Impactful Tweets (pt 3) ICAN 2011 Conference

I tried to catch as much of the Henci Goer chatter on twitter as I could tonight.  We have a full house tonight (our 3 plus 2 neighbor kids spending the night, oy!) so I’m playing with less than a full deck.  Ha!

Disclaimer: Since I read these tweets on a public hashtag channel, I’m not asking permission to repost.  If anyone wants their tweet removed or wants to clarify a tweet, please let me know.

anderzoid #ICAN2011 henci goer: how much we have over medicalized birth? IV drip- not allowed to eat or drink – induction- cord clamping- etc
I assume this was a slide of the topics used to justify the point that birth is over medicalized.  My previous research leads me to concur that these are some of the ‘biggies.’

poderyparto Ineffective & harmful practices: sonograms to estimate fetal weight, planned cesarean for breech,not supported by research. #ICAN2011
Ultrasound is such a poor diagnostic tool for assessing fetal weight in the 3rd trimester.  I can’t recall exactly ‘when’ ultrasound is more accurate for predicting due ‘dates,’ but it’s very early on – I’m thinking 8-12 weeks gestation, but don’t quote me on that.  Only one mom out of the many I know personally that were told they were going to have a big baby actually did have a big baby.  Friends and family members who have had 3rd trimester estimates done with specialists have birthed babies 2 pounds lighter than predicted!!!!  Regarding the no-questions-asked cesarean for breech – a flawed Canadian study is what dictates current US practice.  Thank goodness Canada is taking the lead to restore breech as a version of normal.

bbybirthingmama Scheduling a section for breech, twins, “big baby” and slow labor are not supported by research! #ICAN2011
I was sad to discover that 75% of twins in Montana are born by cesarean.  I imagine all breeches are born by cesarean except for the rare surprise breech or unattended breech births.  Many docs aren’t ‘allowed’ by their insurance companies to deliver breeches naturally – how convenient for them.  Slow labor – yeah!  Most women just DON’T dilate 1cm/hr.  I REPEAT – MOST WOMEN AREN’T GONNA DILATE ACCORDING TO FRIEDMAN’S CURVE.

tconsciousdoula The way to get a VBAC? Tell the Dr you are planning on having 10 children! #ican2011
Now that’s a good one.  I’ll have to add that one to my list!

babydickey: Perinatal death from csec scar uterine rupture is 6 in 10,000. But did you know pregnancy loss from amniocentesis is 60 in 10,000? #ICAN2011 AND Unnecesarean 6% of scar ruptures—> perinatal death (3 per 10,000). Compare to excess risk of pregnancy loss from amniocentesis… 60 per 10,000. #ICAN2011
Here’s what was stated in the NIH VBAC Report: “Approximately 6 percent of uterine ruptures will result in perinatal death. This is an overall risk of intrapartum fetal death of 20 per 100,000 women undergoing trial of labor. For term pregnancies, the reported risk of fetal death with uterine rupture is less than 3 percent.”

tconsciousdoula planned VBAC should be the norm (87%) actual rate is 9% (2007) #ican2011
Add this information to your notebooks in case you need to make the case for VBAC to a doctor, a nurse, a hospital administrator, or a friend.

tiffrobyn A 41 week pregnancy is not only normal, it is AVERAGE! #ICAN2011
Like . . . duh.  Why have care providers forgotten that?  Well, statistically that may not be the exact average for all childbearing groups (i.e. primip vs. multip), but it’s absolutely ridiculous to pressure a woman into inducing at 41 weeks.  Some providers will start pressuring you at 39 weeks, especially if you let them anywhere near your cervix!

bbybirthingmama WHO Recommends no more than 10% induction rate. I didn’t know that. #ICAN2011 BUT poderyparto US induction rate 2005: 47% (babydickey tweeted 41%) of women planning vaginal birth! #ICAN2011 #CAM2011

shedenka So hospitals and docs tell ALL women “you can’t eat/drink” during labor. Total CYA: aspiration risk is 3.2 women out of 10 million #ICAN2011

nashvillebirth Henci Goer makes my head hurt in a good way. She always melts my face off. #ICAN2011
*Giggle*  This really made me smile.  I love having my brain hurt in a good way.  It’s invigorating!!

bbybirthingmama Early Cord Clamping can take up to 40% of newborns blood volume! #ICAN2011
I had no idea!  All of my babies have had their cords clamped immediately.  I will definitely add this to my notebook – I had decided a while back that I wanted delayed cord clamping.  I know it’s not really a strange thing to ask of a CPM but may be strange for an OB.

anderzoid Henci Goer still on ineffective & HARMFUL practices: Care by an OB for LOW-risk & MODERATE-risk women #ican2011
This point was made by a NYC OB in “The Business of Being Born.”  It’s overkill, and generally speaking, normal birth just isn’t exciting enough for them.  Plus, most of them have never seen a normal birth – especially the younger OBs.

anderzoid: #ICAN2011 #ppdchat Henci Goer: it’s hard to get #PTSD on radar bc TRAUMA is centered in Institution. DEPRESSION is centered in women.
This is a very interesting statement and one that I’d like to have fleshed out for me.  I can almost grasp it but not quite.  I will say that people seem to be aware of PPD and acknowledge it but are less able to grasp PTSD as it relates to childbirth (or pregnancy loss).

Want to read more conference hi-lights?  Here is part 2 and part 1 of my Impactful Tweets “coverage.”

DH & I have a big to do list for the weekend, so I don’t know how thorough future posts will be.  Enjoy the weekend!

EDITED to add “Birthing Beautiful Ideas’s” wrap-up of the day’s presentations at the ICAN 2011 Conference.  Have a look!

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.

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.

Gloria Lemay Responds to ABC Segment on Unassisted Birth

“The baby could be born in a breach [sic] position, or with the umbilical cord
wrapped around its neck. The mother could suffer from significant tearing or
from a maternal hemorrhage and bleed to death in as little as five
minutes.”

Dear Women,

The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.

I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.

First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING.  Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough I.V. fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could.  I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.

Think about it – would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes?  I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1000). Two women have required transfusions. The other 8 recovered with I. V. fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.

What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post operative mothers very distressing.

I hope this information is helpful to you.

As far as the other nonsense this person is trying to frighten you with:

1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.

2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs”. Breech presentations are about 3 percent of births.

3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.

Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at www.consciouswoman.org
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008
www.trustbirthconference.com