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Friday, February 26, 2010

Thomas Beatie must have a really good OB

Regardless of how you feel about the Pregnant Man, he must have a very supportive OB to guide him through three pregnancies.

From what I've read, it hasn't been easy . He and his wife Nancy went through nearly a dozen doctors before they found one to help them when they were seeking to become pregnant with their first child. Beatie told Oprah that doctors refused him treatment, citing "religious beliefs" (which I find an immense laugh) and that they felt uncomfortable about the whole thing. That's understandable, but it's not really your job to let personal beliefs and preferences get in the way of treating a patient, who, coincidentally, is a human being, regardless of gender.

So, does that mean it's okay for a pregnant woman to decline interventions based on religious reasons? Something tells me you can try, but it will be very difficult. My guess is they would see it as 'child abuse' (even though it might be hard to prove, i.e. the Laura Pemberton case) and you would be forced to comply.

During his first pregnancy, Beatie said:

“A few months and a couple thousand dollars later, he told us that he would no longer treat us, saying he and his staff felt uncomfortable working with ‘someone like me,’” he wrote. Beatie added that he and his wife’s situation “sparks legal, political and social unknowns.”
So the doctor basically took his money and then decided he didn't want to treat his patient anymore. I wonder, did he give Beatie a refund for wasting his time?

He continues that one doctor referred them to a psychologist to see if they were 'fit to bring a child into the world.' (Do they routinely do the same for drug-addicted mothers, or parents who obviously should not be bringing a new life into the world?) Beatie says they were refused insemination treatment by nine physicians, and that 'receptionists laughed at them.' From the experiences I've had with some of them, I can assure Thomas that it's not just him - some of them are always that rude to everyone.

Despite the reluctance from so many doctors to treat him first as a human being, and secondly, as a patient, he found one who would. Dr. Kimberly James told Oprah that the baby was totally healthy and it was a "normal pregnancy."

Tuesday, February 23, 2010

Between a rock and a hard place?

A few weeks ago I went to an acquaintance's baby shower. She was due sometime in early March, but apparently was developing kidney problems as she got closer to the end of her pregnancy. She told me that doctors were concerned, and even though she had no swelling and no high blood pressure, protein was spilling into her urine and it had her doctors puzzled. Therefore they were considering inducing her two weeks before her due date.

I have to remember that often times my facial expressions are so easy to read, and I need to do a better job hiding my feelings. I probably looked annoyed? Concerned? Puzzled? Who knows. I try to remember, it's not my pregnancy, it's not my baby, it's not really my business. I asked if maybe she could go on bed rest and take a wait and see approach, but not really knowing the full scope of her problem, I wasn't about to offer too much advice. But in the back of my mind I thought, There is no way this is going to work. I felt so badly for her.

I asked her coworker about her yesterday, and he told me she'd had the baby. They tried to induce, it didn't work, and did the section around 4 a.m. He told me her mother had kidney complications, and I knew her mother had died a few years ago. I thought, What should she have done? She was put between such a rock and a hard place.

Ultimately, her baby was born healthy, and that's the best thing for everyone. I won't say "that's all that matters," because for many women the journey to having that healthy baby is very important, too. But I just wonder why they even bothered putting her body and her baby through all of that when they knew it wasn't going to work? Why kid her about entertaining the possibility of having a vaginal delivery?

That was her first lesson in the School of Childbirth, and I felt so badly for her, but even more so for not really being able to avoid it. I felt the same way with my last section. It's sometimes a daily struggle to not feel "ripped off" by the whole experience, and somehow come away from it positively and hope to help other women (without coming off as the "Pregnancy Police" or a "birth nazi" - I hate that term).

Maybe if she has another baby she'll have a chance for a "do over."

Monday, February 22, 2010

Mini fetal monitor "saves lives"

While researching my last blog post, I read this article on Science Daily : a new (as of January 2009) portable fetal monitor was 'helping to save lives' in high-risk pregnancies. 

The device, which looks a lot like a cell phone, includes strapping five electrodes to mom's belly to monitor things like fetal movement, mother's heart rate, and the baby's heart rate, as well as baby's position. The monitor is capable of collecting data over a 24-hour period and stored "on a USB that doctors can access at any computer - allowing them to note any signs of danger early on."

While I'm all for helping to save lives in truly high-risk pregnancies, this kind of technology makes me raise an eyebrow. The effectiveness of EFM has been debated, and often leads to more c-sections because doctors can misinterpret the signs of true distress and freak out, often for no reason. 

The article states that "ultrasound is not a perfect technology" when doctors are monitoring high-risk women, therefore justifying the use of the new monitor in high-risk pregnancies. 
"[Ultrasound] It doesn't tell you very much about fetal movement, it doesn't tell you anything about maternal well-being and it doesn't monitor the uterus," said Ahmet Baschat, M.D., a high risk pregnancy specialist at University of Maryland Medical Center in Baltimore, Md.
The irony in this statement is that it surely seems "perfect" or accurate when doctors are trying to induce because of a baby's size, failing to admit that ultrasounds can often be off by a pound or two either way. The monitor, the article gushes, "can spot danger signs earlier, giving doctors time to intervene and help save lives."

And if this monitor tells doctors about the 'state' of the uterus, then perhaps this means more OB's would be comfortable "letting" their patients attempt a VBAC?

Oh, if only. I mean, that's what they originally said about Pitocin, ultrasounds and c-sections. They were only done in desperate measures (theoretically) and to save the mother and baby. People are still under the impression that doctors, by and large, will 'not induce you unless there is something wrong with you or your baby.' Based on the induction rates of some doctors, we know this isn't exactly true.

The article continues:
In the future, doctors intend to use the monitor for home use to wirelessly transmit health information on mother and baby to doctors' offices.
Oy. This sends up a huge red flag. How 'perfect' is this science? How much is the room for error? And if you refuse, well heck, they know where you live. They know, by reading their monitor, that you must be doing something, it sounds like. If you fail to come in by their definition of a timely manner, then they could just dispatch the police , which hospitals seem to be doing in some areas, in order to get you to comply.

I can totally see this wonderful technology being overused and abused, applied to every pregnant woman in the future rather than just those who are truly high-risk. Other interventions in pregnancy and birth that once were reserved for 'emergency' cases are now commonplace, so why not this one? And based on what we know about the sketchy credibility of EFM as it is already, there might be something to the theory that 'some day, every baby will be born by cesarean.'

Saturday, February 20, 2010

And you wonder why women don't want to give birth in hospitals ...

'Birth is inherently dangerous,' cries Dr. Amy, an outspoken 'skeptical OB' who seemingly roams the internet, looking for 'birth gone bad' stories in order to fan the flames of panic and worry. Skeptical of what? I wonder. That women can actually give birth without fear, worry and all the other trappings that come with it?

I've been pondering a couple of things lately: namely, again, the death of my great-grandmother, precipitated by my reading Tina Cassidy's book, and a recent visit from my mother. We talked about the physician who delivered my grandmother and again of his disgusting medical practices, even though the word about proper infection control was no doubt spreading faster than a colony of germs. She told me how classmates of hers remembered going to this same doctor for routine shots, and he would use the same needle on both kids.

Gack. No wonder my grandmother died, I thought. I'm partly tempted to use the 'they didn't know any better' defense for some of these a-holes, but yet I'm not sure that's entirely true. I mean, you wouldn't eat dinner with those filthy hands, would you? So why would you deliver some woman's babies with them?!

Dr. Amy wants us to believe that 'birth is inherently dangerous' because we never know what can happen around the corner. Yes, I suppose there is some truth to that. I can't account for every birth disaster or bad outcome, but neither can you compare it to the births of yesteryear (which I think she wants us to do). She relates that women routinely died in childbirth, but makes it sound (maybe not even intentionally) like it was a product of their own doing, a result of their body being 'defective,' rather than admit that many, many bad outcomes were a direct result of improper and inept physician care. (Cassidy cites this in her book, using the example of a well-qualified late 18th century midwife who had very positive outcomes, until a young, inexperienced doctor delivered one of her client's breech babies with fatal results.) She wants us to believe that being in a hospital is the safest place for us to birth our babies, even though we're treated like robots, or processed faster than a new Chevy on an assembly line in Detroit. (Never mind that, with modern obstetrics and interventions, the rate of neonatal death continues to rise in the United States.)

And anymore, it just seems like you can't put all your faith and trust in that guy in the white coat. Just because he has a diploma hanging on the wall doesn't mean he has common sense. In comparing my grandmother's death to medical practices of today, I found the curious 2005 case of Dr. Harvey Finkelstein , a Long Island anesthesiologist who was found guilty of reusing syringes in multi-dose vials, which put thousands of patients at risk for contracting blood-borne illnesses such as hepatitis and AIDS. So, do you want him giving you your epidural? Sadly, it is known that he is not the only doctor to have done this.

Even my dad, who attended my brother's birth in 1982, noticed the doctor arrived basically 'covered in blood' from another delivery and noted that he looked a mess. (Ironically, my brother suffered from severe group B strep after birth.)

But, if you are a health professional who happens to call your doctor on his/her mistakes, you just might get sent to prison for it. Anne Mitchell , a whistleblowing nurse from Texas, wrote an anonymous letter to  her boss, Dr. Rolando Arafiles, Jr. because of what she considered 'unsafe practices.' He promptly fired her. (At her trial, she was acquitted.) (More on the case here , where patients also stood up for the good doctor because 'he saved their lives,' including the town sheriff. It seems like poor Anne had the cards stacked against her from the beginning, maybe.)

Maybe this is why so many OB (and other) nurses don't complain about patient treatment when they work with a doctor notorious for being harassing or aggressive towards pregnant patients. Or, perhaps it's a case of 'if you can't beat 'em, you might as well join 'em.'

We know better now about infection control and safe medical practices, and have countless studies that prove some of the interventions and procedures performed on women might have the opposite effect on them. Yet doctors still blatantly disregard these common sense practices and throw all caution to the wind, often putting countless mothers and babies at risk for no reason.  Is it any wonder why women don't want to give birth in hospitals?

Friday, February 19, 2010

Study: 'Start Obesity Prevention in the Cradle'

America is obsessed with weight. That's not much of a surprise. We're either too thin or too fat, but either way, we're a nation obsessed.

Recently American doctors released a new study that determined the following:
The "critical period for preventing childhood obesity" in the children observed in the study would have been in "the first two years of life and for many by three months of age," said the study, published in Clinical Pediatrics.
Wait a minute. Three months of age?

I have a problem with this study (LOL I said that about the last one!) - unless you're one of those rare moms (or dads) who is feeding your baby pureed pork rinds, at three months most babies are not even on solid foods yet. They are either completely breastfed or on formula (or a combination of the two). The study found that a quarter of the kids in the study had a weight problem 'at or before three months of age.'

I see visions of growth charts dancing in my head...growth percentiles that mean nothing, basically. Most pediatricians will tell you that the charts don't mean a whole lot (at least mine does) and that "Every baby is different!" And even more parents will tell you that their child was a huge chub at 6 months old and is skinny as a beanpole now as a grade schooler.

There are so many things this study (or at least the article) didn't even mention: the eating habits of the parents or family, exercise or activity level and genetic make up of the parents, namely. And an April 2009 study done by the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care, and Children's Hospital Boston, found that: 
"The mounting evidence suggests that infancy may be a critical period during which to prevent childhood obesity and its related consequences." 
How, exactly, can you prevent obesity in a three-month-old? Refuse to nurse him? Withhold that extra jar of peas? Give me a freaking break.

The Harvard-based group found data from another study that had this to say:

"Take for example two infants with the same birth weight who, after six months, weigh 7.7 kg (16.9 pounds) and 8.4 kg (18.4 pounds), a 0.7 kg (1.5 pounds) difference. According to study estimates, the heavier of these two infants would have a 40% higher risk of obesity at age 3 (after adjusting for potential confounders). (My emphasis) 
Really? Wow. Read on:

While this study confirms earlier ones examining the relation between infancy and childhood weight, there were certain limitations. For example, the researchers weren't able to examine social and behavioral interactions around feeding between parents and infants. And while families in the study represented various ethnic backgrounds, they were fairly homogeneous socioeconomically, so there may be some question regarding how widely the results can be generalized.
This admission alone tells me that this research is somewhat flawed. Like, what are the eating habits of the parents? Do they emphasize good nutrition in their youngsters, or do they have a pantry full of juice boxes, kid sized vienna sausages and macaroni and cheese on standby 24/7? Do they come from cultures where more fattening foods are the norm, or are they vegetarians? Do they have the finances to eat strictly organic (which is, by and large more expensive than convenience foods) or do they have a lifestyle that often necessitates 'eating on the run,' where nutritious meals might be harder to come by? Basically their findings tell me nothing, other than babies who weigh the same at birth aren't necessarily going to weigh the same when they're three. I wonder how much money their study spent to come to that stunning conclusion?

Some mention 'missed satiety cues,' basically meaning some parents are overfeeding their babies and causing weight gain because they can't tell when their baby is full. Well, maybe, but I'm not sure I buy that, either. Infants, unlike adults, will not eat when they're not hungry (at least none of my three would). They don't have the 'clean plate club' mentality at three months old, and you can offer the breast, bottle or 20 jars of baby food and they're not going to eat it if they're not hungry. Whether they turn their heads or push it away with the wave of a chubby hand, they'll refuse it. Too much formula or breastmilk? I'll bite the nipple (or your nipple!) mom, to tell you I'm not interested. Or barf it all back up on you. How can you miss that?

The words 'breastmilk' or 'formula' don't show up anywhere in the article, either. So we aren't told what kind of diet these kids had, if you could even call it that, since most experts tell us it's better to delay introducing solids until six months or older. And studies have also shown that breastfed infants are usually thinner than their formula-fed counterparts.

The study goes on to say that things like appropriate weight gain in pregnancy are factors to consider, but they are still trying to understand some of their findings. Interestingly enough, pregnant women are generally heavier than they were say, 30 years ago, when women often dieted heavily in order to prevent having 'large' babies, which not only produced smaller babies, but did potential harm to them. Can we achieve a common middle ground here? What's too much? What isn't enough?

With the emphasis already placed on the pressure to be thin in our culture, I find these kinds of studies more harmful than helpful. The White House is 'cracking down' on obesity, especially in children, and the Obama girls have been placed under a microscope for being called 'chubby' by their parents (as if they aren't under one already just by virtue of being the First Family). I fear that studies like this will serve to scare parents who want desperately to be the best parents they can be by feeding them (no pun intended) questionable data or just plain misinformation that has no clear result or solution.

More interesting information can be found here: Average growth patterns of breastfed babies, including comprehensive growth charts that compare boys and girls, according to both CDC and World Health Organization data Baby Denied Health Coverage Because of A Pre-existing Condition: Obesity

From the article:

"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."

Because his dad's a news anchor, you can bet that had something - everything - to do with this story being picked up the national news media. And the insurance company, when pressured, reversed their stance. Imagine that.

Life is Fragile; Handle with Prayer

Yesterday was our visit with the pediatric cardiologist. I want to say that they've found the answer for my son's fainting episode, but honestly, I blocked out so much of the visit I'm not even sure what I learned from it.

It didn't help that, when we first entered the office waiting area, I crossed paths with a man on his cell phone who told someone on the other end, "The baby didn't make it." It wasn't even my child, but I nearly lost it. That sort of put things into perspective for me - that it could always be worse. Much, much worse.

We're finishing the last three-quarters of a 24-hour session with a holter monitor, because the EKG didn't tell the doctor a whole lot. What it did reveal, though, is something called "ectopic atrial pacemaker," which basically means that my son's 'natural pacemaker' is on the opposite side of his heart than it should be. While the results looked promising, and the doctor reassured me he just wanted to be sure that everything was okay, the mere mention of the words "sudden death episode" sent me into a downward spiral. I think my brain blocked out all the positive words of encouragement he offered, like the fact that my son shows no 'alarm signs' that could possibly lead to such an episode.

Normally I'm a 'research nut' and will look up anything to learn more. But at times like this, Google is definitely not my friend. I've decided that, after a basic cursory search, I'm not interested in raising my blood pressure that much and will wait patiently to see what the doctor says. 

Of course any questions I had, I thought of after our visit. And it doesn't help that the first thing that came to mind was a young man whom my husband knew in college who collapsed and died suddenly while playing floor hockey. I am trying very hard to banish that image from my mind.

If anything, this episode serves as a wake-up call. To appreciate my children more. To be more patient with an otherwise normally trying, active six-year-old. To spend more time enjoying my children. To pick my battles better and not freak out about the stupid, unimportant stuff that doesn't even matter. Sometimes that wake-up call is subtle; sometimes it's like a two-by-four smacking you upside the head to get your attention NOW. I guess this would be one of those times.

I look back over my time so far with my oldest and kind of laugh, jokingly thinking about how he's been a "troublemaker" since his days in the womb. When I was four months pregnant, I had an unexplained bleeding episode that resolved itself. At six months old, he had minor surgery to repair a clubfoot, which was done on an outpatient basis at our local children's hospital. I overheard a couple talking to their child's doctor about "biopsies," which put things into perspective for me. I thought about that couple yesterday, and the worries that I've had about my child over the years. What if something did happen? What if I lost my son? That is definitely something that no parent should ever have to think, but unfortunately some do, every day.

In the meantime, we are taking one day at a time. Doing our normal thing, trying to ignore the possible black cloud that might be lurking in the background, and praying to God that it has a silver lining.

Wednesday, February 17, 2010

Vacation Time: I think I'm gonna be sick

There has to be a phenomenon known as "Get Sick While You're on Vacation." I looked it up and found nothing. But I know it's there.

The long-awaited winter break is here. While every day is (sometimes) a vacation day for me as a stay-at-home-mom, I was excited about having my husband back for a week without anything major going on and just puttering around. He is a teacher, and his job requires he spend a lot of time on campus and with his students normally, so that break was just going to be 'fun time.'

As if.

Before break even started, my poor son meandered downstairs to the breakfast table with pink eye. I looked at him from a distance and saw the faint swelling of an eyelid and just knew. Dread and sorrow well up as we decide to call him off for school, which means he'll miss the Valentine exchange. I run his newly-decorated shoebox for Valentine collection into school anyway.

My daughter has a library story hour on Fridays, and since my son was basically "well," we decided to go. I figured I could easily isolate him from other children, (especially since this branch almost never has more than a handful of people in it anyway) which was successful. But minutes before we were about to leave, after a trip to the bathroom for hand washing, my son inexplicably passes out. What the heck? I think. Fast forward a few hours and we've been seen by paramedics and the pediatrician. And by now, Wednesday morning, we've seen them as well as the neurologist and had blood work done this morning (during which, I must say, my son was quite the brave little trouper). Tomorrow we have a cardiology work-up, and next week, the Big Shebang: An EEG, ordered by the neurologist, in which I have to somehow deprive my son of sleep AND keep him awake until we get to the appointment.

My mind races. How am I going to do that? I'll need someone to watch the other two and then someone else to sit next to my son and poke him the entire time in the car while we're en route to the lab, which is about 45 minutes away, easily. There's only so much noise I can make to keep him awake,  and the radio and air conditioning can only be turned up so high.

Can this get any worse? At least if it was going to happen, this is the best time, I suppose.

I thought back to vacations past, and definitely remember some doozies. Lounging, if you want to call it that, on the deck of our hotel room at Jekyll Island, Georgia, the sounds of the surf punctuated only by severe congestion and nose-blowing. My mom, on a trip to Florida one year, gave me the same report during a phone call to see how her "vacation" was going. I've had countless bouts of nasty cold, stomach flu and other junk while my husband's been off, thank goodness, so he can take care of the kids. But it doesn't make for a very exciting time.

And in 2011, we plan on taking a mongo family vacation. I'm starting to get nervous already in anticipation of which one of us will be puking our guts out on the eve of our trip. Why is it we always seem to get sick while on vacation? It's like our bodies know there will be a period of rest, and finally break down. If anyone can answer this question, please let me know!

In the meantime, I think I need a vacation from my vacation.

Saturday, February 13, 2010

Study: Poor, less educated women get fewer epidurals

Another new study recently hit the headlines: Apparently poorer women with less education don't receive epidurals as often as their more educated sisters.

Apparently socioeconomic factors determine who has an epi - things like race, income and level of education, and not necessarily insurance coverage - and researchers determined that nearly one fifth of women from the poorest neighborhoods were "41 percent less likely to have an epidural" than their more wealthy counterparts.

The study noted that epidural use was less frequent at smaller community hospitals than at larger teaching hospitals, but weren't sure why this income and education disparity was also common at those smaller hospitals. I can venture a guess that perhaps doctors at smaller facilities had less access to an on-call anesthesiologist and thus had lower epidural rates overall, perhaps.

I have a couple of problems with this study. Namely, were these poorer women first-time mothers? Had they labored previously? Do we really know WHY these women refused an epi, or are researchers just speculating? I think, if nothing else, the perceived take home message of this study is going to be that "women are dumb if they refuse an epidural." They're already often treated that way by medical professionals and other women.

One part of the study caught my attention: "Women with more education may know more about epidurals and be more open to having one," the study speculates. That part makes me laugh - because if anyone really knew about epidurals and their risks, they'd probably NEVER want one. 

Perhaps these women had supportive female family members who raised them with the belief that childbirth is painful, but worth it. That your body can handle it. That it's often just something we innately do as women and then we move on. Not, "You're gonna need that epidural, honey!"

Less education should not imply no education, though. And they didn't specify to what degree these women were educated. One thing that strikes me, though, is those seemingly "disadvantaged" women were probably better off in the long run and might have had a better birth experience overall. It also proves that more education is not necessarily better.

Thursday, February 11, 2010

Tell us something we don't already know

OK, so to most of us this is already old news:

Studies find that "Staying upright speeds the first stage of labor." But of course, we all know that "gravity doesn't help during birth." (insert major eyeroll here) Here's more on the best positions for labor and birth , and also some interesting highlights on why the most widely-used position in hospitals (lithotomy or in a "c shape") can cause more harm than good. Combine that with overuse of Pitocin and it's surprising anyone in a hospital can manage to give birth these days.

And this study shows that eating during labor has no ill effects.  Not surprisingly, the incidence of vomiting between the two groups studied was the same. Of course, we're not talking about a seven-course meal, here, but rather eating lightly. It's common sense that light food and drink during labor are going to give you energy that your body needs to undertake such a tremendous task!

We already have information that shows episiotomies are widely overused and often not even necessary , causing more damage than preventing it. But yet, they're still widely performed. We know that Pitocin can actually slow down some labors and cause problems in the infant that could be avoided, if only it weren't used in the first place. And yet both are standard procedure in today's delivery rooms world-wide.

The information is there, plain for all to see. The big (rhetorical) question is, why aren't doctors listening? Why is this not the norm?

Wednesday, February 10, 2010

Getting There is Half the Journey

During my daily blog reading I came across this post from Jill at The Unnecesarean , about a Bulgarian woman going through a horribly traumatic childbirth. My heart ached for this mother, whose body was literally torn apart by rough doctors who seemed to have little regard for her or her baby. It was like something out of a science fiction movie, or at the very least, reminded me in part of what birth was often like here in the US just several decades ago.

My mother-in-law gave birth to my husband (who had a 'large head') in 1972 under many of the same conditions. Combine an already-nervous person with a labor in which you're no doubt strapped down or restrained in some way, and you get the perfect recipe for a high-forceps birth (which is out of fashion in the States now because of the increased risk of brain injury to the infant). I would ask my mother-in-law about it, but since she was drugged to the gills, she, by her own admission, doesn't remember any of it.

So many women are completely unaware to what lengths some women go to give birth in the gentlest manner possible, or even why they want to. Traumatic birth experiences, knowledge about the true nature of modern obstetrics in general, or just an innate desire to give birth more naturally might be just some of the reasons. 'It doesn't matter, as long as you get a healthy baby' is usually the mantra, as if to say you should just shut up and submit already. But for many of us 'crunchy,' 'granola' or 'fruity' moms, it does matter. One thing I don't think the 'it doesn't matter' crowd understands is that their apathy sets the tone in obstetrical care for everyone, even those of us for whom it matters very much. Try telling that Bulgarian mother that 'it doesn't matter,' because obviously it does. (I hate referring to her so impersonally, but I don't know her first name.)

This is, in part, why I chose a VBAC for my second birth, because my first childbirth experience, in retrospect, was pretty awful. Second to the morning sickness, the pain of c-section recovery was the single-most thing I dreaded about being pregnant again. I feel ridiculous even mentioning it in the same post as this woman's traumatic birth, because my experience was nothing when compared to hers.

With my first child, I was scheduled for a c-section because of breech presentation. We had picked the day, and my doctor made passing reference to me going into labor first as 'not being that bad' and 'they wouldn't let me go too long' if that happened. No mention of the risks of surgery, anesthesia, the possibility of respiratory problems in an infant after a surgical birth, no nothing.

I went into labor two days before the scheduled date (in hindsight, I thanked my body for this later, as it was 'proof' that my body could start labor on its own, a prerequisite that would be very important later on.) Despite the curtain being raised above me to essentially 'protect me from myself,' I could see my reflection in the overhead lights and did everything I could not to look as my body was cut open. After the baby was born, he was examined and weighed out in the hallway where I couldn't see him (my husband was with him) and it was surreal to hear him crying from so far away. They didn't even bring him up to my face so I could kiss or touch him, and the whole birth seemed rather detached and cold. As they were finishing the surgery, I thought to myself, "Do I even remember what he looks like?" because I had seen so little of him.

I was wheeled into recovery with the baby next to my bed. I couldn't hold him because I was still under the anesthesia, but the best I could do was watch him as he got used to his new surroundings. Once I regained sensation in my arms, I proceeded to itch myself silly from the spinal for a few hours afterward. I remember briefly holding him, I think, but no attempt was made to help me nurse him. Probably because of my own inexperience with breastfeeding, he didn't latch on for nearly 2 1/2 days after the surgery. The baby, and my husband, could only stay for a little while, and I was left alone for the rest of the night (this was about 2 a.m.) to 'rest.'

One thing I noticed right away was how much my arm hurt every time I used that ridiculous PCA (Patient-controlled anesthesia) pump. There was supposed to be Demerol flowing through my veins; instead, I got a burning, stinging sensation that felt like my veins were being filled with acid. The pump beeped intermittently, the nurse ran in and then back out again after adjusting it. I complained that I was still in pain; they ignored me.

I knew something was wrong with the IV - that explained the beeping. On an IV pump, when a line is blocked or the tubing is otherwise compromised, it will beep to let the attendant know. (After calibrating enough IV pumps during my work at a pharmacy, I knew at least this much.) Yet the nurse would flutter in and out and adjust this, adjust that, then return to her post at the nurses station to continue the discussion on the Lord of the Rings movie at 3 a.m. I remember this because I could hear everything they were saying clearly, being awake almost the entire night.

Throughout the next day I tried pushing the button for more pain meds, but nothing happened. "You can't have anymore," explained a nurse, "because you're only allowed ten doses in an hour, and you're over that limit." "But I'm still in pain," I said. That was the end of that. Never mind that, when I was supposed to rise from my bed the first day after surgery in an attempt to get up and walk around, I felt like my body was being seared in half as I tottered like an elderly woman to the bathroom.

While all this was happening, I was getting increasingly hungry. I stopped to think and then realized, I hadn't eaten breakfast. What happened? Oh, someone replied, you're supposed to go down and get it yourself in the cafeteria.  Never mind that you've just had major abdominal surgery, and I hadn't the faintest clue where the cafeteria even was. A nurses' assistant felt sorry for me and stole a turkey sandwich off the lunch cart.

Later, after my hand swelled up to about twice its size, the nurse looked at it in horror and reported, "We've got to get that out of there!" So I ventured a guess that I was managing pain with about six doses of Lortab a day, with an ibuprofen thrown in here and there for good measure. The Demerol? Who knows where that was going. At least my left hand was pain-free, in theory.

Not everyone has a terrible c-section recovery, and not everyone has a great vaginal birth. Like our pregnancies, our births are all different, and so is the way our bodies react to them. Birth is not the 'one size fits all' experience that most doctors, and patients, think it is or should be. And birth is not just about going to the hospital and pushing out a baby. Because while having a healthy baby is the main objective, sometimes getting there is half the journey. And sometimes the choices we make while on that journey can make the end result take a totally different path.

Friday, February 5, 2010

Uninformed non-consent

There seems to be a popular myth that a doctor cannot do, or never does, anything to a pregnant woman's body that she hasn't consented to first. Yes, in an ideal world, but this is the furthest thing from the truth. But in some cases, it seems that 'informed consent' is a relative term.

A baby is born via c-section in Brazil, where surgical birth rates are among the highest worldwide. 

While hopefully not the norm, this kind of stuff does happen. Even here, in the United States of America, the most wealthy country with all this knowledge, medicine and technology at our fingertips.

The other day on Yahoo! Answers I read a question about a woman who had received a tubal ligation without her consent. Her now ex-husband had ordered it after the birth of her third child, in the event that if they ever divorced she wouldn't be able to have children with another man, from what it sounds like. The doctor agreed, and thus the tubal was done.

It's important to note that this woman was posting from India, where reproductive rights are not what they are in Western countries. So I have no doubt that this woman was telling the truth when she presented her plight.

Women left and right answered her with a barrage of stupid, insensitive answers, some calling her a "troll," others assuming that there is no way a doctor could do that to her without her consent and suggesting she seek legal action. Yeah, sure, in a perfect world she could do that. But it is plainly obvious that women the world over, even in this country, are treated like nothing more than vessels to hold the baby, like they have no feelings whatsoever and are hormonal time bombs waiting to explode.

When I responded, I took notice of how the reproductive rights of women in her homeland were probably very different than in the US. I also noted, however, that women even in this country suspect they've been the victim of tubal ligation (and other procedures) without their consent. One particular website, that of a tubal ligation reversal clinic, features a forum in which several women have written in complaining that they inexplicably can't get pregnant after three children, and suspect that their doctors did a tubal without their consent. On another forum, thankfully one physician saw it for what it was: a felony and assault, if proven that the procedure was done without the patient knowing. But what are you going to do about it? (Read on to see that the woman in question reports that other patients in the practice suspect they had the same thing done, yet were totally okay with it.)

And even if the practice is consensual, many times the OB will ask a woman in labor if she wants a tubal while he's 'at it.' Surely you can discuss this beforehand or at the six week check up, when hormones aren't raging and the body's response to a painful birth isn't doing all the talking. Lots of women give in to a tubal at this point, and later come to regret it.

Another procedure often done for no reason and without consent is the episiotomy. The option is to tear or be cut, and conventional wisdom assumes that it's better to be cut in a 'controlled' manner than to tear. Thankfully my midwife asked me what I wanted to do, and I consented to be cut because I wanted the baby out. (I know... duh!)

People are horrified at the terrible acts of genital mutilation often practiced on women in African countries, yet a similar practice goes on in the obstetrical wards of hospitals every day in the US (and in other industrialized nations). One criteria for true female genitalia mutilation is 'non-therapeutic reasons,' and given that it's estimated that nearly 99 percent of all episiotomies are totally unnecessary, I'd say this definitely qualifies. And while Wikipedia, of all places, has an in-depth article on FGM as used in African cultures (including types that don't involve tissue removal, which I'd guess is most similar to a typical  'western' episiotomy), they don't mention anything about this phenomenon in American obstetrics.

Studies have shown it's actually easier to heal from a tear than from a cut. Some OB practices do them on every woman, whether they really need one or not. And sometimes it's done before the woman can even say anything, or even though she's already refused and has continued to do so immediately before the procedure takes place. I've read countless stories - including my own, I believe - where the mother has requested no pain relief during labor, which somehow cruelly translates to the OB, "Don't give me pain relief for an episiotomy."

And sadly, one of the most common obstetrical surgeries is often done without "consent" - a c-section. In this situation, I think it's important to define 'consent.' Consent under duress seems much more fitting - (Read it and weep. Literally.)

No one is arguing that sometimes a section is necessary, or that sometimes there is just no time to dilly dally and debate it. But in the case of a woman who is actively, successfully laboring on her own, can this interruption of normal labor be considered true consent?

In the case of Florida homebirthing mom Laura Pemberton , who was arrested during active labor and taken to the hospital in shackles for a court-ordered c-section, do you really think she had a choice? Was her consent given? Or this woman, who was in the process of a successful VBAC, nearly ready to birth her baby when the attending physician interrupted and insisted on a c-section ? She granted consent only after extensive harassment, which included the threat of not helping her deliver her child and discharging her from the hospital, even though she was moments away from giving birth.

It's sad and terrifying to think that women have to take such protective measures with their own health. And that the more educated about their bodies that they are, the more threatening their situation can become. The words "First, do no harm" have long flown out the window and been replaced with shades of grey.

For more reading on this subject, click here .

Thank you, Target!

I just got off the phone with my local Target after searching high and low for a big honkin' box of baby wipes I just bought there a few days ago. Where could they be? Not in the car or the house. I tried to make a mental picture of the shopping cart and don't remember even putting them in the car to begin with. I know they were on my cart ... my receipt says I paid for them ... was I ever at Target in the first place? LOL My mom brain is trying desperately to remember.

I thought I'd call just to see if anyone brought them to the service desk, in the off chance that someone like me would claim them. She said they weren't there, but because the item was under $20, I could come back with my receipt and get another box! How cool is that? (And thankfully I didn't buy the super big honkin' box that was over $20)

It's nice to know they don't just assume I'm crazy. And I'm sure the cashier might forget to give someone his or her bags, or people leave stuff behind all the time. Although it's way out of my way, I'm sure my son's butt will thank me for it...

Thursday, February 4, 2010

Scar tissue adhesions and female pain

Today I woke up with another killer lower backache. At first I attributed it to the crappy pillow-top mattress we have. But then as the day wore on I noticed I was getting almost cramping, like a period. I just had my period, I thought, and realized that it must be mid-cycle.

I then remembered that I had been experiencing back pain and more strange feelings 'down there' on a more frequent basis, almost cyclically. I've had two c-sections and thought, Do I have adhesion pain?

It's not severe, but annoying. It certainly wasn't enough to cause me infertility (at least after my first section) because I got pregnant twice more very easily. My doctor supposedly cleaned up scar tissue during my last surgery, but of course more would have formed after I healed up. Every now and then I get twinges that are almost like round ligament pains, and am starting to wonder just what the heck is going on.

Knowing little about adhesions and 'female pain,' I did some research. I was shocked to learn that among women surveyed for a particular study, between 55 and 100 percent of women had adhesions. Apparently they're pretty common after pelvic reproductive surgery, but not as many women experience complications from them.

Basically what happens is that when you heal, your scar tissue can literally grow into other organs around that space that are not normally connected. The worst-case scenario could mean infertility and even bowel obstruction, because the scar tissue has formed around the bowel tissue and literally cut it off. Other problems that are probably a total pain in the ass to live with include pain during urination and sex, and just pelvic pain in general. Unfortunately a lot of the treatment for c-section adhesions often means opening you up again to see what's going on, which just creates more scar tissue. And from what little I've read about it, it's often hard to get someone to take your pain seriously - often difficult to diagnose, it's estimated that around 33 percent of women will have it during their lifetime, and up to 20% already do.

As far as pain from c-sections go, the one website made a vague reference to 'an ounce of prevention being a pound of cure,' since they cited that nearly half of all women develop adhesions after their first c-section. That figure rises dramatically (to 75%) after a woman's third section. What are they saying? They don't exactly make it clear, but let's hope that it's 'if you can avoid having a section in the first place, it can help prevent this problem.' (Since this website is created by the Women's Health and Urology Department of Johnson & Johnson, I'm guessing that is the reason for their vagueness. Who knows.)

A patient referenced on the website said that while her first c-section went quickly, her second was much longer because her doctor had trouble removing the baby through the excess scar tissue. She added,
“If I had known about adhesions, I would have talked to my doctor about what can be done to reduce my risk for getting them.”
My fear is that her doctor never told her the risks, which is his responsibility as a physician. Looking back, my doctor never mentioned them either, only until I brought it up while preparing to have a VBAC with my second child. As expected, he totally downplayed the risks, in my opinion. (Avoiding a possibly unnecessary c-section in the first place would have even further reduced that risk, but I guess that's a moot point.)

And much to my amusement, one of their suggestions was that your risk of adhesions could be lowered if your doctor 'took great care during surgery.' Well, let's hope they all do that!

Wednesday, February 3, 2010

The media doesn't know crap about childbirth

OK, to some of us this is no surprise. I mean, if you model your ideas of childbirth after an episode of Friends, then you're in trouble.

While scanning the blog roll today my eyes fell upon this: CrunchyDomesticGoddess' post  about how the Today Show was airing a live c-section. The gist of the story is that the mother was having a repeat c-section because 'babies ran big in her family,' she was past due (by what, 12 hours?) and this child was 10 pounds at birth. Ummm...'kay. The doctor said that with those indications, a c-section was a lot 'safer than a vaginal delivery.'

He then went on to lie that if the mother had another child of a 'normal weight' she could 'absolutely choose to deliver vaginally.'

Hahahahahahahahaha...(this is me laughing hysterically.) Because if this mom already couldn't do a VBAC with her second, what makes her or anyone else think this doctor would support her possible decision to VBAC after two cesareans? I mean, sure, it's possible, but most doctors don't want you to actually know that!

And Meredith Vieira, in her divine wisdom, piped up at the end how 'they chose the right way to deliver.'

Oh Meredith. You brainless puppet, you. This part almost makes me want to start swearing, and I don't want to do that.

If you read my post about the mom who sued her insurance company because of a botched VBAC , you'll see what I mean: a "news" report that is so one-sided, so ill-informed that it makes me want to puke. But this is the only part people see, if those little alarm bells don't go off in their heads and convince them to do their own research. Sickening.

And even in their series on "The Empowered Patient," CNN's coverage of controversial VBAC mom Joy Szabo didn't even mention how she'd already had a prior VBAC before she had to fight to get a second one.

Before I left the workforce to become a mom, I wrote for a major newspaper. Whenever I did a story, I did tons of research and tried to give the most thorough information I could that told both sides of the story. I felt that was my duty, especially because whoever was reading might know otherwise, and I didn't want to be caught 'not doing my homework.'

I shudder to think of the number of women who might have chosen a home birth, a VBAC or just plain refused unnecessary interventions in labor until they saw one of these very one-sided reports. Perhaps the best thing that could have happened was for Szabo to voice her opinion in a very unique way. Because when she talked, it got people's attention. It raised awareness of a very real problem.

It's such a disappointment to those of us who are informed and know better that Meredith didn't do her homework. I only hope that thousands, maybe millions, of women watching could take her to task for it. Because there are so many women out there who base their decision on the half-truths and skewed facts of their doctors, and Meredith, honey, you do nothing to help.

CORRECTION: Because I'm anal, care about my work and was probably too heavily caffeinated,  I will add that Crunchy Domestic Goddess has informed me that this was the mother's first c-section, not her second. Which is even sadder: she hasn't even been allowed to experience labor, and just went straight to the assumption that her body couldn't handle it. How very, very sad. I hope this mom finds a new doctor if she plans on having any more children.

Tuesday, February 2, 2010

Am I on a birth crusade?

I think I need psychiatric help. The more I read, the more I want to bang my head against a brick wall.

I often like to punish myself by reading (and answering) questions on Yahoo! Answers, an internet forum where people can write in and ask questions about all kinds of topics. I am a regular in the pregnancy forum, and consider it, on a good day, a way to reach hopefully hundreds of women and perhaps help them out in some way, whether it's by providing comfort, information or just my own personal experience.

However laughable it sometimes is, I consider this board and others like it (BabyCenter, etc) a network of "real" moms, a healthy cross-section of what women are experiencing in today's obstetrical system. One hot topic is induction of labor and c-sections, and of course, I have a lot to say. I've never been induced, but have three kids, have been through the 'labor and delivery system' with my own share of roadblocks, and have read a ton. Sometimes I think it's never enough, because I keep learning more each day that makes me want to run screaming for the hills.

I'm "just" a mom. Not a doctor, nurse, or even a doula (although I might be one when I grow up!). I haven't labored with countless women to see firsthand. So for those who are and have, I don't know how you do it. Combatting the myths and ignorance on a face-to-face basis every day would be enough to make me want to drink. Heavily. All the time.

One gem on the Y!A board of questions today made me cringe and laugh out loud. A concerned mother was writing in because her baby's heart rate during a non-stress test was over 160 beats per minute, and the doctor was concerned and mentioned an induction.

I thought back to all of my pregnancies and how, more often than not, the baby's heart rate was hovering between 150 and 160 BPM during each checkup, which the doctor said was perfectly normal. In fact, there's a wide range of "normal" when it comes to this.

I answered her and told her that was considered normal (one source I read suggested even up to 180 was "normal,") and that I thought her doctor was trying to scare her. Bring on the thumbs down, of course. As it often plays out with doctors, if you are pregnant and don't want to be induced, poked or prodded, people don't know what to do with you. Women were quick to reassure her that what the doctor was doing was right, that inductions are no big deal, blah blah blah. One poor woman had this to say:

I was induced at 11am, when I hadn't progressed at 4pm the inserted IV and gave me epidural, I had no pain so read a book, then at 7.15pm I gave 2 grunts and my baby was out without and (any?) need of intervention ...
This is the part where I started laughing. If an IV and epidural aren't interventions, what exactly are they?

Someone else responded with this:
Don't worry about it too much, it really isn't that bad. If they want to induce you, it'll be for a good reason. My baby wasn't ready either, but you have to do what's best...I had a perfectly normal labour and a beautiful baby boy. Ignore the horror stories, everyone's experience is different.
I honestly don't think this woman would know what a "normal" labor was even if her doctor beat her over the head with it, which is unlikely because her doctor probably doesn't know what "normal labor" is, either...

(I hate coming off as anti doctor, and it pains me to accuse doctors of not having their patients' best interests in mind, but really, how could they when they submit women to these things?)

What really gets me is that if you ask these same women if it's okay to take Tylenol during pregnancy, they'll probably say no, that it's unsafe for the baby. And yet you willingly go through this for no reason?  *scream*

We can blog all we want, but do we know if we're really reaching enough women to change anything? Sometimes I feel like they don't want to change, because they have no idea the reality of the situation. Their reality is not their own; it's their doctor's. Whatever he or she is telling me must be true, and therefore I'm not going to trouble myself to find out otherwise. Anyone who comes along and tries to tell me differently is a nut, and I'm just not going to listen.

For those who are true birth advocates in the field that offer support and truth-based, evidenced-based care to your patients, I don't know how you do it without coming apart at the seams.

I wonder if perhaps putting a list of the dangers of inductions and c-sections on the side of a milk carton might be the way to go here...