Hispanic Female Pelvises are Better?

My OB said the most bizarre thing today.  At first it didn’t really strike me as bizarre, but the more I’ve thought about it, the more I’ve realized it’s a crock of shit.

I’m not exactly sure how we got onto this topic this morning, but he stated that the Hispanic female pelvis is bigger than the average white woman’s pelvis.  The best birthers are short hispanic women according to the doc.  And then said something about a study in Southern California that I didn’t really pay any attention to.

Let’s just break this down a bit.  According to this post over at The Unnecessarean (July 2010), the cesarean rate in Mexico’s private hospitals is 70% and 40% in public hospitals.  If Mexican women are so much more physically capable of using their pelvises, then why does their cesarean rate exceed ours?  Perhaps pelvimetry is not as much a factor as OBs would like us to think?

The Unnecessarean post, an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010, further points out:

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

None of these cesarean rates support my doctor’s assertion that a woman’s genetic structure has anything to do with achieving a vaginal birth.  According to Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal, other factors are at work here.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

Aha!  I knew it.  I wonder if some jackass OB in Mexico is currently telling his patient that you need to be tall with a Nordic bone structure (my genes) to have a baby fit through the pelvis?  What do you think?

For more information on CPD (cephalo-pelvic disproportion) diagnoses (and what it probably doesn’t mean for you) and pelvises, I recommend:

What Will This Home Birth Summit Look Like?

The upcoming Home Birth Summit, supported by funding from the Transforming Birth Fund, is raising numerous questions in my mind, and for numerous others, such as: 

  • How are the agreed-upon ‘stakeholders’ being represented?  How are consumers, in particular, being chosen?
  • What percentage of invited participants have direct experience with home birth?  In my opinion, a representation of 1/3 HB midwives, 1/3 CNMs, and 1/3 OBs would not be an appropriate proportion from the practitioner group.
  • Why exactly is the American College of Nurse-Midwives interested in the issue of homebirth considering that very few actually attend home births?
  • Given the above question, I’d like to know if the home birth midwifery organizations (NARM, MANA) submitted a grant application?
  • How will the outcomes make home birth more accessible and more safe?  Will an outcome be that hospital systems and serving on-call OBs will be more respectful toward homebirth transfers?  Will OBs begin offering back-up services to homebirth midwives?  What might that look like?
  • What are the potential positive outcomes of this summit?
  • What are the potential negative outcomes of this summit, especially considering that the need for this summit originated outside of homebirth midwifery?

With permission, I share the following e-mail from retired homebirth midwife, Linda Bennett:

Are you invited? Who is going?

I have concerns about this “Summit”. I want to encourage communication with invited participants the same way I have encouraged communication with our elected representatives. These participants have been appointed to represent the interests of mothers, families, and, coordinated by a midwifery group, I also assume the interests of midwives. I have every hope this will be the case. My long experience with some of the groups that have been invited raises some doubt.

The “Home Birth Summit”, scheduled for some time and some place in the Fall of 2011, is being coordinated by the organization called “Future Search”. The ACNM originated and identified a need to hold this “Summit”.

The American College of Midwives has many CNM members who actively support families and mothers who want a low-tech physiologic labor and birth in the hospital, in birthing centers and at home. CNMs have demonstrated over and over the value of personalized physiologic management that dramatically reduces unnecessary major surgery while improving outcomes. Their work continues to be overlooked, ignored and impeded by Obstetric professionals in overt and subtle ways. If this summit was only held with these particular participants I would have little concern for the outcome.

Unfortunately the ACNM also has very vocal and politically active members who oppose home birth and/or non-nurse midwifery on local and national levels. Here in Oregon we have the “Home Birth Safety” committee organized by L&D nurses and CNMs in Portland at OHSU for instance. Nothing they have done has improved home birth safety in Oregon, rather their actions have polarized the birthing community and has caused even more mothers to consider unassisted home birth for their VBAC attempts after multiple cesareans.

It should not surprise the ACNM and Future Search organizers that home birth families, midwives with home birth practices, and long-standing Birth Activist groups and individuals feel uncertainty about the outcome of a “Summit” top-heavy with groups who have a history of opposition to maternal choice as well as to the independent practice of midwifery.

We have a vested interest in this “Summit” as its pronouncements will be used against maternal choice at every possible opportunity. Statements made in any documents released as a result of this “Summit” will be entered into testimony for or against legislation affecting mothers, families, home birth and midwives across the USA.

Amy Tuteur is an example of a vociferous emotionally-charged tea-party-esque commentator on the subject of home birth. She is not an expert on home birth. She has never been to one. In order to be allowed to deliver another baby in the hospital she would be required to re-train. If she is in any shape or form part of this “Summit” then it will be obvious that it will not represent the interests of mothers, families or address the real concerns of home birth.

Is Lynn Paltrow invited? Her work with NAPW has been as one of the most effective advocates for mothers in the USA in the tradition of  Doris Haire.

The reality is that home birth exists in the form it is currently functioning in the USA because of what it offers mothers and families AND because of what hospital-based ACOG-controlled maternity care does not.

Please communicate to individuals carefully selected for participation in this “Home Birth Summit”. They have been selected to represent you.

Future Search
4700 Wissahickon Ave, Suite 126
Philadelphia PA 19144
800-951-6333 or 215-951-0328
fsn@futuresearch.net

Here are additional links you might find interesting:

The Bestest VBAC of All

So I got an epidural for my VBAC.  Get over it.”  What a great title!  You know exactly what kind of story you’re going to read and can even take a guess at the spectrum of responses to such a post.

I think this is an important post to read.  A VBAC doesn’t have to be a fully unmedicated waterbirth at home to be a ‘success.’  Yet, we run the risk of presenting a set of demands on VBAC mamas, and for many if not most this might be obstructive.

My sense of this woman’s story is that she got the epidural knowing what risks and benefits are involved.  If not, then yeah, maybe she got lucky.  My sense of other women’s stories who have had epidurals, is that even though in most women, the risks may outweigh the benefits . . . some women just don’t dilate or labor well without them.  Perhaps we can hindsight quarterback their birth preparation process, but I think that’s a fruitless discussion.

I agree with Andrea’s point that fighting about the best way to VBAC isn’t constructive.  Ideally, we wouldn’t even need to address the “best way to VBAC” if we had a medically-appropriate cesarean rate in this country.  And if “normal birth” (and I do mean natural) has a high degree of variability, so much so that we insist women be left to labor in peace without clock pressure, then we must be willing to accept variability in the way women pursue their VBACs.

Most of us, I would assume, who consider ourselves to be VBACtivists, are working so hard to re-educate women about patient autonomy, patient choice, informed consent, and participating in health care choices, that we start from the position that a woman who requests an intervention such as an epidural during a VBAC labor doesn’t know the risks.  And this is probably how the squabbles begin.

Further, plenty of “die hard” VBAC gals make “natural choices” that I find potentially risky.  I’m pretty specifically talking about the use of EPO for home induction and tonics such as 5w or PN6.  And some women say NO to induction but YES to augmentation.  And some women agree to AROM (having their waters broken).  Some women have their membranes stripped.  And I get it . . . because as soon as you get to 40 weeks, you’re treated as a ticking time bomb.

What will I do this time?  Only time will tell.  But you bet your butt that if I get exhausted laboring at home but think an epidural will help me regain the strength to birth this child vaginally, we’ll hop in the car and accept the the bad with the good.

Toilet Watch

I noticed something this evening . . .

I spent the first 6 weeks that I knew I was pregnant, examining the potty after doing any business.

I’m spending the last 6 weeks that I will likely be pregnant, examining the potty after doing any business.

Are #1s and #2s ever more interesting, exciting, and scary than when you are pregnant?

Warning: FDA May Inspect and Destroy Your Bathtub!

I find it interesting, perplexing, ridiculous, and absurd that the FDA seized a shipment of birth tubs from a Portland, OR dock, claiming that they’ve been ordered to “inspect and destroy” them.  According to Barbara Harper, the founder of Waterbirth International, “They claim they are unregistered medical equipment, but they are not providing a way or means to get them registered. In other words, if the medical authorities can’t stop waterbirth, then just have the FDA take away the birth pools.” [emphasis mine]

feel free to reuse this image; please pingback if applicable

What’s more, the FDA believes this to be their jurisdiction because childbirth is . . . an . . . ILLNESS.  Yes, that’s right . . . I’m ill; ill with child.  VERY ill with child actually.  So ILL with child, that I might just any day now crawl into my bathtub for relief, medical relief of course, from my nearly 10 month ILLNESS.  Harper was told: “Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment.”  Now, I will say that the FDA isn’t the only institution that believes pregnancy and birth to be an illness, but that’s another story for another day.

So, when I say that the FDA may want to come into your home and inspect your bathtub, hot tub, pool, pond, toilet, sink, whatever . . . hopefully you can see that I’m not really that far off the mark for these are all things water containers that women may use to facilitate childbirth.

More info can be found on this blog as well as Barbara Harper’s Facebook notes.  Please spread the news and watch for news of a petition that Harper may be starting on Change.org.

Update: 34 weeks

I can’t believe I’m 34 weeks(ish).  This pregnancy is moving sometimes at glacial pace or meteoric speed!  Since I haven’t done an update or a post lately, I thought I’d give an overview of where I’m at.

git out of me belleeee!

I posted this ‘self portrait’ yesterday on Facebook.  It doesn’t give the full effect, but hey, I think it’s cute!

What I’m doing

  • cleaning – yesterday, I lightly organized and fairly thoroughly swept out the nasty garage; it’s really that gross – my friends’ comments on FB kind of embarrassed me…
  • shopping – groceries, plants, flowers, wish lists, baptismal dresses, you name it, I want to shop for it (who am I?)
  • reading – ICAN & BAC lists, twitter, Facebook, blog posts, MDC, pregnancy books, etc.
  • belly dancing!
  • going to appointments – midwife, OB, chiro; I need to take the dog to the vet and I need a haircut too
  • hanging out – with my kids, with good friends!

How I’m feeling

  • tired (gone are the days of sleeping well; hello to daily naps – TG I’m done teaching for the year)
  • restless in an excited and nervous way
  • achy – when I do too much physical activity
  • big
  • sexy
  • energetic in spurts
  • cluttered – still so much to organize here at home before the baby comes; too many birth resources at my disposal
  • anxious
  • ready to get the show on the road!

On Becoming a Birth Activist

I’m surprised that more people don’t ask me how I became such a “questioner” of the maternal-fetal care system.  So I’ve had a couple of cesareans, but it’s not like I work in a health-related field.  What does opera singing and being a professor of music have to do with health?  More than you might imagine.

2004 – I was pregnant with my first child; I did all of the ‘right’ preparations – I chose a CNM over an OB based on the recommendation and experience of a good friend (such a RADICAL thing to do . . . choose a midwife over an OB!); I took childbirth education classes from an independent educator; I took prenatal yoga classes and stayed in pretty good shape for most of my pregnancy.  As far as I knew, the baby should have just ‘fallen out’ after all of that good preparation.  But it didn’t.

My hindsight quarterback post of this birth experience is posted here, but let me tell you how it made me feel.  Actually, after the stomach flu > labor and dilation from 0-9cm in mere hours > AROM to speed things up and end my misery > cesarean . . . I felt like a rock star.  It was the most intense experience of my life, and I ROCKED.  Just ask my hubby!  He still talks about how I went to some ‘place’ he never new existed.  I broke a ton of blood vessels in my eyes (yes, I was ‘purple pushing’ but no, I wasn’t only pushing ‘high’).  I was still violently ill after the cesarean.  I had to send the baby to the nursury some.  My hubby had to leave because he caught the GI ‘death and destruction’ bug too.  (So did MIL!)  A lot of things went wrong . . . others were just far from ideal, but whatever.  I survived and a lot of things went right too – I recovered quickly from the surgery; breastfeeding was easy for me and my DD.  I was performing by 8 weeks post partum and took a few on-campus final interviews for University jobs.

Feb 2005 – I had my post-partum appointment with the doctor who performed the surgery.  For the first time, and I don’t know why this was the case, I heard . . . really heard . . . things like “risk,” “uterine rupture,” “dead baby,” “brain-damaged baby,” “repeat cesarean,” “VBAC,” and the like.  How did this happen after all I did to ensure that I went against childbirth norms!  Why me?!!!

In the heat of the moment when you’re feeling distressed because pushing isn’t relieving the pain or bringing your baby closer to you, the cesarean can seem like an easy way out.  I pushed for several hours . . . I resisted pushing when waiting for the OB and then waiting for the surgery.  When the OB arrived, she was pretty sure she could help me get the baby out vaginally.  However, she quickly gave up and fairly nonchallantly suggested the cesarean.  I was READY!  Phew, being ‘stuck’ like that sucked, and no one was really helping me get ‘unstuck.’  I didn’t have a doula (because I didn’t think I needed once since I hired a CNM); DH didn’t know any more or less than I.  I was totally relying on the medical providers.

Why do OBs not feel the need when childbirth hits a major roadblock to really explain the consequences of the next step?  I wasn’t in distress.  My baby wasn’t in distress.  The OB could have said, “Now Kimberly, you’ve been such a strong mama through this, but I want to offer you a cesarean as an option.  Before you agree to it, let’s talk about what happens and what impact this decision may have immediately and for future births.”  There was time for this discussion, and it’s not like she was busy with other patients . . . this was 3 or 4 am!

Please care providers, you MUST let us participate in our health care decisions.  We need information before we can make life-altering decisions like these.  When there is time to inform us of the benefits and consequences of interventions, you are ethically obligated to do so.

July 2007 – I became pregnant again, and a couple of gals from my 2004 due date club reminded me about ICAN.  I joined their Yahoo group and dove in.  My eyes were opened and resentment poured into every corner of my existence.  I lost that baby.  I lost the next baby.  I stuck with ICAN, began a local chapter, and brought The Business of Being Born to an indy theatre in town.  I lost another baby.  I found a new doctor who found new things wrong with me.  I struggled for my life.

Summer 2008 – I was going to spend the summer in Denver doing research.  I began looking for a reproductive endocrinologist so that I could get some answers.  Why these chronic losses?  Why this misshapen uterus?  I continued to struggle for my life.  The RE diagnosed what I suspected – really crappy progesterone.  He also believed that the misshapen uterus was not a didelphic uterus but a fibroid.  He wanted to do a laproscopic procedure to remove the fibroid; I insisted on the less invasive hysteroscopy.

He didn’t find a regular fibroid . . . instead he did his best to remove adenomyosis without compromising the integrity of my uterus.  He believed the adenomyosis was caused by the cesarean surgery.

By this time I was pretty disenchanted with traditional obstetrics.  I had been misdiagnosed or refused diagnoses too many times.  I had lost three babies.  I became aware that the cesarean had a negative effect on my ability to have more children.

Current – I hope by now that readers understand that this isn’t about hating cesareans or hating interventions.  Not at all.  What I have ‘hated’ is:

  • Not being asked to participate in my health care decisions ~ How does NOT having women participate in their health care serve mothers and their babies?
  • Being made to feel like ‘one of those’ patients for conducting my own research and presenting contrasting information ~ How does being an oblivious patient help mothers and babies?  How does being an empowered patient hurt mothers and babies?
  • Being denied tests and appropriate treatments that may have helped prevent another heart-wrenching loss :(
  • Being made to feel like my body just doesn’t work; being taught to be afraid of my body; being taught to not trust my body’s wisdom ~ How does making a woman feel badly about her body and breaking down her trust in the physiologic process of birth help her and her baby?
  • OBs using scare tactics to win compliance ~ Moo??
  • OBs putting their own beliefs about risks (what’s worth it or not) over their patients’ prioritization and contextualization of risk ~ How does putting medico-legal risks above the health (mental, physical, emotion) of the mother-baby dyad help mothers and babies?
  • OBs turning a blind eye to the fact that women may suffer from birth immediately (in the 0-6 week post-partum range) and long term (I was still in acute pain after my last cesarean 1 year post partum); once the ‘healthy’ baby has been ‘managed’ out of the birth canal or uterine incision, it seems as though that’s where their responsibilities end, especially if he or she is not the patient’s regular doctor ~ How does making mothers in the post-partum period low priority patients help mothers and babies?
  • Exaggerating the benefits of intervention and minimizing the risks to the mother-baby dyad ~ How do increased interventions really help mothers and babies?  Are you sure about that??
  • Doctors who aggressively undermine the valid experiences of homebirth midwives and families who choose to birth their babies away from the ‘comfort and safety’ of the hospital campus ~ How ’bout cleaning up your own backyard before you start worrying about mowing someone else’s?  And again, I ask . . . how does tearing down a valid though very different care system serve babies and mothers? 

This.  This is how one very mainstream person becomes a birth activist.  It’s not about hating on specific people but exposing the inadequacies of operating solely in one mindset with regard to health.  The sooner the medical, public health, and alternative care perspectives can truly collaborate, the better health care in the US will be.  This will require a radical shift in thinking and practice, especially from those entrenched in the medical model.

Coda – why an opera singer and music educator should care about birth?  I am of the opinion that the entire body is the vocal instrument.  Impairment of any part of the body can negatively impact the singing voice.  Particularly the trauma done to the lower abdominal region during a cesarean section need to be avoided.  The abdominal complex is the primary source of support for the singing voice.  Interventions and distruptions to this part of the body can have long-lasting negative effects on the singing voice.

Additionally, music gives us the opportunity to engage seemingly unrelated fields.  My dissertation dealt with gender subversion in modern opera.  Really, how different is this than the institutional hegemony of maternal-fetal medicine.  The female body is still a battle ground.