Choosing cesarean limits future choices

I was irritated to discover that Time magazine published an article entitled “Choosy Mothers Choose Cesareans” in their special Environmental Issue. Since cesarean surgery is an over-used procedure[1], it is quite inappropriate for this type of article to appear along-side articles dealing with the Presidential candidates’ climate change positions and how the US can be more green.  Needlessly consuming medical services is anything but green, and Time magazine should take responsibility for its poor choice in content.

According to the article, more women are choosing cesareans, a trend doctors expect will continue.  I do not know nor have heard of anyone actually choosing a cesarean, save the stories I read or hear about through the media.  I believe that the media is creating this belief that women choose cesareans, and that this is a trend we should expect to see continue.  But perhaps it is true that women are choosing major surgery for reasons cited, such as (1) fear of ripping/tearing the perineum, (2) fear of incontinence, (3) fear of pain, (4) fear of birth, (5) or fear of having a stretched-out vagina.  Time‘s article feeds into the misperceptions of birth generated by Hollywood blogs and reality shows like A Baby Story.

Fear of ripping/tearing:  from what I have learned over the years, women rarely rip or tear during childbirth if they push following their body’s signs, are given appropriate time to labor and birth their babies, and/or have the perineum massaged or supported during pushing.  Episiotomies can cause more damage to the perineum, vagina, and anus than a natural tear anyway.  I wonder if this fear stems from botched episiotomies?

Fear of incontinence: cesarean delivery does not prevent incontinence.  Sorry!

Fear of pain: I wonder why so many women are taught to fear the pain of childbirth.  Granted labor was one of the most challenging things I have ever done, but I think my exercise habits and outdoor enthusiasm (road biking, hiking, backpacking, running) had prepared me for childbirth.  I don’t look back on my labor and regret the pain – I regret the fact that a cesarean became necessary.  Anyone who has done a little bit of study on the purpose of pain in childbirth can tell you that it is actually beneficial – it can indicate problems that need attention as well as provide important feedback to the mother and her careproviders regarding her progress.

Fear of birth: there actually is a term for women who have a fear (phobia) of childbirth – lockiophobia.  If a woman is not phobic, then she should work with a psychologist or psychotherapist to determine the root causes of her fear and overcome those.  Pregnancy can bring up psychological pains of the past, but they are not avoided through cesarean surgery.

Fear of a stretched-out vagina: do I really need to address this?

The title of my post suggests that cesareans will limit future choices.  This is true – women who have had a cesarean are at risk of being pressured into repeating surgery for future births, have a slightly more elevated risk of uterine rupture and other poor birth outcomes, are unable to have normal birth at most birth centers [2], may not be able to have a normal birth at their local hospitals [3], will be pressured to comply with hospital protocols that may lead to interventive birth outcomes for future births, may have difficulty finding providers who will support their choices in future births to name a few limitations.

Other things you may not know about cesarean aftermath [4]

  1. Risk of post-partum depression and post-traumatic stress disorder
  2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
  3. Stillbirth, miscarriage, infertility
  4. Pain, adhesions, slow recover, unsightly scaring
  5. Negative impact on relationships with other family members, particularly partners/spouses
  6. Rejection of birth – some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape

Thankfully I have come to learn about the viability and appropriateness of vaginal birth after cesarean.  I was encouraged to subscribe to the ICAN Yahoo list where I learned much of what I know now about birth that I didn’t know before my daughter was born.  I know the dangers of choosing cesarean for the first, second, or fifth time.  I have experienced stress, depression, and other tangible and intangible outcomes related to cesarean surgery.  I worry that my current trouble with recurrent pregnancy loss is related to the cesarean.  I resent that I have to consume more medical services to rule out uterine defects caused by the cesarean.  Tomorrow I will have a hysterosalpinogram performed.

It is regrettable that women such as Ms. Chung are led to believe and accept that cesarean birth is risk free, complication free, and consequence free.  It is simply not the case, and it does not take more than 30 seconds with an internet search engine to learn that much care should be taken when deciding if cesarean surgery is right for a woman and her baby.  The March of Dimes states that cesarean surgery should only be performed when the mother’s life or baby’s life is at risk.  Cesarean surgery is a blessing when used appropriately, but its safety is not justification for indiscriminate use.

[I sent a slightly abridged version of this post to Time magazine's Editor.]

[1] The World Health Organization maintains that an acceptable rate of birth via cesarean surgery is 10-15%.  When the cesarean rate exceeds this range, the risks outweigh the benefits.
[2] To read the AABC’s recent statement on VBACs at birth centers, click here.
[3] Go to http://www.ican-online.org to see if your hospital allows VBACs.
[4] See also http://www.childbirthconnection.org/article.asp?ck=10166; read ICAN’s book, Cesarean Voices to learn how cesareans have impacted real women and real babies.

Inexplicably tough days

Why has today been such a tough day?  I really can’t explain why I am so down in the dumps.  I think there are enough “reasons,” but I must not give in to them.

This morning I woke up somewhat disoriented because DH’s alarm clock is CRAZY.  So, I thought I was already late for the brunch we scheduled with friends, and somehow that set the tone for the rest of the day.  On our way to our friends’ home we stopped at a local bakery.  I ran into a midwife/herbalist who had been helping me before her mother fell ill.  It was the first time we had talked since my miscarriage.  That continued to establish the tone for the rest of the day.

We proceed onward to our friends’ home.  These are our best friends in town.  My girlfriend is now 11 weeks pregnant, and it’s really really tough.  Of course I am thrilled for her and relieved that all is well with her pregnancy.  But I’m also mad as hell.  It’s a hard place to be – for both her and me.  We had invited another couple to brunch who are considering a move to our town.  They have 2 kids, so of course there was lots of talk about kid-related issues, and my friend’s pregnancy, and whether or not we were going to have another baby.

I had a good conversation today with a friend of mine who has been down a different but no less significant miscarriage path.  She forwarded some threads to me that she thought would be helpful.  I decided to put them off until later.

We returned home from brunch and all decided to nap.  I couldn’t.  My brain started processing MISCARRIAGE MISCARRIAGE MISCARRIAGE again.  It wouldn’t stop.  My heart was breaking all over again right there in the bed where my DH & I have tried and hoped for three babies.  We were planning our upcoming homebirth just days before my last miscarriage.  We believed.  We trusted.  We were deceived.

I went upstairs to my computer to work on some outstanding projects.  Instead, I turned to the multiple miscarriage threads that my friend recommended.  I was quickly overwhelmed.  I am meeting with a different OB (one who spends 2 days a week seeing fertility patients) on Tuesday.  I am starting to panic.  There is so much that can contribute to recurrent miscarriage that is not easily found.  It’s also quite possible that no definite cause will be found.  Then what do I do.

I cried.  I cried more than I’ve hardly allowed myself in the past 6 weeks.  Tears were streaming but I was silent.  Don’t want to wake up my slumbering family.  And what might happen if I actually let loose?  I’m terrified to go there.

I stepped into a nastly little debate on-line today about whether or not women who have had cesareans have actually given birth.  It grieves me that women can be so mentally and emotionally damaged from their childbirth experiences, and while I am empathetic, I can’t relate.  Especially not on a day like today when I have been reminded over and over again that other people get pregnant and carry babies to term just fine.  No, cesarean surgery is NOT an optimal way – even when a life-saving mechanism – to have a baby.  But I’d take another cesarean over the madness and hell I’ve been in for the better part of a year.

I feel like I am starting to lose ground.  Perhaps this upcoming visit to the OB is stressing me out.  Perhaps my professionally-insane April is starting to weigh on me already.  Perhaps being behind on so many projects has more than caught up to me.  Perhaps I’m starting into a new phase of grieving.  Perhaps I’m afraid to get over these losses.  But one thing is for certain:  I am not who I want to be right now.

Grief Is

I found this poem today at MDC.  I just have to share it here.

Grief is a quiet thing
Deadly in repose.
A raging horror, a thunder of abuse.

Raucous -
Demanding -
Incomprehensible -
Tearing all that one has ever loved.

Hopeless,
Forlorn,
Fear-ridden and misunderstood;
Ceasing a moment, and through the years,
Returning…to destroy.

To rage
To curse all that is happy -
Or contented,
Or trusting.

To threaten every beauty that is true.

Grief?
It’s a quiet thing.

- Melba Colgrove, from How to Survive the Loss of a Love

Indeed grief is a quiet thing.  In real life when someone asks, “How are you today?!” or “How are you doing?” I am compelled to answer, “Just fine!” or something similar.  People don’t seem to really be asking me if I’m doing better with the expectation that I might actually tell them how hard every day is.  People don’t understand that it’s not terribly easy to just be fine after a pregnancy loss much less after three.  They don’t want to hear about it – not really.

Recurrent Miscarriage Update

I had a follow-up appointment yesterday with the OB who performed the needed curretage a few weeks ago.  I can’t say that I really learned anything helpful from the meeting. 

Pathology on the baby came back normal though apparently no chromosomal analysis was done.  I hadn’t realized that the pathology would only rule out ectopic or molar pregnancies.  I already knew from the ultrasound that neither of those were concerns.  So that was a costly dead end.

Chromosomal abnormalities?  Perhaps, so she recommends testing for both me and my husband.  I assume that we will go ahead and do that.

Progesterone deficiency?  Perhaps, so she recommends taking Clomid when I’m ready to conceive again.  I was not previously aware of using Clomid to treat potential progesterone deficiency or apparent “luteal phase defect.”  Since I ovulate on our around the 15th cycle day, I don’t think LPD is my issue.   However, I’m not ruling out some sort of hormone imbalance.  When I’ve had HCG levels tested, those numbers have been just fine.  But I’ve never had my progesterone level checked, and this OB wouldn’t do it anyway even after Clomid treatment.  I find that odd.  What if the Clomid wasn’t quite enough to sustain the corpus luteum until the placenta takes over?  Wouldn’t it make sense that I could still possibly need progesterone supplementation even after conceiving on Clomid.  (Remember that I have no conception problems; I’m just “failing” to sustain pregnancy right now.)

Immunological problems?  Not suspected though I am inclined to disagree.  I have a history of endometriosis, depression, low energy, and adult onset acne, for instance.  My mother has rheumatoid arthritis which is an auto-immune disease.  I rarely feel particularly “great,” but then again, given what I’ve been through this past year it would be hard to identify a great day even if it was right under my nose.  I found the Reproductive Immunology Associates’ information on miscarriage prevention to be interesting, encouraging, disheartening, and overwhelming.  I will pursue some of these ideas with local care providers.

Next month I will follow-up with another OB in town.  I may also go see an endocrinologist who has been recommended.  There are evidently fertility specialists as near as Spokane, so perhaps I should be contacting them?  I have so many questions, and I don’t know if I’ll ever find answers.  That’s perhaps the scariest part.  At this moment I think I could deal with being told that trying to conceive again would not likely be successful for X, Y, or Z reasons.  We do have one incredible child, and I might be inclined to consider adopting from abroad.  But to have to deal with the unknown is what really worries me.  Three miscarriages in a row “just” bad luck?  How will I overcome that “diagnosis” if it is the most likely deduction?

Time will tell.  Each day is different.  Some days are ok and some are not.  I am living moment to moment, hour to hour, day to day.  Planning ahead for anything is excrutiating.  But “ahead” will come whether I like it or not, whether I can deal with it right now or not, and whether I can deal with it then or not.

Aimless

I hardly know what to do with myself.  My normal internet activities have been disrupted by my miscarriage, and I find myself wondering what I’m supposed to be doing when I get onto the internet.

I can’t visit my “December Darlings” because they have what I don’t – growing families.  That may seem strange and selfish, but I just can’t deal with seeing the absolutely adorable pictures of my friends’ children.

I can’t even visit the main ICAN list . . . too many pregnant women there.  Too many women worried about their upcoming birth experiences, something I certainly can’t relate too right now.  Plus there’s the issue of having been told that my effing scar is too thin to attempt a VBAC.  (I haven’t had my follow-up with the OB yet to find out how she decided my fate for me.)  How am I supposed to encourage women to VBAC when I’ve now been given this news?  If my scar (which from the outside looks like nothing) can’t be trusted then how can I tell other women to trust their scars?  I feel like a hack.

I can’t visit Mothering’s forums, MDC.  I did today, but it’s been two weeks since I’ve been over there.  And today seeing the signatures of women whose pregnancies weren’t as far along as mine when I lost my baby . . . aaaa, it really stings.

I’m not in a good place right now.  Not at all.  I don’t feel “healed” in any way.  I’m just more drunk than I was 2 weeks ago.  Wow, that’s something to be proud of . . .

I don’t understand

I don’t understand why people who would kill or abuse children are able to get pregnant and maintain their pregnancies and so many wonderful people are infertile.  You hear stories of babies found dead in dumpsters or sexually abused or beaten or abandoned, and these stories hit me so hard these days.  It’s so unfair!!!

I saw something horrible on CNN this evening and found it again through digg.com.  A woman was caught on tape POWER WASHING HER 2 YEAR OLD CHILD at a car wash.  Thankfully the baby wasn’t physically damaged, but I can only imagine what this toddler has endured at home and how emotionally damaged the child is.  It just breaks my heart.