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?

Against All Odds: Gillian, VBA2C

I have neglected to post an announcement about my daughter’s birth.  I was thinking that I would have a birth story ready to post within a few days of her birth, but clearly that is not the case.  Actually, in addition to her birth story, I will be drafting additional posts related to this crazy birth experience and a couple of guest posts for other blogs.  Stay tuned!  For now, here are some stats for your enjoyment, and a picture of my latest love bug.

Gillian, day 2

  • Gillian, born Tuesday, July 12 around 5:30 am
  • 8 lbs, 14 oz
  • 21.5 inches long
  • 15.5 inch head!
  • HARD labor commenced at 7pm on Monday, July 11, about 5 hours after a second dose of castor oil while pumping, at 41w4d gestation, the same day I cancelled the ‘required’ 41.5w cesarean (scheduled for 1:30pm on July 11)
  • About the only thing that was physiologically NORMAL about all of this is that she came out of my vagina and I was not given pitocin (well, not until stage 3)

I must give particular thanks to the women of ICAN and Birth After Cesarean for lifting me up, particularly during the last trimester of this pregnancy.  The last week of my pregnancy was sheer emotional hell, and I wouldn’t have made it through without these networks of amazing women.

My OB: Hello Dr. Jeckyll? Or Is It Mr. Hyde?

I decided to blog about my OB, Dr. Jeckyll & Mr. Hyde, over at My Best Birth.  Here’s an excerpt:

So, I arrive this morning with my husband.  After the nurse weighs me and takes my blood pressure, she tells me to unclothe waist-down.  I then notice the ultrasound machine right by the bed.  “Uh oh,” I think.  Compliant-patient side of me agrees to undress (though I know my cervix is still high and posterior).  Not-gonna-comply-patient will not agree to an ultrasound!

This week, instead of having a big baby, I have “not a very big baby” (based on external palpation) . . . “maybe 6 6.5 pounds right now.”  I’m measuring “right on” (which he didn’t say last week).  Everything looks good.  No worries.  Who is this guy!?  So, a very straight-forward appointment with Dr. Hyde this week.  At this point, I am planning on keeping my 39 week appointment, just so he doesn’t get suspicious of anything.  Suspicious of what, you might wonder?

To read the entire post, click here.

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.

Hispanic Female Pelvises are Better?

My OB said the most bizarre thing today.  At first it didn’t really strike me as bizarre, but the more I’ve thought about it, the more I’ve realized it’s a crock of shit.

I’m not exactly sure how we got onto this topic this morning, but he stated that the Hispanic female pelvis is bigger than the average white woman’s pelvis.  The best birthers are short hispanic women according to the doc.  And then said something about a study in Southern California that I didn’t really pay any attention to.

Let’s just break this down a bit.  According to this post over at The Unnecessarean (July 2010), the cesarean rate in Mexico’s private hospitals is 70% and 40% in public hospitals.  If Mexican women are so much more physically capable of using their pelvises, then why does their cesarean rate exceed ours?  Perhaps pelvimetry is not as much a factor as OBs would like us to think?

The Unnecessarean post, an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010, further points out:

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

None of these cesarean rates support my doctor’s assertion that a woman’s genetic structure has anything to do with achieving a vaginal birth.  According to Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal, other factors are at work here.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

Aha!  I knew it.  I wonder if some jackass OB in Mexico is currently telling his patient that you need to be tall with a Nordic bone structure (my genes) to have a baby fit through the pelvis?  What do you think?

For more information on CPD (cephalo-pelvic disproportion) diagnoses (and what it probably doesn’t mean for you) and pelvises, I recommend:

The Bestest VBAC of All

So I got an epidural for my VBAC.  Get over it.”  What a great title!  You know exactly what kind of story you’re going to read and can even take a guess at the spectrum of responses to such a post.

I think this is an important post to read.  A VBAC doesn’t have to be a fully unmedicated waterbirth at home to be a ‘success.’  Yet, we run the risk of presenting a set of demands on VBAC mamas, and for many if not most this might be obstructive.

My sense of this woman’s story is that she got the epidural knowing what risks and benefits are involved.  If not, then yeah, maybe she got lucky.  My sense of other women’s stories who have had epidurals, is that even though in most women, the risks may outweigh the benefits . . . some women just don’t dilate or labor well without them.  Perhaps we can hindsight quarterback their birth preparation process, but I think that’s a fruitless discussion.

I agree with Andrea’s point that fighting about the best way to VBAC isn’t constructive.  Ideally, we wouldn’t even need to address the “best way to VBAC” if we had a medically-appropriate cesarean rate in this country.  And if “normal birth” (and I do mean natural) has a high degree of variability, so much so that we insist women be left to labor in peace without clock pressure, then we must be willing to accept variability in the way women pursue their VBACs.

Most of us, I would assume, who consider ourselves to be VBACtivists, are working so hard to re-educate women about patient autonomy, patient choice, informed consent, and participating in health care choices, that we start from the position that a woman who requests an intervention such as an epidural during a VBAC labor doesn’t know the risks.  And this is probably how the squabbles begin.

Further, plenty of “die hard” VBAC gals make “natural choices” that I find potentially risky.  I’m pretty specifically talking about the use of EPO for home induction and tonics such as 5w or PN6.  And some women say NO to induction but YES to augmentation.  And some women agree to AROM (having their waters broken).  Some women have their membranes stripped.  And I get it . . . because as soon as you get to 40 weeks, you’re treated as a ticking time bomb.

What will I do this time?  Only time will tell.  But you bet your butt that if I get exhausted laboring at home but think an epidural will help me regain the strength to birth this child vaginally, we’ll hop in the car and accept the the bad with the good.