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.”

Natural Breech Birth Deserves Our Support!

A friend posted a link to the Coalition for Breech Birth on her gmail status. I’m so thankful to know about this resource now.  The following quote applies to all low-risk mothers (regardless of fetal presentation or previous cesarean):

“However, caesarean surgery, while it presents many advantages for the surgeon, has lifelong ramifications for the birthing woman and her family, including issues with subsequent pregnancies, secondary infertility, vbac availability, and depression, not to mention a risk of death in childbirth increased threefold over vaginal birth. Women should not be obliged to accept these serious risks as ‘standard of care’. . .”

Please have a look at this site which provides links to the original report that caused breech birth to fall off the natural birth map and the subsequent research that DISPROVED the report authored in 2000 that continues to govern obstetrics & midwifery access and practice to this day.

What drew me to childbirth advocacy

I received an excellent question from a Facebook friend the other day.  And even though my response is brief, I suppose this might be a question that a lot of folks have for people like me!

“So I’m curious… What led you to become involved with ICAN? Personal experience or passionate commitment to natural childbirth? Or both?”   ”I am always interested in how people come to be involved in this kind of advocacy.”

My brief response:

I had a cesarean in 2004 and didn’t fully understand the impact of it until much later. I joined ICAN when it was time to try for another baby and have been involved ever since. So, now it’s personal experience as well as passionate commitment to evidence-based practices in obstetrics as well as spreading the word about the benefits of natural childbirth, VBAC, homebirth, birth plans, doulas, midwives, whatever! Also, I’m very concerned about the national cesarean rate and our local rate in Missoula. That’s it in a nutshell!!

And of course I suggested that she have a look at my blog!

Legislative Alert: American Association of Birth Centers Announcement

I am just a messenger.  This is extremely important and requires quick action.  I know it’s a crazy busy time of year, but please do take a moment to make these calls.  Midwifery is good for women and babies!  Support a woman’s access to ethical and mother/baby-friendly care.

American Association of Birth Centers
Legislative Alert

URGENT – Make Calls before December 22nd!

We are making progress with education of the House and Senate about the need to add the birth center facility to Medicaid covered services! But, many Representatives and Senators have not yet had a call from you or your clients. We must have sponsors from both parties! We are also targeting key people who will vote YES or NO whether our bill will get out of committee and to the floor — once we have introduced the bill.

For background information click here.

Please make calls to congressional health staffers this week before the holiday recess!

1. Click here to get the names and phone numbers of the Washington D.C. offices of your two Senators and your Representative.

2. Ask the name of the healthcare staffer and ask to speak to them.
3. Write down their name and phone number.

4. Tell them you own/direct/work at/are a consumer of/care about the services of a birth center.

5. Tell them that a bill will be introduced soon to add birth centers to Medicaid. [NOTE: the bill does not yet have a bill number.]

6. Ask for their support and sponsorship of our bill to add birth centers to Medicaid. That’s all you need to say–we’ll do the rest.

7. Then call or email AABC’s lobbyist Karen Fennell (301-830-3910, karenfennell50 @ yahoo.com or me (423-253-4455, jkalliman @ yahoo.com to tell us what they said. We will follow up.

NOTE: We do not have a bill number because it is not yet introduced, but we want to introduce the bill in January and need sponsors now. We can send them the draft bill language if they are interested in sponsoring the bill.

image attribution: justinandelise (flickr)

This is urgent if we want to sustain birth centers in the United States. Please call today.

Please pass this on to your Friends of the Birth Center groups and ask them to call too.

Sincerely,

Jill Alliman, CNM, MSN
Legislative Chair
American Association of Birth Centers

A Note to My Friend

This morning I received an encouraging e-mail from a friend.  She has been through infertility and recurrent losses, but it looks like she finally has a keeper!  Luckily she has found medical providers who were able to come up with a good treatment protocol for her situation.  She has weaned off of the progesterone shots (daily shots of progesterone in oil – owie!) but is still on heparin, I believe, for the duration of her pregnancy.  She is finally in the second trimester!

She mentioned that her fear of childbirth is abating.  Some of that is because she has experienced natural miscarriage, and she has been told that it is like mini labor.  I wanted to share (most) of my response to her.  Of course I could have said much much more, but I really don’t want to be “that crazy friend” who can’t shut up about natural childbirth.

Just remember that the OB is just a person, not a god.  And what YOU want DOES matter.  Ask about birth plans and how the hospital honors them.  I would hire a doula, someone who will be able to advocate for your needs and your desires.  Seriously, that’s the biggest mistake I made – I thought that having a CNM would “save” me from unnecessary intervention, but it didn’t.  The rest is history.

I thought the childbirth education classes at [name removed] were just fabulous.  My only criticism is that I somehow didn’t understand how life altering the cesarean was going to be.  I’m not trying to scare you – the cesarean was a piece of cake for me, and it didn’t mess with breast feeding at all (in my case).  It’s just that I was so shocked when I went in for my 6-week post-partum appointment with the OB who did my surgery and was told about uterine rupture.^  And then last July-August when I was preparing for baby #2 I learned so much about the failings of our maternal health care system, and that’s when I really “cracked.”  I was just so pissed and became somewhat disappointed in [name removed] for not having been more forceful.*

Regarding labor – I didn’t even know I was in labor.  Granted I had a violent stomach flu . . . but I was surprised that I showed up at the hospital 9cm dilated!  Probably one of the most painful things I have gone through was my second miscarriage.  Supposedly subchorionic hematoma miscarriages are pretty bad, and this one was no exception.  And during my last miscarriage I kept nearly fainting from the blood loss.  Labor?  Piece of cake.  You’ll be brilliant!  Remember that the pain is good – it’s there for a reason.  It helps get your baby out and into your arms.

I am just so excited for you.  I am so glad that you’re out of the first trimester!!  And hopefully you’ll really start feeling great, and pretty soon you’ll start feeling your “lemon” move.  That will bring you much comfort and joy.

^ For the record, every laboring women has a small risk of uterine rupture.  Most uterine ruptures in VBACs were historically caused by labor augmentation and induction tactics.  A “window” or a dehiscence (separate terms in my mind) is not the same as a true uterine rupture.

* One thing I forgot to mention to her is that my husband seems to remember our childbirth educators talking about uterine rupture.  Maybe they mentioned it, but again, it didn’t leave the impression that it should have.  I only pushed for 2 hours and then gave in to the cesarean.  I thought it made sense.  Had I known – really known – what a cloud the cesarean would cast over the rest of my childbearing years, I’d have resisted that cesarean.  My baby would have tolerated it – when she was delivered, her APGAR scores were 9 & 9.  Nearly perfect.  Not a baby in distress as I had been told.

Perhaps what childbirth educators could add into their series is a session on how doctors perceive cesarean scars.  Why the medico-legal culture dominates obstetric practices.  Why certain risks (cesarean surgery, amniocentesis, etc.) are acceptable and others (natural birth, especially after a cesarean) seem foolish.

On the Radar, 11/15/08

The weekend is an excellent time to catch up on the latest news. Here are some things rolling around the internet that piqued my interest.

I had to edit my post to include the latest cartoon by Hathor the Cow Goddess.  This one really resonates with me in a funny and sick way.  It’s so true . . . except that I never made it out of the hospital bed, unless you count changing beds to be wheeled into surgery . . .  If wishes were horses, I’d have followed my instincts and not left my house that night.  We were fine until the midwife broke my water. <sigh>

AMA Scope of Practice Initiative Advances – I get so focused on what ACOG and the AMA is trying to do to childbirth, that I forget the far reaching affects of their actions. This post was written by the American Optometric Association. I think it’s a good one to study to get another perspective on expanding SOPP. Plus, it makes me thing that we need to forge ties with other “secondary level” practitioners, hire our own marketing teams, and put together a real professional campaign against the AMA.

Can you give yourself a few minutes every day for the next 15 days to practice relaxation and yoga? I’ve been thinking about this a lot lately, especially since I’ve started reading Living Buddha, Living Christ by Thich Nhat Hanh. One of my students let me borrow it. While I’m at it, let me share one wonderful thing I’ve read from the book thus far:

Peace is all around us – in the world and in nature – and within us – in our bodies and our spirits. once we learn to touch this peace, we will be healed and transformed. (23-24)

It’s so hard for me to recognize peace around me, and, in a way, to embrace the healing and transformation that is promised by embracing peace. I keep being led to practicing mindfulness, peace, meditation, yoga, being present, but I keep resisting it. How about you? And will you also take mamascoffeetime’s challenge to practice yoga? If you have a little one at home, try the Animal Adventure!

I found a petition, “Practicing midwives Should Be Licensed and Carry Insurance.” I sighed in sadness and exasperation when I read it. It really stinks that this family lost their baby in this manner, but shouldn’t they have been aware through the interview process if their midwife was licensed and if she carried insurance? I’m not trying to point fingers back at this family, but these are such basic questions. For some homebirthers, it’s important that their midwives carry the proper credentials. Others recognize that midwives don’t always care about formal recognition for what they do. They help babies and their families at one of the most critical and beautiful times in their lives. A piece of paper doesn’t mean that they’re a good or bad midwife any more than a medical degree ensures that you have a good doctor. And to require midwives to carry insurance is to ask them (and us) to continue to support a system that is completely FUBAR! Anyone who has suffered from major medical problems – even if they have “good” insurance – can attest to that.

Choices in Childbirth Statement Encourages Options and Evidence in Maternity Care. What a concept, eh? Options for women and their babies? EVIDENCE when it comes to maternity care?? Here’s a taste, but please do read the whole thing! I wonder if ACOG or the AMA will respond?

The statement also calls for evidence-based practices in maternity care, and for the American College of Obstetricians and Gynecologists and the American Medical Association “to strike those resolutions that deny childbearing women the autonomy and rights that medical professionals, educators, and women’s health advocates have historically endorsed.”

A wonderful post at BlogHer, It’s lonely out here: planning for a natural childbirth. Some great comments too!

CfM Grassroots Network: MEAC Needs Our Help! What they really need is our $$.

And last but not least . . . a new website and blog to which I will subscribe: The Unnecessarian which I found via CfM and Birth, Interrupted. Read the latest blog entry and you’ll see that they’re already holding the medical community’s feet to the fire.