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Tuesday, March 24, 2009

"DON'T give up!"

I received strange, yet powerful words of wisdom, from my 2 1/2-year-old daughter the other day. 
With squinched face and pointing finger, she demanded of me, "DON'T give up!" Not quite sure where she heard that. But it resonated in my head as I have been preparing for this upcoming birth journey that is really a continuation of her her birth journey. Really, all three journeys are strung together in one long, epic story over the course of five years. 
Lately we've been resting, planning, praying and praying some more as we approach "The Day," whenever that is. A bag of frozen brussels sprouts ("sprubble brouts," as my daughter calls them) and a borrowed blood pressure cuff have been my best friends. I have daily, if not hourly, talks with God, in hopes that this baby turning is His will, but ultimately that whatever happens, it goes well and I can come to terms with it. So far He has already answered one prayer in keeping my blood pressure lower and stabilized, for which I am so thankful. And I also found out last night that my son or daughter does not like having a bag of frozen food placed on its head, as the head is definitely not in the same position it was before. I've been down on all fours, cleaning my daughter's room, anything I can think of - to get this baby to turn. So we'll see ... only a last-minute ultrasound can really reveal the truth.
It would be easy to just give in and assume that the baby won't turn, my pressure will be too high, blah blah blah ... and do the c-section already. Most women would have already done that and been over and done with it and home recovering right now with their babies. But I guess I'm not most women ... I'm not sure if that's good or bad. Time will tell, though. I don't feel like this is a gamble so much as me allowing my body time to do what God intended, or at least try. In a world where we're trained to want answers now without having to wait and are awarded instant gratification, I'm hoping that the end result will be a much sweeter reward for having waited. 
Hopefully my experiences and story will make it that much more encouraging to someone else in my position. In the words of my daughter, "DON'T give up!"

Saturday, March 21, 2009

"So, when's this baby going to come?"

That's what I heard at my last OB appointment yesterday. I joked, "Well, I've put in my request." "When are we going to do this c-section?" he asked, not at all joking. Now that's just not something you say to a woman hoping to VBAC and expect her to take it lightly or think it's even remotely funny. 
At nearly the 40-week mark we've had some interesting, if not startling, revelations. After my OB appointment I spent more than three hours in the hospital for observation of high blood pressure and moderate ankle swelling, only to find out the baby was transverse. Not exactly what I wanted to hear, and it definitely puts a monkey wrench in the works. 
But the good news: I'm still pregnant. Barely. 
After an animated discussion on the phone with one of my doctors in the hospital, I nearly had to beg and plead with her just to let me remain pregnant until this baby chose it's day, malpositioned or not. Her insincerity and total lack of hesitation to pressure me into an immediate c-section was surreal, considering I had the same complications with even higher BPs and swelling in my last pregnancy and was definitely not admitted for observation. I basically told her this, and was in no way going to let her scare me into making an immediate decision. I wanted to go home and rest, think about it, and do some research. 
I feel lucky, considering the millions of women who seem to get duped into taking their obstetrician's word that it's a definite emergency and worthy of panic. I've also heard women say how their reluctance or outright refusal to follow their doctor's orders can result in being treated harshly or ignored, which is inexcusable. I wanted to ask my male doctor why it's only in obstetrics patients get treated this way - as if their bodies are not their own and they are at the mercy of some stranger to make decisions for them, or are completely incapable of making those educated decisions themselves. I wanted to ask, "If you went for a prostate exam, do you think the doctor would say, 'There's a chance you could get prostate cancer. Let's just remove the prostate, and while we're at it, cut off your genitals, too.'" No way would they say that, and no man would tolerate it. Neither should women!
I'm not blaming my doctors for this baby's position, but I can't help but feel ripped off slightly in the whole process. I'm trusting in God to take care of this baby and allow it to turn if it's His will. But in the meantime, it's hard to get over the anger of being made to feel inferior, like you're an idiot, and can't make your own decisions. The lack of support is overwhelming and does nothing but tear down your confidence and spirit - which is unfortunate, considering I have done this before. One nurse at the hospital told me "Good for you!" when she'd heard I had already had a VBAC, and I told her, "You don't normally hear that when you tell someone you've had one." You find yourself clinging to that one word of encouragement in a world full cynicism, apprehension, fear and indifference: as my labor doula put it, "They don't care what happens to you after the baby is born, especially if you have to come to taking care of three children after a c-section." As I told Dr. Congeniality on the phone, 'if this baby turns, I don't want to have had to go through all that for no reason.' 
My only prayer is that women everywhere else don't have to, either. You can't expect your doctors to fully educate you on the risks and benefits and be your advocate by suggesting, "Hey, why don't you do a VBAC?," or "Let's do what we can to avoid a cesarean." Only you can do that, and you owe it to yourself to keep your rights and stop giving them away to someone who only wants you in and out in order to move on to the next unsuspecting patient. 

Tuesday, March 17, 2009

The Fight To Give Birth in the Age of Fear-Based Obstetrics

As I quickly approach the 40-week mark in my pregnancy, I am thankful for many things: namely the fact that my body has essentially "proven" itself to not only me but to my OB's. I am preparing for my second VBAC (Vaginal Birth after Cesarean) and while my journey has been fairly uneventful thus far (I won't say totally uneventful, because that's not the truth), it is nothing less than a tooth-and-nail fight for thousands of women to do the same all over the US. 
I am also thankful that my only reason for having a c-section was breech presentation of my first child - not failure to progress, a "small pelvis," or failed induction of labor. I went into labor on my own even then, and had already progressed well despite the fact that we knew the baby had to be delivered via cesarean. With my second pregnancy, to my OB's credit he did offer me the choice to do a VBAC initially (which I declined, knowing nothing about it) and I think he was secretly relieved when I said no. But as I approached 37 weeks, my baby was heads down - something I wasn't even sure my children could do because of a physical defect of my uterus - and realized quickly that I really didn't want to go through the painful recovery of another c-section. 
I consulted with my OB, whom I thought was going to stutter himself into oblivion at my choice. I had since done lots of research, lots of praying, and lots of reading of very positive birth outcomes that I felt was essential to the preparation process. I couldn't believe what I was about to embark on, but with God's help and my husband's support, I could get through this. And I did. Beautifully!
I'm not totally against c-sections: of course I think there are instances where they are totally necessary. Breech presentations, multiple births (although not necessarily with twins alone, as long as they present correctly), severe prematurity, dangerous pre-eclampsia, and fetal distress are all obvious red flags, at least to me. But with a c-section rate of roughly 30 percent in this country, you have to wonder if those reasons are really why women are having c-sections?
More common reasons that the c-section rate is so high is because OB's want to practice "daylight obstetrics" - they want the baby out in time for dinner, essentially. With the ability to control so many facets of our lives, why not birth? Anymore if you go one day past your due date, you seem to be a candidate for induction. Pitocin-happy doctors willingly try and induce (more like coerce) a baby out even if it's not ready. Unfortunately it seems that fewer and fewer women are sent home as a result and are almost definitely candidates for c-section. Pitocin can bring with it a cascade of interventions that can sometimes alter or stop labor completely - increased use of epidurals because of harder, stronger contractions is not uncommon, which can, in turn, stall labor - leading to an increased number of c-sections. 
Insufficient pelvis size is another common reason many women are encouraged to have a c-section. Scores of women are even told their babies are too big to deliver vaginally just by an estimate on ultrasound, which further scares them away from attempting a vaginal delivery. Sadly, there is no definite way to know how big a baby will be until they're born and put on the scales - and ultrasound measurements can be off by as much as a pound either way. Many, many petite women give birth vaginally to "large" babies (according to the March of Dimes, anything between six and nine pounds is considered average) and do just fine. Even many babies deemed to be "stuck" can be birthed vaginally provided the medical practitioner knows to instruct the woman to change positions to facilitate further widening of the pelvis (known as the "Gaskin Maneuver," named for renowned midwife Ina May Gaskin). 
Because of the high rate of c-sections in the US, many women are faced with a two-fold problem: if they want more children, do they deliver them via cesarean too? 
Not necessarily. The mantra "once a c-section, always a c-section" is thankfully being disproved by women everyday in this country, although we still have to fight for the right to do so. But unfortunately few women choose this option - whether because they're uneducated about the risks, their doctors scare them out of it, or they have no interest - which is their right. I would never advocate a woman do a VBAC if she really doesn't want to, but neither should I think women should be scared into repeat c-sections for no reason, either. 
One reason many women are scared away from VBACs is the phrase "uterine rupture." It is possible, but is rare, provided you have a low, transverse incision (bikini incision). Also, your chances of receiving Pitocin to induce labor are less - because it can increase your risk of rupture. To many women, the risks of a c-section, if they even know what they are, are somehow more acceptable than the risks of a VBAC, even though the percentage of complications is about the same. 
Risk of VBAC, with non-induced labor, include:
• uterine rupture - this is rare, and the rate is around 1 percent, depending on which source you site
• risk of needing emergency c-section, should the same complications arise as in the first birth
• if you can't go into labor on your own, induction is not recommended 
Risks of cesarean section include:
• increased blood loss and chance of infection
• respiratory complications in the infant because of spinal anesthesia
• increased risk of scar tissue adhesion, especially after several c-sections (which can cause pain and sometimes infertility)
• premature birth because due dates are off 
• risk of uterine rupture (without even going into labor) (although small, still a risk)
It all boils down to which risks you are more comfortable in taking - because don't kid yourself that a repeat c-section isn't without significant risks, too. Neither of them are decisions that should be taken lightly, but unfortunately many women shrug it off as though it's nothing. This unwittingly affects birth outcomes and choices for thousands of women they don't even know, because they either don't care or aren't willing to fight their doctor for the right to give birth. And if you don't fight it, nothing will change.