Supermodel Gisele joins the ranks of bathtub homebirthers

GASP! What, you mean there's another one?!


A quick scan of the headlines this morning and I was surprised to read that model Gisele Bundchen is revealing where she gave birth to her son - at home, in the tub. Either whoever wrote it doesn't know "the dangers" of homebirth or thinks Gisele is a big girl who can make the decision for herself, because there were no criticisms, questions or raised eyebrows, just congratulations all around for the new mom and her husband, football player Tom Brady.

Not too pretty to push: Gisele does it her way. 

Although it sounds like Gisele is no dummy - initial reports indicated that she had delivered the baby in a hospital, so who knows - maybe that was a tactical maneuver to fend off the anti- crowd so she could just enjoy her birth and her baby and be left alone in peace.

Perhaps it's still too early, but I haven't seen any criticisms from the AMA or anyone else about her decision. Perhaps they don't read the celebrity gossip pages to know that Ricki Lake isn't the only celebrity to give birth at home. Maybe they think we don't know how to read, or haven't figured out how to use the Google Search function.

I bet after this, in addition to banning homebirths, they'll want to ban bathtubs, too. You can never be too careful when advocating for a mother and child's safety, right?

Validation

I've been a stay-at-home mom for over six years now. I do love it and know that for myself and my children, it's the best thing. But sometimes I still feel like I have to explain myself - validate what I do - to others, and it can be so frustrating.

My 10-month-old is in the throes of teething right now. The overwhelming exhaustion at 2 a.m. is too much for my husband and I sometimes, and tempers flare. Tylenol doesn't work, and there isn't a drop of Orajel to be found in the house (I never had to use it with my other two). He angrily asked me what I wanted him to do - sit up with the baby? Of course not, but I know you want me to, because, after all, I don't have to get up early tomorrow morning to earn a paycheck. So after letting Mister Baby play, holding him, rocking, nursing, whatever I could do to get him to settle down, I finally get him back to sleep and trudge back to bed around 2 a.m. Of course, everyone else is asleep.

My husband is very supportive and a good dad. But it's moments like these when I just want to scream. Why am I the only one who is awake right now and dealing with this problem? Just because I supposedly don't have anything better to do? Just because "I'm the mom"?

I'll never forget the time my mother in law told me that 'her son needs his rest, and you can take a nap during the day.' What about my rest? Why are my sleep needs less important? And when exactly can I take a nap? Is that before, during or after my other children destroy the house and climb all over me like I'm a jungle gym? Sure, I can take a nap. Define nap, exactly. Because sleeping with one eye and one ear open isn't exactly a nap.

This morning as I got my daughter off to pre-school, I had to shovel the driveway after a heavy snowfall. Where we live, we're lucky to have maintenance personnel who plow for us, so I shouldn't complain. Sometimes my husband will if he has time before leaving for work. However, the plow driver has a schedule - those who work and 'need to be somewhere' come first. He'll get to our driveway whenever he has time. Meaning, you don't work and really need to be anywhere, so your drive might get plowed, it might not. This wasn't any different last winter when I was eight months pregnant, either.

When I first got married eight years ago, I wasn't working. I had relocated to be with my husband, and decided to look for a job afterwards. I wanted to be choosy this time, searching for a journalism job that was related to my career field, instead of taking a job outside the field again that would lead me down yet another path away from my chosen profession. Thankfully I could afford to be choosy, but when a colleague of my husband's found out I wasn't working, he asked, "What are you going to do all day?" I flatly answered, "I don't know .... sit around and eat bon-bons, I guess." He just gave me a blank stare.

Perhaps I'm getting defensive. I know I'm doing the best job at mother- and wife-hood as I can, and I know that most people with a brain know that it's hard work. But just because 'I don't work' doesn't mean I don't have sleep requirements like anyone else, or things to do. I don't want to have to justify myself as a person or define myself by my job outside the home. I don't want to have to hear, when I've decided to leave the house to do something, to be back in two hours for no reason, even though my husband is perfectly allowed to be gone for much longer periods than that. Why am I on such a 'short leash,' just because I'm the mother? I don't really consider myself a feminist, and I understand my importance in this household, but sometimes I question these roles, even though I don't know what the right answer really is.

In the meantime, it's estimated that children have 20 primary teeth, and Mister Baby currently has six. So it looks like there will be a lot more sleepless nights in our (my?) future.

Coming Full Circle: Three Generations of Mothers

Even though I'm not sure I could "do" a home birth, I've been acutely interested in it lately. I think it's a deeply personal decision - one that I've become a huge advocate for. If you feel comfortable in your choices and want to do it, go for it, I say. Although some might find that odd if they find out one thing about my family: my great-grandmother, and her baby, both died as a result of a home birth.

It's become almost the stuff of legend in our family: my mom and I often discuss it and have theories. We don't bring it up with my grandmother, because at her age she has memory problems and some topics make her very emotional. So while I've often wanted to, I don't bring up childbirth with her because I'm not sure she'd remember it, or it might upset her.

In the spring of 1925, my 40-year-old great-grandmother gave birth to twin girls. They were born on the family's Ohio farm, where their four siblings were also born. A doctor attended their birth. Unfortunately, no one who could really answer many questions is still alive now, and we've only been able to piece together some facts and thus speculate on what happened.

We do know these things: the first baby, my grandma's twin, came out very blue. I pondered this - was she breech, and got stuck? Head down, but with cord compression? Maybe I'm over-thinking things because of what we know now that might be able to offer some clues. Whatever the case, the baby did live but only for several days. Her mother, Floy, developed severe peritonitis and also died as well.

From what information I have then, I speculated that perhaps the baby was breech, and the doctor either tried unsuccessfully to turn her, or delivered her badly, causing hypoxia in the baby and traumatic internal injury to Floy. Perhaps he used forceps that might have caused an injury; we'll probably never know.

One thing that strikes me, though, is that the doctor apparently was known for his unclean work habits. My great uncle recalled once how the children visited his office for vaccinations or a shot of some kind, and the doctor gave them one - with grease and motor oil dripping down his hands and arms from working on his car.

As I read further, I discovered that proper hand-washing technique for infection control had already been established by Dr. Louis Pasteur in the late 1800s, and by 1910 Dr. Josephine Baker had started a hygiene program for child care providers - to the alarm and protest of physicians who basically thought that it was "...ruining medical practice by...keeping babies well." No doubt it is tragic events like Floy's death that began the hospital birth movement. And yet, during the 19th century,

"Up to 25% of women who delivered their babies in hospitals died from childbed fever (puerperal sepsis), later found to be caused by Streptococcus pyogenes bacteria." 

And, not coincidentally, even today hospital-acquired infections are still a problem.

Unfortunately, there are no medical records that we can study to find out anything else about Floy. The local courthouse experienced flood, fire and theft at various points, which means their records are incomplete. And the doctor, apparently, destroyed his records, which isn't too uncommon anyway.

Despite their deaths, I think somehow my mother - in her before-her-time birth crunchiness that I talked about earlier - and my own birth 'nerdiness' - have come about because of a subconscious connection with our grandmother. Not so much to vindicate, maybe, but to complete the circle, somehow. Perhaps we birthed in a manner of our choosing not so much for ourselves, but for her.

"Ricki Lake, please stop lying about homebirth."

This is the message on the May 3, 2009 blog posting of Amy Tuteur , whom I've mentioned here on this blog before. She is a mother of four herself, former clinical instructor at Harvard (I think we're supposed to be impressed and bow down, maybe?) and is hugely against home births. At least from her negative, biting, somewhat unprofessional criticism of it.

As I await a copy of "The Business of Being Born" on loan from the library, I think of how women have to fight every day to have home births in this country, and I bet Ricki Lake was like a shining ray of light in the darkness to them. A voice that said, 'Yes, you can do this!' Depending on where you live, it's very difficult, if not impossible, to get good support from the medical community when making this decision. And it's definitely a decision you don't make lightly. Whenever I'm in conversation with someone about the 'dangers of home birth,' I basically say, 'It's not like this person woke up this morning - the eve of their due date - and decided to do a home birth.'

It's interesting, though - if you do a Google search on 'celebrity home births' you'll get some fascinating hits. Celebs who have birthed at home include Meryl Streep, Pamela Anderson, Cindy Crawford, Christy Turlington, Demi Moore and Kelly Preston (some of them more than once). Maybe they wanted to avoid unnecessary interventions, avoid the paparazzi, or whatever - but who really cares? They did it. So how come I don't hear Dr. Amy blogging to Cindy, Pamela or Christy - all of whom have probably birthed less than a decade ago - to 'stop lying' about home births?  Did they either have just really supportive doctors and midwives or were they 'too beautiful, rich and powerful' to be told "no"? What the heck?

Another Google search will reveal tons of criticism about Ricki Lake, though. Included among the headlines are "Ricki Lake's home birth film upsets the AMA," "AMA to Ricki Lake:  No more babies in bathtubs, please" (as if), "Doctors unhappy about Ricki Lake's home birth movie," "Ricki Lake irresponsible to promote home birth," and of course the good doctor's blog headline. Curiously there is no criticism of the countless other celebrities who have also home birthed, maybe because they didn't have the guts to make a movie about it.

While I'm sure the AMA's fear about Ricki's movie is partly due to safety issues surrounding the baby and mother, it's also sending a very strong message to the mothers who want to avoid a hospital birth: not only do they not want masses of women 'jumping ship' and doing it 'their own way,' but that they don't trust you, or your care providers, to make good decisions regarding your care. Blogs like Dr. Amy's - "The Skeptical OB" - seem to reflect the feelings of the "industry" in general: that OB's are increasingly skeptical not only of women who deliver without interventions or pain meds, but also that women can make choices and decisions about their bodies and their unborn babies. Ironically, a woman's rights are more respected when she decides to abort her baby, but when she wants to keep it, it's as if she's merely a vessel and nothing more.

If anything, the movie should serve as a wake-up call to doctors and hospitals that perhaps there is a very good reason why these women chose to birth at home - and send a message to the "OB industry": that when YOU stop lying about c-sections, VBACs, and unnecessary interventions and get over your God Complex, Ricki will stop "lying" about home birth.

Your OB said what?!?

OK, I can't send this in to www.myobsaidwhat.com 's website since it's not my story, but it probably would make a great submission.

Today I had lunch with another mom whose daughter is two days older than mine. We were remarking how my due date was actually before hers, but her daughter was born first because she decided to have a repeat c-section. Her doctor only did surgery on Tuesdays, she said, so that meant she had either one of two options: deliver on September 11, or choose an earlier date. Dr. "I Love to Do Surgery" asked how she felt about having a baby that day, and mom said she didn't feel weird about it or anything.

'"Well, I feel weird about it,"' the doctor replied. I looked at the mom and said, "What?! It's your baby! Who cares if she feels weird about it. That's messed up!"

Apparently her doctor hadn't read the studies about babies being born before 39 weeks being more likely to have serious health problems. That's not to say they will be, but why take a chance when you don't really need to?

Georgia Mom delivers Triplets by VBAC

Yes, triplets!

The news has made its way around the childbirth blogosphere, but who cares - we'll say it again! I'm so impressed that this mom could find a caregiver who was willing to deliver her babies vaginally, as well as perform a footling breech vaginal delivery.

The mother went into spontaneous labor at 38 weeks, another rarity in multiple births. And the mother delivered all but the footling breech without an epidural. Wow!

Hopefully this will be an encouraging word for those mothers out there hoping to VBAC with multiples. Here are some links for more info:

http://vbacfacts.com/2010/01/09/hospital-triplet-vbac/
http://www.drmomma.org/2010/01/atlanta-mom-births-triplets-via-vbac.html
http://doulamomma.wordpress.com/2010/01/08/triplet-vbac-in-ga-with-dr-tate/

Congrats!

The Purpose of this Blog

The reason I write this blog is probably obvious - but I want readers to know that I am not trying to judge, be cruel or heartless when it comes to the decisions they make about their maternity care. Merely, I am trying to help people who otherwise either feel helpless or don't think it's a big deal about the way they are treated by our maternity system.

I am using my own research and personal experiences in an effort to possibly help women, who are much like myself, to try and prevent them from having to jump through countless hoops in the first place. I feel like so much of what's wrong with our "broken maternity system" might be prevented if we were encouraged to make more informed choices about our care from the beginning. I know it's not important to some, but to those for whom it is, they need as much information and support as they can get. I hope to be  a source of encouragement to those who are seeking it.

If you're reading, I encourage you to leave feedback. I want to know what you think, good or bad. My greatest hope is that awareness can be raised about the rights of pregnant women, and they be allowed to make informed decisions about their care without fear of being harassed or belittled by care providers, or anyone else.

Positive VBAC Story: Sarah's birth

It dawned on me that, after blathering on about successful VBACs and what not, that I had really neglected to tell my own birth story. And after posting the video of the "VBAC gone wrong," I was concerned that people visiting the site might decide they don't want to VBAC based on the bad experience of someone else.

I began my second pregnancy set to do another c-section, although my doctor initially offered me the choice. I think he was silently relieved when I decided to do a repeat section. I don't remember him going into any details whatsoever about the benefits of VBAC, just the risks - which made me not want to do it immediately. Nor did he tell me any risks about a c-section when my first child was born. If he had, I think I would have gotten up and ran away right then and there.

But back up a moment. When my first child was born, he was breech - most likely due to the fact that I have a bicornuate, or heart-shaped, uterus. This can be a problem for some, depending on the degree of defect. In serious cases, it can cause intrauterine growth restriction or even infertility, because the uterus is so divided that there isn't enough room for a baby to grow. In my case, it merely meant that, depending on the position of the baby, it might not allow enough room for him to turn, and he'd be stuck in a breech position. Which he was.

When they did the c-section the first time, he was stuck. Really stuck. His head was mostly lodged in my ribs the entire second half of the pregnancy, and at one point, I felt very violent motions like he was attempting to turn but just couldn't do it. Of course, my doctor never offered an external cephalic version, and being the idiot that I was at the time, I didn't ask. I just knew that breech vaginal births carried risks (like everything else, it seems) and I didn't want to do it, especially if my doctor hadn't performed many births like this in a long time. (As a side note, an ECV is usually not recommended for a woman with bicornuate uterus.)

Anyway, fast forward to my second birth. I was adamantly against a VBAC and thought it was just too dangerous. Somewhere along the way, my baby decided to be head down, something I found interesting, considering I thought that all of my babies would be breech because of my uterus' shape. I had also been very active on www.babycenter.com's birth forums, and one poster who routinely contributed on VBACs and home births (she was preparing for an unassisted home birth) got me thinking. At first, I'll admit, she boiled my blood a little bit, but something in me decided to research VBAC and give her a second thought. And once my baby was in the right position, it got me thinking.

When I told my doctor at 37 weeks that I was considering a VBAC, I thought he was going to swallow his teeth. Of course, he went on and on about the risks, and how he'd seen two ruptures. He almost got away with completely downplaying the risks of a repeat c-section until I decided he wasn't going to mention it at all, and I respectfully ripped him a new one with the information I'd done about it. I hired a doula, read all I could, prayed and waited. Despite having a few discouraging words from my care providers, (one midwife told me flat out "She didn't want to be doing this!") I pressed on.

I approached my 39th week and we did the routine vaginal exam at my prenatal appointment. Of course, there was no dilatation or effacement at all, which had me a bit discouraged. But I realized that this really didn't mean anything, since I had been about 3 or 4 cm dilated for weeks before I went into labor with my first baby, who wasn't even head down. A week later, I was in the hospital having my baby!

My labor began on the morning of a full moon LOL - I distinctly remember having trouble sleeping and looking out the window at the moon. Early in the morning I had back pain and was uncomfortable in bed, often changing positions and getting down on all fours to relieve the discomfort. After a few bowel movements in the middle of the night, I thought maybe something was going on. (I have ulcerative colitis, which can flare up under stress, so the bowel movements at 3 a.m. were not a sign to me right away that I was in labor. Merely I just thought, 'Oh great, what a wonderful time for this to start!!') Duh. LOL

Once I realized I was in labor, I stayed at home for a few hours and showered, puttered around and paced, which I always do while in labor. I was having some back labor, which we anticipated because we could see my daughter slightly turned on an ultrasound I had just had to check for position. Aside from my mom asking dumb questions during this point LOL, I managed to get through them okay. I decided to eat a piece of bread with butter on it (contrary to the 'starve yourself of food and water' theory in labor) and we decided to head to the hospital. We actually stopped at the grocery store on the way and picked up a few things for my labor bag, and I think the walking around helped me to dilate more.

Upon arriving at the hospital, I realized we had totally forgotten to call the doctor. LOL Whoops! I walked into labor and delivery and announced I was a VBAC, which they needed to know. I do feel kind of bad about not preparing them ahead of time, but perhaps that ended up being a good thing - because it possibly discouraged them from treating me like an anomaly or a problem, but rather like any laboring patient. Hospitals will often ban VBACs, but really, as long as they have the capability to do an immediate c-section on any laboring woman, what difference does it make? You can have any number of emergencies arise during a traditional vaginal delivery!

I labored for about three hours in the hospital before giving birth. The nurse checked me at my arrival and announced that I was six cm dilated and waters 'were bulging.' The doctor did break my water, which can cause an increase in prolapsed cord. Did he inform me of this? No. I should have researched it beforehand, probably, but at some point our physicians need to give us this information, too, as our healthcare providers. In fact, I don't even remember him asking me if he could do it.

I never felt the need to push (with any of my labors), nor did my doctors explain to me why I didn't. Had I known even more about it then, I probably would have waited until I did have the urge. I had no epidural; I remember thinking I might want it, and then decided it was too late. I wanted to see how far I could get without one, and seem to have a high tolerance to pain as it is. I did get Nubain, which the nurse accurately said 'won't do anything for the pain,' which it didn't. But since I had been awake since about 3 a.m., it helped me to rest in between contractions and gear up for the next round of pushing. My daughter was born after about an hour of pushing.

If anything, my labors - all different - taught me how to appreciate the powerful abilities of my own body as it was designed. I learned what I was capable of doing, and it was an amazing experience. It also opened my eyes about the maternity care in our country (world, maybe?) and how few of us are really willing to be our own advocates -- not only for ourselves, but for our unborn babies. So many women are adamant about not even taking Tylenol in pregnancy, yet submit - without question - to tests, poking and prodding, and endless interventions during labor. Why is that?

As they say, 'knowledge is power.' I'm hoping to encourage other women to seek that knowledge and use the power they gain from it.

Other positive VBAC stories can be found here:
http://www.mothering.com/discussions/showthread.php?t=330288
http://www.pregnancybirthandbabies.com/vbac%20stories.htm
http://www.birthrites.org/stories.html
http://www.essentialbaby.com.au/parenting/community/my-vbac-story-20090526-blkb.html

Pitocin: the most abused prescription drug in the nation

"Pitocin is the most abused drug in the world today." -- Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

Depending on how you look at it, I agree with Dr. Caldreyo-Barcia - I think Pitocin is one of the most overused, often abused, prescription drugs in the medical industry today. There are lots of suspected reasons for our out on control c-section rate in this country, but to me, one sticks out like a sore thumb: the number of induced labors.

Sources vary, but it's estimated that one in five labors are induced . (This criteria alone can be a bit murky; to many women, induced labors mean Pitocin and cervical ripening gel. To others, induction can merely be breaking your water artificially, which can start labor for some women. At any rate, it's interference of a non-natural kind.) One day while reading the physicians forum at www.obgyn.net I "listened in" on a discussion of how a particular OB's rate of inductions was at 66 percent  . Holy crap.

He also went on to note that around 30% of inductions fail. Those aren't very promising numbers, then, are they?

The standard procedure among the vast majority of laboring women is that they approach 40 weeks of labor, sometimes within a few days, and an induction is recommended. A holiday might be around the corner, or you're just miserable and sick of being pregnant. Who isn't, by that stage? Or you're 12 hours over your due date and the doctor thinks your baby should come out now, even though a typical pregnancy goes from 38 to 42 weeks.

What no doctor will probably tell you, is that if you're not ready, an induction will likely fail.

In a lot of news articles I've read about the staggering c-section rate, the increased rate of inductions often fails to even register a blip, which is troubling. Some won't even cite physician preference or convenience as a reason, but rather implicate the parents. Others like to cite the age of a patient as a reason, and still others say that the mother's obesity plays a role. Either way, it seems like the blame is increasingly placed with the mother.

And it seems like if you have a birth replete with interventions and something happens that necessitates a c-section, the patient is grateful to her doctor for 'saving her and her baby.' That's like an arsonist setting a building ablaze and then going in to rescue everyone inside. Until you know he was really to blame, you're going to heap on the accolades because he saved everyone, right?

I often log on to several pregnancy and childbirth-related web sites, and the number of women asking questions about elective inductions is troubling. What's even more astounding is that many either 1) don't know the risks, 2) think it's no big deal, or 3) don't really want to do it but are pressured by their doctors.

One woman, Nicole, asked about being induced at 39 weeks because her baby was 'already weighing over 8 pounds.' She said she'd heard nasty stories about being induced, and wondered if anyone could tell her anything positive about it. (Basically, I'm going to do this, my doctor is making me because he's scared my baby will be 'big,' and I only want to hear the good stories and ignore the truth about what could happen.)

The answers she got were a mixed bag, and a few of us  were honest in telling the original poster what could happen. Of those who had 'good experiences,' one said she ended up with a c-section because her 'daughter was too big,' and presented shoulder first (another risk of induction). Her experience, she noted, was that the induction began at 8 a.m. and got increasingly painful as the nurse upped the dose of Pitocin. By 1:30 she asked for the epidural. She then retorted that of all the answers that included an induction going "well," all of them received a 'thumbs down,' and said she was 'so so sorry that my induction went better than yours.'

Funny, I wouldn't call her experience a good one. (Ironically, her answer was chosen as the 'best answer.') Some of us expressed our concerns, but the majority said don't worry about it ... you'll do just fine!

Just today I answered another question that a poster had about an induction of labor scheduled for tomorrow, because the father was out of the picture and no other family would be present. She is 39w4d.  Of course, I politely chimed in and told her that if her baby's not ready, it's not coming out, short of a c-section. I posted some links, and tried to answer her question as nicely as I could. Then another woman put in her two-cents' worth:

I don't know why people say "oh it raises your chances of c-section, blah blah blah." You run the risk of some type of intervention any time you give birth. I had a friend that went into labor on her own and after 10 hours of not dilating they had to do a c-section on her. So don't let people on here freak you out about that.

Ummm, yeah....whatever! You just go ahead and turn a blind eye, hon....*sigh*

Perhaps you run the risk of some type of intervention because your doctor is pressuring you, and you are blind to the risks and benefits of what you're about to do (because goodness knows, it seems like no one's doctor is telling them these things anymore!). One mom's blog (we'll call her Em) detailed her induction, of which she and her husband laughingly 'had no clue what to expect.' Unsurprisingly, it ended in a c-section. How can you be so unprepared for something they're about to put you and your baby through? How can you not want to know everything about it, and just put blind faith and trust in your doctor?

If people like this continue to be the standard procedure at most OB's practices, then of course those of us who actually have the gall to refuse are going to get harassed. We represent a dangerous contingent of women who are actually informed of our choices and stand to pose a roadblock to what the doctor thinks should happen, regardless of whether it's really needed or not. While these are anecdotes or 'just stories,' I find them the most useful - because they're real experiences of real people, and it speaks louder than any 'study' that can often be flawed or skewed. Whatever the case, it represents a growing trend of medicalizing, and interfering, with birth to the point that we're causing more harm than good.

My question is, shouldn't Nicole and Em have obtained all this information before their induction? What is it that their doctors are (or aren't) telling them?

In other words, these women are probably their OB's perfect patients.

"My OB said what?!?"

Before I come off sounding like I'm totally anti-doctor or someone who advocates extreme distrust in your physician, you need to check out this site. No wonder so many women have negative, weird or just plain absurd stories they bring back from their OB visits. After three pregnancies, all of them with their own interesting situations, I've also heard plenty of them.

My own bizarre moments included a nurse midwife at my doctor's practice telling me, when I suddenly changed my mind and decided to try a VBAC: "I don't want to be doing this, you know." Gee, thanks for your support. But the kicker was when, during the early stages of my last pregnancy, another nurse midwife in the practice basically told me that if something happened as a result of trying for a VBAC, it "was my decision." Lovely.

Some good ones from the website include:
"This is the only way your baby will clear the pubic bone!", to a woman told to remain in the lithotomy position. Dear God...

"You know what we call people with birth plans? Cesarean sections!"

Check it out, and be sure to join their Fan Page on FaceBook !

Control Freak!

I'm sure that anyone who's thought about this as much as I have already knows this. Perhaps it's just a rant, an out-loud thought or observation that no one else is here to experience. But when I think of the typical model of birth in this country, especially among women I know (or based on my own experiences) things happen in one of several scenarios:

• You go into labor on your own, you receive an epidural, you have your baby.
• You go into labor on your own, but things don't progress to your doctor's liking (read "I have an important golf game/dinner banquet/my son's birthday party to attend! Hurry up and give birth!") and you're given Pitocin, you have your baby.
• You approach your due date, the due date passes, and nothing happens. Two days after your due date, your doctor gives you Pitocin, "lets you" labor for a few hours, and after nothing happens, does a c-section.
• Your baby is breech either upon the onset of labor or a few days before the due date. Your doctor does a c-section.

It used to be, probably during the days of our grandmothers and great-grandmothers, much different:

• You went into labor on your own, probably even up to two or even three (!) weeks late, had your baby at home, and everything was fine.
• You went into labor with a breech-presenting baby, doctor delivered the baby, and everything was fine.
• You went into the hospital with mild contractions but no other signs of labor, and they told you, "Sorry, honey!" and sent you home until it was really time.

Now, obviously this is an oversimplification, but I think you get the idea. It's important to note, though, that even with the higher infant mortality rates in the days of our grandmothers, that even with all of our medical technology and know-how, we still have extremely high rates of newborn death (in fact, the second worst, according to this article) among other industrialized nations. How on earth did this happen?

Somewhere between our mothers and ourselves, it seems the lines have been blurred. Somewhere along the path of medical school and obstetrical practice, our doctors, by and large, decided they were too busy or important to wait on our babies to be born when they decided to. At this point, they became impatient and wanted to control the one last vestige of life that is, still, largely unpredictable. You can have 100 vaginal exams a week before birth, all of which reveal some cervical dilatation or none at all, and it still won't be a good barometer of when you're going to give birth. You can be tightly closed with no effacement and then, six hours later, be holding your baby. It's the unpredictable nature of babies (both inside and outside the womb) that I think drives most modern-thinking OB's (read control freaks) absolutely nuts, because they just might get interrupted in the middle of something important. Nearly gone are the days of your OB racing to the hospital to catch your baby, like my mom's did - in a tuxedo.

No wonder the stories of women giving birth in elevators, taxi cabs and air planes are so rare and sensational - who gives birth like that anymore? There are some doctors who think every woman should give birth by c-section, no doubt just to avoid the unpredictability of birth and have it done their way. It's important to remember that, while there are interventions that are definitely necessary, those that truly aren't mean there's a price the rest of us have to pay.

Is the rising c-section rate in this country going ignored?

The current c-section rate in this country is hovering at about 33 percent. I don't expect everyone to know the exact percentages, but it would be nice if some people for whom this might pertain would at least know and understand, simply, that it's definitely on the rise.

I had a conversation yesterday with two friends, one of whom has had two vaginal deliveries - both induced - and the other, two sections due to breech presentation. One woman has a sister currently five months pregnant with her first child, and she's scared to death of having a c-section. "Well, the current c-section rate in the US is at about 33 percent," I said, stating that her fears were completely founded. Both women looked at me in complete shock and had no idea that that many sections were being performed.

How can you not know? Based just on the experiences of our common friends, it's so obvious it's like a slap in the face. When several of us were each expecting our second child, our friends held a baby shower. I recall thinking during that shower that all four of us had had c-sections, and three out of the four of us were on either our second or third section. I was the only one who had a successful VBAC. (One woman, a nurse, had attempted one with her second but was unsuccessful due to fever during labor. At least she considered it as an option, though!) Another of us - one who was also on her second section - mentioned to me that her doctor actually admitted once, somewhat tearfully, that she "loves surgery." Well, I wanted to say to her, no shit she loves surgery. This woman is on the American College of Gynecology Liability Committee, so VBACs are definitely a no-go in her book!

I live in a unique community. My husband is a teacher, and we're required to live on campus with other couples and families, many of whom are near my age and have small children. So in a sense, we are all 'victims' of the modern obstetrical system and all have similar stories. Of those women who are older - say, those who are over 50 - their birth stories are dramatically different, and reflect the days in which doctors had knowledge and experience at avoiding a cesarean. Breech vaginal births, twin vaginal deliveries - none of them, that I know of, had c-sections, and know even less about the current trend in surgical deliveries because they are far-removed from their childbearing years.

All these women my age, then, reflect different levels of income, education and backgrounds. Most of us have different obstetricians and some of us have labored in different hospitals. And even though I obviously haven't talked to every pregnant woman in the US, we reflect that trend of an increase in c-sections. How can that not be troubling, or even obvious?

When I think of the people I know who have had children in the last 15 years or so, I am one of three women who've had a VBAC. I know of only two women who have dared to have a successful home birth. And yet, I know 17, including myself , who've had c-sections, all but one of them repeat, and from what I can tell, only one was truly a matter of life or death (the mother had advanced HELLP Syndrome). That figure could actually be substantially higher, but I haven't discussed birth with all of them, so it's hard to say.

It seems that obstetricians aren't held very accountable for the increasing rate of sections they are performing. Yes, there are a number of reasons for them - some of them even legitimate - but it makes you wonder about the not-so-good reasons for them, and why OB's are still getting away with it. The World Health Organization recommends that the rate not be above 15 percent, and our rate is more than double that - and yet no one is waging a mass offensive to change this. That's not to discount the groups, individuals, bloggers and organizations who make it their life's passion to educate people about this - but, even with their efforts, there are still large circles of women who either think people like Ina May Gaskin and Henci Goer are "fruity," or don't even know who they are. ("Ricki Lake? She had that talk show, right? What's she got to do with this?" *sigh*)

Essentially, the increasing rate of cesareans is going unnoticed by the people it should matter most to: those who think VBACs are extremely dangerous and yet don't bat an eyelash at having their second, third or fourth c-section. Those whose doctors still get away with inducing for convenience because their baby had the grave misfortune of being due near a holiday weekend. Those first-time mothers, past their due date by 48 hours, who are sectioned after the Pitocin drip failed to work because their cervix wasn't ripe yet and only were allowed to labor for a measly eight hours. And now with the revelation that some health care providers are refusing women who elect for a repeat section - no doubt at the dire advice of their doctors - it appears clear that, no matter which choice women make, they are being punished, instead of the people who are really to blame. When a fear-mongering doctor builds his practice around half-truths and misinformation in order to protect his bottom line instead of yours, it's not a wonder.

The more things change, the more they stay the same

Reading, talking about and experiencing birth have got me thinking lately. Most of us women seem to love to talk about childbirth and pregnancy when we get together, and our mothers seem to be no exception. How we managed to come into the world is always a fascinating topic, and it's interesting to see how, over the generations, some things have changed for the better - and yet some things, for better or worse, tend to stay the same. 

I was born in a Catholic hospital in a small, semi-rural community in the mid-seventies. My mom checked herself in in the morning and didn't have me until nearly midnight. During that time, she apparently repeatedly refused meds of any kind - probably even saline, it sounds like - because she wanted to have a totally med-free birth. Before I was born, she had even insisted on having a hospital tour, at which point most people thought she was out of her mind, because you just didn't do that back then, apparently. 

The response to no pain meds was this: My mother labored all day and most of the night, in a room by herself. Nursing staff probably saw her as a difficult patient because of her refusals, and decided to basically completely abandon her as a form of punishment. 

Ina May Gaskin talks about this in her book, Ina May's Guide to Childbirth, when citing the story of a woman laboring in a New York City hospital in the late 1960s. With no hospital beds left, apparently, the woman was relegated to an empty gurney in the hallway, where she labored the entire time. Nurses, apparently, were the same brusque, seemingly uncaring kind that my mother ran into during her labor. I can't remember if it resulted in a c-section, but I wouldn't be surprised: lying flat on your back during labor works against the nature of gravity that can help the baby move down the birth canal, not to mention it is extremely uncomfortable, to say the least. 

Another story, from around the same time period, involves a friend of mine (whom we'll call SB), who was ready to deliver her second child in the space of one year. You could say that, because her children were so close together, that perhaps her body was more primed to birth, and as SB arrived at the labor and delivery unit, her baby was nearly crowning. The nurses insisted on giving her an epidural, (insert "You're going to need this!" here), to which SB replied that she didn't want, or even need, one at that point. What good would that do? You're nearly done!

And lastly, the story of a friend's mother, who birthed her daughters throughout the early and late 1970s, who was given, against her knowledge or will, a pill to dry up her breast milk, even though she was adamant on nursing her newborn. In a panic, she asked her pediatrician if she'd still be able to nurse, and he assured her she would and that everything would be fine. 

I find that even though many of these tales seem crazy, the same thing kind of still happens today. Perhaps procedures aren't as overtly clandestine, but patients seem little more informed than they were then. No wonder the pro natural birth movement was spawned in the 1970s, probably because of the nearly robotic nature obstetrics had taken on. In some of the mothering circles I've frequented, the overuse of Pitocin, epidurals and c/sections almost seem to harken back to those days, and for a minute you again start to feel like the anomaly - or at least like a troublemaker, for daring to speak up and question something that just doesn't sound quite right. 

In "the old days," births were often attended by the mothers, sisters, aunts, and other female relatives of the laboring woman. Usually with nothing more than personal experience - whether it be from having gone through labor before or having attended hundreds of births - a midwife delivered the baby, and those deliveries were often deeply spiritual events that signaled a rite of passage. I can attest that there is nothing more spiritual or empowering than giving birth in the company of women, something I will never forget from my one vaginal birth. Not only did I physically give birth via VBAC, but to a daughter - under the direction of a midwife, with female nursing staff in attendance. While it was a hospital birth, I no doubt labored with women who were sisters, wives and mothers - all of whom have probably attended the births of their sisters, nieces, daughters ... there was something so beautiful about that that I just explain any other way. 

While there were negative outcomes of childbirth before modern conveniences, technology and information, there were also many positive outcomes. And sometimes, unfortunately, there can still be negative outcomes even with a modern hospital birth. Some of these things, as Ina May hints at, can be prevented, but some cannot, and I think that's very difficult for some people to accept. With the onset of tons of medical interventions, you're often taking away the deeply feminine aspect of birth - as well as creating more problems in the long run. This kind of thinking has totally changed the way obstetricians practice medicine, as well as how the women in this country give birth, as evidenced by the c-section rate in the US that hovers around 33 percent. 

We seem to have traded one set of concerns for another: yes, the infant mortality rate has improved with modern care, but our cesarean section rate is definitely increasing. Back when doctors (and midwives!) knew how to turn babies in the womb, deliver breech-presenting babies and manage difficult labors, c-sections were rarely performed. It seems, however, that in many other countries - that also practice modern obstetrics - the rate of cesarean is much lower, no doubt because doctors respect and practice concurrently with midwives, and still practice many of the 'old school' techniques our doctors have long-abandoned. 

Women who are informed about their care and act on that information are often discriminated against, treated rudely or seen as nuisances by their doctors. In talking to many of my friends, the routine model of OB care seems to be one of two paths: You approach your due date, possibly go overdue by a day or two, and the doctor brings up the possibility of induction. You decide to do it, and either the baby is born on the doctor's time table (between the hours of 9 a.m. and 3:30 p.m.) or the induction fails, and you are shipped off to the operating room for an "emergency c-section" for fetal distress. End of story. 

In the meantime, it seems that that model of care mirrors the kind our mothers received - treated, on the whole, as robots, whose job is to just lie there and shut up, no questions asked. 

Low Expectations: Labor Pain Management

I often visit a ton of forums that deal with pregnancy and childbirth, and am saddened, shocked and amused at what I read. The perceptions that women have - and pass on to each other - often frustrate the crap out of me, and I wish we could somehow erase all those myths, misperceptions and unfounded fears that often swirl around being pregnant and giving birth. 

Pain management is one of them. One forum that I used to frequent often had first-time soon-to-be-moms asking questions like "How will I know I'm in labor?" or "How badly does childbirth hurt?" All perfectly good questions, that are usually met with total crap answers. Of course, the minute the semi-crunchy granola mom like myself answers those questions you're usually scoffed at or blasted for your opinion that pain is different for each woman. "Trust me, honey," one woman says, "you'll want that epidural!"

Well, not necessarily. I am totally not trying to sound like SuperMom in need of a "vag badge" (good Lord, I hate that expression!), but geez, pain management is different for everyone! I usually tell people, when they ask, that you should take it as it comes - not insist for an epi the minute you step off the elevator - but wait and see what happens. You might get through it and say, "That wasn't too bad," or maybe need something like Nubain instead. There are alternatives to an epi that can bring some relief, or at least relax you so you can focus on the business at hand. 

I had Nubain with my vaginal birth and while it didn't do squat for the pain, it at least made me not care about it. LOL I remember getting half way through my delivery thinking, "Maybe I should get an epidural." Then I thought, "Nope, too late for that." (Maybe it was the Nubain talking? Who knows. LOL) 

With my third child, I essentially went through the entire labor, minus the pushing stage, and didn't have anything. It wasn't anything terribly unmanageable until my water broke, and even then, changing positions totally helped. That's the thing - pain is different for everyone, and can be totally dependent on a number of things: your positioning, the baby's positioning (back labor stinks!), and especially your state of mind. If you go into it with another woman's idea of what pain is, simply because they told you "you'll want that epi!," then you're bound to be scared to death and clenched up tighter than a clamshell about to relinquish its prized pearl. 

Midwife Ina May Gaskin has a terrific analogy for this, which she calls "Sphincter Law," as far as relaxation and dilatation during labor. Picture a man who's been offered a $100 bill, if only he can pee in front of 50 people. There's no way that's happening, right? Just like some people can't go to the bathroom in strange places, giving birth can kind of be the same way for some people. If you're more focused on the pain, or especially the idea that strange people are in the room looking at your female parts, then you cannot relax and neither can you effectively dilate. Some women no doubt become exhausted at this point and stall, causing the cervix to stop opening. 

One thing I did to encourage dilatation was to meditate and picture in my mind the cervix opening up, almost like a flower. I pictured the chart in my doctor's office that shows the different stages of dilatation, and made a circular shape with my hands to further illustrate that point to myself. For my third baby, I actually carried the lid of a coffee can (which is roughly the same size as a fully dilated cervix - can you believe it?)  around in my purse LOL and looked at it whenever I thought about it. (Perhaps it worked a little too well, then, when I showed up at the hospital and my water broke as I was signing myself in!)

Other ways to manage pain in labor can include massage, walking and changing positions. With my second baby, she was nearly posterior, which meant painful back labor. Lying on my left side encouraged her to turn, which made the pain much more manageable. Having a doula present can also help by keeping you focused on something other than the pain, and has been shown to decrease the rate of epidural use. Either way, if you decide to have one, then that's perfectly okay - some women have other issues going on that might necessitate having one, and there's nothing wrong with that. 

Whatever happens, I encourage women to take it on a "let's wait and see" basis, because you just never know how things will turn out. If you go into it having low expectations, then they will almost always be met. But if you think positively and say to yourself, "I think I can do this!," you might be pleasantly surprised. 

A Dangerous "Procedure" known as VBAC

I don't know what it is lately, but it seems like this is VBAC week on my blog. I was doing some reading and came across this video posted on pinkyrn's blog site about a VBAC gone horribly wrong. The video is a news broadcast from some California news station that was posted on YouTube by none other than a birth injury lawyer. 

Unfortunately, along with the hole in this woman's uterus, are tons of holes in the logic of this story. While I feel very badly for her - as uterine rupture is probably the worst nightmare of every laboring woman attempting a VBAC - I just can't wrap my head around this story. The woman is suing her insurance company - not her doctor - because they didn't warn her about the dangers of a VBAC. Apparently, the baby was deprived of oxygen for TWELVE FREAKING MINUTES (and that's the insurance company's fault?!) and, not surprisingly, suffered permanent brain damage. The laboring mom, to her credit, no doubt knew something was up and asked for an immediate c-section, to which her doctor apparently answered, "Shut up." What?!

I'm puzzled why, then, the doctor himself isn't being sued for malpractice. Where were medical staff during that 12 minutes? Hunting down an anesthesiologist to do a crash c/s? Going out for coffee? Who knows. I don't want to sound too critical, because a mother and child were severely injured in this incident. But unfortunately, because of the crappy reporting this news station did, and the nature of this whacked out lawsuit, it paints a horrible, although unrealistic, picture here. 

I'm also curious what part Pitocin played in this birth, since it can cause more painful, stronger contractions that can increase the risk of rupture in a laboring woman with a prior uterine scar. (In fact, they can happen even before labor begins, in a woman with a prior scar.) My own doctor tried to scare me with stories of rupture when I told him of my plan to VBAC, saying he'd had at least two patients experience a rupture. I then asked, "And did those women receive Pitocin while in labor?" He didn't have much to say in response and brushed off my question, saying he didn't remember. With all the births I'm sure his practice has attended, and so few of them resulting in rupture, you better believe he remembered. That's not something you very easily forget, I'm sure. 

I would like to know where this attorney is when countless women are basically forced into having unnecessary c-sections, for failed inductions their doctors know won't work; for suspected 'large' babies who end up being born hovering at around 6 pounds; for women who fail to progress because some overbearing doctor with the bedside manner of a goat has his fingers up your you-know-what while you're trying to relax and forget your surroundings and dilate enough to give birth, all while in a timeframe that suits his golf schedule. Where is this attorney then, representing all those women who are essentially coerced into giving birth according to how the doctor wants it done, instead of being allowed to let their bodies do what they were created to do?

Of course the sensationalist reporting of this news broadcast does nothing to further the cause, only cement in the minds of women within the viewing area that 'the procedure' is a dangerous one and is to be avoided at all costs. Never mind that c-sections can also result in traumatic damage to a woman's body, and babies can die as a result of bad sections, as well. 

Unfortunately this case leaves me with a lot of questions that will no doubt go unanswered, since I couldn't find any information on it. On Dr. (yes, doctor) Fagel's website, it doesn't mention a whit about what his prior experience was in the medical field, only that he graduated from the Illinois Medical College of Medicine (huh?) in 1972 and then received a law degree in 1982. Exactly how much medicine did he practice, then, in that ten-year period, what with going to law school during that time? My guess is not much. 

I wish all doctors thought like this ...

I suppose, if I have another child, it would be considered impractical to give birth across the country with this guy. But I wish more doctors thought like he does. This YouTube video features obstetrician Dr. Stuart Fischbein talking about the risks and benefits of having a VBAC.

Key points that Dr. Fischbein makes include the importance of knowing the risks and benefits of VBAC and how much risk you're willing to accept. After all, he says, getting out of bed in the morning is riskier than staying in bed, but we're all perfectly willing to accept that risk and go on with our day. How is having a VBAC any different?

According to Dr. Fischbein, the risks of having repeat c/s over and over again - especially in the (rare) event that a couple wants to have a large family - can include thinning of the uterus, possible uterine rupture prior to labor in subsequent pregnancies, scarring, pain from adhesions, potential risk of increased blood loss and damage to the bladder, bowel obstruction, and the placenta growing into the uterine wall, which could lead to hysterectomy after the birth. Some of these risks, like blood loss, uterine thinning and rupture, bladder damage and adhesion pain can happen even after one or two c-sections, depending on the person. During my second section, my doctor apparently removed scar tissue that had built up after my first section five years prior. And maybe I'm crazy, but I think the pronounced discomfort I feel at certain times of the month is definitely scar adhesion pain. 

But after all those possible risks, Dr. Fischbein makes one very interesting and important point: that "these risks are usually not mentioned to women. All you hear is that 'your uterus could rupture and your baby could die.'" I call this lying by omission - because if you haven't done your research and believe everything your doctor is (or isn't) telling you, then your choice has really been made for you. Which is unfortunate. 

The biggest obstacles for pregnant women are their doctors - whether unintentionally or intentionally - misinforming them or omitting important facts about the risks and benefits; other women who have a negative story about this that and the other that often discourages women from even wanting to attempt a VBAC; and themselves. Yes, sometimes we are our own worst enemies - because we don't act enough as our own advocates and find out every detail and kernel of information that could weigh in our favor against this medical professional we practically see as God.  After all, he/she was the one who went to med school, right? They know way more about my body than I do, right? 

Dr. Fischbein notes that it's unfair to women to get skewed counseling from their doctors based on lies and misinformation. He does say that ACOG (The American College of Obstetricians and Gynecologists) still supports VBAC in their literature, but I'm willing to bet that if any doctor has that pamphlet in his office, it's probably carefully hidden or sitting at the bottom of a trash can.

One take-home point worthy of remembering: "The choice ultimately belongs to the patient herself." Dr. Fischbein, you rock.