What Can I Say?

I am so out of the loop when it comes to anything having to do with reproduction these days.  I’m not in the loop . . . I’m not in the outskirts or the suburbs.  I’m off the grid.  However, a new comment on my ever “popular” miscarriage and hormones post made me feel compelled to post an update.

Random thoughts about life, birth, and the like . . .

  • My 1/2 acre yard and gardens are in disastrous condition, but I did plant some annuals today; that made me happy!
  • My husband is getting ready to add a second floor to our house – his company is called Aria Construction, and they do fantastic high-end work
  • My youngest is now almost 11 months – I still want to smash her into 0-3 mo. clothes…
  • The twins will be 3 in August, and they are such a joy and such a torment.  I still can’t believe they are mine!!
  • My oldest, age 7, had a stupidly horrible time in 1st grade.  Here’s hoping for rest and recovery this summer and a better experience in 2nd grade.
  • No, I’ve still not written my birth story from July 12, 2011 . . . what’s the hang-up?  Well, I still have issues with G’s birth and with a local care provider.  That’s part of it, I’m sure.

Am I recovered from my birth losses?

Yes and no . . . those losses, in a way, made these last three children possible.  However, I still feel an emptiness that will never go away.

Am I recovered from my birthing losses?

Mostly no.  Physical activity causes the adhesions to hurt.  The unevenness in my lower abdomen (fat layer – scar – fat layer) is something I see and feel every day.  Although my VBA2C was a “success,” I feel quite bitter about the last weeks (from 31 weeks to nearly 42 weeks) of my pregnancy.  From 39 weeks onward, every day was a struggle, emotionally.  The birth was stressful.  I didn’t feel a darned thing and had to be told when and how to push.  I didn’t birth my child, but at least I didn’t have to endure her being cut out of my body.

Birth advocacy . . .

I still feel quite out of sorts about childbirth in Missoula and elsewhere.  Any time I see that someone had a cesarean – primary or repeat – I want to know why.  I wish Missoulians seemed to care more about how they birth their babies.  I feel like people either go the homebirth route and mostly enjoy a rewarding birth experience or people sign up for the slaughter.  I know there are good docs and good nurses out there, but I definitely lack trust.  And people don’t know their rights or don’t care that they have rights or don’t know how to exercise their rights when it comes to their own health care.  Everyone else seems to just mind their own business.  <shrug>  I’m planning a few VBAC Resources and Support sessions this year – wish me luck!

Well, that’s where I am today.  I see that Rixa is blogging about important stuff, of course.  See her latest regarding the Human Rights in Childbirth panel.

Pissed! but Accepting?

Wednesday was a banner shite day.  My midwife had been encouraging me to maintain a relationship with an OB, and I knew this necessitated a change.  Friends and L&D nurses urged me to try this one doc, Dr. A (we shall call him), stating that if anyone was going to give me a chance at VBA2C, it would be him.

So, I naively went to my 9:50am interview/appointment with Dr. A.  I was nervous – didn’t really sleep the night before – but hopeful.  The staff was very nice; the nurse was nice.  (I had previously talked with her.)  I had previously met this doc, so at least I wasn’t worried about that.

He was interested to know why I was there since obviously I had been seeing another OB for the 1st three-quarters of my pregnancy.  I told him I had 4 reasons:

  1. I am very motivated for a VBA2C

He interrupts . . . “Don’t do it.”  Shaking head.  Patronizing tone.

I cry.

The rest of the appointment was him trying to scare me out of it, and by the time I told him I’d been diagnosed with a thin lower uterine segment (LUS) during the RCS, he was certain that I am a nut.  Actually, he recognized that I had done a lot of thinking and researching, but he didn’t think I had given enough thought to permanent damage to the baby and permanent damage to me.  (Like, DUH!  What else have I been thinking about the past 7 months.  FFS!!!!!!!)

What was scary is that he’s familiar with the same research I’ve studied.  He mentioned the Cochrane library.  He refuted the opinion of the NIH VBAC Consensus Panel (because most of them don’t deliver babies).  The research doesn’t point to maternal death from uterine rupture but he’s seen it.  Fetal demise begins within 8 minutes of the onset of bradycardia associated with rupture which is too short a time to get a cesarean performed.  Yada yada.

Terrifying.  And I’ve done my research.  I’ve been researching this since 2007.  I have a PhD.  I have fantastic research and analytical skills.  And I was still terrified.  And I still doubted myself, my support system, everything.  And I resented my baby.

And I freaked the hell out.  Couldn’t go to work. 

So, you probably see the “pissed” part.

Here’s the “accepting” part.

Of course he’s going to do “his job” and dissuade me from VBA2C.  In his experience, it’s too  risky to justify.  He’s not going to understand why I disagree.  I’ll never be able to “educate” him here either.  When I don’t rupture and have this baby at home without incident, he’ll assume I got lucky.  I accept that he views birth with a completely different lense.

However, he’s agreed to take me and said he won’t drop me either even if I go forward with the VBAC.  He’d rather babysit me through this poor choice than turn me away.  I’ll have to sign an AMA (against medical advice) waiver just to cover his butt.  Fine; whatever.  So, for now . . . I’m planning to continue my concurrent care with him.  If it becomes a regular thing for him to try and terrorize me, then I’ll drop him.

Although he really shook me to the core on Wednesday, thanks to the amazing support of ICAN and Birth After Cesarean, I’m back on track and actually feeling more solid about my birth plans.  I just don’t “see” the hospital figuring into this experience.  Perhaps God or my baby or some 6th sense will change things, but for now, I’m back to planning a peaceful birth at home.

Cesarean Awareness Month 2011

© Amy Swagman, 2010 -www.themandalajourney.com

© Amy Swagman, 2010 -www.themandalajourney.com

So another year has passed, and I’m back to wondering where we are with our cesarean awareness ‘campain.’  I’m somewhat ‘skirting’ the loop (not really inside or outside of it, just around), so I’m not your most up to date source.  For truly outstanding resources related to cesarean awareness, read Unnecessarean and VBAC facts for starters!

A couple of things that have my attention lately:

  • Our national cesarean rate is staggering, and some predict that by 2020, 1/2 of our births will be done by cesarean.  We must be vigilant!
  • Montana needs a Friends of Montana Midwives group
  • Montana’s cesarean rate is 29% just below the national average.  However, some counties in MT have super high cesarean rates.  Why is that? (Carter County had a 65.4% c/s rate 2005-08 according to the March of Dimes!!!!)
  • Birth activist are working so hard – it’s just awesome!  Thank you to all who are gettin’ it done!!
  • According to Childbirth Connection, “A high-quality, high-value maternity care system is within reach, and childbearing women are the most important stakeholders to drive system change.”  Have a look and see what you can do!
  • Also, through Childbirth Connection, I’ve learned about relevant legislation that has been introduced.  This legislation needs our support!!
  • ICAN is getting ready for the 2011 conference – wish I could be there . . .

Because I’m pregnant I’m in a great position to find out even more about what is being done locally and what still needs work.  I have found – contrary to what my OB told me – that a few OBs will consider VBA2C on a case by case basis.  I have discovered that our only independent birth center, run by a fantastic CNM, does VBACs (even primary!) but not VBAmC.  I have lots of friends who are pregnant these days and have learned a lot about local practices.

Because I’m pregnant with #4 and work a full time job (one that often has me out of town on weekends in the Spring and has me out at night), I haven’t had the time & energy to get more aggressive.  This too shall change, and when it does – LOOK OUT!  ;)

In the meantime . . . what can you do?

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.

Monkeying in the VBAC BS

These sorts of stories are so common and so infuriating . . .

A fellow ICAN lister posted a recent conversation with a midwife regarding VBA2C (VBAC after 2 cesareans).  The midwife didn’t really even know VBAC rates and quoted this woman a rupture rate of “um, I think like 6-8%” for VBA2C.  Where did she get that statistic?  I’m thinking it came from her . . . “um”.

The midwife called her back shortly thereafter to give her the ACOG act:  Rupture rate for VBAC after one cesarean is 1-3% and after two cesareans the risk is (supposedly) 5 times greater, somewhere in the amorphous neighborhood of 5-17%.  Was this woman given any references?  Well, no of course not.  You have to ask them, and then watch them squirm, and then of course they don’t have that information readily available.  Give us a primary author for chrissake!  Can’t you at least remember an author?  Or is your “author” ACOG?  ACOG the trade union.  ACOG is NOT a research-based college.  The fact that “college” is in their name makes me sick.

Luckily for women across the country and all over the world, there exist numerous evidence-based transparent resources for women who would otherwise get cut.  I talk about them here like a broken record, but it’s necessary.  Again, here’s where I recommend you start:

If your care providers aren’t aware of these organizations (ICAN, CIMS, Childbirth Connections), please refer them to these sites.  And here is one recent study that they should have read already:

Landon, MB et al.  “Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery.”  Obstetrics and Gynecology.  July 2006;108(1):12-20.