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.
WAKE UP PEOPLE!
Tuesday, June 22, 2010
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.
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.
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.
NIH and VBAC
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.
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.
Sunday, March 7, 2010
ICAN
ICAN stands for International Cesarean Awareness Network. It's for any mom who has had a cesarean and wants a vaginal birth, wants to avoid a cesarean, had a traumatic cesarean, or a cesarean that involved postpartum issues such as baby blues, insensitivity from others, depression, anxiety, further complications, etc.
I went to my first meeting on Saturday, and plan to continue to go through out my pregnancy and then be involved with this amazing community for the rest of my career. They meet the first Saturday of every month at the Carver Library in Central Austin. Our Doula happens to be the Austin spokesperson for ICAN locally. You can contact her through moonstonebirth.com, or through www.ican-online.org. ICAN is an outstanding resource for all moms and moms to be. Go to the ICAN website, and watch the video of their mission statement.
Basically, it's raising awareness of the over use of cesarean sections, and why that is dangerous, much more dangerous than vaginal births and how "elective" cesareans should be given with FULL INFORMED consent. Also, how a VBAC is substantially safer than repeat cesareans, especially if you have had more than one cesarean.
Here is some interesting stats for those curious of the difference for the maternal side:
VBAC (pronounced VEE-back)
success rate..................63.2% (2 in 3)
Risk of uterine rupture.......0.87% (1 in 115)
Risk of hysterectomy..........0.23% (1 in 435)
Risk of blood transfusion.....1.89% (1 in 53)
These stats are for a 1st VBAC, all subsequent VBACs the risks lower, and the success rates go up by about 10-20%. The risk of rupture is lower without the use of induction and augmentation, but sadly, there are no studies out there with this number, so if you avoid induction and augmentation, your risk is lower than that stated.
Now, let's compare that to a repeat cesarean: (definitions below)
2nd Cesarean
Risk of hysterectomy........0.42% (1 in 238)
Risk of blood transfusion...1.53% (1 in 65)
Risk of placenta accreta....0.31% (1 in 323)
Risk of major complications..4.3% (1 in 23)
Risk of dense adhesions.......21.6% (1 in 5)
3rd Cesarean
Risk of hysterectomy........0.9% (1 in 111)
Risk of blood transfusion..2.26% (1 in 44)
Risk of placenta accreta...0.57% (1 in 175)
Risk of major complications.7.5% (1 in 13)
Risk of dense adhesions....32.2% (1 in 3)
4th Cesarean
Risk of hysterectomy..........2.41% (1 in 41)
Risk of blood transfusion.....3.65% (1 in 27)
Risk of placenta accreta......2.13% (1 in 47)
Risk of major complications...12.5% (1 in 8)
Risk of dense adhesions.......42.2% (2 in 5)
Hysterectomy-The need and removal of the uterus
Blood transfusion-The need and procedure of giving the mother blood through IV after a hemmorhage
Placenta Accreta-when the placenta grows into the middle layer of the uterus, and removal become more dangerous usually leading to hemmorhage and need of blood transfusion.
Major complications-These include uterine rupture, hysterectomy, additional surgery due to hemmorrhage, injury to the bladder or bowel, thromboembolism (serious, life threatening blood clot), and/or excessive blood loss.
Dense Adhesions-When scar tissue forms and binds two layers of the body together that should remain separate, such as the uterus and the abdominal wall.
Not to mention, the increase in infection, postpartum mood disorders, cost, and longer recovery, etc.
That's not touching on the risks that increase for the baby, ESPECIALLY when a baby is born by cesarean section, before labor starts on it's own.
The lack of VBAC moms is arguably the main reason the cesarean section rate is too high. In a country with a cesarean rate now reaching 31.8% and a city with a rate nearing 40%, we need to be concerned that so many babies are being born through MAJOR abdominal surgery. The recommendation is for low risk moms to be around 10% and high risk around 15%. Yeah, we are WAY off. Regardless of what anyone may say, a cesarean is not "just another way for a baby to be born". IT'S NOT A ZIPPER!
Sadly, in Austin, the hospitals with the worst rates are the ones most used. These include Seton NW and St. David's South. One of the "better" hospitals to go to is North Austin Medical Center. This is mainly due to it being the only hospital in Austin that Midwives can assist in deliveries instead of OBs. Midwives statistically have lower CS, induction, episiotomy, augmentation, etc rates, as well as higher VBAC rates. But it all depends on your provider. You can have an OB who is better than some MW and/or a MW who is worse than some OBs. It's very important to INTERVIEW your care provider to make sure that their birth philosophy agrees with yours and their rates are where they are supposed to be. If your OB has a CS rate of more than 20%, induction more than 10% or offers induction when you don't have pre-ecclampsia or serious gestational diabetes or other health issues, switch providers.
I went to my first meeting on Saturday, and plan to continue to go through out my pregnancy and then be involved with this amazing community for the rest of my career. They meet the first Saturday of every month at the Carver Library in Central Austin. Our Doula happens to be the Austin spokesperson for ICAN locally. You can contact her through moonstonebirth.com, or through www.ican-online.org. ICAN is an outstanding resource for all moms and moms to be. Go to the ICAN website, and watch the video of their mission statement.
Basically, it's raising awareness of the over use of cesarean sections, and why that is dangerous, much more dangerous than vaginal births and how "elective" cesareans should be given with FULL INFORMED consent. Also, how a VBAC is substantially safer than repeat cesareans, especially if you have had more than one cesarean.
Here is some interesting stats for those curious of the difference for the maternal side:
VBAC (pronounced VEE-back)
success rate..................63.2% (2 in 3)
Risk of uterine rupture.......0.87% (1 in 115)
Risk of hysterectomy..........0.23% (1 in 435)
Risk of blood transfusion.....1.89% (1 in 53)
These stats are for a 1st VBAC, all subsequent VBACs the risks lower, and the success rates go up by about 10-20%. The risk of rupture is lower without the use of induction and augmentation, but sadly, there are no studies out there with this number, so if you avoid induction and augmentation, your risk is lower than that stated.
Now, let's compare that to a repeat cesarean: (definitions below)
2nd Cesarean
Risk of hysterectomy........0.42% (1 in 238)
Risk of blood transfusion...1.53% (1 in 65)
Risk of placenta accreta....0.31% (1 in 323)
Risk of major complications..4.3% (1 in 23)
Risk of dense adhesions.......21.6% (1 in 5)
3rd Cesarean
Risk of hysterectomy........0.9% (1 in 111)
Risk of blood transfusion..2.26% (1 in 44)
Risk of placenta accreta...0.57% (1 in 175)
Risk of major complications.7.5% (1 in 13)
Risk of dense adhesions....32.2% (1 in 3)
4th Cesarean
Risk of hysterectomy..........2.41% (1 in 41)
Risk of blood transfusion.....3.65% (1 in 27)
Risk of placenta accreta......2.13% (1 in 47)
Risk of major complications...12.5% (1 in 8)
Risk of dense adhesions.......42.2% (2 in 5)
Hysterectomy-The need and removal of the uterus
Blood transfusion-The need and procedure of giving the mother blood through IV after a hemmorhage
Placenta Accreta-when the placenta grows into the middle layer of the uterus, and removal become more dangerous usually leading to hemmorhage and need of blood transfusion.
Major complications-These include uterine rupture, hysterectomy, additional surgery due to hemmorrhage, injury to the bladder or bowel, thromboembolism (serious, life threatening blood clot), and/or excessive blood loss.
Dense Adhesions-When scar tissue forms and binds two layers of the body together that should remain separate, such as the uterus and the abdominal wall.
Not to mention, the increase in infection, postpartum mood disorders, cost, and longer recovery, etc.
That's not touching on the risks that increase for the baby, ESPECIALLY when a baby is born by cesarean section, before labor starts on it's own.
The lack of VBAC moms is arguably the main reason the cesarean section rate is too high. In a country with a cesarean rate now reaching 31.8% and a city with a rate nearing 40%, we need to be concerned that so many babies are being born through MAJOR abdominal surgery. The recommendation is for low risk moms to be around 10% and high risk around 15%. Yeah, we are WAY off. Regardless of what anyone may say, a cesarean is not "just another way for a baby to be born". IT'S NOT A ZIPPER!
Sadly, in Austin, the hospitals with the worst rates are the ones most used. These include Seton NW and St. David's South. One of the "better" hospitals to go to is North Austin Medical Center. This is mainly due to it being the only hospital in Austin that Midwives can assist in deliveries instead of OBs. Midwives statistically have lower CS, induction, episiotomy, augmentation, etc rates, as well as higher VBAC rates. But it all depends on your provider. You can have an OB who is better than some MW and/or a MW who is worse than some OBs. It's very important to INTERVIEW your care provider to make sure that their birth philosophy agrees with yours and their rates are where they are supposed to be. If your OB has a CS rate of more than 20%, induction more than 10% or offers induction when you don't have pre-ecclampsia or serious gestational diabetes or other health issues, switch providers.
Friday, February 26, 2010
Starting to Feel Good
I'm over 13 weeks now, so, officially I'm in the second trimester. It's been easier the last few days. (Knock on Wood!) I haven't felt pukey, and I'm starting to show a little bit, and the baby is moving a lot. At night before I fall asleep, I put my hands on top of my womb and I can feel peanut wiggling around in there. I hope he/she doesn't start to think that night time is wiggle time!
It's good though, I can eat food, and all the junk food I was craving and was the only thing I could somewhat keep down, now sounds disgusting, so we've been eating a lot healthier. This is very good, because the main difference between Midwifery care and OB care is the focus on nutrition and exercise. My Midwife, as they all pretty much do, give you a paper with a lot of blanks on it, and you fill in what you eat for an entire month. This is so they can see what you diet consists of. Mainly to make sure you are getting enough protein (80-100 grams a day) and fluids (at least a gallon of water/tea) and lots and lots of fiber from fruit and veggies. Also, since we are trying to NOT birth a monster size baby, we are aiming to cut out almost all grains and sugars, keeping the occasional whole grain here and there. So this will be good for me too see a break down of what I eat too. When she handed the page to me at our last prenatal, I asked her if I can wait till after the nausea ends, she smiled and said "of course".
So that's my plan, added to it, will be the daily cups of Red Raspberry Leaf Tea, to help tone my uterus to prepare for labor. Not to be confused with Red Raspberry Tea. It's the Leaf that the tea needs to be made out of. And no, it won't in any way, start labor, it simply helps your contractions when you do go into labor to be more effective. That and hopefully today, I'll pick up my Prenatal Yoga DVD from Angel, and I'll start my Prenatal Belly Dancing DVD later on.
So we're getting there. We are a third of the way done, and have pretty much everything taken care of, the MW is paid, we meet with our Doula again at the end of the 2nd trimester and we will most likely take Birthing Classes again around there too. So, all that's left for me to do is.....grow the baby!
It's good though, I can eat food, and all the junk food I was craving and was the only thing I could somewhat keep down, now sounds disgusting, so we've been eating a lot healthier. This is very good, because the main difference between Midwifery care and OB care is the focus on nutrition and exercise. My Midwife, as they all pretty much do, give you a paper with a lot of blanks on it, and you fill in what you eat for an entire month. This is so they can see what you diet consists of. Mainly to make sure you are getting enough protein (80-100 grams a day) and fluids (at least a gallon of water/tea) and lots and lots of fiber from fruit and veggies. Also, since we are trying to NOT birth a monster size baby, we are aiming to cut out almost all grains and sugars, keeping the occasional whole grain here and there. So this will be good for me too see a break down of what I eat too. When she handed the page to me at our last prenatal, I asked her if I can wait till after the nausea ends, she smiled and said "of course".
So that's my plan, added to it, will be the daily cups of Red Raspberry Leaf Tea, to help tone my uterus to prepare for labor. Not to be confused with Red Raspberry Tea. It's the Leaf that the tea needs to be made out of. And no, it won't in any way, start labor, it simply helps your contractions when you do go into labor to be more effective. That and hopefully today, I'll pick up my Prenatal Yoga DVD from Angel, and I'll start my Prenatal Belly Dancing DVD later on.
So we're getting there. We are a third of the way done, and have pretty much everything taken care of, the MW is paid, we meet with our Doula again at the end of the 2nd trimester and we will most likely take Birthing Classes again around there too. So, all that's left for me to do is.....grow the baby!
Friday, February 19, 2010
Mommy Breakdown
If any of you know me, you know that I am one of those open book type of people. I know a lot of moms go through tough moments, and I am definitely included in that group.
This morning, Liam got up at 6:45. He used to get up at 9:30, which seems so heavenly looking back. I'm always exhausted. Making another human being is a lot of work and really does take a toll on a woman's body. So I hear, that if you want a kid to get up later, go in, lay them back down, and keep doing that till it's time to get up. Yeah, that was so emotionally exhausting. All I wanted him to do was go to sleep. I wanted to sleep. I wanted to crawl back in bed, between the cozy covers and close my eyes and go back to non-nauseated dream land. Obviously, this was impossible with a screaming kid in the neighboring room.
I became so frustrated. He kept signing 'potty', so I'd take him in there and he'd just sit on the potty. Just sit there for 15-20 min. That was the last thing I wanted to be doing; sitting on a cold bathroom floor, waiting for a pee pee drizzle. I finally said, "ok, no more, we're going back to bed." He wasn't too keen on that. He screamed, signed 'more potty', but I was too frustrated to bother to wait any longer. I put a pull up back on him, and put him back in bed. Yeah, I tried the, lay back down thing, only , when a kid gets so big, laying back down doesn't always stick, and at Liam's age, if you can get him to lay down, that's progress. We battled this for about an hour. So there he was screaming, I was crying, so I call Phillip.
Through tears I tell him the situation, and he sympathizes wonderfully. He can't do anything of course, but being Friday, he encouraged that the weekend was coming, and that meant mommy sleeps in while daddy and Liam have morning bonding time. It's sad, but I feel I should be able and feel comfortable calling a mom friend, but we (as mom's) have this weird mindset that all other moms but us are perfect, and how dare well let any of them know that we struggle at any given moment with any aspect of our lives.
I seriously doubted that I would get the words I needed from someone else but Phillip. We had a bid discussion about a week ago, during another hormonal fit, that when people say shitty things like "well, what are you going to do when the other one gets here?" or "And you wanted another one" or "You'll have twice as many in a few months" or "And you only have one right now" or "And there's another one coming". YES THANK YOU VERY MUCH, I KNOW I'M PREGNANT, I KNOW IT'S GOING TO BE ONE MORE ADDITION TO THE FAMILY AND I AM WELL AWARE OF THE INCREASE IS THINGS TO DO AND TAKE CARE OF WHEN HE/SHE COMES. Seriously, I don't know how to take these comments, usually I just shut up and don't say anything. What are you supposed to say? What do people mean by this? To me, the only way to interpret these things is 1) you have it easy because you only have one right now, so why are you complaining 2)what were you thinking having another 3)You have no idea how hard it's going to be so enjoy this "easy" part now. Yeah, none of those are encouraging or helpful or supportive, so why do people, especially women, moms say them?
Just because you want something, doesn't mean it's going to be easy. I am highly aware that a lot of the parts of motherhood/parenthood are tough, physically, emotionally, etc. That doesn't mean it's not worth while. Why do people think everything is supposed to be easy? Sometimes, things are hard. And they suck, and it seems like there is no end. Why can't women, moms, people in general say, "I know it's hard, and you are doing the best job you can, and that's all that should be required." Sometimes, that all someone needs to hear, not how, your situation is worse, not how their situation is going to get worse, just listen, and acknowledge.
To let everyone know, I finally, after talking to Phillip, went in, got Liam, picked him up, held him close as he turned to jello in my arms, and I cried and cried and told him how much I loved him and how sorry I was as he laid then quietly. We got some cheerios, and he cuddled up next to me and ate them. He did take a nap a couple hours later, and we cuddled in bed, and when we woke up, I think we both felt a lot better.
So to all the moms out there, yes, it's hard, not occasionally, not sometimes, a lot of the time. Maybe most of the time. It's very hard, and it's the hardest thing you might ever do, but hang in there, we all do the best we can and that is enough. Why don't more moms talk about this stuff, we know we all must go through it. Let's start talking.
This morning, Liam got up at 6:45. He used to get up at 9:30, which seems so heavenly looking back. I'm always exhausted. Making another human being is a lot of work and really does take a toll on a woman's body. So I hear, that if you want a kid to get up later, go in, lay them back down, and keep doing that till it's time to get up. Yeah, that was so emotionally exhausting. All I wanted him to do was go to sleep. I wanted to sleep. I wanted to crawl back in bed, between the cozy covers and close my eyes and go back to non-nauseated dream land. Obviously, this was impossible with a screaming kid in the neighboring room.
I became so frustrated. He kept signing 'potty', so I'd take him in there and he'd just sit on the potty. Just sit there for 15-20 min. That was the last thing I wanted to be doing; sitting on a cold bathroom floor, waiting for a pee pee drizzle. I finally said, "ok, no more, we're going back to bed." He wasn't too keen on that. He screamed, signed 'more potty', but I was too frustrated to bother to wait any longer. I put a pull up back on him, and put him back in bed. Yeah, I tried the, lay back down thing, only , when a kid gets so big, laying back down doesn't always stick, and at Liam's age, if you can get him to lay down, that's progress. We battled this for about an hour. So there he was screaming, I was crying, so I call Phillip.
Through tears I tell him the situation, and he sympathizes wonderfully. He can't do anything of course, but being Friday, he encouraged that the weekend was coming, and that meant mommy sleeps in while daddy and Liam have morning bonding time. It's sad, but I feel I should be able and feel comfortable calling a mom friend, but we (as mom's) have this weird mindset that all other moms but us are perfect, and how dare well let any of them know that we struggle at any given moment with any aspect of our lives.
I seriously doubted that I would get the words I needed from someone else but Phillip. We had a bid discussion about a week ago, during another hormonal fit, that when people say shitty things like "well, what are you going to do when the other one gets here?" or "And you wanted another one" or "You'll have twice as many in a few months" or "And you only have one right now" or "And there's another one coming". YES THANK YOU VERY MUCH, I KNOW I'M PREGNANT, I KNOW IT'S GOING TO BE ONE MORE ADDITION TO THE FAMILY AND I AM WELL AWARE OF THE INCREASE IS THINGS TO DO AND TAKE CARE OF WHEN HE/SHE COMES. Seriously, I don't know how to take these comments, usually I just shut up and don't say anything. What are you supposed to say? What do people mean by this? To me, the only way to interpret these things is 1) you have it easy because you only have one right now, so why are you complaining 2)what were you thinking having another 3)You have no idea how hard it's going to be so enjoy this "easy" part now. Yeah, none of those are encouraging or helpful or supportive, so why do people, especially women, moms say them?
Just because you want something, doesn't mean it's going to be easy. I am highly aware that a lot of the parts of motherhood/parenthood are tough, physically, emotionally, etc. That doesn't mean it's not worth while. Why do people think everything is supposed to be easy? Sometimes, things are hard. And they suck, and it seems like there is no end. Why can't women, moms, people in general say, "I know it's hard, and you are doing the best job you can, and that's all that should be required." Sometimes, that all someone needs to hear, not how, your situation is worse, not how their situation is going to get worse, just listen, and acknowledge.
To let everyone know, I finally, after talking to Phillip, went in, got Liam, picked him up, held him close as he turned to jello in my arms, and I cried and cried and told him how much I loved him and how sorry I was as he laid then quietly. We got some cheerios, and he cuddled up next to me and ate them. He did take a nap a couple hours later, and we cuddled in bed, and when we woke up, I think we both felt a lot better.
So to all the moms out there, yes, it's hard, not occasionally, not sometimes, a lot of the time. Maybe most of the time. It's very hard, and it's the hardest thing you might ever do, but hang in there, we all do the best we can and that is enough. Why don't more moms talk about this stuff, we know we all must go through it. Let's start talking.
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