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?


Choosing the care provider or not…

Unassisted birth (UC, UB) seems like an all or nothing adventure.  “Either you’re in or you’re out,” says Heidi Klum of Project Runway.  No smile.  Somewhat smug too.  I’m trying to sort out my feelings about UC because even though it’s not something I’m likely to do, it is a birth choice and therefore should be studied at the very least.  I read a lot of unassisted birth posts/forums and have gained so much knowledge and strength from it.  I wish I had that kind of confidence and peace.

So, like I said, it seems like UC is an all or nothing thing.  Most care providers (CP) won’t continue to see you for prenatals if they know you’re planning a UC.  (Maybe that’s not universally true, but that’s the impression I’m getting.)  And if you decide to have a UC then it also means that you’re providing immediate care for your newborn.  That seems a lot to ask of myself much less my husband.

My feelings on care providers seem to change by the second.  One minute I’m ok midwife only.  Then I’m ok with planning for homebirth and hospital birth simultaneously.  And then I’m ok with MW and ‘shadow care.’  And then these plans seem so unsatisfactory in different ways.

 The only ‘universal’ is that I want to have this baby as ‘naturally’ as possible.  But I still don’t have any idea how to accomplish this.

I have lots of wishes for me and our baby.  I want it all, and none of it seems like having it all because ‘having it all’ was stolen from me in 2004 with that first cut.  I know even that is still just a perception, not a ‘truth,’ but for me it feels like a ‘truth.’

  • Ideally, I would continue prenatal care with someone – the midwife or OB, whatever.
  • Ideally, I would birth this baby with my husband and maybe a close friend or two but no one acting as a ‘care provider.’
  • Ideally, someone else would swoop in and take care of the baby.

My ‘ideal’ may have to remain on a pedestal.

Birth Witness: My Friend’s Amazing Birth

My girlfriend gave me an extraordinary gift last week.  She’s had a complicated pregnancy due to polyhydramnios, and no one thought she’d actually make it to term.  She did!  And I witnessed it!

She and her doctor decided that induction was appropriate.  I certainly wasn’t going to pass judgment on that given all she had been through.  When she went in for induction, her fundal measurement was 48 weeks.  Bless her heart.  Of course I worried about her and hated that I had to be at work while she was being “treated.”  She was induced early in the morning and had her water broken around 2:30pm in the afternoon.  I was concerned about that decision since we all knew the baby wasn’t engaged at all.  That could have caused cord compression and/or prolapse which would have been a quite route to a cesarean. 

Pitocin was of course used to increase her contractions, and at some point, the pain became unmanageable, so she was given an epidural.  I think it was a pretty good epi, because she still had a lot of sensation in her legs and pelvis.

I arrived around 7:30pm to keep her company.  She was quite nauseated, poor thing, because she does not tolerate medicine well.  She had been checked at 7pm and was only 4cm dilated.  I don’t think anyone was very happy with that progress.  However, her nurse was very supportive of my friend’s desire to avoid the cesarean, but of course, since my friend couldn’t really move, the way she was supporting this goal was through medical management – increasing pitocin, increasing the epidural to cope with the pain, flipping my friend side to side (when the baby’s heartrate ‘allowed’). 

We were all very pleasantly surprised when she was about 6 or 6-1/2 by 8:30pm or so.  She was becoming more uncomfortable, and things started to progress much more quickly.  Her hubby called her mom and told her to hurry on her way.

Soon after, my friend started to feel pushy.  It was pretty exciting.  The nurse delayed calling the doctor because she assumed it would still be a while.  (I guess you don’t call the doctor until you’re really sure . . . Her doc wasn’t on call but was still planning on delivering the baby.  Good on him!)

Anyway, lo and behold she started making progress rather quickly, and I swear it was no time before you could see the baby’s head.  It was amazing for me as an observer since when I arrived, she was feeling pretty certain that the baby wasn’t making adequate progress.  And it’s not like anything active other than medical management was being done for her to encourage the baby to engage. 

At some point the nurse told her to stop pushing.  Yeah right.  As soon as the nurse left to call the doc, I told her to go ahead and push.  There were plenty of people around there who can catch your baby.  So she went on about her business.  I was surprised that she was purple pushing (pushing to counts of 10), but it seemed like she wanted someone to count, so that’s what was done.

The doctor arrived and told her to slow down.  I didn’t get how wise that was at that particular moment.  But he told her, and I’ll remember this, “let it build, and then push when you can’t resist.”  All in all, I think she pushed for about 45 minutes, and she only needed 2 stitches.  Because he was encouraging her to control her pushing, she didn’t tear badly.

The baby emerged – first the head, of course.  I left my position by my friend’s head, grabbed the family’s camera, and started taking pictures.  I don’t know if she’ll appreciate having pictures of a baby sicking out of her vagina, but man, it was the most beautiful thing I had ever seen in my life.  It seemed like the shoulders were a bit sticky, but they freed eventually, and the rest of the baby slid out easily.  A beautiful big cord hung from my friend’s body.  The baby had a huge conehead – the head really had to mould to get through my friend’s pelvis.

The baby took a while to come around.  I was distressed that they weren’t bringing the baby over to my friend very quickly.  It seemed like they were doing a LOT of unnecessary stuff.  My friend kept asking for him.  I’m not sure she even got to see him for 15 minutes or so.  Ick.

Stage 3 of labor was over-managed, in my opinion.  The OB applied traction to the cord.  An enormous placenta came out.  It was impressive!!  The OB then began externally massaging my friend’s uterus.  I don’t recall what else was done to/for her.  I was more focused on her emotional state and the baby. 

We were all amazed to discover that the baby was 9lbs and 15.4 oz!  No wonder the baby’s head was so pointy.  I am so glad the doctor encouraged my friend to adjust her pushing strategy.  In the end she only needed 2 stitches!  Amazing.  With the cone, the baby measured 24 inches long.  He was so beautiful.

Mom and baby were finally united, and he was latching on within minutes.  I left soon after to give the family some private time to bond.  I had a hard time going to sleep I was so “high.”  I figured I’d be an exhausted puddle of a woman the next day, but I was still “high” from her birth.

I can’t adequately verbalize how much it meant to me to be there as a witness and as a support person.  I don’t know that she really needed me there, but she knew I needed to be there.  As I write this, I am tearing up.  I’ve never seen or experienced a vaginal birth.  It was such a marvelous thing for me.  And it’s helping me “see” my own upcoming birth.

I’ve studied birth.  I’ve watched movies.  I’ve watch natural birth videos on YouTube.  But there’s nothing like being there in person with a laboring mom.  There’s no substitute for seeing a new person emerge from someone’s body.  And now I am bonded to birth – this experience can’t be taken away from me no matter what happens in the next few months.

The Few Minutes I Remember

I was just reading A Day They’ll Never Forget from the Giving Birth with Confidence blog.  It’s wonderful to read stories like those – truly beautiful, uneventful (in a good way), unencumbered births.  I can’t relate to them at all, but I still have hope.

In stark contrast to these four womens, my children have been cut out of me.  I don’t remember all of the details of their births, and I never will.  Is it because of the anesthesia?  Is it because a cesarean section is a traumatic experience for the body . . . and the mind?  So many people just don’t seem to understand that it should be fairly uncommon for a woman to need to have major abdominal surgery as a result of trying to birth her babies.

My water broke just short of midnight one night in August 2009.  I was trying to get comfortable enough to sleep, but Baby A had been making that quite difficult for some time.  This night was no different.  I piled pillows up and tried to lie down in a modified child’s pose.  No sooner had I settled, Baby A started moving vigorously and with a swift kick, obliterated her amniotic sac.  I cried out – “They’re going to cut me open.”

I had hoped that Baby A would turn back from breech before they were born, but breech presentation was confirmed at the hospital.  I was prepped for surgery.  This is the end of what I remember clearly.

You Know You’re a Homebirther When

  1. you find yourself zealously defending the CPM/DEM designation and probably come off as a bit of a wingnut!
  2. you get pissed off just thinking about the horrible things that OBs and nurses (for God’s sake) have said to women who have had to transfer from home to the hospital
  3. you get even more pissed off thinking about the birth that screwed everything up for you (not altogether in a bad way) and your childbearing years
  4. you have this idea to become a doula . . . or worse yet, a homebirth midwife
  5. you have this even crazier idea to leave your day job with full benefits to become a homebirth midwife
  6. you have this even more insane idea to move to Canada or some other country with a better health care system to (a) have your babies and/or (b) become a homebirth midwife
  7. you recognize that malpractice insurance does NOT make birth more safe
  8. you realize that you have to take responsibility for your own choices in pregnancy and in birth – from the Costco dipped icecream extravaganza I ate for dinner tonight (oops, not one of my finer moments) to where you’ll have a baby and with whom and what you’ll allow this person to do for (t0) you as your birth; all of these choices have consequences (hello reflux) . . .
  9. you want everyone to know about homebirth for what it is . . . not what mainstream America assumes it is (been there, done that)
  10. you want families to understand that their choice of careprovider(s) is such an important decision (OB doesn’t mean superior to CNM superior to CPM/DEM; these are very different designations with very different training requirements and very different mindsets; know what you’re getting yourself into!)
  11. you can no longer ignore the voice inside that says . . . “the last thing I want to do is leave my bed and go to the hospital” – I ignored that voice six years ago; now that the option is presenting itself to stay home, I must listen to my inner Truth, pray for God’s blessing and protection, and trust that His Will will be done.

edited to add a point and adjust some “tone”

Pregnancy Update: 20 weeks

I had my 20 week ultrasound today.  I was thankful that the baby looks healthy and is measuring consistent with her “due-ish date.”  Yeah . . . her.  This is my fourth and final baby.  This is also my fourth and final baby GIRL.  My poor husband.

Many concerns were ruled out today.  At my “advanced” age, and after several losses, and after three perfect children, I was sort of anticipating something “different.”  Different, how, I wasn’t sure.  But I wasn’t feeling like it was going to be different good.  The previous indication of an anterior placenta was wrong – my placenta is high and posterior.  I’m thrilled.  All of the measurements were good.  Nice looking spine.  Nice looking skull.  Nice looking upper lip.  Nice looking kidneys and stomach.

So, as far as I’m concerned, I’m done with obstetric care unless something develops that necessitates that type of care.  I can’t wait to talk to my midwife!

Can’t say anthing nice

I have been a quiet blogger as of late . . .

I’m what?  19 weeks pregnant at this point?  I’ve lost track.

But I just can’t really say anything nice right now.  Everything I want to blog about right now is some sort of tirade.  In fact, I thought about authoring a post with the title, “Eff Off, I’m Gestating In Peace, Dammit!”

Can someone explain this to me?  Maybe I’m having a boy?  Or perhaps I’m just reacting to the insane interpersonal stress I’m experiencing at work – I don’t deal well with abuse.  Or maybe it’s the bizarre dreams I’ve been having lately – two of them have involved losing my baby.

Anyway, lots of feelings . . . and most of what I can share is stupid, inane, or negative.  So, I’ll shove a sock in it.

Off to find my happy pants! 😀