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Tuesday, July 6, 2010

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...


sara said...

I've only had one baby so far, but I honestly have no problems with leakage following her unmedicated vaginal birth. I have read the recent speculation that squats help with this more than kegels, and in my limited experience I tend to agree with that idea. I exercised throughout my pregnancy (right up to the day she was born) and squats were a part of my weekly routine. She was born in less than 5 hours, almost in my home (we planned a hospital birth, bummer).

The less we mess with the birth process and just act like normal, healthy women, the less problems there will generally be.

Amy W. said...

Well maybe it's just me, but it sure seems like the possible complications of a c-section that *she even lists* are much more serious than "damage to the pelvic floor, urinary and rectal incontinence, vaginal tearing, and pain".

And "women and their doctors are turning to c-section to reduce the inherent risks of vaginal delivery"- thanks, but no thanks...I'll just have a vaginal delivery in order to reduce the inherent risks of a c-section :)

I so wish that more people knew what a NORMAL birth is like. It might change their ideas about birth, but I guess when most people have only known overly medicalized hospital births they don't have much to go on.

The Deranged Housewife said...

And also to understand that prerequisites for a "normal" vaginal delivery do not necessarily include braided armpit hair, granola or Birkenstock sandals. LOL!

Nice to see you, Amy! :D