The psychology of vaginal exams

Most women would never consider the state of their cervixes as having anything whatsoever to do with their brain. However, for many, this isn't entirely untrue.

Many people think that a vaginal exam in late pregnancy is just part of the old routine when it comes to maternity care. For probably a large portion of them, it is - but it doesn't mean it tells you (or the doctor) anything at all.

I've heard so many people ask "Will I go into labor soon?" after a 37-week cervix check. Or they're losing bits of mucus plug after an exam and think it's because they're dilating (which they might be), likely because the doctor's poking and prodding dislodged something. Many are downright depressed to hear that nothing's going on at all and some are elated to be dilated to 3 at 36 weeks because they think labor is coming soon - and maybe because their doctor said, "Oh, you'll go early." Wishful thinking, at best.

I ran across a very informative article by Robin Elise Weiss that outlines the "myth" of the vaginal exam and what it can (and can't) be good for. I've also survived three pregnancies and different stages of dilation in late pregnancy that tell me one thing: being dilated (or not) towards 40 weeks doesn't mean squat.

Many of us, including myself during all my pregnancies, are curious to find out if there is something going on in that department. Even during my third pregnancy, when I knew dilation and effacement meant little at that point, I was anxious to see if anything was happening - because, after all, this was my third pregnancy. Things are supposed to move faster at that point, right? Wrong. I was actually more dilated before labor (at probably 36 weeks) with my very first baby. I was so excited to learn that even as a first-timer, I could still dilate early and wondered if it meant I would deliver early (after all, both my mother and I had been born before our due dates). The doctor was skeptical. (It turns out I did deliver my baby five days before his due date, thank you very much. But I doubt that had anything to do with my cervical progress when he checked me.)

If you're simply curious (and who isn't?), I doubt having one in late pregnancy is going to necessarily be a bad idea. But neither does it mean you need to be checked at every visit (barring any conditions like preterm labor, etc.). I often tell women if you are dilated, it doesn't mean you'll go into labor anytime soon, and you can be dilated for weeks and still be overdue. Nor does not being dilated mean anything - you can deliver your baby in a matter of hours or days from a depressing cervical check that convinced you labor would never happen. This has happened to me as well: at my last prenatal appointment with my second baby, I was disappointed to learn that I was neither dilated nor effaced. And yet, a week later, I was holding my daughter. So you never know.

Some women refuse them completely in both pregnancy and labor because they know the results are not always that important. I will say this: from my experience I was thankful to have them in one sense - that it could verify my baby's position. With my first, we didn't find out he was breech until probably about ten days before he was born. That uncomfortable, crappy vaginal exam ended up helping me prepare for the very real surgical birth I was about to experience and helped me process it on an emotional level. My friend, however, who also has a history of breech babies, had no idea her baby was breech while she was laboring at the hospital. "Did you have an exam?" I asked her. She said her doctor never did a cervix check on her prior to labor, which can be considered good and bad, depending on your point of view.

The state of your cervix can also play tricks on your mind while in labor, too. Dilating fast? Great! Not so fast? Guess what, you'll be submitted to probably hourly dilation checks to make sure you're moving at one centimeter per hour, that Golden Rule of Obstetrics that means "you'd better make progress, lady!" If not, then some doctors will be patient and wait for you to progress. Others will label you "failure to progress" and you might be threatened with a c-section, or they'll ramp up the Pitocin to force things along. While I've never personally had this happen, I'd think that exploring your options might be a good idea: are baby and mom tolerating labor well? Can you please please please walk around/sit on the birthing ball/change positions/do something else in order to encourage dilation? I can't say for sure whether it worked or not, but I carried a coffee can lid around in my purse for weeks before my birth because it was the approximate size of a fully-dilated cervix - and I visualized my cervix opening up, just as many birth instructors have suggested. Mind over matter! If you can go to that special place inside yourself and focus on progressing, who knows - it just might work.

That famous rule - The Friedman Curve - is a huge pet peeve of mine. We're constantly told during our pregnancies that "every woman, every labor is different!" and yet when it comes right down to it, we're not treated as if we're different. We're forced into a nice, tidy box that says that "even though everyone is different, we're going to require you to perform in labor like everyone else." A brief search on The Friedman Curve draws some scrutiny: one article states that the half-century old rule is "the ideal, rather than the average" curve, calling it an "obsolete approach to labor assessment." If that's the case, and we're living in such a technologically-advanced medical community these days, then why is everyone and their surgeon still using it?

The body is an amazing machine, and if you listen to it, it'll tell you something. Just like the urge to push, when you're going through transition, you may feel a wide range of symptoms: nausea, irritability, vomiting (also affectionately called by some, "The Seven Centimeter Pukes,") feeling emotional and crying for no reason, or shaking. With all those obvious signals, who needs a cervix check?!

For some laboring women, repeated cervical checks can actually cause dilation to slow or stop altogether, what Ina May Gaskin calls the "Sphincter Law " in her book Ina May's Guide to Childbirth. A particularly harsh or brusque doctor with the bedside manner of a goat might create an atmosphere of hostility in the room that discourages the woman from opening up and dilating further. She compares this with trying to go to the bathroom while people are watching - not very easy, and a terrific analogy of how our minds can often control even the most involuntary of our body's actions.

Not only that, but the physical ramifications of constant vaginal exams while in labor can be great as well. Repeated exams can introduce infection, and often times women are led in 'directed pushing' when they reach completion simply because they're 10 cm and "it's time." Well, not if you have no desire to push. Directed, or coached, pushing simply based on your cervical status is probably a leading cause of tearing and trauma to the vaginal area. Again, throughout labor, your body will tell you when it's time to push, and it's not necessarily the exact minute you become fully dilated. If there's one thing I could do over in my vaginal birth it would be to push when I was ready to, not just because I was complete.

It's important for women to remember that the results of a cervical check should not be something to get upset over: if you're dilated, that's great. If not, it doesn't necessarily mean you will have to be induced, sectioned, any of that. All too often women place so much emphasis on those results that they become desperate to induce their labors and get things moving, but for what?

As someone said, checking women while in labor or late pregnancy often 'makes doctors feel like they're doing something useful.'

I couldn't agree more.

Additional links:

More on Pushing
Mother-Directed Pushing: Six Reasons to Listen to Your Body During Labor

Birth Diva

More on Celine Dion, who is expecting twin boys sometime within the next few weeks: apparently there are reports that she has already scheduled her c-section date for October 22, which her husband claims is false. He adds that doctors want her pregnancy to go on as long as it possibly can, that they do not have a date scheduled, and that Celine (like most of us moms, geez) would "never intentionally endanger her unborn children by scheduling a birth early like this."

(There's also talk that she's not having a cesarean, but I'm not sure how accurate this is yet. I certainly don't think it means she's attempting a VBAC, just that she hasn't scheduled her c-section yet.)

Perhaps Celine is well-aware that some twins come early, and yet that some of them are coaxed/induced/nudged/forced into the world early because of doctors' preference when it comes to multiple births. Iatrogenic prematurity, or prematurity of the baby brought on by physicians due to either maternal/infant problems or just plain old miscalculation, is a big problem with multiple births - really, singleton births as well. While I'm sure Celine knows when she conceived because she went through IVF, lots of doctors simply don't believe a woman who insists that her dates are right/wrong based on irregular menstrual periods, ovulation and other factors. They like to say that few women really know when they conceived, but honestly, we were there when it happened, right? You, Dr. Due Date Wheel, were not.

"Reports" (whatever that means) claim that, along with the phantom due date scheduling, Celine "has exhibited diva-like behavior at the Florida hospital where she plans to give birth." Wow. I'm sure hospitals aren't used to that for a change: the mother calling all the shots! Celine has, apparently, been requesting specific nurses (you go, girl!) - that makes her a diva?! (Apparently her husband is denying that, too.)

Hello -  if true, this could be Celine's way of saying "Some nurses are nicer than others, and I don't want unsupportive, judgmental Nurse Ratched anywhere near me." Actually, plain old laboring you and me can request specific nurses at the hospital, if you get someone you don't like. Don't be afraid to stand up for yourself and fire your nurse - or your OB! - if they aren't supportive of you in labor!

Personally, I think all laboring women should exhibit "diva" type behavior when having their babies. Not in an arrogant way, or in one that puts them or their babies in danger, but in a way that says, "I am the laboring mom here, not you, and you will respect my rights. You will not treat me like an object, a cow that's to be gutted for the slaughter. You will not do things to me without my permission, and I will not allow you to mistreat me, or subject me to risk without a good, sound explanation. You will treat me like a person, and realize that I, too, have emotional and physical needs, that it's not all just about the baby. Because when I am cared for like a human being, I can care for others around me all that much more."

Rock on, birth divas!

Read more here.

The bullying epidemic

Lately there has been a lot of news coverage about the suicides of bullied teenagers. Of course like any parent, I am troubled by it and think the behavior of those doing the bullying is reprehensible. I can't help but wonder, where are we as parents - as a society - going wrong?

I look at my own kids and those in my neighborhood and wonder how things will turn out in 10 years or so. I've blogged about this before - one of my son's friends has particular trouble adjusting to new and different situations, and for the most part it seems like his parents comply. Mom nervously laughs it off like "I wonder where he got that from?" referring to her husband.

In this case, the apple doesn't fall far from the tree: her husband is probably one of the most uptight, constrained individuals I've ever met. One change in routine is cause for complaint, and honestly, if he saw someone dying on the side of the road, I wonder if he'd feel too uncomfortable to get involved. My husband, who is much more outspoken and troubled by societal matters, deals with him on a daily basis and we often marvel at how much these people can't think outside the parameters of their own comfort zone. Which makes we wonder: Do we raise our kids to be bullied? Do our non-confrontational behaviors pass down to our children, as in this case?

I can't, obviously, look into my crystal ball and say that's what happened in the cases of these students who committed suicide over being bullied. One father did speculate, though, whether he raised his son to be "too polite."

Sometimes I wonder, though, if our society's "everybody's a winner!" approach to life is actually enabling our children to not take rejection and loss well. In the case of our neighbors, I'm not sure how they're teaching their children coping mechanisms to make it in the real world. Additionally, I've blogged about another family we're friends with, too - who fit the description of 'helicopter parents' pretty well. How does that teach our kids to deal with stressful situations?

Conversely, what are parents doing if their kids are the ones doing the bullying? One mother whose daughter committed suicide related how she did defend herself, but eventually the bullying got so bad she just gave up. At her funeral, the girls who picked on her the most actually came up to the casket and laughed over what the dead girl was dressed in. I can't even imagine. Did anyone confront the parents? Does it even matter if they did?

In this country, at least, the pendulum seems to swing both ways: on one hand, some like to use their "Freedom of Speech" to hurt others. Strangely enough, as a result it seems like we've gotten totally non-confrontational and no one wants to say anything at all. I'm not sure why those bullies were even at that girl's funeral, or why anyone let them in. They should have been turned away at the door. The article doesn't say if the bullies' parents were confronted - unfortunately sometimes the parents are just as bad, or are in complete denial that their kids could ever so anything so terrible.

As a teacher, my husband continues to see an escalation in the number of inappropriate things happening here on campus. Sometimes, the school's "powers that be" act on it; sometimes not. My husband has lectured students on things seemingly as trivial as wardrobe choices - you know the old saying, "If you give them an inch, they'll take a mile." Other teachers have taken him aside and personally thanked him for actually saying something. Is that what it's come to - that we let ourselves feel uncomfortable because we're too afraid to say something?

Several of the parents in question are suing the school district because they feel it did not do enough to protect the kids. Perhaps they're right. Any time kids get away with physical abuse - smacking someone in the face with a water bottle, as one kid did - and the kind of torture these teens were subjected to, the school district better be prepared to take a stand and make it stop. I fail to understand how this behavior could have gone unnoticed, and only wonder if perhaps the school is afraid to take a stand - after all, it seems like everyone is easily offended these days and no one wants to speak out. So much for our "zero tolerance" policies, which somehow seem to get twisted around and protect the very people they're designed to weed out, or at the very least, they go overboard.

I wonder if parents themselves are also afraid to take a stand against their own children. Are they too afraid of making their kids mad, too afraid that their child will rebel and they'll lose them? That their kids will no longer see them as a "friend"? Teens and young people seem to have an overwhelming lack of respect - we read stories of the "Barefoot Bandit," a 19-year-old with a history of burglary and theft who was wanted across international lines. His mother thinks it's "neat." She's tried to parent him, tried to stop him, but it just doesn't work any longer. Excuse me? Who's the parent here? You or him?

Just the other night I passed a police officer pulling over what looked to be a young woman in her late teens or early twenties. I could tell by her stance and body language that she was not happy, and didn't doubt the conversation they were having was not a positive one. Whatever happened to respect for authority?

The idea of teens being bullied obviously isn't new - the rash of school shootings since the 1990s shows us that. Guys like the shooters at Columbine were troubled, bullied teens who carried out their death wishes very differently, unfortunately. One kid, Kip Kinkel, decided to come into his school and shoot his peers after being expelled for having a loaded, stolen handgun in his possession at school. Prior to that, his parents, desperate to "control and connect" with him, decided to use his interest (obsession) in explosives and handguns to actually buy him a handgun. What were they possibly thinking and how could they have missed the warning signs of their son's problem? We may never know, because he shot and killed both of them. (Apparently the teen's psychologist told his parents to let him have the guns, because it would be a 'good outlet.')

One thing that does concern me in all of this is how these parents approached the idea of depression and conflict resolution in their kids - how do you deal with emotions and positive ways to express them? Anytime someone commits suicide I find it so sad, especially in knowing that it's not the best solution, obviously, to solving a problem. The article mentions a friend of one of the dead teens and how she committed suicide as well - and so did her two brothers, leaving a mother of three with three dead children. What is happening here? How can we adequately express to our kids that yes, the teenage years are difficult, but there is life after being bullied? That it doesn't have to be the end but that you can be made stronger from this and eventually triumph?

It has to make you wonder what kind of coping skills these kids had to deal with certain situations, even those outside the scope of bullying. With my own kids, we're now dealing with minor issues like bus ride quarrels and an occasional exchange of words. I tell my son who cares if Jack thinks your zucchini muffin is weird? If you like it, then ignore him and eat it. I hope to teach my kids skills that can help them deal, make them more compassionate and ultimately allow them to grow a thick enough skin to ignore even the worst of it. They are learning that life is not always fair, and they will not always get what they want, along with understanding why people say and do silly, hurtful things. Only time will tell.

More reading: Expert says media dangerously ignore mental illness in coverage of gay teen suicides

Home birth death: are pieces of the puzzle missing?

I recently read the article about a Missouri baby who died after a troubling home birth in October 2009. I felt that, based on what I read, surely there are pieces of this puzzle that are missing.

I've read two separate articles - one who's tone was anything but unbiased and felt very negative towards midwifery and home birth in general. The other was filled with several inconsistencies, and left me scratching my head at the statements made by doctors: "The doctor told the investigator that the baby likely would have been born safely by cesarean section if the mother had come to the hospital soon after her water broke."

It seems like some form of cord compression happened as a result of the baby's cord being wrapped around his neck, which the doctor described as a "common condition that is easily corrected at hospitals." (emphasis mine)

Wow. Where to even begin here?

The whole issue of nuchal cord and their response to it makes me laugh, because women are often made to think this is always a life-threatening issue that can only be avoided by cesarean. Or that it makes it impossible to birth a baby vaginally. I'd be willing to bet that a good midwife will know how to fix it in a way that doesn't end in surgery more often than an OB would, but that's just a guess. And now suddenly it's "common" and can be fixed only in a hospital? Are you kidding me?

The response about wanting the mother to come in several hours after her water broke seems typical: the general rule is that usually if contractions don't begin within 24 hours, a cesarean is recommended. Some are speculating whether they're really necessary even then, as long as the baby is doing okay and if few vaginal exams are done in order to prevent infection. Some doctors wait less than the typical 24 hours, and a few I've read about give only eight hours. Where's the continuity of care in that?

The comments the doctor made to investigators, though, got me thinking. What, really, does this investigator know about childbirth? About current birth politics? About the reasons women want to avoid a hospital birth? All this comes into play when considering the death of this baby. You can't just take a doctor's admission of the baby "likely" being born safely, because even that is not a given. Since the obstetrical crystal ball technology hasn't really been perfected yet, the best you can do is speculate. Unless the jury is remarkably packed with pro-home birth advocates, or at the very least, people who really know something about birth - and why some women feel boxed into a corner when it comes to hospital birth - what do you really think the jury is going to say? Since most of the country naively perceives all midwives as incompetent, and home birth to always produce disastrous results, why even bother going before a jury? Why not just engage in a massive witch hunt and dispense with the formalities already?

What's to stop any doctor who just happens to be anti-home birth from making this into a situation that clearly damns the midwife, no matter what? How is any investigator going to know the difference?

This raises more questions than answers for me, some of which don't have anything to do with the safety of home birth in and of itself. It's not just a question of poor judgment on the midwife's part; there's so much more going on here.

Apparently, the midwife insisted she had everything under control when the parents were asking about transferring to the hospital. However, "minutes later," she decided to dispatch them to the hospital anyway.

As birth advocates, we preach endlessly about trusting your care provider. Sure, that's very important. But I'm not sure it means that you still don't question them sometimes and do everything they say. I don't know - if the parents are asking to transfer, what do you say? Who's to say you're right, and they're not? Or vice versa?

If I reached a point in a home birth where I thought my instincts were telling me to ignore the advice of my very trusted midwife, I don't know if anyone could hold me back from the doorway and take the keys out of my hand as I prepared to leave for the hospital. It makes me wonder about this thing called "patient compliance," where we as patients find ourselves agreeing with things, doing and saying things while at the same time, in our heads, we're wondering, "Why did I just say that? I don't believe that. I don't want to do it this way, and yet I'm agreeing to it anyway."

I can't really blame the parents, though, because if you don't get that "intuition" that tells you that something might be wrong, then what?

It does make me question, though, how in-depth they researched her qualifications. The midwife apparently produced records after the baby's death that said she was some type of "medicine woman and traditional spiritual leader." Umm.... not exactly sure what that means or how it even remotely makes you appropriately qualified.

Another irony is the criminal investigation of the midwife, and others like her - whether they're trained or not - when a baby dies. Conversely, babies die in hospitals every day. Sure, doctors can be investigated, sued, even. No one denies that. But where is the outrage over that? Given the rise of things like the "Pit to Distress" phenomenon and iatrogenic prematurity, it's amazing more babies don't die. What's even sadder is that people seem completely unaware that this stuff happens, simply because babies don't die more frequently. Depending on the situation and state laws, many times an autopsy is never performed - which grieving parents often, understandably, might not think about or want to deal with at the time, meaning negligence is unlikely to be proven.

Interestingly enough, I do remember during my brief employment at a hospital one OB nurse talking to me at length about a doctor who waited too long to do a cesarean. She said nurses were urging him to do so, but he waited. The baby died. As far as I know, he is still practicing medicine, still delivering babies.

One must wonder if perhaps the midwife's obvious reluctance to head to the hospital sooner meant that she would be met with scrutiny and a couple of policemen on each arm. I would hope the mother, when hiring this woman in the first place, would understand that - as well as midwifery laws and their tumultuous history in her home state of Missouri. The often (well-documented) harsh, judgmental behavior of both doctors and nurses during a home birth transfer is, sadly, probably enough to make many only want to head there as a last resort, which could possibly have dire consequences. Couple that with the all-too-common naive assumption that any home birth transfer is likely because of impending disaster, and it's a recipe that leaves a very bad taste in one's mouth.

Edit: Reader Lauren has recently posted this link about the death of a labor and delivery nurse's baby and her hospital transfer when things went wrong. Apparently, you can never get to the hospital soon enough, so it's always your fault, right?

Risked Out

A few months ago I posted the home birth story of my friend, R. She is now weeks away from the birth of her third child and was planning a home birth. The birth kit had been ordered; arrangements were being made. But in the background, other things were happening.

Before R got pregnant, she had been diagnosed with an infection of some kind, which meant her platelets were low and she developed thrombocytopenia. Despite this, her doctor gave her the all-clear to become pregnant. This bleeding disorder means that if R had problems during labor, she could essentially bleed out. She has tried everything, to little avail. She finally emailed me and said her midwife, who sounds very caring and supportive, has officially risked her out of a home birth.

I told her I thought it was the best decision, under the circumstances, to have a hospital birth. In her situation, it was best to know ahead of time and not be faced with it for the first time while in labor. Her care so far, from her description, under both her OB and her midwife, has sounded thorough and excellent (contrary to the belief that midwives can't provide more than adequate care during pregnancy). Her midwife has agreed to also act as her doula and accompany her to the hospital.

While it's a tremendously emotional, difficult decision to make, I think R and her midwife were very wise to do so. I remember being faced with similar decisions in my last two pregnancies: attempt a VBAC or go with a repeat c-section? Proceed with the hopes for a vaginal birth even though the baby had turned and my blood pressure was up? It's a gamble we often have to take, and it does hurt when things are obviously not going to work out as planned.

I told R I wanted to highlight her situation on my blog if only to say, "Home birth mothers are not reckless; they do care about their babies!" Of course, we know that. But many people - including doctors - seem to think that people who desire home birth have an agenda; that they place the actual experience of giving birth over the importance of having a healthy baby. I think R, and many home birthing mothers, agree that you can achieve both. R has dealt with medical issues during her entire pregnancy, and none of what she decided to do was taken lightly. I get so irritated with people who have a certain stereotype of mothers who home birth - and chances are they, and the doctors who hold similar ideas, have never even attended a home birth to even know remotely what they're talking about.

Home birth has recently been a hot topic of debate in the media in the last few months, whether it's the snide, sneering comments about Gisele Bundchen's home waterbirth or the somewhat patronizing headline, "Should American women learn to give birth at home? " (When you click on the link, the headline is different on the page, almost like someone went back and changed it.) Learn? It almost sounds like society is asking itself, "Should we allow women in our culture to behave so stupidly?" not realizing that their own perceptions about care for the average, normal pregnancy and birth are defined by many outdated practices and ideas, shaping their thinking and creating a false idea that everything is inherently right, good and necessary because it comes from a doctor or hospital's standpoint.

What doctors, hospitals, the media and other critics of home birth fail to look at almost every time is why women are choosing to have one. Many like to just scratch the surface with things like unnecessary cesareans, Pitocin inductions and the basic idea that pregnant women are often treated like they're terminally ill instead of just having a baby. Many critics treat home birth and natural birth advocates as if they all disagree with interventions of any kind, when in fact, that's not true. (I haven't met anyone, ever, like this yet.) The idea of a pregnant woman being treated like a medical experiment or as if they are completely incapable of making decisions for themselves - and their unborn children - is nothing new and probably spans more than an entire century.

Therefore, when we understand that the roots of our maternity care system come from this standard of care, we will understand why many women choose home birth. We will understand why things like birth trauma matter, and why some women are even forced into a corner in order to avoid more trauma, which can lead them to make dangerous decisions in childbirth. Instead of demonizing them, however, we need to understand why they felt compelled to make the decision they did - and that sometimes, even though it's perceived as reckless, selfish or stupid it can still work out.

The fine line between advocate and arrogance

A baby died this week. It's been blogged about, Twittered about, FaceBooked about. Apparently, the baby had pre-existing heart problems that some say made him a poor candidate for circumcision, but for whatever reason, he was circumcised anyway. Some are suggesting that his tragic death was directly resulting from his circumcision. His doctors feel that it wasn't.

That's not really what this post is about. I tend to avoid the topic of circumcision because I feel it is a personal choice the parents make, much like deciding to get an epidural while in labor, or perhaps the decision to go straight to a c-section as a way to avoid labor. Whatever the reasons, people have them, feel passionately about them, and decide to go ahead with it. Does it matter if I disagree? Not one bit.

The real issue that has me fuming, frustrated and just plain disgusted are some of the comments people have been leaving on blog posts about this topic. I can't even access The Navelgazing Midwife's post about telling anti-circ people to "STFU" already because my internet filter won't allow me to. The Spirited Doula also talked about it, and was equally shocked and horrified by the comments.

Anytime a baby dies, for any reason, it's a tragedy. But to blame the parents, say they're "stupid," and especially to say you're not sorry for them and that "they got what they deserved" literally makes me want to smack someone in the head. Hiding behind the anonymity of the internet, people are free to make remarks, some of which are absolutely the cruelest things I've ever heard. Ever.

Other commenters were blasting the mother for her remarks on the situation being 'in God's hands,' and used that opportunity to lambast her on her assumed religious beliefs as well. This segues into another slam on the spiritual beliefs of parents who circumcise.

It almost makes me want to delete my blog and give up on childbirth and parenting issues forever, I am so disgusted.

It does remind me of one blogger (I am trying desperately to find a link; maybe someone can help me - here is the link , in case someone is interested) who was very passionate about birthing issues and homebirth. Then she had a difficult home birth herself, only to decide to give it all up after being disillusioned with the astounding hubris some hardcore advocates had over the subject. When I read this, I was saddened by her decision and it was hard to comprehend. Now I understand.

I've had frustrating conversations on my blog and fan page about people I know - even people I don't know - having unnecessary inductions or c-sections for no reason, and all manner of other things in pregnancy and birth. The best you can do, we concluded, is to offer the information, and if they decide not to take it, walk away. Because, really, it's not our business. How is the topic of circumcision not the same?

That same "gentle" approach to birth and parenting could apply to advocacy, too. In-your-face activism, whether it be about breast vs. formula feeding, vaccinations, or co-sleeping is not going to get anyone anywhere. If you want to be an advocate, do so in a respectful, productive manner. Ultimately it's not your business what parents decide to do, or not do, with their son's penises. You can respectfully educate or inform, but if they still want to go ahead and do it, that's their decision. There are plenty of ways to constructively direct that passion: but doing so as a hateful bigot - cloaked under the guise of advocacy - isn't one of them.

I am pretty active on birth boards that represent a cross-section of women, some who are informed, some who aren't. One thing I try not to do, ever, is come across as superior or fear-mongering. It's a very fine line, and ultimately if they want to follow my advice, heed my suggestions or click on my links, that's their decision.

This whole situation makes me wonder, sometimes, if perhaps we aren't jumping to conclusions about situations and letting our egos get in the way. Were we there when a home birth went wrong? No. Were we capable of making a sound medical diagnosis at the time? No. We need to be very careful before we demonize all doctors, all mothers, even, who make decisions that we ourselves would not have. This puffed up and inflated opinion just comes across badly, and I can see sometimes where Dr. Amy's criticisms of birth and parenting advocates come from.

Another commenter argued, rightly, that by spewing attacks and vile comments that it was only giving people like Dr. Amy and her group ammunition. And I totally agree. I would love to see some of these "advocates" step up to the plate and admit they were being harsh and insensitive. Regardless of their opinions, they were not there, and to the best of my knowledge, are likely not doctors. Even if they are, until you can provide your own professional, first-hand diagnosis, perhaps you'd be wise in following The Navelgazing Midwife's recommendation to "shut the ---- up."

VBAC survey online

A new birth survey is circulating from the ICAN Athens (GA) branch on VBACs and attempted VBACs, no matter what the outcome. Follow this link here to fill out the form.

The survey's authors, Makini Duewa and Michlene Cotter-Norwood, both have had VBACs. Michlene had a home birth after cesarean (HBAC), and Makini had a home birth after multiple cesareans (HBAMC). While the survey is ongoing, the authors say they need to have a great number of them filled out within the next five to seven days. Respondents can send the survey to makiniduewa@gmail.com.


Also, I invite you to take The Birth Survey if you haven't already done so!