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

What Can I Say?

I am so out of the loop when it comes to anything having to do with reproduction these days.  I’m not in the loop . . . I’m not in the outskirts or the suburbs.  I’m off the grid.  However, a new comment on my ever “popular” miscarriage and hormones post made me feel compelled to post an update.

Random thoughts about life, birth, and the like . . .

  • My 1/2 acre yard and gardens are in disastrous condition, but I did plant some annuals today; that made me happy!
  • My husband is getting ready to add a second floor to our house – his company is called Aria Construction, and they do fantastic high-end work
  • My youngest is now almost 11 months – I still want to smash her into 0-3 mo. clothes…
  • The twins will be 3 in August, and they are such a joy and such a torment.  I still can’t believe they are mine!!
  • My oldest, age 7, had a stupidly horrible time in 1st grade.  Here’s hoping for rest and recovery this summer and a better experience in 2nd grade.
  • No, I’ve still not written my birth story from July 12, 2011 . . . what’s the hang-up?  Well, I still have issues with G’s birth and with a local care provider.  That’s part of it, I’m sure.

Am I recovered from my birth losses?

Yes and no . . . those losses, in a way, made these last three children possible.  However, I still feel an emptiness that will never go away.

Am I recovered from my birthing losses?

Mostly no.  Physical activity causes the adhesions to hurt.  The unevenness in my lower abdomen (fat layer – scar – fat layer) is something I see and feel every day.  Although my VBA2C was a “success,” I feel quite bitter about the last weeks (from 31 weeks to nearly 42 weeks) of my pregnancy.  From 39 weeks onward, every day was a struggle, emotionally.  The birth was stressful.  I didn’t feel a darned thing and had to be told when and how to push.  I didn’t birth my child, but at least I didn’t have to endure her being cut out of my body.

Birth advocacy . . .

I still feel quite out of sorts about childbirth in Missoula and elsewhere.  Any time I see that someone had a cesarean – primary or repeat – I want to know why.  I wish Missoulians seemed to care more about how they birth their babies.  I feel like people either go the homebirth route and mostly enjoy a rewarding birth experience or people sign up for the slaughter.  I know there are good docs and good nurses out there, but I definitely lack trust.  And people don’t know their rights or don’t care that they have rights or don’t know how to exercise their rights when it comes to their own health care.  Everyone else seems to just mind their own business.  <shrug>  I’m planning a few VBAC Resources and Support sessions this year – wish me luck!

Well, that’s where I am today.  I see that Rixa is blogging about important stuff, of course.  See her latest regarding the Human Rights in Childbirth panel.

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.

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 1) from ICAN 2011 Conference

I’m taking a break from my “Emotional Clutter” post that I’ve been working on.  Ahhh, nice to take a breather from that topic.  My friend, L, pointed me to http://twitterfall.com as the best hashtag (#) reader out there.  And well, she would know!

So, I’ve been reading the #ICAN2011 channel and want to share some of the tweets that I’ve seen that should make an impact on VBACtivists as we do our important work!  (Since I’m pulling this content from a public channel, I am not asking permission to repost.  I will remove tweets if the OP requests.)

@DeepSouthDoula: [Macones] Be patient and keep working on us (OBs). Things will get better but it will take time. #ICAN2011
This is encouraging to read.  Other tweets indicate that consumers should be addressing hospital administrators.  However, from personal experience I can tell you that our hospital’s CEO said he can’t make the OBs change.  It’s easy for folks to displace and deflect in this business.

@Preparing4Birth: VBAC candidacy – low vertical incision 98% are this type. 1 or 2 prior ces should have access. Birthweight not a predictor. #ICAN2011
I read another tweet that indicated he supports VBA2+C but that it takes the right patient with the right provider in the right hospital.  I’ve also read that the steepest increase in rupture rates is between 1 (.5%) and 2 (1%) cesareans and then begins to level out.

@Unnecesarean: Macones: We’ve all focused so long on uterine rupture but need to also focus on the consequences of multiple cesareans #ICAN2011

@babydickey: We are underestimating the risks of multiple c-sections. #ICAN2011
A great site for weighing the risks of VBAC and repeat cesarean is Childbirth Connection.  Also have a look at the NIH VBAC Consensus.

@ShannonMitchell: When vbac rates CAN be 60-80% Don’t ask me to wait for ten years for a 20% rate #ican2011 #birthaction
I love me some Shannon.  She’s absolutely right, so we all need to get off of our duffs and DO SOMETHING!  Or do MORE!!

@ Unnecesarean: Macones: If hospitals can’t respond to emergencies, they probably don’t have any business doing obstetrics. (attributed to Landon) #ICAN2011
This is a very important point and should be addressed any time a facility with a maternity ward imposes a VBAC ban.  People who live in towns with VBAC bans in place should write letters to the paper, picket the hospital, and set up an on-line petition at the very least.  The average family doesn’t know that a facility that can’t handle a VBAC is unsafe for childbirth.

@ShannonMitchell: From 30 to 32% is 40,000 cesareans #ican2011 #birthaction
Wow, 30-32% is not nearly as offensive as knowing that 40,000 more women were cut open . . . many (most?) unnecessarily!  And other tweets indicate that the 40K cuts refer to the increase from 32-32.9% (our current national cesarean rate).  If that’s the case, how is that not perceived as a national crisis????

@tiffrobyn: Dr Macones: ECV, CVS testing, carry 1-2% risk, greater than vbac. #ICAN2011
Tests and procedures (including cesareans) that OBs may offer are sometimes riskier than what they refuse to do (attend VBAC).  I will say that I’ve never been offered an amnio, ECV, or CVS even at my advanced maternal age. ;)

More later, I am certain . . .

Cesarean Awareness Month 2011

© Amy Swagman, 2010 -www.themandalajourney.com

© Amy Swagman, 2010 -www.themandalajourney.com

So another year has passed, and I’m back to wondering where we are with our cesarean awareness ‘campain.’  I’m somewhat ‘skirting’ the loop (not really inside or outside of it, just around), so I’m not your most up to date source.  For truly outstanding resources related to cesarean awareness, read Unnecessarean and VBAC facts for starters!

A couple of things that have my attention lately:

  • Our national cesarean rate is staggering, and some predict that by 2020, 1/2 of our births will be done by cesarean.  We must be vigilant!
  • Montana needs a Friends of Montana Midwives group
  • Montana’s cesarean rate is 29% just below the national average.  However, some counties in MT have super high cesarean rates.  Why is that? (Carter County had a 65.4% c/s rate 2005-08 according to the March of Dimes!!!!)
  • Birth activist are working so hard – it’s just awesome!  Thank you to all who are gettin’ it done!!
  • According to Childbirth Connection, “A high-quality, high-value maternity care system is within reach, and childbearing women are the most important stakeholders to drive system change.”  Have a look and see what you can do!
  • Also, through Childbirth Connection, I’ve learned about relevant legislation that has been introduced.  This legislation needs our support!!
  • ICAN is getting ready for the 2011 conference – wish I could be there . . .

Because I’m pregnant I’m in a great position to find out even more about what is being done locally and what still needs work.  I have found – contrary to what my OB told me – that a few OBs will consider VBA2C on a case by case basis.  I have discovered that our only independent birth center, run by a fantastic CNM, does VBACs (even primary!) but not VBAmC.  I have lots of friends who are pregnant these days and have learned a lot about local practices.

Because I’m pregnant with #4 and work a full time job (one that often has me out of town on weekends in the Spring and has me out at night), I haven’t had the time & energy to get more aggressive.  This too shall change, and when it does – LOOK OUT!  ;)

In the meantime . . . what can you do?

We already feel inadequate

I watched Orgasmic Birth last night on Amazon.  When I told my husband what I was watching, he gave me a look like “oh no, you’re going to be one of those women this time, huh?”  I told him that despite the title, the movie was supposed to be good, and for the most part it was.

If you go to the OG website, you’ll see that they define the word orgasmic differently than you would expect: “Intense or unrestrained excitement or a similar point of intensity or emotional excitement.”  I’d agree that all of the normal physiologic births shown on the video demonstrated intensity.  It’s important to read the definition above with the word “or” in mind.  A woman does not have to achieve orgasm during labor/birth to have an orgasmic birth.

I found it interesting that one of the interviewed NCB experts suggested that we don’t share our birth stories because we don’t want to make other women feel inadequate.  Perhaps a woman who consents to an epidural in a hospital setting will feel inadequate, I don’t know.  But, a woman who has undergone a cesarean after trying to labor will almost always feel inadequate in some way.  (I know there are always women out there who will say different.)  Let me explain.

A woman is told that babies come out of vaginas, and that most of the time that is possible.  Women may enter into the last stages of pregnancy knowing that they want an epidural or to be induced, but they still expect that in most cases, the baby is going to come out normally.  However, most hospital birthers are not given the right kind of support to achieve a natural physiologic birth or normal birth.  Inductions are fairly normal.  Augmentations are fairly normal.  Epidurals are extremely common.  As one expert pointed out on the movie, when most (like 90%) laboring women receive an epidural, and you don’t, you take the staff out of its comfort zone.

So after these interventions and more (constant monitoring, restricted movement in labor, etc.), women are still expected somehow to birth vaginally.  And a third of us are sectioned – or more, depending on the location.  Our bodies failed us, we are lead to believe.  “Thank God I was in the hospital or my baby and I would have been in big trouble.”  Our inadequacies are magnified by the overwhelming successes of the medical machine.

Women who have had cesareans are defensive.  “My cesarean was necessary” is a common belief.  But to suggest that women don’t share their birth stories because they don’t want to make a cesarean mother feel inadequate is not understanding the situation.  We already feel inadequate.

I am 1 of 3 women sectioned in childbirth.

I am one of numerous women told that her body wasn’t capable of birthing her baby.

I am 3 of 4 women sectioned in Montana for twins.

I am nearly 100% of women in my community told they cannot have a VBAC in the hospital after multiple scars.

I am nearly 100% of women told to be thankful that they have a healthy baby after a cesarean section.

Share your birth stories in a supportive, instructive, and hopeful manner.  Give cesarean mamas hope that next time can be different, if she chooses.  And she has to choose; you can’t choose for her.  I myself am preparing for a transformational experience this summer.  I can’t get there unless I embrace stories of uninhibited natural physiologic birth.