April: Cesarean Awareness Month

Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean surgery on mothers, babies, and families worldwide.  Cesarean birth is major abdominal surgery for women with serious health risks to weigh for both moms and babies.  Cesareans may be safer now than they ever have been, but this surgery is being conducted more frequently than is prudent or safe.  The acceptable rate established by the World Health Organization (WHO) is 10-15% – what is your community’s cesarean rate?

The blogosphere is atwitter about Cesarean Awareness Month.  Here are some posts I found today that deal directly with CAM:

  • Instinctual Birth’s post
  • No Womb Pod’s post
  • Strain Station’s post
  • Cesarean Awareness’s post
  • CT Birth Experience’s post
  • She Got Hips’s post
  • CT Doula’s post

If you have blogged about Cesarean Awareness Month and don’t appear on my list, please leave a comment so we can read your post.

To learn more about cesarean awareness, support, and education, visit the Internation Cesarean Awareness Network (ICAN) website and/or look for a chapter in your area.  Another great resource to consult when weighing the benefits and risks of intervention in chilbirth is Childbirth Connection.  Also, I recommend looking at and considering the Mother-Friendly Childbirth Initiative.

How do you plan to honor Cesarean Awareness Month?  How can you let people know that natural birth is an important issue for you and for them?  I promise that there is some way, no matter how small it may seem, that you can have a positive impact on your birth community.  Even wearing a cesarean awareness ribbon several days this month will help.  If you need ideas, feel free to ask.

Recurrent Miscarriage Update

I had a follow-up appointment yesterday with the OB who performed the needed curretage a few weeks ago.  I can’t say that I really learned anything helpful from the meeting. 

Pathology on the baby came back normal though apparently no chromosomal analysis was done.  I hadn’t realized that the pathology would only rule out ectopic or molar pregnancies.  I already knew from the ultrasound that neither of those were concerns.  So that was a costly dead end.

Chromosomal abnormalities?  Perhaps, so she recommends testing for both me and my husband.  I assume that we will go ahead and do that.

Progesterone deficiency?  Perhaps, so she recommends taking Clomid when I’m ready to conceive again.  I was not previously aware of using Clomid to treat potential progesterone deficiency or apparent “luteal phase defect.”  Since I ovulate on our around the 15th cycle day, I don’t think LPD is my issue.   However, I’m not ruling out some sort of hormone imbalance.  When I’ve had HCG levels tested, those numbers have been just fine.  But I’ve never had my progesterone level checked, and this OB wouldn’t do it anyway even after Clomid treatment.  I find that odd.  What if the Clomid wasn’t quite enough to sustain the corpus luteum until the placenta takes over?  Wouldn’t it make sense that I could still possibly need progesterone supplementation even after conceiving on Clomid.  (Remember that I have no conception problems; I’m just “failing” to sustain pregnancy right now.)

Immunological problems?  Not suspected though I am inclined to disagree.  I have a history of endometriosis, depression, low energy, and adult onset acne, for instance.  My mother has rheumatoid arthritis which is an auto-immune disease.  I rarely feel particularly “great,” but then again, given what I’ve been through this past year it would be hard to identify a great day even if it was right under my nose.  I found the Reproductive Immunology Associates’ information on miscarriage prevention to be interesting, encouraging, disheartening, and overwhelming.  I will pursue some of these ideas with local care providers.

Next month I will follow-up with another OB in town.  I may also go see an endocrinologist who has been recommended.  There are evidently fertility specialists as near as Spokane, so perhaps I should be contacting them?  I have so many questions, and I don’t know if I’ll ever find answers.  That’s perhaps the scariest part.  At this moment I think I could deal with being told that trying to conceive again would not likely be successful for X, Y, or Z reasons.  We do have one incredible child, and I might be inclined to consider adopting from abroad.  But to have to deal with the unknown is what really worries me.  Three miscarriages in a row “just” bad luck?  How will I overcome that “diagnosis” if it is the most likely deduction?

Time will tell.  Each day is different.  Some days are ok and some are not.  I am living moment to moment, hour to hour, day to day.  Planning ahead for anything is excrutiating.  But “ahead” will come whether I like it or not, whether I can deal with it right now or not, and whether I can deal with it then or not.

International Women’s Day: Investing in Women and Girls

Last Friday one of my students presented me with a potted mini rose bush.  I assumed it was a gesture related to my recent miscarriage, but actually it was a gift in celebration of International Women’s Day (3/8/08).  International Women’s Day?  I had never heard of such a thing, but in my student’s home country, it is customary to present women with flowers on IWD.  I was glad she chose a potted flower!

My last post listed the top 10 countries for being a woman according to the UN Development Programme.  The US (12) did not make the list, but neither did the UK (16), Mexico (52), my student’s Ukraine (76), or Germany (22). [1]  In the course of looking up the data I found Kemal Dervis’s statement for International Women’s Day.  The theme is “Investing in Women and Girls.”  Dervis states that this theme “is about changing the systems and attitudes that discriminate against women and prevent them from fully participating in and benefiting from the economies and societies in which they live.”  How do we plan to honor this goal in the US?  How can we tackle important women’s issues in our communities?  How will we positively influence local, statewide, and national political trends to discuss and improve the lives of women and girls in the US?

Are you “unseen” in your community or recognize women at risk in your community?  Do something proactive!  Whether it’s starting a support group, mentoring teen moms, taking a meal to a family or friend in need, picketing City Hall, raising legislative awareness, or even simply smiling at a woman or girl who looks like she needs it, you can make a difference. 

[1] UN Development Programme, Human Development Report 2007/2008, GDI Rank

Contrast these homebirth news stories!

I have followed homebirth legislation news in Utah and South Dakota with interest and concern.  I don’t want Montana getting any stupid ideas. 

UtahI blogged about their nonsense recently.  Yesterday, the Utah Senate voted to restrict homebirth practices.  The bill was supposed to have been a compromise, but what resulted was something restrictive and punitive.  Women will be forced to attempt VBACs in hospitals or on their own.  Were this the case in my state, I would have an overwhelminly large chance at “failure” since my hospital’s VBAC rate is a pitiful <1%.  They only had 16 successful VBACs at the hospital in 2006.  Utah legislators have chosen a path that makes homebirth less safe.  To search for Senate Bill 93, click here.

South DakotaI also blogged about their homebirth “situation,” and it appears that both the SD House and Senate have approved a homebirth bill. 

The bill would require midwives to become registered nurses, get master’s degrees in nursing, and pass additional tests. Certified nurse midwives wanting to attend home births would need approval of both the Nursing board and the Board of Medical Examiners.

Allowing certified nurse midwives to attend home births in South Dakota would be allowed on a trial basis until 2013.  (click here for source article)

My concern is that CNMs were previously required to have OB back-up, and evidently no OBs were agreeing to provide back-up services.  What will be different?  And I’m not sure that having a Masters Degree makes anyone particularly qualified to attend labor.  Shouldn’t these homebirth midwives have assisted on “x” number of births before they become licensed?  Why is it always about the piece of paper??

Also, the bill states that CNMs will be able to attend homebirths “under certain circumstances” but doesn’t clarify what those circumstances may be.  I suppose we must find the Board guidelines to find more clear language.  To read the bill, click here.

Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed – via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed – we treat them. We don’t judge the obese who come in with MI’s. – we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis – we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading – we treat them. We don’t judge many other behaviors which really ARE obviously poor choices – because they are just that – choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

Caring for Women Who Suffer Birth Loss

I posted the information below elsewhere on the internet in response to a request for advice regarding care protocol for women who experience miscarriage or stillbirth.  I am amazed at how upset I got just writing these seven points.  Women who miscarry or otherwise lose their babies are treated so strangely.  I’ve been reading a terrific book called Motherhood Lost which looks at birth loss from a feminist perspective.  It really speaks to me, so click on the link and check it out.

For what it’s worth, here was my personal advice regarding birth loss “care” – something we don’t always experience when we’re being “treated”:

1. Take women having active bleeding IMMEDIATELY to a room. Don’t make them sit bawling their eyes out around other pregnant women or in a horrible ER waiting room.2. Don’t subject them to unnecessary protocols when they make a request – I was “forced” to accept a heplock, and not only was it completely unnecessary, but the nurse sucked at getting it into place.

3. Don’t tell a woman (especially when you’re not her provider) that she put the pregnancies too close together and that she pushes herself too much. We already blame ourselves enough.

4. Don’t misread ultrasounds. Misread ultrasound leads to misdiagnosis which further complicates care and treatment. Because of this misdiagnosis, I was treated like a woman who wasn’t miscarrying “correctly” instead of a woman experiencing “threatened miscarriage” due to a subchorionic hematoma.  5w4d may be too early to see a fetal pole, and the presence of a yolk sac implies the existence of a fetal pole.  I did NOT have a blighted ovum.

5. If your patient miscarries over the weekend . . . follow-up with her. It’s the least you could do.6. Make the billing process more clear and more simple to digest. I don’t know where all of my bills come from and why I continue to have to pay so much out of pocket. I thought I had insurance???

7. Make sure you have RESOURCES to share with your patients/clients in the form of personal support, support groups/networks, reading materials, etc.

Yeah . . . all of this (and more, I’m sure) I experienced with my 10/07 miscarriage. That was my one and only experience with our local hospital. I won’t be going back there unless I’m seriously dying.