A Quiet Advocacy

Of the few friends I have who have either VBACed or had a homebirth, I've never understood why they aren't more outspoken advocates of their experiences. Maybe they just don't have the time to devote, or the desire, seeing their "alternative" birth as a once-and-done experience and are ready to move on to something else. In my circle of friends, I seem to be the one loud-mouthed person who is writing about it, reading about it, talking about it, and I wish that could change.

When I was pregnant with my second, I had no intention of having a VBAC at first. A woman from my church quietly took me aside and asked if I had ever considered having one, and I said I wasn't sure and they sounded too dangerous, blah blah blah. In fact, I had never done any research on them at that point, and just thought a repeat cesarean was my only option. She herself had had a long, arduous vaginal birth, bargaining with her doctor to be allowed more time to labor, finally delivering a baby boy with a nuchal hand. In short, a real "birth warrior" who was exercising her rights and being her own patient advocate at a difficult time. After that, though, probably because she was done having children, her interest in advocating childbirth choices seemed to fade into the background, at least until she spoke to me.

Little did either of us know that, in my 37th week of pregnancy, I'd be calling her on the phone at 10 p.m. to ask about her VBAC. Not what either of us ever expected!

I liken those parallels to some of the celebrities we know of who have had either a natural birth (more on that later) or a homebirth. There is no shortage of them, and websites galore list them. If you were to picture a mental list of celebrity homebirthers, Ricki Lake and Gisele Bundchen would probably top the list. And that's okay - they're both outspoken and educated about it, passing on that information to any and all who can benefit from it. Gisele does have a blog, and while her primary focus seems to be on the environment, she does devote some space to childbirth.

Some would argue that perhaps the reason we're so familiar with Ricki's stance on birth is because, thank God, she's made a movie about it. Whatever it takes! It got our attention (whether good or bad), and people know she's a staunch advocate of homebirth and choices in childbirth. But where the heck is everyone else?!

Dozens of celebrities have had homebirths, and only one I can think of has VBACed - Kate Winslet. I remember reading awhile back how she lied about the birth of her first child because she felt ashamed or a sense of failure over her c-section. Not uncommon, sadly. However, I'm not sure she really tooted the VBAC Horn, either, and I think even made mention how she "quietly VBACed" with her second child. Not sure if that means it was boring and uneventful, or if she just didn't want to talk about it. While she probably has strong opinions about VBACs, it's not like she's talking about it regularly or encouraging other women to have them.

Julianne Moore, Kelly Preston, many entertainers (Nelly Furtado and Ani DiFranco, to name a few) and the wives of many male celebrities all had home births. Remember Kenny Loggins, a folk/pop singer from the 70's? His wife gave birth at home unassisted, albeit by "accident," because of a precipitous labor. Meryl Streep had all four of her children at home. Pamela Anderson had both of her sons at home, and apparently is a big advocate of long-term breastfeeding. Really? Who knew? I know she walked down the catwalk pretty much nekkid to promote PETA, of all things, but why not do it while having an infant at her breast?

Perhaps a little extreme. But sometimes I just wish these people in positions of "clout" would promote their successful, safe "alternative births" more - like, the way they talk about PETA or environmentalism. Wouldn't that be a wonderful boost for the cause?

One midwife's website that I recently read stated that Gisele was the next celebrity spokesmodel for homebirth or something like that - "move over, Ricki Lake!" I frowned and thought, no need to move over - there's room for many more.

The Best Answer

At least one of my regular readers is familiar with Yahoo! Answers, where I often go when I'm bored or hoping to encourage that certain pregnant someone who is on the fence about things or just needs advice. I'm no expert, obviously, but I try my best to be forthcoming and honest, as well as offer my personal experience. So my antenna went up the other day when the question "C-section vs. natural birth - pros and cons?" came up!

I checked my email today and found that the asker had chosen me as best answer! This is why I do this - this blog, this advocacy stuff: so that someone, even if it's just one person, can be more informed and know her options. Be encouraged to ask more questions and demand answers. To know that she's not alone, and yes, you DO have a choice.

The mom had a rather bad experience with her first, a vaginal birth, and was wondering if a scheduled c-section wouldn't be better for next time. I wonder if that isn't the reason for some of the c-sections scheduled today - because the experiences that first brought them into motherhood were so downright horrible that they never want to relive them again. What a way to gain passage into one of the most rewarding jobs ever.

She thanked me for my lengthy answer LOL and I even got two thumbs up. Which means people are reading and agree. Which means the information is getting out there. She might never read anything by Ina May or watch Ricki Lake's movie. But hopefully she will have been helped by my post, somehow. Yes, I tend to be long-winded, but it's just so much more than a yes or no answer - it's so multi-faceted and really, the more information, the better.

Celine Dion pregnant with twins

I have sort of been following the Celine Dion stories about her struggles with infertility. The 42-year-old Canadian singer has apparently been trying for six years to get pregnant, and sadly suffered a miscarriage after one IVF attempt. She recently went public with her infertility problems on Oprah.

I was happy, of course, to hear that she's expecting and I hope everything goes well for Celine, who is due in November. But I think back to an article I read and one thing stuck out: she basically said she would keep trying , at any cost, to get pregnant.

Of course, when you're a celebrity, you can afford to do that. Apparently Angelina Jolie conceived her twins , Knox and Vivienne, with IVF not because she'd had trouble getting pregnant, but because she didn't have time to do it the old fashioned way. The procedure reportedly cost $12,000.

We can estimate that, if Celine Dion went through six IVF procedures, that it cost around $72,000, using Angelina as a baseline. It could have cost Dion more or less; who knows.

Thankfully, I've never had problems with infertility . Tons of other crap while pregnant, yes; but I've always been able to get pregnant easily. But I can't imagine the heartache, the worry, the financial stresses of the average working-class couple who is struggling with getting pregnant - the average married couple deals with many of these things as it is, minus the infertility. Both men and women can suffer depression as a result, not to mention the draining of savings in order to fund the procedure. Multiple failures or miscarriages can cause even more stress on a marriage or relationship, as well as the inevitable feeling of wondering when it's just time to give up and accept it.

Psychologically it can make both men and women feel like a failure, like it's something they're doing wrong that is causing it. It can also cause immense stress on a couple's sexual relationship when sex becomes a "chore" because timing is so important. Strangely enough, in one study of infertile couples it found that their rate of divorce was much lower than in the general population.

One couple I know chose to forego IVF altogether because of the possible stress it would put on her, and decided instead to adopt (which has its own challenges, including loss and financial pressure). I can't help but wonder to myself if they would have gotten pregnant from undergoing in vitro, but can understand their situation and just not wanting to put themselves through that physical, emotional and financial strain.

I wonder what other infertile women think about Celine's trials and her ultimate success - perhaps wishing they, too, could keep trying until they finally got pregnant, but knowing there was just no way that was going to happen. I can't imagine the heartache of knowing that, among other possible factors, money was keeping a much sought-after pregnancy from happening. Financial help is available for some, but not for all.

Back in November, Dion's husband, Rene Angelil, said they were "living the reality of the majority of couples who face these procreation techniques."

No, unfortunately for some, it's not even close.

When a good doctor gives bad advice

In my reading lately, I came across an article from urologist Jennifer Berman's website about her scheduled c-section. Although it's an older article, it still pertains to our current 'birth climate,' and is an eye-opener about a couple of things: namely, how dysfunctional birth has become the "norm," and how even doctors are unwitting victims (although some people would laugh at that term) of the broken maternity system.

Ironically, I was just reading about Dr. Berman's "Why ruin a perfectly good vagina?" comment in Jennifer Block's "Pushed," which made me nearly want to vomit. She may tell "friends" this, but does she give this kind of crappy advice to patients? (Does it even matter? Once they see a "real doctor!" saying this, they're all on board with it and automatically demand their c-section, now!)

I've read about obstetricians who are clandestinely sneaking off on their own to give birth at home, simply because they know the way their industry works and don't want to be subjected to it. At risk for criticism - even to the point of being ostracized - by their peers, they have chosen home birth - or at the very least, gentler birth - as an alternative to the over-medicated, pushed, rushed option that has become what most women associate birth with.

So what about those who don't choose that alternative? How do they give birth?

No differently than any other woman, it looks like. After reading Dr. Berman's account of her first child's birth, I would guess that a buttload of Pitocin (although she doesn't mention it or an induction) might have had something to do with it. She does admit to 'getting the epidural too early,' which she says slowed down her labor (wait a minute - I thought that wasn't supposed to affect labor?!). Her son's weight was estimated (read, "supposed to be") within a certain range and he was larger (nine pounds), and had shoulder dystocia, which resulted in a difficult birth. So, when she got pregnant a second time, she decided to avoid the unpleasantries of a vaginal birth (such as urinary incontinence, prolapse, etc.) by having an elective cesarean.

Part of her reasoning for doing so came from, on her admission, her work as a urologist, where she "saw women who suffered the effects of incontinence and prolapse. These effects are directly related to vaginal delivery."

It sounds like Dr. Berman had the typical dysfunctional birth - pull your baby out as soon as possible, even if your body doesn't have the urge to push, the mother of all episiotomies cut - resulting in a baby that's delivered vaginally, yes, but under forced conditions. Dr. Berman probably hasn't attended any of the births these women experienced to see how the use of forceps, directed pushing, lithotomy positions and vacuum extraction had on their "perfectly good vaginas." I'm sure that at some point in her life, Dr. Berman has experienced constipation. And as a urologist, she knows that prolonged straining on the toilet can cause all kinds of bad things to happen, the least of which is a bowel movement when you don't have the urge to go. Think of that bowel movement as a seven- to eight pound kid. If you have no urge to push out a bowel movement, it's easier to wait until you do, right? The same applies to a baby.

Had I known this, I would have refused to push when told to. Instead of working against my body, I know now that I should have worked with it - waiting, and yielding to the urge when I got it, instead of when a bunch of nurses told me to - and pushed a baby out with much greater ease.

Dr. Berman mentions how her incontinence continued for several months after her son was born and returned later in her second pregnancy. This kind of made me laugh. What urologist doesn't consider that the weight of your unborn child sitting on all your organs is going to cause you, and every other pregnant woman, to leak urine? I think back to before I had ever experienced a vaginal birth but was pregnant with my second child. Had I had a vaginal birth yet? Nope. Was I experiencing bladder leakage? Yep. (Heck, you can still pee your pants even before you've ever given birth!) Dr. Berman didn't mention kegels (or squats, which are actually more effective) at all. Maybe those didn't work? (eyeroll)

Dr. Berman did go on to say that if she has a third child, she will choose a section. That is, if the scar tissue built up allows her to become pregnant. But wait, she didn't mention that, either. And so what - women are only having two kids anymore these days, right?

It saddens and frightens me to think that Dr. Berman openly admits that, had she seen cases of urinary incontinence and prolapse before her first child was born, she would have chosen an elective cesarean then, too. So your urine leakage, however brief it might be, is more important than the health of your child? Avoiding the risk of something that might never happen, or really, in the general scheme of things, might not even be that problematic, is more important to you - to the point that you're willing to expose yourself and your child to the risks of surgery?

Studies have shown that age, and not necessarily just a vaginal birth, can cause incontinence. There are lots of other factors at work - like genetics, the number of children you've had (we all know that those muscles don't work as well as they used to when you're on baby #4) and obesity, so it is totally inaccurate to say these things are "directly caused by vaginal birth." Nor is it accurate to assume that this is even a necessary consequence to having a vaginal birth, but rather reflects how abnormal birth is considered normal in our society. There are ways to mitigate those risks, like by pushing when you're ready and not lying flat on your back, for instance. But, because those two things are so engrained in our idea of how birth should be, it is considered normal to see problems of incontinence and prolapse in women. I wonder: if a good portion of Dr. Berman's patients were home birthers, where, you can assume, the use of Pitocin and epidurals, suboptimal birthing positions, episiotomy and directed pushing are not the norm, would she say, "Hey...wait a minute..."?

What percentage of her patients were overweight? Had a family history? Had several children? Had never had children, maybe?

Ironically, urinary incontinence happens in men, too. But...they don't have vaginas or a uterus. Is Mr. Dr. Berman being counseled by his wife to have some form of surgery to avoid a possibility of this happening to him, too?

Stay tuned ... maybe we'll see them both shopping in the Depends aisle of the grocery store in about 25 years...