Monday, December 13, 2010

HAD to have a Cesarean

Ok, so this is controversial, as most things worth blogging, but I'm going for it....

This phase annoys me in many ways..."I HAD to have a Cesarean." Here is why, I'm sure almost every woman says that who has had one. Very few say 'I chose one because I didn't want to vaginal birth'. Though, there are some, few. The reasons and statistics for needing a cesarean equal at MOST 15% of birth, and with good prenatal care, equal about 5-10% of births. So, all the moms who are not in those 10-15% didn't need one.

This is why it bothers me. I feel that a birth for a mother is important. Even when a mom doesn't see the value prenatally, if she does choose to birth vaginally and has a natural vaginal birth, she can't help but feel proud. This is of course if you have a CP who supports birth correctly and not implies that it should be done in hazardous ways (laying on back, in bed during labor, IV, EFM, etc). You just did a miraculous thing, and your body has been designed to peak the levels of oxytocin in your brain so you are more proud, more in love, more consumed with those moments than you will ever be again in your life. Second, birth to a baby matters. I hear women who FINALLY see a baby born without meds and say "look how alert, I've never seen a baby so alert before" Um...yeah, they aren't doped up that what they are SUPPOSED to be like because those same peaking hormones are in baby to fall in love with you and those around at that moment. So...BIRTH MATTERS.

Me, I did have to have a Cesarean. We opted for the best, easiest, safest birth BOTH times with both our babies, and it didn't work out. While it was heartbreaking for me to not get those moments with my babies or my babies' moments with me, given the hand delt, it was safest for both and I wouldn't take it back and opt out of a CS with either of them, because I needed one.

When other moms who not only choose to use this phrase when they had other options, but ALSO KNEW....KNEW KNEW would be safer to avoid one, really, frankly, pisses me off. I feel like they cheat themselves, which yes, is their right, but also their babies, and they perpetuate the myths in the obstetric world that there is more of a need for these invasive surgeries than there truly is.

I feel that it IS low of a mom to opt for an CS because in the moment it is easier (not in the following months though, as recovery is MUCH longer, painful, risky, usually required more interventions, etc) in that moment for her. I feel that when I say that I needed a Cesarean, I'm put in that category as well. The category with moms who says 'well, the baby was measuring big', 'I couldn't before', 'I've already had one/two/three CS', 'I went past my due date', 'I went past 41/42 weeks', 'I didn't past 3/4/5/6/7/8/9 cm in 10/12/20 hrs'. Yes, I am judging, based on facts. I'm judging with the same intent as a mom who says 'I beat my kids because they don't listen'. Yes, I'm judging with the same tone as I would tell that mom, 'that's wrong'.

Now, if you fall into one of these categories, please PLEASE don't think I'm being insensitive. I fell the opposite. I'm being HIGHLY sensitive to moms in MY position, and to the babies that you chose to undergo a quite rough procedure at the very very beginning of their fragile lives. Is it a mom's choice to birth how she wants. SURE, YES, ABSOLUTELY. And by all means, birth how you want. But how about you use terms like 'I chose a Cesarean' 'I didn't wantto vaginal birth'. These are not only statements that express sensitivity to moms in my position, but they are true, and let's all start being honest and stop lying to the general public, because ever time you share your birth story that holds these false claims, you plant that seed in that mom that if she is every pregnant and in your position, she should have the same. Whether you know it or not, you, who speak of free birth choice, emotionally limit her choices.

Monday, October 4, 2010

Annabelle's Birth Story

I'm going to start this, and am even before beginning I have knots in my stomach. I have thought rationally, logically, emotionally, spiritually, and physically have come to many conclusions. All though, agree, this is hard, it sucks, and not fair.

I was a VBAC. I had my first Cesarean with Liam, and swore after going through that, to do everything in my power to not put myself or my baby through that again. If possible, I would do everything I could to bring my next baby into the world peacefully, safely, and with a transition that would leave me feeling empowered and him or her being welcomed into loving arms, and not a team of people who commonly forget they are dealing with two people and not two specimens.

I began before trying to conceive educating myself every way possible, reading, listening, learning, and when we started to talk seriously, I began interviewing. I knew that with the VBAC rates and Cesarean rates in Austin, hospital birth would be possible, but it would be a fight, a stress, and not safest for me. I called 10 different Midwives, some ran birthing centers, some home, and went to 9 interviews with them before choosing. I wanted someone who was skilled, knowledgeable, but understood the journey I was on. I chose Christy Tashjian, who was a Homebirth MW, and who had a Cesarean for her first and then a homebirth for her second and she really understood the path I was on and how much support I would need. She also is the 2nd Vice President of MANA (Midwives Alliance of North America) One of the largest MW groups in the world. She also respected that I was educated, and that I wanted to make fully researched decisions out of safety and out of empowerment.

We ate right, exercised, de-stressed, and I did all the work I possibly could. I went to ICAN meetings, and found our Doula Brielle there. She was amazing. Through my journey I was convinced I CAN do this, and I WILL. I kept my weight down, and hers too.

Our Due date came and went...and became further and further in the past as we approached 43 weeks. Any OB practice I could have gone with would have put serious pressure on me to induce, which being a VBAC, would be very dangerous, or have a repeat Cesarean, which I knew was far more risky than waiting for labor. Beginning Thursday night, we had prodromal (commonly called 'false') labor all through the night. The it would stop during the day. Liam was thankfully in Dallas with Phillip's parents, so we were able to cope well with the adjusted sleep patterns. Finally, Sunday night, it felt much more intense. Monday morning I called our Doula (for the second morning) and prayed she would not have to go home and I would end up with a baby by the end of the day. I labored. Phillip was amazing. He stood by me through the whole thing, and even when I went to the bathroom, he stood by the door as I contracted on the pot supporting me with loving encouraging words. He said "If you don't sleep, I won't either". At one point, on Tuesday I had a very intense vaginal exam, where we found my cervix was still posterior, so Christy held if forward through a contraction while I gently pushed to get the baby to move down and hold it forward. It left me quite shaken as it took me back to when Liam was born and the treatment we got at the hospital, and panic set in when I felt out of control. I got back in the tub to cool down and Phillip and I held hands and cried together as we labored on. I felt much more secure being at home with loving support. In the tub my water broke, and we only saw a slight bit of meconium, which wasn't all that to worry about. I didn't want to go on as I had what I call Back Labor From Hell. Which is not only an intense back pain during a contraction, but pain that didn't go away even after the contraction. The contractions were easy to deal with, but that pain in my back was terrible. That was pain. I had been doing this now for over 24+ hours and wanted relief. Brielle came to the tub side and gave encouraging words and told me that I was 9 cm, and I could do this. It was all about bring the baby down. I believed her and I believed in myself. We labored more, I walked around the house, then when the later afternoon hit, hours after the 9cm exam, we needed to re-evaluate. Chirsty suggested another exam, and this time, hold my cervix through 4 contractions. Before the exam Annabelle repositioned and a large amount of fluid came out with much thicker meconium. It's obvious to tell the difference between old meconium which is not really dangerous and fetal distress meconuim, and this was in no way fetal distress. So we did the exam. As much as I didn't want to, I did. It was still posterior. So, we walked more. She suggested we go on a walk around the neighborhood, briskly for about half an hour. We did, and through the contractions, I'd stop, hold on to Phillip and loudly vocalize and he held be strongly in his arms. I really felt like we were doing this together.

I couldn't go on. I said I was sorry, he said not to apologize, but we should go in and talk with Christy and Brielle. We did, I was in tears, and I knew that staying and doing what we were doing wasn't working. I wept more than I think I ever have in my entire life when I talked of going to the hospital and potentially dealing with the stress of last birth, and knowing that if I went, I would go for an epidural, which would limit my chances for a vaginal birth, but that I wouldn't get my peaceful birth as I wanted for my baby and me.

Finally we decided to go. I started having some bleeding that was heavier than I thought was normal. We got packed up, and headed out. The car ride was torture, every bump, every turn, every contraction was like my back was being hit with a sledge hammer. Phillip pulls up to the entrance and Christy meets us there to wheel me up to Labor and Delivery. "I know that car ride must have been hard" she said, I don't think she will really ever know. We get up to the room, start with the IVs and paper work, and I tell the nurse, I really need some relief, I think she could tell that I wasn't just being a wimp, and got me an epidural with in 20 minutes or so. Before that, I had much more bleeding, which Christy showed to the nurse and she didn't seem to think anything of it. I could tell that Christy thought it was something, I thought it was too. Dr. Sorin came in, and did an exam, and said that my cervix was swollen and I was down to a 7 now. He noticed the bleeding, and said it was 'interesting'. We also noticed that her heart tones weren't fluctuating. A baby's heart tones are supposed to go up or down during a contraction or stimulus or movements and her's weren't. This was no 'emergency' but it was non-reassuring and very concerning. He said since birth is not imminent, that a Cesarean would be best. This is the first time those words crossed my mind. I felt like I my emotions collapsed. I asked for a few minutes to take everything in, he comfortingly smiled, said 'sure', and left. I burst into tears. How could I be here facing this? Chirsty and Brielle agreed. Considering the meconium, the fact I was 43 weeks, the heart tones and the bleeding, a Cesarean was safest at this point in my opinion. So we agreed.

Dr. Sorin came back in, and I started to open up, holding back tears of fear of being discredited and began to tell him how our last birth was very traumatic for me, and I wanted to avoid that. He pulled up a chair next to my bedside and asked "What made it traumatic". I felt more secure knowing that this man would help me. We talked with the nursing staff, the anesthesiologist, and Dr. Sorin, and they all agreed to a 'gentle cesarean' of once the baby is out, in the absence of medical problems, to give her straight to me, so I can hold her, breastfeed her in the OR, and then be wheeled back to recovery with her in my arms. I knew my daughter would still have a gentle entrance. I was also allowed to have not only Phillip but Brielle with me in the OR.

They wheel me back. During the shave and the numbness testing we come to find that I am not fully numb as I'm supposed to be. They give me more anesthesia to a point where they can't give me more with out putting me under. They start the surgery, and I feel them kneading on my stomach and they push her out for me. I felt myself scream, but don't remember hearing it. I hear Brielle say 'she's being born', and I hear two small cries. "she's beautiful" Brielle says. They hand her off to the nursing staff and the next thing I hear is "She's not breathing".

Phillip and Brielle are asked to leave, and Phillip goes up to the NICU with her. I'm there alone, dozing in and out of consciousness, and then I see Phillip come back. I'm glad he's there, I can't stop crying at this point, out of pain, fear, sorrow and joy all at the same time. I hear Dr. Sorin state there was a placental abruption, which later he told me he never thought I had had since I presented no other symptoms of it.

Then finish, and I'm taken to recovery. I'm in total shock as I try and absorb all that just took place. The NICU neonatologist comes in and tell us of the situation. She had meconium below her vocal cords and when they began to suction it, she crashed, her APGARS were 1, 4, and 7, very low. They have her on a breathing tube, a nutritional IV, and a tube down to her stomach to pump out the fluid. I made small talk to try and get my mind off what happened to just get away for a bit.

We get to postpartum and then things slow down. We have a very up beat, friendly nurse who offers me a sandwich and tells me that even though it's in the middle of the night, I only have to be on bed rest 8 hours before I can get up and go see my baby. I'm thrilled even though I know that means it will be 2:30 in the morning, getting out of bed after major surgery, and wheeling and some walking all the way to the NICU. I have no idea what she looks like, how big she is, or anything, just know I'm going to finally meet my baby.

I get there, am told I can't hold her, but they let me pick her up above her bed so they can lay a chucks pad down for her bath. The nurse says most parents don't want to pick up their baby with all the wires and cords, I couldn't fathom how one could resist.

To make a long story not as long, it wasn't till day 3 that I was allowed to actually hold my daughter. I could look, touch, but not hold. Day 4, I could breastfeed, every 3 hrs, and their 'for only 30 minutes a feeding' turned into an hour. So every 3 hours, we made our way up to the NICU, fed for an hour, and then headed back to eat, shower, sleep, make calls, etc for 2 hours before heading back up. She later got to room in, but that was still hard, as she had antibiotic rounds she had to have every 12 hours, and her IV flushed every 4 or so.

Finally we went home.

Was this typical? No, I hope not at least. Could any of this have been prevented, no, not that I know of. If I had to make the choices again, I would still choose everything. Our MW had a great point that while this was a crappy birth, it's the prime example of what Midwifery care is. You have very interactive, supportive, loving prenatal care, supportive labor, and then, if you feel things need further assistance, a transport to the hospital, and great obstetric care when and as needed. I'll give that notion more thought, as I feel it's the only 'good' that came out of the birth experience.

The best thing that came out of the birth is my little girl. She's beautiful, smiley, and while a decent sleeper, she is healthy, and here and in my arms.

Do I feel differently about the birth than I do her? Yes, I love her, I hate her arrival. If she could have been born another way, I would prefer that, but not over her being here now. BUT, I still grieve the loss of birthing my baby. Something I do hold dear, and something that does leave me broken and sad. That's another post though. Am I allowed to feel that way? Yes. Is it okay to feel that way? Yes. Does it change the way I feel about her? No. Does it mean I'm ungrateful? No. It simply means I value and understand the importance of a peaceful birth, and wanted that for me and both my children and I'm sorry I couldn't provide that for them, but know that I did try everything in power to give them the best, and that's what I plan on doing for the remainder of their lives.

Thursday, August 5, 2010

Big Baby

In light of being pregnant again and previously given birth to a 9lb 8oz baby, I found this topic extremely interesting as I didn't realize how different view points could be. I ran across this briefing/study/data/whatever you want to call it and found A LOT of the info on here VERY thought provoking.

It's really really long, so I'll sum it up on the topics I'm going to talk about.
1)A baby born with weight below the 10%tile and above the 90%tile is considered 'abnormal'. Baby's between the 10% and 90%tile are between 7lbs 3oz and 9lbs 6oz. VERY broad range! No Liam really wasn't all that massive as some thought (mainly the OB who made it very clear while sewing me up that he was such a HUGE baby, I politely asked her to stop and after a glance at the other OB and nurse didn't say anything else)

2)Ultra-sound is NO BETTER at guessing baby weight than your care provider palpating on your belly. Personally, I would venture to say that Midwives are better at guessing baby size based on feeling on mom's belly because they don't use ultrasounds unless medically necessary, and as we all know (even ACOG) finding out the baby's size IS NOT a medical necessity, so it's therefore IT'S NOT recommended to have an ultrasound for this reason alone. EVERY HEALTH ORGANIZATION STATES THAT DUE TO THE LACK OF KNOWLEDGE OF THE EFFECTS OF ULTRASOUND, THEY SHOULD ONLY BE USED WHEN MEDICALLY NEEDED. (Yes, this means, not just because you got a positive test, not because you are 20 weeks, not because you are 37 weeks, etc) But this can be a whole other post.

3)When studied, estimating baby size by ultrasound, estimations are off by less than 10% of the baby's weight a little less than 60% of the time. This is HUGE! Basically, if your ultrasound says that you have an 81/2lb baby, there is a 60% chance your baby is actually between 7lb 10oz and 9lb 6oz. And there is a 40% chance the ultrasound is off by more than that, in either direction.

Why is all this important?
Well, today, there is a HUGE 'BIG BABY' scare out there for pregnant women, and I think it's sad that women are scared at anytime in their pregnancy, and I think further, care providers (including some Midwives) push to 'get the baby out' sooner rather than later, so a mom makes an emotional decision based on fear of 'not being able to birth her baby' and consents to either early induction and/or cesarean. Why are these things bad? Well, again that's another whole blog.

Can a woman's body build a baby too big for her to birth?
Yes, in some cases, yes. For instance if she has polio, rickets, dwarfism, extreme pelvic injuries that leaves her pelvis severely traumatized or scared, then her pelvis may be too small to birth her baby. Most women don't have these. OR if a woman has a really really really crappy diet, which commonly leads to gestational diabetes (as these moms typically have bigger than average babies). By this I mean, eating pints of ice cream a day, not eating veggies for fruits practically ever, surviving off of coca-cola and bacon and sugar for the entire pregnancy, you get the point.

What reasons does a care provider have to be afraid of a 'big baby'?
Well, they say shoulder dystocia. This is where once the baby's head is past the pelvic outlet, one of the shoulders get stuck, and since most women in a hospital have an epidural, the maneuvers to get baby out are limited and usually it's pretty invasive for baby to get baby out. Here's the kicker, only 50% of shoulder dystocia cases are with babies larger than 8lbs 15oz.! So just because your baby is big(ger) doesn't mean you will have this problem. In fact, you are just as likely to have this problem with a baby smaller than 8lb 15oz.

Why do care providers think an 8lb-9lb baby is 'abnormal' when it's really NOT?
Well, years ago, like when our moms were pregnant, a 8lb baby was quite normal, even a close to 9lb baby. We women haven't changed in that short time and neither has the size of our babies, so one must think that it's the thinking of the care providers. Today there are MANY MANY more early inductions and cesareans before a women goes into labor herself. The reasons vary, and most are not reasonable. So if babies are being born EARLIER, their sizes are going to be SMALLER. Now, this varies from practice to practice, so, one care provider may say 'oh yeah a 8-9lb baby is normal' while another says 'I've never seen one that big! 6-7lb is normal!'. I bet the second CP has a very high induction and cesarean rate, or just really unhealthy moms.

How should we be measuring 'normal'?
This is all my opinion, but I do feel it makes a LOT of sense, and I'm going to compare a typical MW practice with a typical OB practice.
MWs focus on healthy living. This includes a diet high in water, protien, fruits, whole grains, veggies, low in sugar and flour, especially white sugar and white flower. They don't really focus on weight gain if a mom is eating healthy. They also focus on exercise and getting some type of workout through out the week to move your body to burn off calories. Even if you weren't exercising before pregnancy, they will most likely tell you it's a great idea to start walking a few days a week around the block to your comfort level. Due to this focus, very few moms become high risk and develop things like eclampsia, gestational diabetes, IUGR, fluid issues, etc. Now, Midwives, (talking specifically about out-of-hospital Midwives) don't induce, wait till the mom goes into labor, don't do cesareans, but most midwives don't consider a 9lb-10lb an issue. Oh, and most MWs don't run into shoulder dystocia as they allow women to birth in pelvic opening positions, and if they do, they simply change the position of the mom and no more invasive intervention is needed.
OB, of what I know and in my experience and in the experience other women have told me, don't do so much diet counseling. Of course they say eat healthy, etc fruits veggies, etc. But they don't typically hold moms accountable and have them actually list out what they ate for a week/month to really see what that mom considers 'healthy'. During prenatal visits, not much is talked about diet, when it is routinely with MWs. The current recommendation is, if you weren't exercising before pregnancy, don't start now. Ok, I understand don't start marathon training, but DO get off the couch and walk at least, especially if you haven't before! OBs typically have a higher rate of eclampsia, gestational diabetes, fluid issues, growth issues, etc due to this lack of focus, which commonly leads to low weight/not the right kind of weight issues in a newborn. OBs obviously do many more cesareans, inductions, etc. So therefore, an OB would see many more smaller babies. This explains why I was told 'WOW! LIAM WAS HUGE!' When really, he was no bigger than most moms' babies were small.

Here are some interesting blurbs from other women who were given the big baby scare, and some turned out much smaller than expected...dangerously small. Keep in mind 'normal' baby size is 7lb3oz-9lb6oz. Smaller babies especially have many more issues than bigger babies.

"For the record, DD was 8lbs 12 oz and 21.5 inches long. About a week before her birth, ultrasound estimated 9lbs 3 oz.....doc was worried about a "big baby...I do however, believe that the "Big Baby" scare is way out of control and that most women will not create a babe that is too big for them. I especially think that women should at least give there bodies a chance to try....they might even be surprised!"

"With DS, my ob did an ultrasound right around 39 weeks. US showed baby 9 pounds plus or minus a pound. She pushed and pushed and finally got me convinced to induce. Since it was my first and this was a newer dr because of a move, I felt like I was doing something wrong by not listening to her. My birth went okay, as in I didn't have a c-section or anything, but I still had a harder labor because of the induction which included pitocin and an epidural. "

"With my first, they induced because they thought he was going to be 11 lbs or more, and they did repeated sonograms to check. He was 8 lbs 10 1/2 ounces at 40 weeks.

My SIL was told that her baby could be induced at 37 weeks, because he was already 7 lbs (according to ultrasound) and that his lungs looked mature, but sure enough, he was 4 lbs 11 ounces and not at all ready when he came out."

"Now if they had something else like the baby is jumping in size (like gaining 5 lbs) and wasn't purely based off of u/s I might support it. Or if they thought the baby was going to be like 14lbs, yeah I can see it. For me personally I just happen to have big babies. ODD was 7lbs 14 oz and she was 2 weeks early (induced because of hbp). Ydd was 9 almost 10 lbs. "

"Oh I forgot to add that my ob pushed and pushed to induce my 9 pound plus or minus baby...3 days later he was 8lb 1oz. Hmmm...really glad I am not seeing her again! "

"Before I delivered ds 2 the midwife kept telling me that my baby was going to be very small. She said I was measuring very small, and the U/S showed him to be 3 pounds at 38 weeks......Um. he was born at 39 weeks weighing 8 lbs 3 ozs and 22 1/2 inches long!!"

"My SIL was sectioned at 37 weeks because they told her the baby was too big and running out of room to grow. She is 230 lbs pre-pregnancy and not a small-framed woman. Baby was 4lb13oz at birth. My sister was "overdue" with her ds and was induced at 41w3d for dr convenience (not size at least). Ultrasound at 40 weeks "showed" baby was about 8 pounds. He was born weighing 6lb3oz. Their guesses and "proof" are so inaccurate. "

BELIEVE IN YOUR BODY! Baby's are really quite squishy and mold very easily (if positioned right) and pelvises are really quite stretchy too (if your in a good position during labor and pushing)

Oh, BTW, ANY care provider that says, baby is getting too big, we should induce, as them what ACOG says. They are the ones that mandate the recommendations that should be followed, and even THEY say inducing or scheduling a cesarean for a baby thought to be macrosomic (over 8lb 15oz) IS TOO RISKY and should NOT be done! I would be hesitant to continue my care with an individual who bases their practice on experience alone and not on recommendations that come from more experienced sources.

Tuesday, June 22, 2010

Is it really "medical"?

I've come to discover that our society has a very poor understanding of birth, and that is why we rank 42nd (yes there are 41 other countries better than us) in infant mortality and 35th in maternal mortality. It's so sad. We are such a wonderful country with foundations of great knowledge and experience, research and data, and yet, we still butcher something as simple as birth.

I love the fact that midwifery care is so preventative. As in, we want to spot complications early, to treat them early, so they go away early. Things like gestational diabetes or Hypertention (Pre-eclampsia), breech positioning, low/high amniotic fluid, etc. And they can do most of this preventative care by counseling or simply feeling on mama's belly. For gestational diabetes, it's probably the most invasive, and that requires a finger prick after eating a big breakfast.

Yes, it would be great if OBs were this preventative, but I think THEY think they are. This is why every mom has an IV in the hospital, and every mom is hooked up to the belly strap continuous monitor, and why every mom is encouraged to come to the hospital early....'just in case' they say. Yeah, I know, things DO happen in birth and medical assistance IS needed, and THANK GOD IT IS THERE! But when we say, for example IVs, about oh....3% of moms will NEED an IV in labor/birth, so let's give all moms an IV. Yeah, that doesn't make sense. Especially when there is an alternative of a heparin lock, where you can just hook a tube up to it, and presto, instant vain access. Why are IVs bad, well, they are not 'bad', just not normal. You don't need a hole in your vein to birth a baby. Some moms do if they require IV antibiotics, ect, but when a mom gets to the hospital and just given and IV with no second thought by the medical establishment or HER, that's a problem. It's a medical-izing a process that is not medical. And seriously, how long does and IV take to put in? If it really is "every second counts" then please put me under and get the process going as soon as possible, and IV is the least of my worries. And MAYBE, just MAYBE if you would have actually been paying attention to ME (and not charts, machines, cervical dilation) MAYBE you would have caught this 'problem' much earlier when there was time and prevented the whole thing in the first place.

So, I ask, it is really medical? For some yes. It's been studied (in normal pregnancies, not crazy complication prenatally) that birth requires a CS about 3% of the time, and a total intervention rate of about 10%. This total rate include episiotomies, IVs, forceps, coached pushing, vaginal exams, and anything else our mothers years and years ago didn't have.

I'm not going to go into safety, but will say, when out of hospital birth has been studied, it's been shown to have better or equal to maternal and infant mortality, and substantially less maternal and infant morbidity. You can do your own research there.

I find it funny when women say, 'well, in a hospital, everything is right there, so I feel safer." Yes, I would feel safer if everything was right there (which it usually is in a out of hospital birth except for CS, which you have plenty of time to transfer because issues are, again, caught early and better monitored) IF, IF, IF, IF the medical establishment didn't use these things because they were 'right there'.

A woman's body was meant to birth a baby. That's how our very thoughtful maker made it. Leave her alone, support her WELL when necessary, and let her birth. Don't just say oh, you're doing fine, and walk away. Now days, with the brainwashing that has happened towards women and birth, women need much more reassurance than that.

In the past, women were 'put under' with anesthesia and their babies were literally dragged out of them. They woke up later, told they had boy/girl, and were told to rest and they could see baby shortly. Now, we think, OMG, what were we thinking? How could we do that to women? It was so UNSAFE, and we did it without proving it was safe for her or baby, and look at all these problems they had! I wonder if in 20-30 years from now we will say 'can you believe we used to PARALYZE women so they could have a baby? What were we thinking? It was never proved safe, totally went against LOGIC, and look at all the damage it has caused to women and babies?!?!'

OR, in 20-30 years, the medical establishment will have invented this new 'technology' to help us pee and poop. Either way, what we are doing now is not good enough and the safety rates and mortality rates SHOW that.


Tuesday, April 27, 2010

Prenatals Midwife vs OB

Today was our monthly prenatal appointment, we're 22 weeks-ish, and almost 5 months-ish. I found this appointment very interesting though. A friend of mine asked if I needed her to watch Liam while I went and I didn't really understand why at first, so after some thought, I began to really see the difference is the care of a Midwife prenatally, and the care of an Obstetrician. We did in our last pregnancy with Liam go through an OB for the roughly the first trimester, and then switched to a Birthing Center here in Austin. This time we are Homebirthing with a Homebirth Midwife so I feel like I have gotten to really experience all types of care and I can adequately see the differences. So here is a little bit of how our appointment went today.

10:00-got to Christy's office, went inside and waited for her to show up. It's about the size of an efficiency apartment, with queen size bed, fire place, sofa, rocking chairs, massage table, dresser, and a bathroom with a real tub, turquoise tiled, toilet, and sink. Liam went to the toys, she had a few baskets and a few other bigger toys for kids to play with. This must be why a friend offered to sit, OB offices, of what I know don't have these commodities in the "exam rooms" (such a funny term for a pregnancy related room)

10:01-Christy shows up, and we start to chat. She first states that I"m glowing and look very pretty today, even having not showered or washed my face. The first thing she always asks as she plops in one of the rocking chairs and gets comfortable is "So, how are you feeling? What's going on?" We talk about all the issues going on with our families health. Phillip got to talk about his stresses with his dad's health. I talked about my worries of VBACing. She said things like, "I went through the same things", "It's good to cry". "I wish you would have called me when you were feeling down." (For those who don't know, I had an emotional cry fest a couple weeks ago and Phillip was left subject to it). She encourages me, but at the same time, truthfully tells me, how every woman has to find their trust in their bodies themselves, no one can say or do anything that will make them trust themselves. She asks me how I'm eating, sleeping, drinking, etc.

10:15-she check my blood pressure, 100/something I forgot already, it's normal. She asks me to go pee and check my urine, I get to do this myself instead of peeing in a cup and handing it off to a stranger who I always felt sorry for, having to deal with other's excrements. It's normal. I weighed myself, 170, gain of 9 lbs so far. To which she says 'yay!, you gained some weight!'.

10:20-we listen to baby heart beat, it's in the 140's. Sounds wonderful. She asks about baby movements, and I say oh, yeah, moving a lot. Then we start the Arvigo massage. For those who don't know, it' basically helps release the ligaments and muscles that are stressed and stretched in pregnancy. It's a little uncomfortable, but very relaxing. We chit chat through it, laugh and talk about potty training, tattoos, and other stuff.

10:50-we chat some more, she plays with Liam a little, and then let's me borrow a book on empowering, positive VBAC women and their experiences. I felt better.

11:00-we leave

The only thing I would have changed is remembered to pick up some more pregnancy tea. ERRR! I'll stop by tomorrow on the way to the grocery store.

So to me, this is A LOT different than an OB visit. It used to be, go in to office, pay, wait in waiting room where you feel weird if your baby even babbles (if you dare to bring him with that is), get called back, weigh yourself, asked to pee in cup, see nurse, change clothes (why do we need to do this again?) wait for Dr. on table that is weird to sit on, especially in those gowns, it's small, cold, and again, if you make any regular conversational noise, you feel like people are ease dropping on you, wait for OB to come in, have BP checked, lie back and hear baby heart beat (this was always the best for me) for a few seconds, and then helped up and asked for any further questions. This always made me uncomfortable because I felt like I was always taking the Dr.s time, and he was always in a rush. So I limited my questions, and his answers were usually short, and rarely did I dare to ask him to elaborate further. No more questions, he leaves, I dress, we schedule another appointment at the front, and leave. All that (not including waiting time) usually was about 10 min, if that, and usually only 5 of those minutes were with the OB himself.
I always felt "sick". Like they were waiting for something to go wrong, or something to be an issue, with weight, growth, BP, ect. Like me and my baby were a ticking time bomb.

Now, let's talk about what is the SAME:
Medically, everything. They check BP, heart tones, weight, urine, and you get questions answered. I know the OB I saw may have not been typical for an OB, but of what I hear and know, it's just about right. The amount and frequency of the appointments are the same. Once every 4 weeks till 30 weeks, then once every 2 weeks, till 35 weeks, then once a week till 41 weeks if you get that far, and then maybe 2 twice a week after that, depending on what is going on in your pregnancy.
They do all the same tests, all the bloodwork etc. The glucose test which is done at 26-ish weeks is different. The OB will usually have you come in before you eat or drink anything, draw blood, have you drink a sugar orange drink, and then come back in an hour to see how the sugar metabolized, then then draw more blood and usually you will have to wait for the results. The MW, will say, come in about 2 hrs after you eat a big breakfast. She pricks your finger, tests it on a test strip and tells you what it is, and what is normal, and what you can do if it's not. She may have you then change your diet, eliminate trigger foods, and have you experiment on what foods spike your blood sugar. If things are concerning, she will retest, and then go up from there. The reason this is different is because very few women, especially in pregnancy, wake up, and on an empty stomach drink that much sugar. This is why with the 1hr glucose test there are many false positives, basically saying, something is wrong when there is nothing wrong, which calls for more testing, etc. It doesn't read your normal blood sugar. So, if you eat a normal big breakfast, that will tell you what is normal for you, and compares that medically.

Don't get me wrong, there are plenty of OBs who give better wholistic care than most MWs, and there are plenty of MW who give worse care than a typical OB.

I feel like sometimes I take for granted the care and compassion I get from our MW. I am so lucky I have her. This also makes me feel sorry for those moms who don't get to experience their wonderfulness. I truly feel blessed. I really encourage any one who gets to thinking after reading this to go interview a Midwife. It's free, they will take as much time as you need, but generally block out a full hour for you. It's worth atleast knowing what options you have, especially as a pregnant mom, you want to be educated on options and choose the best for you.

Tuesday, March 16, 2010

Poor System

There are women who know these risks that the last two posts talked about, but they are with a Dr. who doesn't "allow" VBAC. Or, they are with a hospital that doesn't "allow" vbac. Austin's VBAC rate is 1%. Very low, and not enough, to me, to feel like I would have success in a hospital birthing. Some moms have then become pushed into a corner for homebirth. Personally, yes, this did influence my decision to HB. Also, I believe birth is an event our womanly bodies were designed for, and yes, there are things that can come up, and most of those can be solved by simply manuevers that a MW can perform. When it is out of her scope of practice, she has the means to stop the complication (like bleeding after birth)to give enough time to get to a hospital to receive medical help. Studies show, it's just as safe, if not safer than hospital birth. I personally didn't care for the stay I had in the hospital, it was weird, awkward, dirty, impersonal, rude, and something I don't think a new mom should have to go through or take her new baby through.

One woman at the conference said, with my first I was induced, it failed, I never dilated because my body was not ready for labor. I ended up with a c/s with my son. With my second pregnancy, the only thing I was told was at your 28 week appointment, make sure you schedule your c/s. I did, and we had a c/s. Now, with my third I am learning so much more. My Dr. put in my medical records that it was an "elective repeat cesarean section" (ERCS). I didn't "elect" to do it, I had no other option presented to me. There are 6 hospitals in my area and 1 birthing center. 3 of the hospitals and the birthing center have "banns" on VBACs, they don't "allow" them. The other two hospitals, that the closest is 2 hrs away, have a VBAC rate of 0.2%. So, yes, they do "allow" them, but my chances of birthing there successfully are almost nothing. If I have to, I'll homebirth, it's not the route I want to go, but I have no other choice.

This is so sad to me. First, women are induced, usually without medical reasons. I say this because when studied, induction IS NEEDED about 10% of the time due to health reasons. In Austin, for example, induction happens about 70% of the time. Elective inductions. And just to let you know, ACOG says DON'T DO THESE. They are too dangerous for mom and baby. You have to have true medical reasons for ending the pregnancy, like pre-eclapsia, severe gestational diabetes, baby life in threat or mom's life in threat. Just because your Dr. offers it, doesn't mean it is safe or recommended. This should be your first warning sign if your OB doesn't follow ACOG recommendations here.
Second, she was never told of VBAC. Simply told to schedule her CS. And then it was put down as "elective". Again, ACOG says to encourage VBAC in any mom with 1 low incision. Again, another sign if your Dr. doesn't promote VBAC, to get a new Dr.
Third, she now has just about no option but to HB if she wants a safer birth. VBAC compared to ERCS for the third time, is a hands down, safer route, especially if you want more kids. I think HB is a personally choice, and one should be very educated in choosing a caregiver that matches what they need and a support system that provides what they need. I don't think anyone should be backed into a corner and given HBAC (home birth after cesarean) as the only option. Sadly, this is what most women are faced with when they find out the facts of VBAC vs ERCS.

What is wrong with our society? There are seriously people who feel that c/s is safer than vaginal birth. They are few and far between, but most now feel that c/s is just as safe as vaginal birth. How arrogant of us humans to think we know how to do something better or as good as God designed the human body. Seriously, I think he knew what he was doing when he made us, and more importantly, there is a reason he did everything the way he did. Scientists, Doctors, Researchers are now finding out that labor is GOOD for the baby and for mom. Labor prepares the baby's lungs to breathe and pushes out the fluid in the lungs to air can come in at birth. The hormones that go one in labor get to the mom and baby, and have a dramatic effect on mom and baby bonding, which in turn, has effect on breastfeeding, postpartum mood disorders, both with mom and baby. Again, it's not a zipper that you can simply open and close with no risk to both parties.


For those who don't know, the National Institute of Health met last week to come up with a consensus on VBAC (vaginal birth after cesarean). They met in DC, and thankfully, the entire conference was available to watch online. After almost 13 hrs of online watching, the finally came up with a decision that, yes, VBAC is safe, safer than ERCS (elective repeat cesarean section) and should be encouraged. This is the same conclusion they came up with back in 1980 and back in 1959 or so. As show, the studies repeat themselves, they show the same thing over and over, so for one to say, there are not enough studies on the safety, is bull.

Let me give you some info you may not have. The reason Dr.s are "scared" of VBAC is mainly due to uterine rupture, when the scar reopens during labor. This is studied to be less than 1% of a chance of happening. Induction and other factors increase these chances. There are no studies only looking at non-intervention moms, ie, no inductions, like cervical ripening agents, pitocin, prosteglandins, pain meds than inhibit mobility, etc. So you can imagine, that if you don't have those, or your caregiver doesn't supply those (like a midwife) then your risk is even lower.

Let's now take a look at other "risky" things in pregnancy and birth. ECV (external cephalic version) when the baby is breech and at 37 weeks they try to turn the baby to head down by pushing/turning on the mom's belly. This is done MANY time in the OB world, and nothing is thought of it. It holds a risk of more than 1% that the the baby will need to be delivered immediately like withing 20 min. The heart rate can plummet and the baby's life (>1% of the time) can be at serious risk. But this happens so infrequently, that it's deemed safer than an ERCS, and a way to opt to a vaginal birth.

Another, CVS testing (Chorionic villus sampling), is done around 11 weeks or so to test for the risk of downs syndrome. It's dome by a sampling the amniotic fluid and testing it. It's similar to amniocintesis only it can be done earlier. This carries a 1% chance of miscarriage. Yet, Dr. offer it to all women, and sometimes, encourage those with twins, advanced maternal age (which is greater than 35 btw, not less than that) or a family history that raises the risk. All of these are questionable reasons to have it done, but it's still a woman's choice. Keep in mind, a miscarriage this early, the baby doesn't survive. Now, with a uterine rupture that happens less than 1%, 6% of those babies will not make it. Yet, there is no fluff, or controversy about CVS, and the risks are rarely mentioned (it wasn't with me at least with Liam)

So, why is it that VBAC gets all this crap? Well, that was brought up numerous times, and the only answer besides 'we don't know' was 'malpractice'. "The only cesarean I got sued for doing was the one I didn't do". A common quote among OBs in the anti-VBAC world. While the average law suit in childbirth is rewarded $5 million, I can see how one would be "scared". Also, in some areas, like South Florida, (where the CS rate is up to 70% in some parts) malpractice insurance to cover the OB in these rare cases is now over $200,000 annually. That means an OB pays $200K for insurance for these just in case situations. If they opt to cover VBAC, their rates go up.

As you may see from my previous post VBAC is safer for mom by far. For baby, it's much safer. Maybe, just maybe in a highly medicalized birth with many interventions it's riskier for baby. But for me, even if I was having that type of birth, I'd still opt for VBAC. If the baby dies, yes, that is truly sad. He/She was a member of our family already, and now they are gone. But, if I DIE, which is 4 times more likely with a ERCS, I leave a husband, a son, family, friends, etc. So much more lost in their lives than than loosing the baby. Also, with each CS, the risk goes up more and more to seriously dangerous levels with subsequent CS. So if a mom has a CS with her first child, and then never allowed a VBAC, then her hopes for a large family should be seriously weighed, as the more CS, the higher the serious, life threatening complications are. With a third CS, the risk of all those hopes ending is a 1% chance, that is how common a hysterectomy is in a third time CS mom. But again, you never hear of OBs telling moms of these risks. That's sad.