Current Research and Paradigm Shifts

I will never be free from medical ethics and consumer advocacy.  I am thankful for that.  Not only have I learned so much about my body and the complications of the medical field, but I have also learned that much of this knowledge can be applied in other fields.  I am hopeful that my research will help further an inevitable paradigm shift in my field that has yet to be “named.”  I can’t be more specific about it at this time.

I can be specific about my reading list:

  • Groopman’s How Doctors Think is at the top of the list (but currently MIA from my library, argh!)
  • Gawande’s The Checklist Manifesto and Complications: A Surgeon’s Notes on an Imperfect Science
  • Gadamer’s The Enigma of Health
  • Medical Error, Rosenthal & Sutcliffe (eds.)
  • Medicine Looks at the Humanities, Newel & Gabrielson (eds.)

I suppose this will keep me busy over the long winter break!

Leaves

Leaves make me sad.  Things tend to go to hell in a handbasket (or more) in the Fall.  I’ve NEVER liked Fall.  Even when I like Fall, I’m wary of Fall.  And for good reason.

Do you see this picture?  I suppose I look happy.  I’m not.

By this time in 2007 I had suffered two consecutive miscarriages.  I was starting to panic.  I was starting to lose it.

This photo also reminds me of our last good day with Alfred, the first dog my hubby & I had together.  We were playing in the leaves that day and with our baby girl.  Life seemed complicated then, but things were good and we knew it.  Alfred died soon after.

Leaves surround me now and make me remember the wonderful things I’ve lost this time of year.  And I’m thinking of a student (and friend) with two young daughters who just lost her husband.  Another loss in the Fall.

These losses also remind me of the many blessings of my life.  I prayed and prayed for another baby . . . and lo and behold I have had 3 more!

Silver linings abound.  Blue skies lurk behind the grey menacing clouds.  If i were more of an optimist, I’d always be looking for those silver linings and blue skies.  However, the wicked past has taught me that the grey menacing clouds return, perhaps more frequently than I would like.  Does the blue and silver merely tease me?  Or does the grey remind me to be thankful for the brilliance of the others?

I continue to ponder this . . . this chiaroscuro that is life.

 

The Beginning of the End of the Beginning

I am sad (and relieved) to announce that ICAN of Greater Missoula is officially closed.  I really don’t understand why it wasn’t sustainable in this community.  Here are a couple of thoughts . . .

1.  The homebirthers and homebirth midwives are doing their part for sure, but unless you know someone personally who has birthed at home or who has used a midwife or is a midwife, you just won’t know much about how that works here in the greater Missoula area.

2.  The traditional birth culture prescribed by the medical community does not want to change.  Sure they built a “birth center” at the hospital, but all that really means is that women now have private bathrooms, tubs (I wonder if women are even allowed to use them?), and nicer accommodations.  I don’t think anything has fundamentally changed to make birthing healthier for women and babies at our hospital.  If I’m wrong, I’m happy to update this post at any time.  Our docs participate in a town-wide on call group.  What this means is that if you don’t birth your baby during office hours or during your doctor’s on call duty, you’re not likely to have your doctor help you birth your baby.  There are a few doctors that this does not apply to, and the key is to be with one of them.  Our medical community “killed” the birth center established by Dr. Montgomery, but kudos to Jeanne Hebl, CNM for establishing a successful homey birth center after Dr. Montgomery’s untimely death.  By November 15, 2011 Hebl’s birth center had assisted with 100 births.

3.  Women (families) in this town don’t know that they are “allowed” to have an opinion about birth much less how to have the birth experience that best suits their needs and wishes.  This is where I feel like I failed.  For example, when I was planning my HBA2C I ran into an acquaintance whose wife was getting ready for her 3rd cesarean.  They were told they weren’t allowed to do a VBA2C in Missoula.  I didn’t birth my baby at home, much to my surprise and chagrin, but I did have a most unlikely and uncommon VBA2C at the local hospital with a very good OB who did his best to scare the shit out of me during my appointments.  However, when push came to shove (literally) – HE WAS THERE.

Support for women and families in this community will always be there.  I hope families continue to seek out the best birth experiences that fit their needs and their dreams.  I will continue to offer support when and where I can.  And VBAC/CBAC support in Missoula does have a Facebook presence.  Click here to reach our page.

Here’s a recent picture of my amazing VBA2C baby:

My precious VBA2C baby at age 23 months

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.

Birth Snapshot: The Epidural

Labortrials got an epidural?!  Oh me oh my.  Yes, friends, I consented (begged for, even) to the bleepin’ epidural.  How did this happen, and how do I feel about it now?  Well . . .

I arrived at the hospital worried that something was wrong.  The labor contractions came fast and painful, and I knew that less than 24 hours previously I was not dilated but a smidge.  I also felt as strange ‘pop’ down there and knew it wasn’t my water, so that in conjunction with the scary contractions (tetanic, perhaps) sent me packing to the hospital quickly.

The OB arrived, checked me, and found me to be 2cm dilated, but the baby was high.  According to the monitor, the baby was not handling the contractions well.  (She was having late decelerations.)  The OB restricted me to laboring on my side; the labor nurse told me I had to relax my body in order to dilate.  The contractions really were more than I could handle with the position restriction.  The OB checked me a few hours later, and I was still stuck at 2cm.  I knew that as soon as I could get an epidural that I needed to have it put in.  There was no way I was going to withstand the contractions, restrict my movement, and relax enough to dilate without pain management.

Interesting that this evening on my twitter feed, I saw @RobinPregnancy’s tweet about epidurals:

Did you ever have an #epidural that didn’t work quite as well as you’d hoped? http://ow.ly/6ejKI #pregnancy #About

I had an intrathecal with an epidural placed.  The idea was that the intrathecal could possibly get me through the next several centimeters of dilation more quickly and would wear off.  If and when I wanted the epidural, it would be ready and waiting for me.  The intrathecal improved my quality of life dramatically, and indeed I did progress quickly from 4cm to 8cm dilation.  Then I got stuck at 8cm and for a few hours, so I wanted the epidural.

However, the epidural was slow to work, and when it did, it didn’t provide enough relief.  My labor was not progressing very well, so I was concerned that if the epidural didn’t work and I needed a cesarean, that I’d feel the surgery.  I was terrified, actually.  This caused me to over-react.  The anesthesiologist gave me a bolus of something (yes, it’s horrible that I can’t recall this information), and when that didn’t seem to give me enough pain coverage, I received another bolus of something (nope, can’t remember what that was either).

So, when it came time to push, and thank God I got to that point, I couldn’t feel a darned thing.  I could sense when a contraction was beginning, but that was about it.  I had some sensation in my toes.  I had no idea where my vagina was or how to push.  That was terrible.  My OB was a tremendous labor coach, so he talked me through every contraction . . . every push.

Ideal?  I suppose that depends on how you look at it.  The purist in me says “technically, you had a vaginal birth, but you missed the whole darned thing.”  The practical-ist in me says “honey, if you hadn’t gotten that epidural, who knows if you’d have dilated quick enough for the OB, or if the epidural is what helped calm the baby’s response to the labor contractions (stressed mom can lead to stressed baby), or if you would have outlasted the pain.”  No one made me get an epidural.  I told them on entry that I wasn’t interested, and they left me alone.  I asked for the epidural – it was my request; my choice.

People can be sooooooo judgmental about the use (or refusal) of epidurals.  Read this woman’s story over at Unnecessarean.  Don’t miss the comments which are QUITE polarized.  Given what I’ve been through, you may laugh at my comments.  Would I recommend an epidural to my closest friends and family members?  Yes, with caveats.  Would I recommend my closest friends and family members NOT accept an epidural?  Yes, with caveats.  Would I recommend epidurals for VBACs?  Yes, with caveats.  Is the epidural the beginning of the end in terms of natural childbirth?  Yes and no.  Does the epidural cause a cascade of interventions?  Yes and no.

Yes.

and

No.

Yes, it’s not that simple . . .

Birth snapshot: Two weeks ago today…

Two weeks ago today I was utterly hopeless.  By 1pm I had lost my midwife and pissed off the only medpro that was ‘in charge’ of me.

Two weeks ago today and at this time I should have been getting prepped for a repeat cesarean.  Instead, we called the hospital that morning and called the OB’s office to cancel that surgery.  We felt the surgery was at best premature but more than likely completely unnecessary and scheduled out of medico-legal fear.  The only reason I allowed the scheduling of that surgery was because I didn’t think I’d still be pregnant at 41 weeks and 4 days and didn’t plan on needing an obstetrician anyway!

Two weeks ago today and by this time of day, my husband had called my midwife.  He thought her suggestion to just show up at the hospital on that day (with relatively no labor signs) just to appease the doctor was quite strange.  Little did we know that she no longer felt comfortable helping us at home.  Thank God my husband was able to pull that out of her.  So . . . by this time of day I was that patient who goes against medical advice (AMA) and cancels a scheduled surgery and doesn’t check back in with the OB and doesn’t show up at the hospital during business hours.  And my midwife abandoned me when I needed her and expected her the most.

Two weeks ago today and an hour from now, I took a 2.5oz dose of castor oil that did nothing but make me feel sick to my stomach.  We started getting ready to go to the hospital.  I had no idea what you put in a hospital bag . . . couldn’t remember.  I tried to rest but was restless; tried to sleep but was too wired.  Sleep was way to passive for me at the time – I had walked a big blister onto the bottom of my foot; I had bounced on the ball; I had squatted.  I researched ways to help get my baby better positioned if and when contractions resumed.  I researched post-41-week birth outcomes.  I looked and looked for any justification for a pre-42-week cesarean.  I looked and looked for evidence that stillbirth rates doubled at this point in a healthy pregnancy.

Two weeks ago today . . . by 1:02pm, I had no faith in myself.  I had no faith in my birth community.  I had no faith in my care providers.  And yet I had so much . . . an amazingly supportive husband, my in-laws who dropped their plans and raced up her from Denver to take care of us, my 3 sweet girls, and my cozy happy healthy baby in utero.  Why did it have to be such a hopeless day?