife told me that I’d have to pay for the birth experience that would be best for me and my family.  It’s true – if I want an optimal experience, it’ll be a huge out of pocket expense with the possibility of additional hospital expenses should 1-3 of us need additional care.  I wish I were made of money and could afford the birth experience of my dreams.  I’m not so fortunate.  This is not how healthcare or maternity care works in the US.  No, I can’t put a price on the health and well-being of our triad, but that doesn’t mean that I can afford alternative health care or maternity care at this time.  And I’m not going to feel guilty about that either, ya know?!

My personal out of pocket max from 7/1-6/30 is $2300.  My family out of pocket max is $4600.  An out of hospital birth will cost at least $3500 (if I travel) or closer to $7000 if I stay home.  I can’t ignore the math – not on my salary.

I am so glad that I have explored my options.  I am still considering these options but am back to planning my “best birth” at the local hospital with an OB and a fantastic doula (who just happens to be a wonderful homebirth midwife).

* Check back soon for my review of Your Best Birth and a book giveaway.

MRI Techs Post Top 100 Natural Birth Blogs

The MRI Technical Schools site posted a list of the Top 100 Natural Birth Blogs.  The compiler, L. Fabry, did a wonderful job of categorizing and providing brief bios of each blog.  Categories include: natural birth info, natural birthing stories, midwife blogs, and more.  Please do check out this list!

I’d like to thank MRI Technical Schools and L. Fabry for including Trial of Labor on this list.

Vague Musings

It feels like an eternity since I wrote anything authentic and of substance, but I’m fighting my way back.  I’ve been in survival mode, in a way, since finding out I was pregnant in December.  I was excited and terrified, and it was all I could do to stay sane and work my job and meet my family’s needs.  Now that I am 24 weeks pregnant and doing well, the semester is nearly over, and family life will be more simple with me in town, it’s time to direct my attention to me and these babies!

I have had a lot of ultrasounds with this pregnancy.  As much as I have read about the controversy regarding the safety of ultrasound (search for Sarah Buckley’s articles on the subject, for instance), they were absolutely necessary for me and my husband.  I’ve also noticed things . . . like Baby A seems to be a pretty “chill” baby and insists on snuggling down on top of the birth canal.  Baby B, on the other hand, appears to be a terror.  Heartrate is usually about 10 points higher than her sibling’s, and this baby is always in motion.

I’m concerned about my pelvis and sacrum – they’ve already been giving me grief.  Thankfully my visits to the chiropractor help with this immensely.  My chiropractor also helps release excess tension in my round ligaments.  But the babies seem to prefer breech and transverse positions.  Rats!  I’m only 24 weeks, so there’s time, I know this, but again, the pattern they have established has been marked by malposition.

I haven’t talked to my OB about VBAC since our first appointment back in January.  He’s the most likely OB in town to support VBAC, natural birth of twins, and even twin VBAC.  However, my history has him a bit spooked.  Perhaps the babies’ presentations will take all of this out of the equasion, I don’t know, but it is getting close to time to talk with him about natural birth again.  Hopefully by now he can tell that I’m not some ill-informed, emotionally-driven crazy feminist or something.  I don’t know.  But I don’t look forward to revisiting the issue with him.

I haven’t been proactive about pregnancy exercise or further education.  I’m rereading sections of The Business of Being Born, and that’s helping me find my fire again, I think.  I also just e-mailed a doula/CBE in my community for advice.  I’m hoping to review My Best Birth sometime in the near future – I’m sure that’ll help.  I should probably read something by Michel Odent, Silent Knife (Wainer), or Pushed (Block).

I just feel very alone.  Sure on-line communities help . . . they’re awesome support, but they don’t substitute for face-to-face support.  The natural birth community here lost much momentum and power when Dr. Montgomery died.  He ran the only free-standing birth center and employed a handful of talented, caring CNMs.  We’re down to two CNMs in town who have hospital priviledges.  I’ve been risked out of homebirth because of the twins, so I’m forced to “choose” the hospital.  As I posted at another location today, “I’m at McDonalds trying to fashion a crappy meat-like patty into a steak.”