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Thursday, August 26, 2010

Spreading the word on 'cut happy' doctors

Original photo credit: Gareth Weeks

There is a lively discussion underway on The Unnecesarean's FaceBook fan page about a doctor who's c-section rate is allegedly around 50 percent - and, not surprisingly, he has a yacht named "Sea Section." Nauseating? Yes. Surprising? Not really.

Apparently, several patients have complained on a doctor ratings web site that he is an '8 to 5' doctor who likes to deliver babies during his shift (at any cost) and then go home for pleasure cruises on his boat (just my speculating, here). One woman admitted that he actually turned down her epidural at the end of his shift - what, in an attempt to get her to consent to a cesarean? As punishment because she didn't want to submit to his brutality?

Another woman gleefully commented that 'both of her children were delivered by c-section by him and that she tells all her friends to go there.' Dear God, help us!

This is the interesting thing about recommending a doctor: if a patient feels they've had a good experience (whether it really was or not, it seems) they don't hesitate to tell all their friends. However, if the doctor does a terrible job, they often chalk it up to a bad experience and move on. If they know the truth behind what he did, do they talk about it to everyone? For those few women who do say something, those who are completely brainwashed seem to disregard it completely.

That ratings website is just one way we can be better advocates - it doesn't take you standing on the rooftops screaming full tilt about your episiotomy, or getting into anyone's face about it - but just leaving a review to speak about your experience in hopes of warning others. Cut and paste, and leave on another site. And another. There is nothing wrong with that. As long as you are level-headed and polite about it (and heck, even if you aren't, you have a right to be angry about it), it's a free country - you can say whatever you want. Why are we so afraid to 'hurt the reputations' of those who have hurt us? As long as it's the truth, it deserves to be told. And loudly.

This is the 'age of information,' where private and public details can be made known in the blink of an eye. It's easy enough to do the research and have the paper trail to back it up: at least one commenter on Jill's site said that a fellow physician could confirm that this doctor does, in fact, have a yacht named "Sea Section." His alleged rates (which can probably be confirmed quite easily as well) obviously reflect that, and by having a boat named that (lots of OB's do, apparently) is making a mockery of a woman in her most vulnerable moment. It's making a mockery of her pain (as the one reviewer could testify to), and of the beautiful experience that childbirth ultimately should be. It also seems like a slap in the face to the insurance companies who are paying for these procedures that often drive up costs for other people, all so Dr. Yacht can go and enjoy his long weekend.

I would love to see someone go down to that marina and take a picture of his boat - and then get testimonies from patients about what has happened to them - and take it to the local paper or television station. It may not result in much, but then again, it also might. If enough pressure is put on, maybe it can result in disciplinary action. Maybe complete loss of privileges. Maybe, at the very least, public scrutiny can cause this guy to change the way he practices medicine, because people realize it's not in their best interests and puts them at needless risk. To the wrong person, it might sound like a witch hunt - but then again, a news broadcast viewed by one member of the Florida State Medical Board might result in an investigation that could finally open the eyes of Dr. Yacht's entire patient base. You just never know.

My very first blog giveaway!

As I said on my FB fan page, I'm in the mood to give something away!

Once my fan page gets 50 fans, I'll give away a new copy of Jennifer Block's Pushed to a lucky reader! Read and enjoy, or pass it on to a friend who might be able to use it. It's great reference material for those arguments on birth we often find ourselves getting into, (what, me? Argue?! Never!) and a real eye-opener as far as what's truly wrong with maternity care in this country today. If you have a copy already, pass it on - heck, maybe even donate it to your local public library so there is one more copy of a reliable source of information out there besides the same old same old that's probably been on the shelves since 1986.

Click on the FaceBook box to the left to go to my fan page and click "Like" to be eligible. Hope to see you there!

And while you're at it, check out Jennifer Block's website at .

Wednesday, August 18, 2010

Woman wins right to keep placenta after birth

According to this news report , a Las Vegas woman has fought her battle with a local hospital to keep her placenta after the baby was born. She planned on encapsulating it and using it to combat postpartum depression.

The hospital put up a fight about it and lost, but not before they warned the patient not to ingest it because it could be 'contaminated.' They told her it was "contaminated medical waste and that federal law required them to dispose of it."

Apparently, the hospital told the woman that it carried risk of being tainted with Hepatitis, HIV, etc. which is all true. However, don't you think that a person interested in the benefits - however subject to scrutiny they might be - of eating their own placenta is aware of this? I'm also curious how, if she doesn't have any blood-borne illnesses now, she is going to get sick from eating it? If you already have HIV, for instance, eating your placenta isn't going to make you get HIV - you've already got it. Right?

It also makes me wonder what exactly they mean by 'contamination' - as if to suggest that perhaps their storage of such an organ is being compromised and she could get a blood-borne illness from someone else?

In my state, pregnant women are tested for many blood-borne pathogens such as HIV, hepatitis - the works. After three normal pregnancies and a stable sex life with one partner, I pretty much know by now that I do not have HIV or hepatitis.

One thing the article mentioned struck a nerve with me: it starts in about how the placenta is full of hormones, etc. but then goes on to say the practice of encapsulating and eating the placenta is "far from widespread." As if to imply, you're a complete nutjob if you even entertain the idea of doing this. It also mentions how the field of traditional Western medicine is skeptical that eating it can be useful for anything at all.

A physician quoted in the article said that 'animals eat their placenta for nutritional reasons,' but speculated that with our better diets, there was no need for humans to do this. It makes me wonder - sometimes we see things in the animal kingdom that make more sense than we realize, as if they're on to something that we don't understand yet.

I think we can recall a number of procedures that have slowly worked their way into our traditional medical culture: acupuncture, for one, is beneficial for many. Just because it seems weird doesn't mean it might not deserve a place in our model of medicine, where everything is over the top and excessive.

The article ended on this interesting note: there is no law in Nevada that says the woman can't keep her placenta (so the fact that the patient's hospital told her it was against "federal law" might be a lie?), but usually it's not kept unless a doctor needs it for medical tests, or unless a patient asks for it because of "religious or cultural reasons." So "just because you want to," even though it is a part of YOU and something your own body created, is not a good enough reason.

One woman who commented on the story through a FaceBook link remarked that her doctor wanted to keep her placenta to use for educational purposes. The doctor respectfully asked first, even though there was a good chance that the patient never would have known the difference. Perhaps this doctor recognizes that this organ - a unique one that only certain people at certain times can make! - was part of her body - not just 'medical waste.'

Thursday, August 12, 2010

The Double Standard of Statistics, Scientific Literature and Anecdotal Evidence

Wow, that sounds like more of a dissertation than a blog post. Which this could easily turn into, because I must be on a tear or something.

Yesterday I was surfing My OB Said What?!? and was equally amused and horrified to see that Dr. Amy had joined the fray of commenters. (She even brought one negative Nellie with her, unfortunately, although her post thankfully didn't make a damn bit of sense.) Somehow I welcomed it, though, because it makes for interesting debate and dialogue, all while exposing her typical urgency and unprofessionalism. It's hard not to while in that forum because of the negative, condescending comments of the readers - and who can blame them? As I told Dr. Amy, how can we not be condescending when we're used to, over the course of one or several pregnancies, having lies poured in both ears, over and over again, which have only served to either make us paranoid of our own normal bodily function or cause us to despise and demonize doctors and medical staff?

It's the same condescension offered up every day to pregnant patients, but now that the shoe is on the other foot, it's a totally different ball game!

I think Dr. Amy was getting a little paranoid, because she was definitely not in her own territory. Her pleas of "read the scientific literature! Ignore all the home birth studies because they are lies!" kind of made me laugh - a desperate grasping at straws to get us to turn from our 'ignorance' and come rushing in droves to the hospital. Remember my friend's home birth story I posted a while back? Especially how she was approached by an acquaintance who works in labor and delivery, who literally bribed her with a fancy vacation in order to prevent her from having the birth she desired and deserved? My friend R knows perfectly well, as do many, many homebirthing mamas, that if a true need for medical care should arise, they will be en route to the nearest hospital. Once there, they should not be treated cruelly or with disdain, and neither should Dr. Amy assume that all home birth advocates are out for the 'experience' only, ready and willing to put their baby's life in danger. Honestly, who in their right mind does that?

Dr. Amy told us to 'read the scientific literature.' Okay, I will. But after many of us have read that 'literature,' we're criticized. We're told (especially by Dr. Amy) that we cannot possibly understand risk, interpret statistics, or be able to decipher complicated medicalese. So which is it, doc?

We're also criticized for where we choose to obtain that knowledge: often, the Internet. Sure, you can't always believe everything you read on the computer - Billie Jo's Guide to Pregnancy might not be as reliable a source as any number of good birthing sites or blogs out there. But most blogs and sites I frequent do one thing: post links to studies and cite sources. Is that 'researchy' enough for you?

Many of the same medical journals our doctors read can be accessed by us, the average pregnant lady. Sure, they might be a bit difficult to understand if you haven't recently completed a college course in Medical Jargon 101, but some people do have the mental capacity to look up those terms to get a basic grasp of what they're reading. *gasp!* I know, this sounds crazy, doesn't it?!

The interesting thing about studies and statistics is that they can and often are flawed. When it comes to the safety of VBAC (a relative term, I know) I remember reading one doctor on a message board presenting the highest possible rate of rupture to readers, which scared more than one away from even attempting a VBAC. I cited another study that presented the actual rate of rupture as much lower, but again, because I'm just a woman with personal experience and no lab coat, it didn't mean much to them.

As far as studies and statistics go, you also have to be able to read between the lines. A lot. Some figures estimate that 85 percent of women who attempt a VBAC are successful. That does not mean that in 15 percent of women they experienced a catastrophic uterine rupture, hysterectomy or loss of baby. Some people tend to see that 15 percent as a failure and nothing more, which to them totally overshadows the 85 percent.

Another thing doctors have a problem with is anecdotal "evidence." "They're just stories!" many of them say. Who cares if your grandmother's neighbor's sister's aunt had a VBAC. That's only one person!

To me, birth stories are important. They must be - we tend to get into the nitty gritty personal details of our parts and their functions with perfect strangers when it comes to talking about birth, yet otherwise would clam up tighter than a drum. Somehow when it comes to the state of our cervixes, we are all too willing to share. And that's okay!

Take a group of five women who meet weekly for play date. Say three of the women have all been attended by the same physician and were all induced, all ending in a cesarean for either "failure to progress" or fetal distress. Mom #4 saw a different doctor, and mom #5 is newly pregnant, new to the ballgame and wanting to know as much as possible in order to have a normal, low-intervention birth. If that were me, the anecdotes of these women would tell me that the doctor who attended moms 1, 2 and 3 might be a little intervention-happy and it's time to move on.

Don't the stories of these women account for anything? They should, because the number one thing most pregnancy websites recommend you do when searching for a new OB is to seek the advice and recommendations of friends.

It doesn't take a rocket scientist to realize that when hearing the stories of moms, that the c-section rate is through the roof, that inductions are heavily used and often completely unnecessary. Even though you aren't reading their chart or conducting a formal investigation, these stories definitely say something, loud and clear.

The thing that gets me about 'anecdotes' is that they're only bad when they're coming from you. You can tell your doctor about the dozen or so moms who have safely VBACed and have healthy babies, and yet you're told to completely disregard the stories of these moms. Yet, when I was weighing my options with my doctors (two separate physicians, two different pregnancies) both physicians felt obligated to tell me about previous patients who had experienced ruptures. Were either of these women induced with Pitocin? I asked, only to get a muffled response of "I don't remember" both times. Either you're making it out to be something it wasn't, doctor, or they weren't even your patients - because if they were really catastrophic ruptures resulting in hysterectomy, loss of baby or mother, that's something you're unlikely to never forget. So what makes my anecdotes dismissed, and yet suddenly my OB is more credible? Isn't he, in fact, doing the very same thing I'm doing - telling a story?

The problem with all of this, especially "scientific literature," is that it seems like you can always find a study that tells you what you want to hear. There are no shortage of studies that say VBAC is safe, and yet there are those studies that say it's dangerous. It's all in how you interpret it, or how it's interpreted to you. If you're cornered in the doctor's office with a fear-mongering OB who only wants to sway you away from making the Big Decision to VBAC, it's going to come off as a lot more dangerous because of his/her influence.

Lots of studies have come out now to completely blow most of the outdated practices of modern obstetrics out of the water: the often unnecessary use of episiotomies, using a c-section as a way of  avoiding pelvic floor damage , inductions leading to a higher rate of cesareans , and the importance of both maintaining an upright position as well as taking in light food and fluids in labor. Actually, to some this is old news, and has been practiced by old-school midwives for centuries. Any woman can access this information from countless books, reliable internet sources, and other places, and yet this continues to be status quo in many hospitals around the world, despite the studies and literature that proves otherwise. So it looks like the only person who isn't "reading the scientific literature" is the doctor.

Ultimately, though, especially with doctors like Dr. Amy, the research you do will never be reliable enough, never be good enough, never be the right study. The rules constantly change as the game is played, and it seems like the pregnant patient is rarely the winner, no matter what.

Monday, August 2, 2010

Stars who 'ditched the epidural'

A few months ago I posted a link to a study that suggested poorer, less educated women refuse the epidural.  When you see a list of celebrities who are opting out and choosing natural birth, it makes you wonder how accurate that study really is.

Granted, I know they're not in the majority. But it's refreshing to see celebs choose a more user-friendly approach to birth. And young women, too - I think that's awesome. They are sending a message that yes!, this is possible and no, you don't have to grow your armpit hair long and braid it or eat Grape Nuts cereal every day in order to want a natural birth.

Among the list are:

Gisele Bundchen - At the top of the list is supermodel-turned-birth-activist Gisele Bundchen. Everybody's heard about her bathtub home birth, and while some are riled about it, who gives a crap. She should be at the top of the list - but I'm not sure many people understand why. Given the fact that in her home country of Brazil the c-section rate is around 36 percent, and she chose an unmedicated home birth, I think this is of the utmost importance. We can only hope that her fellow countrywomen are looking on from afar, thinking, "Hey, maybe a vaginal birth isn't such a bad idea." I'd love to hear what Brazilians think of her as a result. And the reaction elsewhere? The Daily Mail says, "Gisele claims son Benjamin's birth didn't hurt." Claims? What, do you think she's lying?

Nicole Richie - The actress refused "even an aspirin" in labor with her daughter, which the author describes as "hardcore." Considering Nicole is a recovering drug addict, I can see her reluctance to have pain meds. What makes that "hardcore"? I think it's smart. This is probably one gray area that is often ignored - the addict who is managing pain of labor. I remember reading (maybe on The Unnecessarean?) about an addicted mother who refused pain meds, and the nurse made sure to come in early and often to badger the patient into getting an epi. I can't think of a more humiliating experience - having your addiction thrown in your face, especially when you're trying so hard to overcome it. 

Jessica Alba - This young, first-time mom had a very 'zen birth' with daughter Honor and apparently 'didn't make a sound.' The author's comment: "Ok, somebody's lying." Huh?

I found that vocalizing during labor helped, but it's different for everyone. Many women make noises, many are quiet - it's not all the way you see childbirth portrayed on soap operas. I've heard women claim that screaming is a 'sign of weakness,' which I think is complete garbage: we know that for some, vocalizing can help them manage pain and works as a release, of sorts. I tell people, "I screamed in labor not because of the pain, but because it was freaking hard work!"

Joely Fisher - Carrie Fisher's younger half-sister gave birth to daughter True Harlow Fisher-Duddy at home, in the company of doulas, midwives, and a doctor, according to mom. The author's comment: when we can't think of a jab to make about her opting out of pain meds, let's say something creative, like "Maybe each person got to pick one of the baby's million names?" What?

Interestingly, the article's author mentions a friend who'd recently had a baby and felt that she was manipulated into having a c-section for fetal distress. Of course, when the baby was born, it was perfectly fine. The author even mentions Ricki Lake's movie "The Business of Being Born." And yet, the overall tone of the piece is that women who choose to opt out of the epi are somehow crazy, liars or "hard core," which attaches sort of a freak label to the whole thing. For some who might be curious about a natural birth, this association alone might be enough to completely scare them away from the idea, and 'poor and less-educated' seems to have little to do with it: "Women who give birth without drugs are out to prove something, and are completely nuts."