Fiction gives me unexpected confidence

This may sound strange, but I’m reading Dan Brown’s The Lost Symbol at my husband’s suggestion, and it’s really helping me . . . at this moment . . . find peace with my path to successful birth at the end of this pregnancy.

This book introduced me to noetic science.  Huh?  According to Wikipedia, noetic theory is “the study of mind and intuition, and its relationship with the divine intellect.”  That is just right up my alley in some ways.  I’m more prone to read a research study about pregnancy than I am to delve into Birthing from Within, but part of my non-fiction pursuits in the past have focused on theology and mysticism, and this book (and a recent talk with a trusted friend, a “straight up” talk with a midwife who doesn’t live in my area, and some soul searching) has helped remind me of the mystical aspect of birth.  Birth is a divine gift and one bestowed on women.  Should it surprise us that the male-dominated world would try and rob us (think gender subversion, think hegemony, heck think Marxism) of this unique gift?!

Ok, so back to my unexpected fiction-induced fervor and confidence in my ability to birth:

  • “Our untapped potential is truly shocking.” (p. 27)
  • “We have barely scratched the surface of our mental and spiritual capabilities.” (p. 67)
  • Our thoughts have physical mass & can interact with the physical world, “. . . whether or not we [know] it, effecting change all the way down to the subatomic realm.” (p. 67)
  • Intention requires practice! (see http://www.theintentionexperiment.com/how-to-intend)
  • This seems to coincide with what I’ve already learned about Bodytalk (see http://www.bodytalksystem.com/learn/bodytalk/) – that the body can rebalance and repair itself.

Gosh, what does this have to do with natural birth?  Well, in my case, I’ve had a lot of experience with programming myself in the medical model of women’s health.  I have benefitted from this model, surely, but when it comes to natural physiologic birth, the medical model has its severe limitations.  I feel like a hostage to the medical model – and sometimes victims are oddly attached to their captors.  I am one of those victims.

I need God to work with me BIG TIME during this pregnancy.  He continues to keep me safe even though I fall flat on my face every day.  He never forsakes me.  He will protect me and this baby too, if it’s his divine Will.  God’s plan may not be my plan, but I have to believe that no matter what my and my husband’s decision may be for this birth, that His Will will be done.

“Lo, children are an heritage of the LORD: and the fruit of the womb is his reward.” ~ Psalm 127:1

“Peace I leave with you; my peace I give you. I do not give as the world gives. Do not let your hearts be troubled and do not be afraid.”  ~ John 14:27

“Commit everything you do to the Lord. Trust Him, and He will help you. Be still in the presence of the Lord, and wait patiently for Him to act.” ~ Psalm 37:5,7

Clearly, I’m still working all of this out and how it connects, and how it may or may not be useful to me.  But I am excited to share this renewed faith with you.  I’ve always been interested in the spiritual aspect of science, and now I’m discovering even more connections to and evidence of God’s presence in modern science.

Here’s to a peaceful and powerful 2011!

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.

Hospital VBAC: The Don’t Forget List

[NB: Most of what I’ve written below applies specifically to the hospital venue.]

We all know the books to read when preparing for a VBAC or the videos that will help us gain confidence in our ability to give birth vaginally.  We all know to pack our hospital bags, including our mental focus recordings, and bring a copy of our birth plans.  We all know that we need a doula with us, one who is experienced supporting VBACing women. 

Many of us even know that we need to talk powerfully about our upcoming VBACs.  “I’m trying for a VBAC” is not nearly strong enough.  Replace that with “I’m planning a VBAC.”  Did you birth the first time with “I’m gonna try to give birth vaginally” going through your brains?  Probably not.  I myself never doubted my ability to give birth naturally.

Anyway, I digress.  In addition to constructing a clear but concise birth plan, you need to also do the following:

  1. obtain a copy of the hospital’s VBAC consent form; review it and make changes as you see fit; give a copy to your care provider and bring a copy with you to the hospital
  2. obtain a copy of the hospital’s cesarean consent form; review it and make changes as you see fit; give a copy to your care provider and bring a copy with you to the hospital.  My hospital doesn’t have a cesarean consent form.  They have you sign their generic “invasive procedure” form which I find unacceptable.
  3. discuss the modifications you’ve made to the above forms with your care provider(s)
  4. especially if you’re NOT married, make sure your will is in order
  5. make sure you bring a medical power of attorney in case medical decisions need to be made and you are incapacitated

Bruce Flamm’s VBAC consent form appears everywhere on the internet.  I personally didn’t find it sufficient, but it is a place to start.  Here’s a great post - an actual cesarean consent form with some added commentary from the blogger.  I’ve taken this form and modified it so that (1) consent is not given for elective cesarean; (2) consent is withheld until the situation would arise for an emergent cesarean; (3) my husband is named as having power of attorney in the case of an emergency where I was unable to make my wishes known.  I also added some things that were missed on the form.

Please ask questions or offer your own suggestions!

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.

Stressed: Woulda Shoulda Coulda

Shoulda:  One of my strongest feelings from DD’s birth in 2004 is that I shouldn’t have gone to the hospital.  When my husband started to nag me about getting to the hospital (I was severely dehydrated, and he wanted to take me in to get that treated), I thought, “I couldn’t possibly leave my house right now.”  Somehow I did get in the car and didn’t puke or poop myself on the way to the hospital.  The minute I got there, I *needed* a wheelchair.  I was sick. 

I wasn’t treated for illness.  I was treated for childbirth.

I should have hired a doula.  I thought I was “safe” because I was being attended by a CNM.  I should have reminded her that my birth plan stated no artificial rupture of membranes.  I should have insisted on changing positions even though I was peeing out my butt.  What shouldas are ahead?

Coulda:  I could have told my DH no, I suppose.  I certainly could have told my CNM to go jump when she suggested breaking my water.  What sorts of couldas are ahead?

Woulda:  Had I a “do over,” I’d have stayed put.  Or I would have refused AROM.  I would have changed positions while laboring and for pushing.  I would not have purple pushed.  Not gonna do that again.  Thinking too much about future wouldas is overwhelming.  Let’s not go there.

Woulda shoulda coulda is that much more stressful when you aren’t given options.  I’m not supposed to give birth to twins at home.  That’s risky.  I’m supposed to want to give birth at the hospital.  That’s safe.  Yeah, hospital birth is so safe for American women and their babies that our infant mortality rate ties Poland and Slovakia.

Hindsight Quarterbacking a hospital VBAC

I recently joined My Best Birth, a network on NING.  Today I noticed that a woman posted a link to her VBAC story, so of course I had to go read.

My goodness what she encountered:

  • Urge to push at 2cm dilation
  • Pressure to have a cesarean
  • Early epidural
  • More pressure to have a cesarean
  • Stalled labor
  • More pressure…
  • Slow dilation
  • More pressure…
  • Scare tactics
  • Multiple birth attendants
  • Fear
  • Swollen cervix
  • Presented with “limit of liability” and cesarean consent forms
  • DH had to go fight off the OB
  • A lovely doula
  • Wonderful calm-inducing friends
  • Finally ready to push
  • Pushed in stirrups
  • BABY!!!!
  • Doc pulling on the placenta
  • Contraction finally finished birth
  • SUCCESS!!!!!

My goodness me!!

I was intrigued by a back and forth in the comments between the Feminist Breeder and At Your Cervix.  At Your Cervix was saying that pitocin augmentation might have helped speed things along for this woman.  Feminist Breeder stated that pitocin augmentation was contraindicated for VBAC… which is certainly what I thought as well.  So, I had to look.  I googled VBAC “pitocin augmentation” and one of the first things that came up was a page from Dr. Wagner’s Born In the USA (table 6) with a chart which estimated uterine rupture rates:

1 in 33,000 – woman with unscarred uterus
1 in 200 – VBAC without augmentation or induction
1 in 100 – VBAC with oxytocin augmentation
1 in 43 – oxytocin induction
1 in 20 – Cytotec induction [ref]
Have a look also at Homebirth.org’s information on “Induction or Acceleration of Labour in VBAC Candidates.”  All of this makes me understand the wide variety of rates that I’ve heard doctors cite.  Of course they never admit a .5% rupture rate probably because a large number of them induce and augment labor.  (Maybe that’s an unfair assumption, I don’t know; the fact remains that I’ve never heard a doctor actually use that rate.)  A CNM I talked to this past year used the 2% rate.  I’ve heard 1%.  I’ve even heard 5%.

I read an interesting discussion – “How high is too high for pitocin” at All Nurses Dot Com.  Definitely something to keep in mind.  I should write down some of this . . . and ask our hospital staff about their policies.

Another related resource that I highly recommend can be found at VBAC Facts, one of my favorite sites – “Two doctors respond to the Hastings Indian Medical CenterVBAC Ban . . .”  Specifically, pay attention to the charts and suggested protocols in the Leeman/Espey response.