Recent Posts

Tuesday, August 30, 2011

Has the woman's right to choose gone too far?

When it comes to abortion, I often find myself with one leg straddling each side of the fence: while it's never a choice I hope to have to make, I think it's a deeply personal issue that's between a woman, her doctor, the baby's father, and God. Unfortunately, because of our "right to choose," have we often eliminated everyone but ourselves in that equation? Is it really just about us, and no one else?

Like many women, I don't know if I could make that decision even if it meant dire straits for me. Most mothers would willingly sacrifice their lives for their children, but anymore we are being told that's only okay some of the time. If you want the baby, that's okay; if you don't want to keep the baby, then forget everything and put yourself first. If there is a fetal anomaly, they tell us, it's murky but usually perfectly acceptable to abort based on test results that indicate something might be wrong. Many terminations for fetal anomalies take place because of a problem that is incompatible with life, and I guess I can understand that.

But the "right to choose" starts crossing gray areas when you abort for disabilities that can be corrected: club foot, for instance (a birth defect both myself, my father and my son were all born with). Cleft palate is completely correctible but might leave some obvious scars, but hasn't stopped some people from aborting anyway. Where do you draw the line? At some point, are we engaging in more social engineering to create 'the perfect child?'

That said, I'm not really here to debate abortion in and of itself, just some of those areas where we're unsure - like in this case: mothers who "reduce" the number of fetuses they're carrying for social reasons.

But here's the kicker: Jenny, the mother, is older (which predisposes her to multiples) and she was undergoing fertility treatments - another almost surefire way to guarantee you'll be taking home more than one bundle of joy from the hospital.

Ever since I read that article, I just can't seem to wrap my head around that idea. If you're ill and birth control failed, I can understand that. I've known at least one friend - an evangelical Christian - who terminated an essentially non-viable tubal pregnancy because it could have killed her. But this - just because you only wanted one child and think you can't handle any more than that? I don't get it.

Jenny didn't want to look at the ultrasound screen during the "procedure," because this is "no blob of cells," this is an already formed fetus at around 12 weeks old, with finger- and toenails forming. A tactic often used by the pro-life movement, it puts a face on the child you're carrying, and often resulted in women changing their minds about going through with it. After all, if you don't look at the screen, you can't see movement, the baby sucking its thumb or hiccuping.

A fascinating debate unfolded in the comments section of this article, and many people - even some who claimed to be pro-choice - were left shaking their heads in disgust. It also caused many pro-choice advocates to rethink their stance on the right to choose, and how that right has essentially turned into something much, much different than originally planned. I applaud their ability to perhaps reexamine their stance and question the moral and ethical lines that this issue has crossed.

As the sole bearer of a pregnancy, it seems we have taken that power to extremes and used it in ways that give us unimaginable power over another human being - and not just the potential life that we're carrying. While the pro-choice culture seems to do everything in their power to demonize "sperm donors" as uncaring and uninterested (which many of them are, admittedly), I've heard from many heartsick dads who desperately want the woman - the mother of their child - to reconsider before having an abortion. They want to raise the child, even terminating the mother's rights if that's what she wants, so they can be the dad they feel responsible for being. But they're basically told "it's the mother's right to choose, buddy" and that he has no recourse whatsoever in seeing his offspring into this world. Because it's her womb, he's basically shit out of luck.

On the flip side, there are those women who unintentionally get pregnant and want to keep the baby, but the father does not. Perhaps both of them thought they were protected by birth control, and were using it correctly but something obviously failed. Should he be forced into being a father, even after taking reasonable measures to protect himself? If neither party expected the birth control to fail, even after using it responsibly, then what? I have no real answer for that one. But I bet the court system does: it's called child support.

When a father wants to walk away, we hear "he needs to man up and take responsibility for his baby." But just by virtue of the fact that she has all the right "parts," the same does not apply to her. 

Jenny is just one of many who virtually strong-armed her doctor into performing the procedure, and still "resents" that a doctor refused her. How can she ethically force someone else's hand to be part and parcel to her idea of a "perfect" family? Is it fair, or ethical? Do these people even care?

As far as Jenny is concerned, I see a common line of bizarre reasoning pop up when she voices her concerns: how will I have enough love for all my children? I don't want to neglect my older children and be a "second rate" parent, whatever that means. How will I be able to provide for those children? Those fears are not uncommon, even among mothers of singletons. And yet, once that child (or children) is born, you suddenly forget all about that and focus on your child. And no doubt, you just do it. I know my kids would probably be thrilled at the idea of having two babies in the house, but it seems few think of consulting the remaining siblings in the family. What if they say, "Sure mom, that's great. We'll do whatever we can to support you?"

Some of the comments came from parents of twins, one mother flatly stating, "I wouldn't wish twins on anyone." That makes it sound like a death sentence; as if anyone who conceives twins is doomed to failure and can't possibly take on the task. Culturally we've come to see children as an inconvenience, and something about these women suggests that they want to control the conception, the pregnancy and the birth, right down to the letter. Perhaps these are the mystery women we keep hearing about that want to schedule their inductions and planned cesareans around their work schedule? I'm sure they exist, somewhere.

Yet, women living in the 21st century have more access than ever to toys, television, video games, high-tech cribs and all kinds of stuff to keep kids busy. Strollers, Moby wraps and Baby Einstein were completely unheard of in our grandmother's generation. I once told my dad, "I don't know how your mother did it with seven children and no stroller or playpen." He just laughed - because that was what you did - you just did it. Because they were your children and you loved them. I think we have this idea that every woman everywhere was tied down to the bed during ovulation every month so that she would immediately become pregnant with 14 children during the course of her lifetime. While there are women in my distant lineage who fit that description - probably a baby every 18 months or so - they weren't all that common. I think we take that information and apply it to our own lives, in a modern sense, and think "Dear God, how insane is that? How could you possibly handle all those children?" Since we can't travel back in time to ask Great Grandma Mabel herself, we probably won't really know the answer to that question.

The one major problem I have with Jenny's situation is that she never gave it a chance. You can assume, based on how high energy your toddler is (come on, what toddler isn't high energy?!) that you couldn't do it. I would venture a guess that yes, it's pretty tiring and emotionally draining at first to raise twins, just like it often is with singletons. In retrospect, some singletons are probably even more "work" than twins would be - but you can never know for sure. When I think of the people I know who, before modern ultrasound, didn't even know they were having twins until mom suddenly got the urge to push one more time - I think, "Ha - you think you've got it bad?!" At first, it's a shock, but then you step back, reexamine your priorities and pull your head out of your ass and say, "Okay, I can do this." Especially since I basically predisposed myself to this "problem" to begin with.

I question her motives for terminating based on what her life is like now, before having another baby - because our typical American culture is so beyond spoiled that real, true poverty is virtually unheard of for us. Perhaps for some they are truly scrimping and saving as much as they can; for others it means they'd have to get rid of a third car and send their kids to public school instead of private, and well, that's just unacceptable. I know at least one couple who are struggling through adoption, and I speculate it's because they do not want to risk having their own biological child due to his hereditary heart defect. Are their fears grounded? Probably. But instead they have chosen not to create that life in the first place, rather than take a chance and then renege like Jenny seems to have.

There are some who believe if an abortion is sought, it should strictly be used for dire circumstances. There are also those who believe, as one commenter did, that a woman should have a right to choose at any time during her pregnancy. As we saw in the recent murder case of Dr. Tiller, he often aborted babies very late in pregnancy, often near term, which probably makes even some of the most hard-core activists squirm. As it should - because, we can argue, that at that stage in the game a baby can survive, even with some theoretically minor complications, but still have a quality of life. If they were all medical terminations, you'd think whatever was so life-threatening would have claimed the mother's life before 40 weeks gestation. To me, Jenny's situation is more like a designer pregnancy - where parents and doctors can basically socially engineer the "perfect child." One OB in the article says she would definitely terminate if an anomaly were found; and reducing a pregnancy is just engineering that family size to better suit your supposed wants and needs. How is it really any different than say, sex selection in India or China - which is still based on cultural beliefs and expectations, just different ones, perhaps.

It's easy to say, as Jenny did, "don't judge" - which sounds, anymore, like code speak for "Don't judge me, because I don't want to be held accountable for my actions," however morally repugnant they might be. We certainly "judged" women like Susan Smith, Andrea Yates and Casey Anthony for their part in the deaths of their children - who, one can argue, at least had the opportunity to live a life, no matter how short. Like one commenter said, "What's the difference if you give birth to twins and then stab one of them?" A few weeks, maybe months. The behaviors we observe on ultrasound at 12 weeks aren't much different than those seen in a newborn, except that they can live and breathe outside the womb.

When you have even pro-choice advocates questioning their stance, it becomes clear that the "freedom to choose" has become completely manipulated and abused, to the point where it has morphed into something totally different than what it originally set out to be. And now, as a result you see almost a callous lack of appreciation for human life - which you can't deny at 12 weeks gestation. I've seen much of that same coldness in many teens facing pregnancy today.

It seems like Jenny's biggest problem is that she sees life as a guarantee, when it really isn't: there is nothing saying that she wouldn't miscarry the remaining baby, experience a still birth at 38 weeks, or her husband wouldn't drop dead of a heart attack the day after she came home from the hospital. Some in the article talk at length about all the risks of having a twin pregnancy, yet in the same breath we tell women, "Pregnancy is not an illness!" And I'm sure many of the supposed risks and fears Jenny and others were gripped by would, like they often are with everyone else, never be fully realized. Like the last couple mentioned in the article, who were both expecting twins at the same time, they reduced and then later miscarried anyway. They have to ask themselves, was it all worth it? Are we really exercising our right to choose, or playing God?

Sunday, August 28, 2011

There's a hurricane (and a baby) a comin'

Rock you like a hurricane: Who knew giving birth during
one of the worst storms ever could
be such a normal, natural experience? 
As the nation tenuously waits for Hurricane Irene to make landfall on the east coast, I can't help but think of all the expectant mothers, nervously waiting for their due dates to arrive and praying that it will pass uneventfully: will the baby come during the storm? Will I make it to the hospital in time? Will I be stranded somewhere?

I wouldn't be surprised to hear of a slight increase in the number of cesareans or inductions in the days prior to Irene's arrival, as doctors and patients took a "just in case" approach to avoid any such incidents from happening. It also reminded me of a passage from Jennifer Block's book, "Pushed," regarding Hurricane Charley in Florida - an F-4 storm that was the most powerful they'd seen since Andrew over a decade before. The storm lasted nearly a week, with winds topping out at 150 miles per hour. Pretty scary stuff.

With limited electricity, the hospital was facing measures to treat labor and delivery patients more efficiently given the lack of resources they had. Tracy Lethbridge, a nurse working on the unit during the 2004 storm, was on duty.

"...Hunkering down that evening was a minor interference compared to the week that followed. The hospital's emergency generator kicked in, but, like the rest of the town, the facility lost main power until the following Friday. With only enough generator capacity to run essential functions, there was no air-conditioning and no lab capabilities. That meant that the 13-bed labor and delivery ward wasn't a very comfortable place to either labor or deliver, nor did it have the lab setup required to manage epidural anesthesia safely. Lethbridge and her colleagues had to treat their patients much differently."
With limited power and no access to epidurals, what do you do?
 "We canceled all labor inductions," recalls Lethbridge. Normally, two beds a day would have been reserved for inducing women into labor, an often lengthy process that begins with drugs that "ripen" and dilate the cervix (Cervadil or Cytotec) and contract the uterus (Pitocin). Normally, even women who arrived in early labor – when the cervix is minimally dilated and contractions are several minutes apart – would often be encouraged to stay and would be administered Pitocin to hasten contractions. Lethbridge observed that under normal circumstances, the vast majority of babies were delivered during the day. 
"We only admitted women who were in active labor – regular contractions and progressive cervical dilation," says Lethbridge. "If they were not in active labor, we'd send them back home." 
Block speaks of this new, relatively unusual situation as an "altered universe" and writes that the nurses on duty during that period started noticing some surprising changes.
"Women were delivering within hours of arriving, even first-time mothers, without any Pitocin," says Lethbridge. ..."We had no cases of fetal distress during labor and no respiratory distress of neonates following delivery..." "We had an incredibly low cesarean rate. Amazingly, the babies were about evenly distributed between day and night shifts."
 "What happened was, women were going into labor all on their own, having good labor courses, and delivering healthy babies. Even the women who were scheduled to be induced that week, three-quarters of them came in and delivered anyway. And basically, they did better than if they had been induced. We thought, wow, this is amazing!"
Block notes that nurses, including Lethbridge, observed during the week period that among the 17 women who gave birth, "one was induced, two had scheduled repeat cesareans, and just one had a cesarean for 'failure to progress.'" Block states, "That works out to a cesarean rate of 17%; excluding the repeat cesareans, it was 6%."

Perhaps this almost informal "study" reveals that yes, birth can be a normal, physiological process if only it's allowed to proceed as such. That, instead of a "94 percent of births are complicated," it's quite the opposite - that 94 percent of births are over-managed, which has completely skewed our idea of what "complicated" means. In other words, that we're treating it as an accident waiting to happen and sometimes creating or precipitating that accident in the process.

As a result of this little experiment, surprised nurses reported their findings back to the charge nurse and hospital officials - who were relatively blase´ about the whole thing. The hospital's lack of action spoke louder than words: "this is not the way we do things because it doesn't make us money." You can't bill a patient for an induction, Pitocin, epidural and cesarean if she doesn't have those things, instead laboring naturally at home and letting her labor unfold by itself, with little to no interventions. Because Mother Nature is completely free - and perhaps not quite as flawed as they want us to believe. Technology can be very useful and life-saving, but only when used appropriately and wisely.

For a number of reasons, including what Lethbridge felt were safety concerns as well as the hospital's lack of support of normal, physiological birth, she quit her job - mostly precipitated by what she saw in women during Hurricane Charley. Within the year, many of the nurses she worked with left their jobs as well, perhaps completely jaded by the system. I don't blame them.

Pushed: The Painful Truth about Childbirth and Modern Maternity Care - Jennifer Block
Why You Need Pitocin in Labor

Saturday, August 27, 2011

My response to Free Advice Legal Forums: Childbirth issues

Once in a while I stumble on the mother lode of all blood pressure triggers: in this case, it wasn't The sOB but the legal forums on "Outstanding advice, unbeatable price" is their motto. Let me tell you: you get what you pay for.

There are no shortage of odd, extremely sad cases floating around over there, and this was one of them: in short, a mother was 38 weeks pregnant with a breech presentation, and requested an ECV to turn the baby. The doctor was hesitant - probably taking the "Well, it might not work and you'll end up with a cesarean anyway!" approach that is so typical. Basically, the mother was given a VE-turned-membrane sweep and began labor three hours later. *sigh*

It's clear that the doctor was hesitant to do the ECV because she was afraid it would work, not because it wouldn't. The patient was obviously somewhat, at least, informed that she had options, and when she tried to exercise her rights, was thwarted. A cesarean ensued, and the patient had other problems as a result. While this was three years ago (so her child would be about six now), she still had lingering thoughts and bitterness over it, which was understandable and completely justified.

Boy, did the idiot comments fly after that. Of course the "You have a healthy baby, get over it!" was among them. I had been reading this forum for a few days prior, and saw the nastiest comments come up from the same woman every time - but this time I could not keep my big mouth shut. I had to say something before my brain exploded.

Here is my response:
While I know this is an old thread, hopefully someone might return to it to gain some perspective and help. 

There are some major philosophical issues that first must be addressed here - namely, the rights of the pregnant patient. People seem to have a lot of trouble understanding those areas and that, even though you are pregnant, you are still entitled to be treated like a person. Some of the comments here are so hateful and almost misogynistic - and I think that is indicative of our legal culture when it comes to childbirth issues and injuries/malpractice that might occur - that basically say, "You wanted a baby - you should therefore subject yourself to anything that might happen to you in order to deliver that child." That is not true, but because it's the predominant theme among most people, they'd lead to believe that the things happening to you were somehow normal and justified, and you should just "get over it." Too bad!

Unfortunately, I can't say their answers would be the same if this were a male patient; or someone receiving cardiac care, for example. There is such a double standard that exists when discussing childbirth issues and most of it, I think, is from ignorance. Yet, ironically, those very same people come back and tell YOU that YOU are uneducated. Very sad. 

You have every right to be bothered by this, but unfortunately because of the time frame, you probably don't have much recourse legally. Unless there are multiple complaints filed against the physician or hospital, they probably wouldn't do much to entertain your complaint. Even if there were multiple complaints filed, they probably wouldn't do much more than issue a perfunctory slap on the wrist. I say this not as a legal or medical professional, but as a childbirth advocate who has talked to many (MANY) women who have gone through similar scenarios, and as a mother of three young children. 

Reading between the lines here, I think it was obviously very unwise of your doctor to purposely strip your membranes without your permission. While some people think you can't really "prove" that this is what happened, you will know that a typical vaginal exam does NOT feel the same as when your membranes are stripped - that is your first clue. Not only that, but the obvious admission from your nurse friend says that she knew in advance that a stretch and sweep was going to be performed; I'd be curious to know what it says in your chart about that. Why would they do this when the baby was in an unfavorable position? Because they wanted you to go into labor and hence deliver the child by cesarean. I think your doctor hesitated about the external cephalic version because she was afraid it *would* work, not because she feared it wouldn't. A portion of them ARE successful, and while painful, that is why they admit you to the hospital and administer an epidural - most of the people who commented here either overlooked that or didn't know that is usually standard procedure. Unfortunately, what they also don't know (or don't want to admit) is that sometimes, babies will turn up until the last minute, even while in labor, into a vertex position. While some people will tell you this is rare, I think it's probably because the baby was never given a chance to turn because mother was sectioned before labor even began. 

A healthy baby DOES matter, but so does a healthy mother. Many people are too quick to completely dismiss any emotional or psychological aspects of birth, especially those that are traumatic. What many of those same people - including mothers - don't realize is that often times the very procedures we're subjected to cause more problems than if they had just been left alone; in other words, they treat birth like an accident waiting to happen, instead of treating things as they happen, IF they happen. Preventative, defensive healthcare in pregnancy and childbirth often causes more harm than good. 

It is the lack of compassion and utter venom that people like these forum members spew that makes women afraid to file complaints against their doctors, and the idea that unless you've lost your uterus, your baby or your life, there is no harm done. Bull----. And if you do complain, someone steps up and gets into a virtual pi***** match to compare birth stories and just how more terrible theirs was than yours, so you just better sit down and shut up. The truth is, few people know what normal is anymore, and are actually normalizing the abnormal. Unfortunately, it's rampant in obstetrics, and very difficult to just up and switch care providers, especially at the last minute. While it sounds like a good idea to just tell the OP to change doctors - at 38 weeks? Are you kidding me? No one would have taken her on, I'm sure. 

Consider your rights and options should you have another child (maybe you've already had one) and at least know that you have them. I'm glad someone mentioned ICAN; they are a good resource for support. Your lack of trust in doctors is not uncommon and you should not be made to feel like a freak because of it - you were violated and had things done to you without your permission. If this had been a sexual rape, would those same people tell you to just "get over it?" Is it simply okay because this was a physician, someone we should trust and respect, who did it instead? It's still a violation of your body and your rights and has changed the course of the way you birth future children FOREVER.
Sally, who thinks your birth was the worst ever and you didn't sue, no! This one's for you.

I'll anxiously await a response. *eyeroll*

Friday, August 26, 2011

The "Truth" about Pelvic Organ Prolapse

I'm not a Dr. Oz fan, but couldn't help noticing that he was talking about something not many women like to discuss: pelvic organ prolapse. I also was intrigued not only because of my birth nerdiness, but because I share some of these complaints and wondered: does anybody else?

Supposedly the "last taboo topic" in gynecology (nah, I think that'd be having a homebirth) I was curious, because I too was hesitant to talk about it. With strangers, sure; but friends - I wasn't really anxious to share that info with people I went to high school with (which is why I don't advertise my blog around casual acquaintances - I really don't want them knowing the intimate state of my vagina.)

Anyway, Dr. Oz revealed just how common pelvic prolapse - when your reproductive organs come out through the vagina - really is. The crowd was hushed as women in many age groups looked like they were hanging on to the edge of their seats. We all cruise through the female incontinence aisles at the grocery store (on our way to somewhere else, right?) and know those problems exist, and that they're actually pretty common. (There's even an entire company devoted to sending you your incontinence products, in discreet packaging directly to your house, so as to avoid being spotted at the grocery store.)

The primary risk factors are childbirth (especially after having several children), weight, and age. The problem is, Dr. Oz - and pretty much everyone else outside the birth advocacy circle - don't tell you that how you give birth can impact your risk factors.

If there's one thing I'd like to change about my vaginal birth, it's directed pushing. As one article on Dr. Oz's website said, "You take a genetic predisposition, a 9 pound baby, and three hours of pushing" and it's not a wonder we have these problems.

Back up a minute.

Three hours of pushing - even the one hour and ten minutes I pushed - is probably more common than it should be in hospitals. From my experience, I know I had absolutely no desire to push. Laboring down was not an option, and I wish I knew better to just wait for my body to do it on its own. Even if you were knocked unconscious, your body would still involuntarily contract and push that baby out on its own, but who has time for that anymore? It's rush rush rush to get the baby out (even in the absence of problems) and move on to someone else.

Consider what happens when you're constipated and trying to have a bowel movement. Pushing and straining - much like during childbirth - are probably going to do little more than produce a wicked case of hemmorhoids and even rectal bleeding. But if you wait until you have the urge (which is involuntary, much like pushing out a baby) it's a lot easier with a lot less work. So even though I personally detest the phrase 'it's like taking the biggest crap of your life' to describe childbirth, in some ways it can be compared, yes.

In the process of laboring down, the body can actually stop the labor process altogether, sort of as a last-ditch effort to conserve energy for the big event. And like a bowel movement, most women describe the urge to push as uncontrollable and something they just had to do. Unfortunately, I have never experienced that feeling, the feeling of knowing my body is doing something on its own volition because that's what it's supposed to do - not push a baby out at lightning speed just because somebody told me to.

In reading about the subject, some physicians simply blame childbirth in and of itself for prolapse, while others say traumatic childbirth is a cause. I'm not sure women realize there is any other kind, which is sad. Things like cord traction - literally pulling on the cord to get the placenta to detach from the uterine wall - is another risk factor. Forceps deliveries, episiotomies (again, largely unnecessary but done anyway) and prolonged, directed pushing are other causes, and yet all are considered standard procedure in many labor and delivery wards. In other words, we've experienced this crap for so long that we don't even know it's the cause - and that it's not really as normal as we think it is. We're normalizing the abnormal.

Many times, in an effort to avoid postpartum hemmorhaging after birth, they use cord traction to avoid a "retained placenta" - and cause even more bleeding as a result.

"Retained placenta" is another term I have a problem with. While the standard seems to be around 30 minutes after birth, it seems that, like everything else, it's different for everyone. While I'm obviously not an expert, I'd guess that in the absence of bleeding - and with the presence of breastfeeding right away - leaving it more than half an hour is probably okay. When I did some quick searching on it, I found several who said an hour, two hours - even 30 hours - and she lived to tell the tale. *gasp!*

More often than not it seems doctors are too quick to expect the placenta to come out and rush it with cord traction, which is often quite painful and dangerous if too much force is applied. I've also talked with people who agree their doctor was way too eager to detach the placenta and literally yanked on it - which can cause the very complications you're supposed to be preventing.

One study has shown that injections of oxytocin into the umbilical cord vein does not decrease the need for manual placenta removal; however, you're back to that murky definition of 'retained placenta' again. According to the article, retained placenta is more likely to happen to women in "wealthier nations." Not surprisingly, the study found that among women in the UK, Uganda and Pakistan, the women in the UK were more likely to have a retained placenta:
The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).
Many are quick to point out how dangerous it is to give birth in third-world nations like Pakistan and Uganda. While there is no doubt some truth to that, giving birth with overloads of obstetrical interventions - like in the UK - is probably just as bad. (Side note: not surprisingly, Uganda is the only nation of the three that doesn't have a relatively low rate of breastfeeding, which is often a good way to encourage the placenta to detach by itself. Incidentally, the CDC has determined that most US hospitals are severely lacking in their breastfeeding support, which could be further contributing to this problem. Add to that the frequent, often prolonged separation of mother and baby immediately following birth and it could add to further reliance on active management of the third stage of labor.)

Ironically, many in the UK scratch their hands and wonder why women in the UK are experiencing this problem, despite having access to all the best care and resources. Dr. Andrew D. Weeks of the University of Liverpool thinks prolonged cord traction might be an issue. Ya think?

Some sites list things like "unusually large babies" as a cause - perhaps it's more the interventions perceived as necessary in delivering that "large" child (and the idea that everyone has a different definition of what a large baby really is) that are key here. It's not uncommon for someone to have a very actively managed labor with a larger baby that results in significant trauma to the pelvic floor. Conversely, we hear of many women successfully delivering bigger babies with little if any tearing - which can depend on the birth setting. (Home birth? Natural hospital birth?) and the attendant (midwife vs. doctor? Someone who is more pro-natural birth?)

Sadly, doctors like Dr. Oz and urologist Jennifer Berman might hand out less-than-helpful advice because they've never actually seen a normal birth in progress. They often see the end result of years worth of obstetrical manipulation and intervention and chalk it up to just plain old childbirth itself, perhaps recommending an elective cesarean to avoid all that damage (even though studies have shown it doesn't). Yes, some women will be prone to this - for a number of factors besides childbearing - despite having an intervention-free birth. Some women get it and they've never even given birth. But until you can compare what often is and what could be, you have no real idea that the process is totally tampered with.

In doing some reading, I came across a very sad post by a nurse who experienced a pretty difficult birth, no doubt precipitated by the fact that she was induced at 37 weeks. The baby sounds like it just wasn't ready, but doctors attempted every means possible to get that child to come out, resulting in some nasty-sounding results. She wondered if she had a case against them because of everything she went through.

Some of the answers she got were quite shocking. Daring to call the normal 'abnormal,' she got berated, told she was a liar, and that what she went through didn't happen as she said it did. She was told that "controlled cord traction" was basically no big deal and an "acceptable practice." Maybe so, but it shouldn't be, especially in the absence of other complications. In the end, another forum user piped up and said "You think you had it bad??" as it to get into a virtual pissing contest about who could tell the most Horrible Birth Story Ever. I felt sad for the woman, not only because these women attacked her for questioning the status quo, but because they echoed what our legal system tells us: that unless you have something permanently wrong with either you or the baby, that you should just shut up and get over it.

After seeing some of the audience members on Dr. Oz's show, you realize that women have basically been giving birth violently for decades, perhaps even more than a century. I didn't see any hippie mamas standing up in the audience saying, "Well, I had a natural home birth and mother-led pushing in any position I wanted to, so I don't have that problem." She'd probably be stoned to death if she did. That, and the number of what we could call near-failed inductions - those where a vaginal birth happens but I'm not sure I'd call it successful, exactly - probably means more women are continuing to suffer.

While Dr. Oz's segment was titled "Suffering in Silence: The Shame of Pelvic Prolapse," I really think the people who should be feeling shame are those who insist on continuing these practices even though it's not in the best interests of their patients.

More reading:
Diagnosis and management of retained placenta after vaginal birth - Dr. Andrew Weeks talks about the risks and complications of retained placenta, but admits:
There is no consensus worldwide as to the length of the third stage after which a placenta should be termed "retained" and intervention initiated.

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial - This study suggests the use of CCT is beneficial and says that a continuous infusion of oxytocin were given to each patient after delivery of the placenta. I'm curious, though, what percentage of mothers breastfed immediately after birth, and how long were their placentas retained before someone decided to manually remove it?

Controlled Cord Traction During Third Stage of Labor - This study seems to contradict what the previous one said, in that
"Controlled cord traction (CCT) is actively promoted in combination with prophylactic uterotonics for the prevention of PPH. While the administration of uterotonics has been proven effective, there is no evidence of CCT being beneficial or safe. 

The purpose of the study was to determine: 
  1. In women having term, single vaginal deliveries in hospital settings, in whom the third stage is managed with prophylactic oxytocin, does CCT produce a clinically significant reduction in the incidence of postpartum blood lose? (sic)
  2. In these women, does CCT produce a clinically significant increase in the incidence of severe complications, including uterine inversion or the need for subsequent surgical evacuation of retained placental tissues and membranes (curettage or manual removal)?
Injections Aren't Solution for Retained Placenta: Study - ABC News
Management of the Third Stage of Labor - Medscape
The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. A leading North American obstetrics text devotes only 4 of more than 1500 pages to the third stage of labor but significantly more to the complications that may arise immediately following delivery.[1] One respected author states: "This indeed is the unforgiving stage of labor, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster."
While that may be true to some extent, why do our bodies have these built-in mechanisms to aid this natural, physiologic process?
Postpartum Hemorrhage - Wikipedia 
Cochrane database study[5] suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour reduces severe maternal bleeding and anemia compared to expectant management. However, the review also found that active management reduced the baby’s birthweight and increased the mother's blood pressure, afterpains, nausea, vomiting, and use of drugs for pain relief. The number of women returning to hospital with bleeding also increased. Another Cochrane database study[6], focusing specifically on the timing of the administration of the uterotonic drug oxytocin as part of the active management of the third stage of labour, suggested that administering the drug before the expulsion of the placenta did not have any significant influence on the incidence of postpartum hemorrhage when compared to administering the drug after the expulsion of the placenta.
 Eight Ways to Avoid Pitocin in Labor and Why You Should - Birth Sense blog 

Tuesday, August 16, 2011

Have women been duped by the feminist movement?

When it comes to sex and relationships, our culture is messed up - a jumble of ideas and opinions that focus little, if at all, about the true nature of what those relationships can do to us or mean, especially long-term. The divorce rate is at about 50 percent right now, and I'm wondering if it's because many people wouldn't know how to have a healthy married relationship if it bit them in the ass, in all honesty. The "anything goes" ideas of the 1960s (basically, our mothers' and fathers' generation) are trickling down and bringing with it a hefty emotional price tag.

The over-sexualization of young girls is especially troubling. Teen sex has always been a "problem" in some way or other, but the rate of STD's among teens has reached an all-time high. Our society is obsessed with sex in all forms, and if you aren't, then you're perceived as the one with the problem. No more so than for women, who are subject to double standards and all kinds of 'rules' that don't seem to apply to men.

I can't help but wonder if the 'liberated woman' mentality that came out of the most recent feminist movement is nothing but a farce - a way of making us feel better about our past bad choices, justifying otherwise bad behavior, and basically making us think that whatever problems we have will just 'go away if you ignore it.'

I can see how the feminist movement did more than try to get equal rights for women: it tried to remove the social stigma of women having sex before marriage. Women who had promiscuous sex, and those who probably trusted a partner before marriage and had a steady relationship that might have ended in something other than holy matrimony, were sort of lumped into the same category: slut. Women were supposed to be pure and chaste, and sex was "for men." If a man had more than one sex partner, that was okay; women were supposed to look the other way. However, women were labeled.

This public health ad warns men about "those kind of women." No guilt on them, just the unspoken permission that it's okay for you to be wherever you want, but the woman gets the blame. (And no one's asking why on earth they're looking for a good time when they might otherwise be in a relationship with someone else, either.)

In some ways, perhaps indirectly, the women's movement brought about a new way of thinking about sex - anything goes, "love the one you're with," etc., which has been a time bomb waiting to go off - for both women and men. Perhaps as a way to free ourselves from that negative stigma, it's become a self-fulfilling prophecy, and only made things worse. Rather than help us learn about our self worth as women and the amazing things we can do, our culture has taken it to extremes, trying to separate love from sex.  In other words, they have tried to drain all the emotional ties, both good and bad, out of sexual relationships and what it symbolizes. In some ways, it's like trying to fill a cup that has a large crack in it; eventually it's going to slowly leak out, maybe imperceptibly at first, but noticeably. Patching it back up helps for a little while, but then the crack gets bigger - until it can't really be repaired at all.

The idea that sex = fun and is for everyone pervades, even though it seems, as a greater public consciousness,  there are still some of the same stereotypes persisting. One campaign geared towards HIV-positive teens (read the PDF here) basically said "it's totally okay" to try on multiple partners like a pair of sweat socks, experiment, do what makes you happy, but protect yourself from pregnancy and disease. The one thing they're forgetting is that even if you don't get a physical disease, it can create another kind of disease: one of the mind, of the emotions. I don't necessarily think we should be shamed into feeling that sex and our bodies are dirty; but neither should we think that it's perfectly okay to give it away to anybody that walks by, either.

If you do have somewhat of a checkered past, we're told to ignore our inner feelings that perhaps what we're doing is wrong, and proceed as if nothing has happened. Get over it! It's in the past! We can all be friends here! is the mantra. If you don't want to be "friends" with someone, it's perceived that you're still pining away for that person, even though it couldn't be further from the truth. Maybe people think you're still bitter, or behaving like a child if you don't manage to have some contact, however benign, with the former boyfriend/girlfriend.

Just like teenagers, adults are impressionable when it comes to relationships and sex. We have fallen for the big lie that says it's okay to throw your feelings away and just do whatever feels good. Every time I see Cosmopolitan magazine on store shelves, I want to puke my guts out: 10 things guys want you to do to them in bed! Learn how to please your man! What is your man really thinking about sex? Blah blah blah, it's freaking endless. Who'd think that all the while the editor of that magazine, Helen Gurly Brown, was the biggest shriveled up looking prune of a woman that you ever saw. That's not teaching us how to have REAL, meaningful relationships with anyone but OURSELVES. Heads up, people: (ladies?) YOU are not the number one priority in your life. Stop thinking about yourselves all the time and then you'll be able to take care of others, and even yourself. I wonder: when women, accompanied by their young daughters, pass through those checkout aisles, what do their daughters think when they see these magazines?

What is our over-sexualized culture teaching us, and our daughters, about how to love and respect their bodies, within appropriate parameters? The same culture that has a hard time separating breasts for pleasure and as a source of nourishment to a baby; the same culture that likes to tell us "You don't need a man to validate yourself as a woman," yet does just the opposite. No one seems to want, or even know how, to put those ideas into practice.

If anything, the sexual liberation movement has taught us less how to behave and think like women, but to approach those same ideas of sex and relationships and think like a man. The other day I was reading an article from Cosmo (gag) called "Should exes be friends?" At one point, I thought this might be true, although it certainly depended on the relationship. Bad idea. Very, very bad idea.

One tidbit they mentioned: more men, statistically, still pine over former flames than women do. (Who said anyone was pining for each other?) This stat might be telling: that as women, we're taught to treat these once-important relationships as more 'throwaways' than anything else. That it's okay to pick up and move on without more than a passing thought.

The article set some parameters for whether you should be friends with an ex. Like, it's okay to be friends with an ex if, after a night of drinking, you "still wouldn't sleep with him." One Ph.D. offers this "advice" -
It is possible to be "just friends" with an ex, especially if the relationship was mostly platonic anyway. "Even if a romance loses its spark, you can still enjoy each other's company," says Patricia Farrell, Ph.D., author of How to Be Your Own Therapist. Plus, he remembers why he fell in love with you and can give you an ego boost when you need it. 
What, exactly, does "mostly platonic" mean? Not only are those boundaries fuzzy, but using someone else to get an 'ego boost' is doing just that: using them. I imagine this psychologist's patients are going to need more than just therapy after taking advice from her.

Further in the article, you are suggested to "booty call him for a sporadic shag if "the sex is fantastic but your feelings don't run deep" or "the day after a booty call, you feel just as good about yourself as you did the night before." Another expert Ph.D. tells us that sex with an ex can be positive because you're just in it for the fun: "Not only are you already comfortable with this person sexually, but also there's little at stake since the relationship aspect is over."Yep, like a pair of sweat socks that can just be washed over and over again, such is completely emotionless sex with another person.

Two things this article doesn't mention at all: how the other person might feel if he knows you're just using him, and how your possible current (or future) partner might feel about your past. It's all about me, me, me and what I can do to please me, me, me. We want to be seen as the sensual and emotional females that we are, but yet simultaneously want to be able to act like it's perceived men are allowed to act. What?! 

Conversely, we allow - no, expect - men to behave cooly and detached from relationships as a matter of course, as if that's the measure of a man. (And yet, somehow when they do behave that way, we can't stand it. Weird.) Deep down, no doubt, they don't even want to behave that way - because many of them aren't - but there's sort of a societal expectation of them to behave badly. Sure, many of them do, but if they don't, they're sort of treated as an anomaly, as if it's too good to be true.

The entire idea of sexual liberation, just like Cosmo magazine, has taught us how to do little more than justify our own needs over those of others and gratify ourselves at any cost, all while saying it's okay. And in doing that, it's supposedly cloaked in learning how to respect yourself, but has done the total opposite. All those ads from the 1950s that warn men about "those kinds of girls" has pretty much come true. 

Somehow, in all of this, we misinterpret new-found 'sexual freedom' as loving and respecting our bodies, that it's okay to show them off because we're proud of what we have. We let ourselves and the female image be objectified and take the emotion out of what we have to offer a man - not just any man or a string of them - because we don't even recognize our own self-worth and beauty that we already had and just didn't know it. Whatever innate power we had, we have let ourselves give away for the asking.

More reading:
A Return to Modesty, by Wendy Shalit
Love Your Body - Offensive Ads 
Statistics on HIV/AIDS, STDs and Unintended Pregnancy - State of Illinois pamphlet
STDs and Teens: A Reality Check
The Daily Mail: Friends with Benefits

Monday, August 15, 2011

Cinderella story: Is Barbie ruining your daughter?

As I helped my nearly five-year-old daughter get ready for church yesterday, I realized that to many people, she looked "old-fashioned." She had on a flowered dress that I made (which reached well below the knees when I first sewed it for her) and her hair was in pigtails. She had frilly socks and a pair of squeaky white patent Mary Janes.

I am on a crusade to keep my daughter young. We'll deal with all that other crap when we come to that bridge, but in the meantime, I am enjoying the shred of control I still have left over whether they wear stripes with solids for their first day of school.

Madonna's 14-year-old daughter, Lourdes.
(What a terrific role model her mother is)
I've blogged about this before - how our culture is literally forcing us to make our daughters into little skanks well before they even reach their tenth birthdays. Padded bikini tops for 8-year-olds? Check. High heels for little girls? Check. Pole dancing at the "Teen Choice Awards?" Um....check.

You can't look ten feet in front of you without seeing someone who should probably be showing a little less skin. At the mall, at school, wherever - some teenagers look like they're wearing glorified band-aids for a skirt. This article highlights some of the top teen performers who look more like adults, and when you see them all lined up like that, it's rather shocking and sad.

I thought, these are the musicians little kids - like the 4-18 (yeah, four!) year age group - listen to. I remember once dropping my daughter off for preschool, and one of her little friends had on a Hannah Montana t-shirt. Another was prancing around in shoes I wouldn't even wear, and I was repulsed every time I saw them. How can their mothers think this is cute? Have they ever seen Hannah Montana perform? Why would anyone think that is a suitable role model for a preschooler?!

As usual, Miley shows us a little more
than we really needed to see. 
In defense of bullied singer Rebecca Black, who sang that annoyingly overplayed song "Friday," she noted that she was faced with two choices when she came to the music studio to record: that song, and one about love and relationships - themes that, according to her, were still a little too mature for her to singing about yet.

Everyone decries how quickly our girls have become targets of the fashion industry to look over-sexualized at young ages. And in the same breath, it's perfectly okay for your kid to watch some of these performers on television, listen to their music, and emulate them. While we're busy lamenting how our daughters are looking older and older at younger ages, it seems like one fact has slipped by us: over the decades, while hemlines were getting shorter and clothing was getting more and more risque, we sat back and let it happen. You could argue this all started during the infamous sexual revolution of the 1960s, when our mothers and grandmothers were encouraged - more like, expected - to release ourselves from the bondage of female virtuosity and use sex as a way to behave like empowered, enlightened beings. So much for that.

And now, it's no big deal to some that Miley Cyrus pole dances at the Teen Choice Awards. Some might not like it, but turning a blind eye or adopting the "If you can't beat 'em, you might as well join' em" approach seems much easier than picking a battle over a miniskirt that shows major butt crack (and other things) when you bat your eyelashes. Yeah, you have to pick your battles as a parent: but I pick a lot of them, because I'm essentially at war with the rest of the world over MY KIDS. No one loves or cares for them like I and my husband do, and the biggest battle is between me and them - to look and do like everyone else does. Somewhere along the way, that battleground has gotten bigger and bigger, and the war has become tougher than ever.

People always say that kids are subject to peer pressure, but I think even more than that, the parents are. Parents are afraid of being scrutinized and made fun of because they think Katy Perry's outfit on Sesame Street was inappropriate. They are getting bullied by those who tell them to "lighten up," "get over it," or "you see worse outfits on blah blah blah." Parents who dare to take a stand on this issue need to do one thing: tell the "bullies" to shut the hell up and stand their ground, because it's the morality and virtues of their children - and really, everyone's children - that they're fighting for. No one ever said it would be easy.

Many are quick to blame the Cinderella and Barbie ideals that our girls grow up with for why our daughters are turning "bad" so young. Whatever. I have my own ideas about this, especially based on my upbringing: it's because mothers aren't instilling in their daughters self-respect. Enough self-respect to dump a guy who doesn't treat you right, and the tools to help you find one who WILL. While it sounds like I'm bashing my mother, I never had any real modeling of what a good, functional and loving relationship was as a kid. My parents divorced when I was three, and my mother has been unhappily married for several decades. With the divorce rate what it is today, what are mothers teaching their daughters about what to look like, how to act, and how to choose a good mate - when they can't even do that stuff properly?

I'm not saying I'm perfect, but it was by the grace of God, I think, that I even ended up where I did: with a loving husband who knows how to treat me right. I certainly never got much advice on that from the women in my family while I was growing up.

You can quickly point fingers of blame in the direction of Barbie (whose skirts are, admittedly, a little on the short side these days) or the fairy tale princess mentality that every girl latches on to as a preschooler, but I don't see much wrong with that. Kids are going to like things because it's what they like - you cannot convince them otherwise. As females and males, we are just hardwired differently, and no amount of "Oh come on, honey, wouldn't you much rather play with Matchbox cars?" is going to work if they don't want to play with Matchbox cars. Cinderella and fairy princesses are not our daughters' problem; it's turning a blind eye to unsavory stuff that IS the problem. Even this author notes:
To be perfectly honest, I wasn't that concerned when Miley Cyrus took her clothes off, or when her then-9-year-old sister, Noah, showed up for a Los Angeles Halloween event dressed in what looked like a Goth hooker outfit. (Those crazy child stars, I said to myself.) I rolled my eyes at the YouTube clip of scantily clad 8- and 9-year-olds in a dance competition, pelvis-thrusting to BeyoncĂ©'s "Single Ladies"; it reminded me of the showToddlers & Tiaras — disturbing, but very different from the reality of most kids.
It's when you're "not concerned" and "roll your eyes" that this is a problem. By not doing anything about it when it hits close to home, you are part of what's wrong about all this stuff, and letting it happen.

Bratz dolls are wildly popular - why? Because people buy them. What would happen if suddenly everyone decided, Hey, dolls that look like hookers aren't so cool, so let's pressure Mattel to take them off the shelves? Huh. They might suddenly do away with them, and before you know it, Bratz dolls would be a distant memory.

Perhaps. Until they're simply replaced with another flavor-of-the-month weird, inappropriate toy.

Cinderella is not the problem. Permitting children to be exposed to inappropriate role models is. Allowing them engage in provocative behavior or style of dress before their time is, and not taking a stance on these things early enough in their lives is. By not picking this battle, you are failing to defend and shape their character by handing them over to the 'enemy,' and therefore have no right to ask the question, "Why are girls growing up so fast these days?"