Blog it out: 38 week OB appointment

As I get ready for my 38 week OB appointment tomorrow, I feel the need to just ‘blog it out.’  Ya know . . . as a way to relieve some tension and stress from last week’s appointment.  I’m maintaining ‘shadow care’ with the only OB I know in town who would ‘tolerate’ babysitting an ill-advised VBA2C in the hospital.  Only thing – I’m not planning on going to the hospital.  However, I’ve been encouraged to keep up this disingenuous relationship just in case I do need to transfer during or following the birth.

I blogged last week about his ridiculous statement that “short, Mexican women” have the best births.  Here are some of his other de-motivating tactics:

Sketch by American artist, Ben Murphy

  • “So . . . we still doing this?”  He likes to begin my appointments with this rhetorical question.  He knows the answer, but yet, he continues to ask.
  • “You’re not gaining weight but you have a BIG BABY.”  Such bullshit.  He doesn’t share my fundal measurements with me, but I know I have been and continue to measure ‘right on’ each week.
  • “When you have a bad outcome, ________.”  He’s filled in the blank with a variety of scary things.
  • “When you need a cesarean, you can’t freak out on me.”  I told him that was way too much for him to expect.
  • I have to have a perfect Friedman’s labor.
  • CEFM, IV, yada yada.  Ok, whatever.  I’ll agree to the monitoring assuming they have telemetry.  I’ll consent to heplock but not an active IV.
  • As soon as I’m in labor, I’m to go directly to L&D.  (Yeah, right, doc.  I’ll do that.)
  • I asked him why my rupture risk is increased since they went through the old cesarean scar.  His response: “Because it just is.”  My response: “Come on, you know that’s not a good enough answer for me!”
  • When I told him that I gestate longer than 40 weeks, he said “that’s bad!”
  • Doesn’t believe vaginal delivery is best for healthy babies (?!?!?!?!!!!!)
  • Places VBAC in the “want” not need category, though he seems to understand that I have my reasons
  • Doesn’t seem to believe that the pelvis expands during pregnancy and birth?  The only way to get more room would be to break my pelvis (not that he was suggesting that route).  Does he not ‘get’ the physiology of birth?  Does he not understand the role of hormones in preparing the body to birth??
  • Seems to consider 37 weeks as term . . . not early term as I suggested.  (A newly released NIH study asserts that babies born in the 37th and 38th weeks are more likely to die before age 1 than babies born in the 39th and 40th weeks.)
  • “You know I’d prefer not to do this.”  In response to my objections over having him and an anesthesiologist breathing down my neck during my entire labor and birth.  Which is a mis-representation anyway of what would actually happen.  If I’m in labor during the day, he can continue seeing his patients.  If I’m in labor at night, he’s welcome to go sleep somewhere in the hospital or at his office.  And our hospital has 24-hr anesthesia immediately available, so he shouldn’t be guilting me about an anesthesiologist having to be there for my labor.  If a hospital isn’t safe for a VBAC . . . . it’s not safe for any birth.

Wow, when I write all of that down, I just get angry.  I’m going to crawl under the covers with my Hypnobabies tracks, strengthen my bubble of peace, work on fear cleansing, listen to my pregnancy affirmations, and call it a day.  My husband will go with me tomorrow to my appointment, so I imagine it will be uneventful.  I have a mind to bring in my “birth preferences” just to see how the doc would react, but really . . . is it worth it?  Probably not.  At this point, I’m no longer interested in his opinion because he continues to skew the ‘truth.’  I don’t want to argue about laboring in water or delayed cord clamping or any of it.

Point is – I’m not going to the hospital to have this baby unless the need arises before, during, or after the birth.  I fully recognize that at any point between now and my birthing time, that I may need hospital services.  My husband and I will decide if we agree with recommendations to abort our homebirth plans.  Otherwise, I’m not planning on needing the hospital or an obstetrician.  So the last thing I want to do tomorrow morning is have an off-putting, destabilizing, stress-inducing discussion with someone who begrudgingly is putting up with my wingnut idea to have a natural birth but very vocal about what all “will” go wrong.

You can read my last pregnancy update (34 weeks) here.

Too Late for Natural Birth?

In my google alerts today, one headline stuck out: “Too late to reverse rise in c-sections?” from the Boston Globe.  It is a letter to the editor from Lois Shaevel, co-author of “Silent Knife.

Shaevel states:

For eons we females had been capable of giving birth with very little medical intervention. Then childbirth went into the hospital, and the process became a medical and increasingly surgical event.

It’s sad really.  I’m not saying that all women don’t need a hospital and that all births can be achieved non-medically, but what makes me sad is the shift in how pregnancy and childbirth are viewed by our society.  Pregnancy and birth used to be normal and expected events in a woman’s life.  Now when you tell someone that you are pregnant they ask you if you have a first trimester ultrasound scheduled yet.  When you respond by saying that you don’t plan to utilize ultrasound technology unless it becomes medically necessary, they cock their heads, look at you funny, and respond with a suspicious “huh!”

Shaevel continues: 

When Nancy Wainer and I wrote “Silent Knife” in 1983, we hoped our work would reverse the trend and give women confidence in their bodies’ innate ability to birth their babies. If this trend of surgical intervention in the natural process of childbirth continues, the only women who will birth their babies naturally 50 years from now will be those who don’t make it to the hospital in time for their caesareans.

Some women are finding ways to become more confident in their bodies.  I joined the International Cesarean Awareness Network (ICAN) which greatly increased my confidence and understanding that a repeat cesarean would likely be unnecessary.  However, the doctors will always find a way to rob us of our confidence.  One ICAN list member was told early on in her pregnancy that s/he was supportive of her choice to VBAC.  Now at 36 weeks she’s been told to schedule a repeat cesarean.  This is not an uncommon story.

Here are my thoughts on how/why this keeps happening to women who desire vaginal birth after a cesarean (VBAC).  Perhaps the doctor just wants the business and thinks s/he will be able to change the patient’s mind along the way?  Perhaps the doctor believes in a woman’s choice but loses confidence along the way?  Perhaps in losing confidence in the mother along the way, the doctor is thinking about the legal consequences of not performing an elective repeat cesarean?  Perhaps the doctor, losing confidence along the way or thinking s/he can coerce the patient into surgery, also has the $$ in his/her eyes since surgical birth costs so much more than vaginal birth?  Perhaps the doctor knows that VBAC labor can take longer, and since s/he will have to be more readily accessible thanks to ACOG directives, s/he pushes for the quicker solution – major abdominal surgery?  Perhaps the doctor is more afraid of the uncertainty of normal (as in natural) birth because s/he is not familiar with it versus that which s/he is trained to do – perform surgery?

Shaevel’s letter was formed in response to this recent Boston Globe article.  Here are a couple of important points to consider from the article:

“It’s important for us to step back and say, ‘Why is this happening, and is it in the best interest of the public?’ ” said [the state’s secretary of health and human services, Dr. JudyAnn] Bigby, whose research before entering state government had focused on women’s health issues at Brigham and Women’s Hospital. “This is not a minor surgical procedure; it’s a big deal. We need to understand why this trend continues.” [emphasis mine]

She is “sufficiently alarmed” that her state’s cesarean rate now eclipses the national average of 31.1%.

Obstetricians’ fears of lawsuits may also fuel some of the increase.

“There’s no doubt about the medical-legal burden; the litigious nature of society has an impact on this,” said Dr. Fred Frigoletto, chief of obstetrics at Massachusetts General Hospital. “Very few obstetricians have been litigated because they did a C-section. But they’re always litigated because they didn’t do one.”

Fear of litigation is NEVER an appropriate motivator for medicalized childbirth.  Interventive practices are only appropriate when there is sound evidence of need.  Basing medical opinion, advice, and practices on a fear of litigation is unethical and violates the oath and creed to “first do no harm” that all doctors agree to when they become registered practitioners.

It once was popular to deliver subsequent babies [following a cesarean] by vaginal birth, but by the late 1990s the practice began to fall out of favor because of potential risks.

Potential risks – yes, it is possible that a woman’s uterus may rupture during labor.  The risk of rupture may be as low as .5%, and any doctor who puts forward a rate of greater than 1% should be asked for the research to support such a statistic.  Avoiding induction and augmentation of labor and having continuous labor support (an experienced doula and/or midwife) will help VBAC moms achieve their goals.

Anyone who doubts the importance of natural childbirth for both mother and child should register for the “What Would Mammals Do” webinar through Conscious Woman