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Saturday, May 11, 2013

Why do women choose "risky" births?

Whenever a tragic birth outcome makes the headlines, especially if it's perceived as "risky," I know women ask themselves, "How can a woman do this? What on earth was she thinking?" It's hard not to, but much of the time, I can totally understand why.

The death of any baby is tragic, and I guess hindsight is 20/20 when you pronounce the death "unavoidable." In the case of this Australian woman, who was attempting a VBAC at home after two cesareans, she was summarily lambasted for not following the advice of her doctor and "internet advisers" were blamed for giving her false information on what she should do. One woman said, "I blame the 'variation of normal' crowd." (The woman's baby was breech.)

Contrast that to this story, of an American woman who died of complications following her sixth cesarean section. No is blaming her for her risky decision to have so many cesareans, as I'm sure she took her doctor's advice - and I highly doubt he/she was pleading with this mother to "please have a VBAC! It's safer!"

What's the difference, really?

Why is accepting one death - that could have also been avoidable - okay, but not the other? Imagine if the Australian woman had decided on that third cesarean, perhaps going on to have more children and more cesareans, and ending up like the woman who died? Are we saying that's just an acceptable risk that you take and "so what?"

I see it as merely shifting the risk. The more you discourage VBAC in women who've only had one prior cesarean, especially in those who desire larger families, the more you end up hearing stories like this. It seems like our medical community, and society at large, is perfectly willing to believe in dangerous paradoxes - namely, that VBAC is dangerous and cesarean section is "perfectly safe." Many commenters were disgusted that she went against the advice of her doctor and attempted a VBAC, which was unfortunate; but for many women who do take that advice, you better believe their doctor can churn out just as much misinformation as that sandal-wearing hippie natural birth advocate you so despise. How is being the opposite side of the same coin any better?

Add the fact that very few hospitals receive an official "Mother-Baby Friendly" designation (not that that matters, I guess) or can seem to be supportive without treating mom like brainless chattel and it should be easy to see why women choose an alternative birth. How many times have you heard that it's damned-near impossible to have a normal, let alone natural (gasp!) birth in a hospital setting? I'm not saying it can't be done, just that it's usually difficult and you have to really work the system (which has quite a learning curve, let me tell you).

For those who frequently bitch about how reckless or crazy women are after disastrous home births, what are they doing to make hospital births more hospitable? Oh wait - they're usually the ones that tell you to just "let go of your anger and get over the 'birth experience' - just deal with it." I'm guessing they've never once cracked open a book that details some of the absolutely barbaric birth practices that "modern" obstetrics have put women through* over the generations, and for what? To be treated like a human guinea pig? Or the formidable, unmentionable "physicians" who like to demonize all women for even thinking about a home birth, much less having one - are they making stunning strides and initiatives to support women in a comfortable, accommodating hospital atmosphere? Or just complaining about it and publishing the names and addresses of those women who've lost children in home births?

I'm not sure how I managed it, but I had a VBAC in 2006 and sort of fell into an OB's practice that would actually "let me" do it. I don't think I had any clue how difficult it is for some women to have one. If I hear someone say "just find a supportive OB and hospital with lots of experiences in VBAC" one more time I'm going to scream. Because it's definitely not that easy.

From the ICAN website.
If you look at this list, many are rural hospitals or in smaller towns. And many are hospitals in large cities. I'd like to know how you are just going to up and "find a supportive hospital" when they don't seem to exist. If you live in the boonies, your options for supportive hospitals and OBs or midwives is probably pretty limited, and I'm willing to bet the cesarean and induction rates at those hospitals that serve rural women are through the roof. ACOG Guidelines be damned; they aren't offering up an attorney, birth doula or physician to see you through your VBAC - which means the "guidelines" they issue do little to help the patient if a doctor can just pick and choose which guidelines to follow.

(*And for the record, I'm not intimating for one second that before modern obstetrics, women didn't suffer or go through torturous experiences in order to birth children, sometimes with disastrous results. But I think our glorification of modern medicine might be, at times, misguided and perhaps glosses over  its sordid history and past failings.)

More reading:
The "C" in ACOG stands for "castrated"
Tori Spelling and cesarean complications: why we need to hear about it

Friday, May 10, 2013

Newsflash: Pitocin could harm your baby

For some of us, the idea that Pitocin is not exactly a walk in the park is nothing new. So when this official proclamation came from ACOG, a lot of people were like, "Well, duh." 

Apparently this is "the first study of its kind to present data on the adverse effects of Pitocin use on newborns." Considering how deeply entrenched its use has been since its inception as the drug we know today, I find that incredibly shocking.

Unfortunately it seems like either those who swear up and down that it's the Devil's poison end up getting it, or those who are warned "don't induce!" often find out the hard way that in many cases, yes, it does suck as badly as everyone said it would. (Although obviously this is not the case for everyone.)

Back when my niece was expecting her first child, she said she was not planning on inducing but asked for advice about it. I tried to offer my opinion without sounding preachy, and a many of her friends said that in their experience, it was terrible and to avoid it if she could. I don't know what happened, but the next thing I knew, she was getting induced, had a hellish labor, and now apparently doesn't want any more children. *sigh*

What I've noticed is when people are asking about Pit, there are usually tons of people who relay their experiences - some okay, some great, some perfectly horrific and the stuff of nightmares. I'm not one to try and scare women by propagating horror stories, and whenever I speak of this stuff I try to be as balanced as possible. But I can't help but notice that usually, all the dissenters are ignored, their advice chucked to the curb and the mom is induced, sometimes with not so happy results. Sadly, it seems like those who filter out what they don't want to hear seem to have the worst time of it.

Either that, or one of two things happen: a dozen people say, "Well, I had it in labor and did just fine," as if they refuse to believe there is actually a problem. Or, they list the numerous reasons why they needed it in a defensive tone, which is kind of sad. Again, for some women, it's what they need and can really benefit them. But for everyone? I don't believe it.

I think some women get defensive because their hackles immediately go up and they miss the part where, again, it says that for some women, it can be a life-saving, very important drug to have on hand. I also wonder if they are in denial that their doctor could ever give them something that might be unsafe, completely trusting them with their own wellbeing as well as their unborn baby. I'm not necessarily saying that they aren't acting in your best interests, but rather questioning why this needs to be standard fare in so many hospitals today. One source suggested that approximately 81% of women receive Pitocin either to augment or induce labor. 81 percent?!

And because it's become so commonplace, it's perceived as unequivocally safe, a perfectly normal and acceptable routine of labor. If you question it, I highly doubt your doctor or nurse is going to calmly say, "Oh, you don't want it? Okay, that's fine." Administration protocols seem to vary by hospital and doctor, and while some appear to follow perfectly reasonable guidelines (especially the idea that if this isn't working, let's send mom home), others are outrageous - as expressed by nurses who work with these people, not just "natural birth hippie chicks."

From a popular internet forum for nurses. Click to enlarge. 
Some things to consider:
• Sometimes inductions and Pitocin use are completely necessary and the best thing for both mom and baby. If at all possible, perhaps suggest a gentle induction that can get things started in a minimally invasive way. Remember that in first-time moms, inductions can increase the risks of cesarean, although sometimes this is unavoidable. (Pre-eclampsia is a good example.)

• Sometimes it is not necessarily the best course of action but is given anyway. Know that you have rights. Some women do say that while they refused it during their labors, they had it given to them anyway; perhaps hiring a doula or having a birth advocate present with you may help. Some reasons for its use are dubious at best, and can cause more harm than benefit. (For an example, click here.)

• Get all the facts prior to an induction and ask lots of questions. If your doctor starts talking about an induction early on as a matter of course, this could raise some major red flags.

• Throughout its history, it has affected different women differently. This can depend on a number of factors, including how aggressively it's administered. While it can have many benefits, it is not without risk to both mother and baby.

More reading:
Pitocin side effects
Five ways Pitocin is different than oxytocin