Why I don't go to the OB anymore

As the news of team doctor Larry Nassar's sentencing makes headlines and his victims are finally being heard, it makes me fearful of their futures as they potentially enter their childbearing years. How will they ever trust a doctor again to care for them?

Awhile back I visited my gastroenterologist for a yearly follow up, and the assistant taking my medical history gasped when I said I hadn't been to an OB since my eight-year-old was born. She asked me why and I'm not even sure I responded. A friend gasped when I told her the same thing, and that I hadn't had a mammogram despite being 43, and she said her doctor has been ordering them for her since she was 35 despite being low risk.

To the intake nurse who was shocked and probably thought I was being irresponsible with my health: do you really want to know why I haven't gone? How much time do you have?

My very first gynecologist when I was college-aged was nice, she took the time to answer my questions and explain procedures. She also treated one problem effectively; the other, not so much. Not much questioning going on, just creams and this that and the other that made it worse.

The second guy, more cream. A cream that basically makes it feel like you're lighting fire to your skin. Not even sure what he felt he could accomplish with that. When I relocated out of state and saw someone else, the nurse gasped audibly when I told her what he gave me and couldn't imagine why he did that.

Soon I would start having children. The next practice I was in involved a doctor who had only recently had his license reinstated, I found out later, because he had made inappropriate sexual remarks to a patient. He's also the same guy who inaccurately told me that my child was vertex, even though I knew he wasn't, and argued with me. This was probably a major turning point in my pregnancy because we could've likely attempted a version at this point (they never offered, not once). But no, he remained breech, undetected, until I was about 37 weeks. Another physician in the practice did an internal on me - which now I wonder was really her stripping my membranes despite my child not being in a head down position - and determined that he definitely was breech, which was confirmed by ultrasound two weeks prior to my delivery.

When I had the baby, the first thing I said when my primary OB checked on me in the hospital was, in a super groggy state, that "all my children would have to be born this way." How naive and uneducated I was, and he knew it, because he didn't correct me.

When I got pregnant with my second, I was still naive and uneducated. He presented me with a choice at my first appointment: have a repeat cesarean or try for a VBAC. What little I had heard about VBAC sounded dangerous, and I told him so, that I felt I would just have another cesarean because "that was safer." He didn't correct me.

When I was nearing delivery with my second, I had an epiphany. Not only was she not breech like her brother, but I was more informed in my delivery options and just pissed off enough to exercise them. I remember vividly the appointment where I told my husband he had to come with me to break the news to my physician, who would not be happy. As if he was my daddy or something. The doctor already had a bit of a nervous stammer and it came out even more during that appointment. My husband was not pleased and shortly after that expressed his outrage and hatred for the doctor, who literally told me "I have one patient on her fifth cesarean and she is doing fine" when I confronted him about why he was downplaying the risks of repeat cesarean and making VBAC sound so terrible. That was his idea of informed consent. In response to this mystery patient that probably didn't even exist, I said, "Well, I don't want that to be me."

One of the midwives in his practice, upon hearing my plans, said, "I do not want to be doing this." Whatever happened to those caring, supportive midwives I kept hearing about?

I finally left that practice at the beginning of my third pregnancy, when another midwife in the practice basically made it sound like it was "my choice" to go through with it, despite the possibility of catastrophe. In other words, my fault. I left there in tears and never went back. It was not my first horrible interaction with her.

The next physician's group employed no midwives. Just doctors who bullied, coerced and lied. The lead physician in the practice examined my "little problem" and immediately tested me for herpes, even though I knew it would be negative. It was. He also didn't tell me what he was doing it until he had literally torn a piece of my labia off and it was over. He billed my insurance, I'm sure, but never asked me for permission to do the test.

At one point during that pregnancy I felt there was one doctor in the practice I could trust. That trust quickly eroded when, during a particularly lengthy conversation, she was having a tough time getting me to give up my hopes of avoiding another cesarean and then admitted she herself had had three of them. And then billed me for a 'consultation,' despite not having told me of what she was doing and the fact that my insurance was supposed to cover my office visits in full. This same office had billed me one other time for observed swelling as being "outside the scope of pregnancy care," despite it being quite common in pregnancy, in summer, and especially after the patient is being forced to wait in the lobby for over an hour to be seen.

One doctor in the practice worked hard to get me to consent to a cesarean for high blood pressure a week before my due date. I really wanted my baby to come on his own, hopeful that it wouldn't be a surgical birth. I quickly refocused and hoped it wouldn't be a cesarean done by her, praying that she wasn't on call. She had already scared me into thinking he was big after taking almost no time to measure me properly, sending me for an ultrasound where the lovely technician basically told me very politely that my doctor was full of crap.

When I was admitted for observation, the same doctor called my room repeatedly to harass me. When I finally answered the phone after several tries, she angrily asked, "Do I have to come down there?" like I was a disobedient child.

A resident had been counseling me yet again on the dangers of VBAC and told me the rate of rupture was 10%. I cringed inside and found myself shriveling in fear, as if I couldn't possibly stand up to their tactics. I remember thinking to myself, if I am going to preach to countless women about being advocates for themselves and their babies, it needs to start with me. I then told him he had his decimal point in the wrong place.

This same practice also had at least one nurse on staff who was downright nasty, even making a negative comment about my baby after he'd been born. I don't even remember what she said, but knew it must've been bad if the old lady receptionist apologized on her behalf, embarrassed.

When I came back for my six week checkup, I felt off. Not depressed, but just blah. The physician blankly stared at me and asked, "Are you depressed?" "Not that I know of," I answered, but wasn't exactly sure what to tell him. He told me he was obligated to ask and then ordered bloodwork and went on his way. The blood work revealed that I had a thyroid problem, which he also didn't know anything about, and I went untreated for probably another 18 months.

So I haven't been back. It's been over eight years and I know I should go, but I'm terrified. Waiting to be asked, "why'd you wait so long?" and subjected to a battery of bullshit I probably don't need, same as before. Only now it's a new game to play: when can we schedule your mammogram? I hate to tell that friend who's doctor ordered them at age 35 - but that's not even evidence based care. So when you transition out of childbearing to perimenopause, you're basically trading one set of fears over bad care for another.

When my online friends would talk about having a close-knit relationship with their OB or midwife, who is caring and listens to them so well, I realize I have never had that, not once. That I can't relate to that on any level whatsoever and now have an overwhelming sense of needing to watch my back. As if navigating the waters of "birth outside the box" wasn't stressful enough, now you have to worry about menopause and cancer this and cancer that. Being subjected to the same crap time after time despite countless studies - some of which that are at least a dozen years old - that suggest it's not really the best way, but seemingly take decades to implement, all the while receiving gasps and stares because you're dangerous and irresponsible. It makes me want to punch the Susan Komen Foundation in the face.

So this is what I want to tell someone when they ask why I don't go. And there are millions of women who have had it much worse than I. I know there are good, caring and supportive care providers out there but as of yet, I just haven't found them. I'm hoping that Larry Nassar's victims will.

Review: VBAC Facts Class with Jennifer Kamel

Image: VBACFacts.com

This weekend I had the pleasure of attending Jen Kamel's VBAC class "The Truth About VBAC: History, Politics and Stats" in Buffalo, NY. She is amazing - traveling the lecture circuit to present loads of information to both laypeople and birth workers alike.

I've already had a VBAC and I'm "just" a birth advocate, but I highly recommend the class if you can either attend in person or check out the webinar version. Why spend money on a class when I'm not even a birth professional? For philosophical reasons, this was as inspiring as it was educational.

What an opportunity it was to network with local doulas, midwives, advocates and birth professionals! I met new friends, heard and shared stories and exchanged information that not only could I use but pass on to others as well. The presentation was heavy on graphs and charts (Jen's favorite LOL) which is a good thing - putting it all into perspective is important. Without that perspective and information, women are potentially making a life-changing decision with less data and fewer facts, perpetuating the idea that "VBAC is dangerous!" and that it's selfish, foolish or risky to even consider it.

Some important take-away messages that I left that night with:
• Studies are important, as long as you're looking at the big picture. For instance, rupture rates are key, sure; but if the study you're reading doesn't tell you the number of women who had labor induced or augmented, then it's not going to give you all the facts. That is very important information to have - because it can increase the overall risk of rupture. Without it, it can definitely skew your impression of whether it's safe or not. Is your doctor quoting these same studies, that might present data the way he wants it to? Perhaps.

• Ultimately it all comes down to the level of risk that you are willing to accept. One is perceived as inherently safer, or more dangerous, than the other. Why is this? Because one is performed much more frequently than the other, to the point where risks and disadvantages are glossed over and minimized. I've always thought that it's just a shuffling game: you're trading one set of risks for another. You put off the more immediate risks of a VBAC and trade them for the more long-term, cumulative risks of repeat cesarean. If you're not looking at the long-term picture, you may not have all the best information at the time.

Why does a rare but well-publicized uterine rupture (which is not always catastrophic) send up more warning flags than surgical complications after four cesareans? Why are we more afraid of the risk of rupture - which may not even be realized - than we are about cesarean complications, that are becoming increasingly more common as more women have more cesareans?

Jen's presentation may be just the thing to give a VBAC mom the edge when it comes to studies and statistics - and it's downright sad that you even have to walk into a doctor's office defensively posturing yourself with a ream of studies to back up your birth plan. Don't expect your doctor to know all the facts and figures - or to even come close. Jen's information is nothing that you can't already find on your own, it's just painstakingly put together from the same medical journals and articles your doctor has access to - conveniently all in one place. The benefit to you is that the legwork has already been done - which is a big plus when it comes to the virtual sea of data that can be very overwhelming. Kudos to Jen for her hard work and determination!

For a list of upcoming classes and webinars, visit www.vbacfacts.com.

Tori Spelling and cesarean complications: why we need to hear about it

It seems like everyone wants to hear about celebrity baby gossip. And with Tori Spelling's recent birth complications in the news, it's something we should be hearing about.

At the very least, Tori Spelling's
post-cesarean complications could
be an important vehicle for raising
awareness about risks of c-section and
the importance of adequate
informed consent. 

As Spelling underwent emergency surgery for complications after her fourth cesarean, the media was slightly abuzz about why it's such a concern, as they should be. I was elated that finally, finally someone was beginning to question the high c-section rate and how repeat cesareans can pose dangers for women. Not that I would ever wish those repercussions on anyone, but to have it happen to a high-profile celebrity, someone who's face we recognize, whose births are highly publicized - is perhaps instrumental in getting our attention when it comes to a very important topic that few people seem to really understand.

I don't know about Tori and her marriage, don't watch her show, or know what her motivations are, but it sounds like she wants a large family. She is in the minority, as more women are stopping after two children and therefore are not often exposed to the risks of what that number of c-sections can do to the body. Whether it's one, two or four or more, it always carries risks - but obviously with four surgeries under your belt you're going to be exposed to more risk than someone who's only had two. It's unclear, though, whether women really 'get' why this is important to understand - because many of them spend much time digging Spelling for 'not using birth control' (even though someone commented that yes, she was using it, and yes, it did fail). Some speculate that she did initially consider a VBAC, but decided against it when her first and second births were also close together (which can bring additional risk).

Instead of bashing her for having lots of kids, not 'getting fixed,' etc. etc. it should make us question why she wasn't encouraged to have a VBAC after her first birth, especially if she wanted more children. Although close births do pose a unique set of complications when considering VBAC, this is probably one case where why her first cesarean occurred is important to know: did she have a medical condition? Was she 'too posh to push' or did she simply want to schedule the birth? Who knows. Preventing the first scar is key, but sometimes it's not that easy, especially if you aren't sure how many kids you want. It's hard to gear up for a future birth when you're barely finished with the first one, but knowing before you get that uterine scar just how it could impact future births is very important.

After the birth of her first son, Liam, Tori said this:

"I had a c-section...One of the biggest misconceptions is that celebrities have C-sections because it's easier. If I had a choice, I would not have. The recovery is much worse." 

To me, it almost sounds like her doctor was a "once a cesarean, always a cesarean" type of person. And while I'm sure there is some strong-arming going on when it comes to pleasing a celebrity client, these women are no different than we are: if a doctor tells you a VBAC is "unsafe, dangerous, and your uterus will shatter" then you are just as prone to believe it's true as any of us might be.

I'll never forget it: that's what Anna Nicole Smith reported that her doctor told her before the birth of her daughter, born by scheduled cesarean. That her "uterus would shatter," as if it's made of glass, as if one tiny contraction could forcibly blow the entire thing up like a bomb. I was so sad for her, because she naively believed him, much like any of us probably would have.

Some articles surrounding Spelling's complications ask an important question: are doctors doing enough to inform patients about the risks of cesareans? I was happy to see that headline, because I argue wholeheartedly that they're not. If you were scheduled for brain or open heart surgery, would a doctor simply tell you, "Everything will be fine, trust me! It's totally safe!" and walk away without so much as an explanation of the procedure? Highly doubtful.

I know my own physician, whom I saw for two of my three pregnancies, definitely did not. I still remember clearly our conversation prior to the birth of my first baby, who was breech: to his credit, he didn't schedule the cesarean until the week of my due date, but never went over any risks - if he did, I probably would have left the office that day in a panic instead of nervous excitement about the arrival of my child. Thankfully I did go into labor days before the surgery, which meant my baby (and most importantly, my body) experienced labor on its own, which is critical for future births. Yet I had no idea just how important that was at the time, because I was naive and very uninformed. No thanks to him.

When I became pregnant with my second child, my doctor gave me a 'choice' of what I wanted to do: the cesarean route, which I was already familiar with and had survived (isn't that a benchmark of just how casual our approach is to it?) or a VBAC, then proceeded to tell me that it could be dangerous and he'd had two women rupture on him. I decided the word 'rupture' sounded very unpleasant and I wasn't even going to consider it for a moment. Duh. What an idiot I was!

As my pregnancy progressed, I decided maybe having a VBAC wasn't such a bad idea. My primary motivation for choosing one was a) my baby wasn't breech and b) I wanted to avoid a potentially horrific recovery like I had with the first. I was terrified to tell him my intentions, because I had just three weeks until my due date. I stammered my way through our office visit, my husband at my side, while he proceeded to again tell me just how dangerous VBACs were and "I have one patient who's on her fifth cesarean!" I will never forget those words. That's when I asked him, "Well, what about this? That? Or this?" He had to concede that yes, those were definite risks to multiple cesareans. But reluctantly.

I know I'm not the only one. I've read so many accounts from near-panicked women that are on the eve of their inductions: "What should I expect? What do they do? Is this really necessary?" Something is clearly wrong with this picture. Either we trust our doctors too much, feel completely incapable of asking them questions, or they are completely inept at adequately informing their patients of risks and benefits to procedures. It shouldn't be a "don't ask, don't tell" policy; even if the patient says she has no questions, you should probably go ahead and tell her anyway. If she doesn't even know what to ask, then she's probably not even thinking about what could happen, what should happen, or what doesn't even need to happen.

I asked people on Facebook if they were induced or had cesareans, did their doctor cover the risks of the procedure? Of those that answered, all of them said "no."

It doesn't help that many doctors will discourage you from 'reading too much.' The internet be damned, because that means you're a religious follower of Ricki Lake and she only wants women to give birth in bathtubs. *eyeroll* Here, here's a copy of What to Expect When You're Expecting, now please - I don't have time to go over all the risks with you because there are none and it's perfectly safe so have a nice day. Does that sound like informed consent to you? Me neither.

So it's not a wonder Tori Spelling has had her fourth cesarean, and I don't think she should be blamed for it, either. Not because she's "old," or "a breeder," or any of those things. Stop blaming the person who just trusted her doctor, as you often blindly tell her she should. Start blaming the people who knowingly put vulnerable, often inadequately informed people at risk. Stop enabling the very system that allows this to happen.

Words of discouragement

I woke up this "labor day" and began thinking about my own labors - my Labor Day-ish baby will be five in two days. I picked up Tina Cassidy's "Birth" and read a passage about influential but misunderstood obstetrician Grantly Dick-Read and how he, along with Dr. Joseph deLee, both though fear could hinder and negatively transform the birth process.

I thought back to my pregnancies and how fear took hold, both in pregnancy and labor. A negative attitude or word of discouragement not only gave me doubt about my body, but doubt in my care provider. I never received a "You can do this!" or "Good decision, you'll be thankful!" at any time during my care, except perhaps when I naively decided to have a repeat cesarean (I later changed my mind). It was only after the fact, after the VBAC that went well, that I heard "Good for you!"

"I do not want to be doing this." That is what one midwife told me before my second birth. She spent more time talking about how much she liked my haircut than the philosophy of birth, and didn't hesitate to tell me that she felt my decision to VBAC would be exposing her to more risk. I was taken aback and thought, What if I can't do this? What if something happens?

"I do not know how to do this." These were the words of a resident who 'attended' me during my last labor, during which showed a footling breech baby and a cervix that was fully dilated. While I could understand his nervousness, later I thought I should have yelled at him, "Yeah, so maybe you should LEARN!" You always hear stories of laboring women yelling at their birth attendants - I wished, for once, that I could have been one of them in that situation. I pictured him sitting in a classroom, full of other clueless students, and wondered if the dying art of breech birth would just slowly, quietly go away and no one would be the wiser. What would he do, I later thought, when a woman comes in with precipitous labor of a breechling? In other words, what would he do if he got more 'crazy' women like me?

I think of the women who had traumatic, difficult births and how those transformed them, fearfully: the women who wanted more children, but decided not to because things were handled so miserably. I have waffled back and forth since the birth of my last child on whether or not to have another baby, at one point resigning myself and saying "I just do not have the mental energy to fight the good fight anymore." Then something would change: I'd see a mother out and about with her brood of kidlets, or hear an empowering story from someone who had an amazing birth with confident care providers that supported her in every way possible. Last night my husband and I scanned the list of names in our phone book for an endocrinologist and ended up finding an OB who advertised that she specialized in home birth. That gave me a ray of hope - but of course our insurance doesn't cover her services.

The journey is an uphill battle the whole way, as I feared it would be the moment I had an unintended repeat cesarean. The nurse told me, moments before I was wheeled back to the OR, "You can have this baby vaginally, you know." A glimmer of hope, but at what cost? I wasn't mentally or physically prepared for that eventuality, and I'm not sure she was, either: was she prepared to see me through this birth by herself, in the wake of physicians who - with more power than she had - were not? Was she silently hoping I would speak up and advocate for myself in ways that so many others had not? I'll never know. I'd like to go back and ask her, though, if only I could: How were you planning on helping me?

That uphill battle, I am realizing, has more than one hill: the biggest being, do I want to try this again? I knew I wanted to lose weight in an effort to start out better than before, but hadn't really done much about it until nearly 2 1/2 years after my last birth. I realized that, had I been more serious about it, I probably would have dropped the extra pounds and been pregnant by now, if that's what I really wanted. Then I think, Well, maybe not - I consider this time one of reflection not on just "Do I want another baby?" but "How can I gear up for this process? Am I ready to climb those hills?", of which there are several. The biggest fight of all is finding a supportive care provider who is willing to climb those hills with me. After hearing so much discouragement, I wasn't sure if that was even possible.

I know Drs. DeLee and Dick-Read said that a woman's fear in labor can negatively impact her birth. But I also know a care provider's fear, transferred to the patient, can too. I wonder if I wouldn't have more confidence, and less fear, if I were cared for by someone who "gets it" and doesn't allay her fears and insecurities to you. Instead of hearing "I do not want to be doing this" you hear, "I want to be doing this as long as you do, and I will be here for you."

Some upset over ACOG's "April Fool's" Press Release on Elective Cesarean

In a recent April Fool's prank, someone, somewhere, issued a fake press release supposedly from ACOG that touted the headline, "ACOG announces plan to stop elective c-sections." Collective eyebrows, including mine, raised in a "What the (!&%(?" moment, before realizing the truth. (The smiley face in the ACOG logo was a dead giveaway.)

Some, including this blogger, thought it was in very poor taste. Perhaps, if it had really come from ACOG. Otherwise, I don't see a whole lot wrong with it.

(This author also said she tried looking for it, but couldn't find it on line and figured ACOG was taking measures to "remove" the falsified document from web pages everywhere. If you do a Google search, you'll still find a lot of hits - and ACOG would essentially have to ask web masters - including those from natural-birth supporting sites like mothering.com, to remove the offending link. Which I seriously doubt they would agree to do.)

At any rate, I agree with the author, who sums the elective cesarean debate up nicely: if you want to have one, and are truly informed of the risks and possible benefits of doing so, you should be supported in your decision. However, the same is not true, sadly, for those women do no not want a cesarean, or who decide to have a natural or normal birth.

In the comments section, it didn't take long before women were quick to be offended: "I had two cesareans and loved them! They were wonderful!" Thankfully, someone further down told this mom, "You are missing the point."

We can argue that these women need to be totally informed of their decision - but I grow suspect when I wonder where, exactly, they are getting their information from. The same OB who, in my last post, told his patient a cesarean was "100 percent safe?" To some, that's their idea of informed consent. To the rest of us, it's a complete joke, and a very misleading, potentially dangerous one at that.

I'd like to see this right to choose extended more to women who seek a VBAC, or perhaps those who refuse a cesarean and end up having an extremely healthy, normal birth and baby - yet some entity in the hospital decides to have children's services investigate. If you have the right to an abortion, as one doctor suggests, you should have the right to choose a cesarean - but what about the right to not choose one?

It's clear to me that when it comes to the birthing choices of women, ACOG doesn't really give a crap. Because they aren't willing to actually make sure that physicians are adhering to their guidelines, it tells me they are all about the doctors, instead of what's best for the patient. Sure, they want to extend even women who have had two prior cesareans the "right" to have a VBAC, but what physician is going to back them up on that? I find many physicians like to get all preachy about what ACOG suggests and doesn't suggest - when it comes to something they mutually agree on, like the safety of home births. ACOG has definitely spoken up about that, and many doctors are in agreement. But what about the stuff they don't agree on? Is ACOG going to investigate a doctor who is unaffectionately known as "Dr. Cut and Slice" by many of his staff? When a moniker like that is given to a doctor, I feel so sorry for the patient, who is usually the last to know.

More reading:
Is ACOG pulling an April Fool's Day prank?
ACOG Announces Plan to Stop Elective C-Sections
The "C" in ACOG stands for "Castrated" 

The "100 percent safe" cesarean

Yesterday this lovely little gem came across my FaceBook news feed:

“Really, I don’t like any risk at all. If it were up to me, we’d just go with the 100% safe cesarean section.” – OB to parents during a VBAC discussion.

Really... I bet!

And unfortunately, sometimes this is the closest women get to being "informed" about their options when it comes to childbirth.

I've been lambasted on at least one blog (not even gonna go there) for questioning what OB's say and suggesting that their white coats and medical degree make them sound more "right" and authoritative. I don't believe I've ever intentionally painted all doctors as bad, because I know they aren't. But I think there are a lot of people out there who think like this guy (woman?) - and simply don't want to deal with you because to them, you wear the words "potential lawsuit" on your sleeve. You are essentially perceived as a more difficult patient to deal with since you have a scarred uterus.

No cesarean is "100 percent safe." I'm not sure that anything in this entire world even is, honestly. There are clear risks to surgery - both short- and long-term - that it seems few physicians are open and honest about. If you plan on having more children, multiple cesareans can pose complications in future pregnancies and make it even harder for you to have a vaginal birth.

It seems ridiculous to think of future pregnancies and babies when you haven't even had your first yet, but remember: cesareans are forever.

The Girlfriend's (misguided) Guide to Pregnancy

"Or everything your
doctor won't tell you."
(Oh, if only that
were true.)

I vaguely remember when I first heard about this book - that and Jenny McCarthy's Belly Laughs were pretty popular, and I figured it would be a nice alternative to those books that depicted pregnancy as all flowers and sunshine.

What I wasn't prepared for was the tone (of either book) to be the verbal equivalent of a cheese grater. I read a few passages of Jenny's book and thought, Ok, this is going a little too far in the opposite direction. (She obviously has never been known for her grace or demure behavior.) While not necessarily that bad, Vicki's book struck an uneasy chord with me on much the same level. 

This book is probably one of the biggest reasons I would hesitate to rely on  something written from the author's perspective. (Unless she's like Robin Elise Weiss, who is on like her eighth child: that alone gives her a bit more leeway in that department.) Iovine rubbed me the wrong way on several topics, namely:

• Home birth. Her perspective on it is somewhat sad, and reflects the notion that only doctors are capable of handling a birth. Not only that, but it sounds like she did little - if any - research on it, and relates the story of her friend Kathy, who transferred from a home birth to the hospital.

"....[Kathy's] midwife did everything from make her herb teas to walk with her in the hills ... to bring on regular contractions. The nurturing and reassurance were extraordinary... Unfortunately, Kathy found labor longer, more painful, and more frightening than she had anticipated..."

I'm not exactly sure how to interpret this passage. What is she saying? Have a plan? Be prepared for it to fail? The way she describes it, the midwife must not have been that reassuring.

Iovine says she "gleaned three lessons" from her friend's experience: you can never get to the hospital too early, (oh yes, Vicki, you certainly can!), save the "homebirths, midwives and underwater deliveries for the second, third and fourth babies" (because you have no idea what to expect or how to manage labor when it's your first child), and "never elect to have a child where you have no access to medication, or God forbid, real doctors."

(I think here is where Vicki just figuratively smacked the collective group of home- and waterbirthing women across the face with her book. Ouch.)

I don't really get the mention of water birth - which can be done in the "safety" of a hospital with "real doctors! Gasp!"

She says that "childbirth is as messy as a pig slaughter," and wonders who would want to 'sacrifice' their beautiful sheets and other linens for such a thing. She recommends giving birth in a four-star hotel, where the maids can clean up afterwards. Seriously?! 

So much for a real, meaningful or educational dialogue on home birth. No wonder it gets so much flak!

• Regarding pain management and epidurals:

"You will tell yourself from now till labor begins that you intend to try delivering without an epidural, but I can't think of a Girlfriend who didn't take it when it was offered."

What the heck kind of thing is that to say?

So don't even bother, because no one else does, and you're weird if you think you can actually try to get through this without it. Just go ahead and try, because I bet you can't! Honey, I think you need different friends.

(One Amazon reviewer noticed this too, and said Vicki was "downright hostile" towards moms who don't have epidurals and "chastises women who are disappointed to end up with c-sections." While she emphasizes the 'natural' changes in your body such as weight gain, the reviewer notes, she "has no use for the natural process when it comes to birth," and "thinks everyone should induce labor at a convenient moment.")

As far as childbirth in general, she concludes that:

"A delivery that results in a healthy mother and baby is a gift from God, no matter how that delivery was achieved. Period. Childbirth is not like a visit to a spa: It is not designed for your personal enjoyment and fulfillment. It is not an opportunity to demonstrate your abilities or fitness....I think this feeling of being "gypped" by a birth experience that doesn't match our expectations is one more example of that yuppie self-centeredness that is none of our least attractive characteristics." 

This passage .... this part made me mad. Right after I thought my eyeballs were going to pop out of my head, I then felt like barfing. So, all you ladies who feel victimized, used, abused, betrayed or otherwise treated like crap by an OB, you better just get over it. Because all that matters is your baby was born healthy, okay? Your feelings don't really mean much, in the broad scope of things, now do they? (sarcasm off)

It's this kind of behavior that makes women feel like their thoughts, feelings and emotions surrounding childbirth are completely invalidated, and that is so not fair. Who are you to say another person has no right to feel the way she does?

As far as the whole "personal enjoyment and fulfillment," I bet there are loads of women - both of whom had epidurals and those who didn't - who would definitely beg to differ. For many of us, it definitely is about fulfillment - of your role as a mother, as the giver of life.

And as more women are realizing, sometimes those interventions that are supposed to help us have a "healthy baby" do more harm than good, and we would oftentimes be better off without.

Ironically, a few pages back she talks about her primary cesarean with a baby conceived through IVF, and how let down she was by the experience of not having a vaginal birth. So much so that she had her next three children by VBAC, because she says that she "felt so robbed of something my soul had yearned for." (At least one Amazon reviewer said Vicki frequently contradicts herself, and I guess this is one of those moments.) She goes to on to mention two of her friends and their husbands, who, at the time, were planning on all natural births. (emphasis mine)

Both of them labored for more than twenty hours. They were in the kind of pain that only fear and no end in sight can create....I call these husbands Golden Retrievers because they continue to act sweet, loyal, and dumb even when all evidence is making it abundantly clear that everyone in their little family had been unimaginative in how big and long and scary the pain of childbirth can be. 

Finally, it was the insistence of their doctors that got the laboring moms and their clueless husbands to surrender and release their stressed babies via the zipper. 

The babies were "scandalously healthy and robust," she adds. So maybe that means they weren't so stressed after all? I feel badly for her friends, who I bet aren't anymore after that one.

So basically it's okay for Vicki to feel "robbed of an experience," but no one else should be because she says so. "Period."

I don't know if I can go any further, honestly.

Ladies, you have every right to feel "robbed" of an experience if that's what happened to you. Taking into account that not every birth can always turn out the way we'd like, that "experience" can be very important in deciding the outcome. As the person giving birth to this child, it can be about you and your wishes too, without compromising the "healthy baby" part. It's important to realize that some of what is done and isn't done in labor - that can either add to or take away from the "experience" of birth - is key in the healthy baby equation. Don't let Vicky Iovine or anyone else tell you to just get over it and move on; a true girlfriend would never say that. 

The "C" in ACOG stands for "Castrated"

OK, call me bitter. But every time I read about a brand new and improved ACOG guideline, especially the latest ones about VBAC and VBA2C being safe, I think, "What's the point? Who is really listening?"

Ever since this summer, the news of the safety of VBAC was on the tip of everyone's tongue and ACOG was urging doctors and hospitals to relax their restrictions on doing them. Yet, thousands of women are still turned away, led to believe no doctor will support them and that they are actually illegal, according to state laws. Thousands more are still telling other women how dangerous they are, even though they know little about them. I'd love to see the figures on what this lack of support is doing to increase the alarmingly high rate of c-sections in the US.

What does ACOG really mean when they restructure guidelines like this, or create new ones? Who's listening? As I decide about having a fourth baby, after two cesareans, what does it mean for me as a patient? And is there any doctor in my county who will "allow" me to have a vaginal birth?

I'm beginning to think that ACOG is the new United Nations, an organization that probably means well but has little power when it comes right down to it. They can shake their fist, demand better, and set 'guidelines,' which is really saying, 'We'd like you to do this, but we are powerless to do anything should you decide to ignore us.' Is ACOG personally going to come after and investigate doctors who have astounding c-section rates? Those who don't do VBACs? Yeah, as if.

One of the biggest reasons for primary cesareans, and in my case as well, is if the baby is breech. I had a primary cesarean in 2003 for breech presentation, and another one last year for breech as well. ACOG's website doesn't necessarily say "we don't recommend a breech birth," but neither do they say "This should be recommended as a way of cutting down on the number of cesareans." Not too many doctors, I suppose, would be willing to admit that a sheer lack of training (among other things, as well) in this area is what leads to a surgical birth. I think that perhaps that would be a blow to your pride, to have to admit that you don't know what the hell to do if a mom comes in at 10 centimeters, waters broken, with a footling breech (been there, done that). So you just whisk them straightaway to the OR.

ACOG's website on this subject actually implies that there are "options" for a mom when she realizes that her baby is breech. Yeah, like "would you like to be sectioned on a Monday or a Tuesday?" While they acknowledge that there can be risks to a vaginal breech birth, they admit that "most breech babies are born healthy." (No where do they mention the skill of a caregiver being able to mitigate significantly risks to you and the baby when he actually knows what he's doing.) Without really coming out and saying it, it's like they're quietly whispering, "If you have your baby vaginally, it'll probably be alright." Not screaming, "YOUR BABY IS GOING TO DIE!" They go on to say that "it's not always possible to plan for cesarean birth," and as your due date approaches, if your baby is breech your doctor "will discuss the risks so that together you can plan the delivery that is best for you." Cue the happy music and the hugely pregnant mom wading through a field of daisies ... I think I am going to barf.

Right! If you read between the lines, ACOG says right there in plain text: "Your doctor will discuss the risks." Of a vaginal birth, you mean. Never a cesarean. This is also what happened to me on at least more than one doctor visit - he sure discussed the risks with me, all right. Let's not mention the benefits of a vaginal birth - like not having a scar on your uterus and all the complications that come with it, both potentially life-threatening and just plain annoying. No more is this underscored than in the death of a mom after her fourth cesarean , due to a combination of placenta problems and doctor error.

This death could have been avoided, some suggest, if more women were encouraged to have VBACs, or - dare we say it - not have a cesarean in the first place, even if the baby was breech.

In this area, I wish ACOG would look north to their Canadian cousins - The SOGC, or Society of Obstetricians and Gynecologists - to get the scoop on how to handle breech vaginal births. It seems, from what they're saying, is you don't have to 'handle' anything: just let it happen, and chances are, the mom and baby will do fine. But that's our biggest problem: they can't keep their hands out of the cookie jar, even when the jar is empty and there's nothing to grab - just leave it alone already and we'll let you know when you're needed.

I'm beginning to think that if ACOG were really serious about lowering the c-section rate and giving women "options," they'd be passing that information on to everyone and her sister and not just allowing it to rest in the often idle hands (and brains) of your well-meaning, but obstinate, physician. Still think your OB is only acting with your best interests at heart?

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!

Insurance coverage dropped for breast cancer patients

This headline screamed at me yesterday morning over my cup of coffee: "WellPoint routinely targets breast cancer patients." It's all over the internet now and raises a few questions about the treatment of patients - specifically women.

Interestingly enough, the original version of the story I read yesterday included this one brief nugget of information: That to insurers, breast cancer patients, as well as pregnant women, were an "anathema." Even as proficient as I am with the English language, I had to look that one up. It means "a person or thing, detested or loathed."

When I went back to reread the article through Reuters, I couldn't find the word "pregnancy" anywhere. Puzzled, I read the comments on the Reuters reader forum and realized, after someone noticed it, that the article had been severely edited, including the negative comments made about pregnant patients. Someone must have said something inflammatory and made the corporate lawyers mad, which prompted further editing of the article. However brief the mention was, though, at least it got some notice. (Ironically the comment was made by the city attorney of Los Angeles, not someone from the insurance carrier itself.) And while I think he is on the right track, the threat of disability is not the real reason here.

"But there are two things that really scare them and they are breast cancer and pregnancy. Breast cancer can really be a costly thing for them. Pregnancy is right up there too. Their worst-case scenario is that a child will be born with some disability and they will have to pay for that child's treatment over the course of a lifetime."

It's not news that insurance companies have been dropping pregnant women from their care for the last few years, especially in the case of a repeat c-section or the choice of doing a VBAC. For the group who don't want to do a repeat cesarean, often insurance carriers would refuse to pay for a VBAC, undoubtedly because their "panel of doctors" deemed it too dangerous. For the group who don't want to do a VBAC, the insurance carrier refused to pay for what they considered an 'elective' cesarean when a VBAC could be cheaper.

The take-home message in this particular case is that your insurance carrier is saying, "Don't get pregnant. We'll be glad to pay for your birth control pills, though." Because that baby has to come out, either way. So what is a woman to do, when her options are limited not only by her doctor, but by her insurance carrier?

In both cases of pregnancy and breast cancer, basically WellPoint uses a computer algorithm to single out particular patients. Certain conditions, apparently, "trigger investigations" with the company, even though the computer appears to be doing all the work. Apparently WellPoint is concerned about fraud, but really, when it comes to cancers, the United States has a high rate of survival for many cancers because of their rather aggressive treatment. If they're interested in investigating fraud, especially when it comes to pregnancy, perhaps they need to look into the overuse of the expensive induction agent Pitocin, which can cost hundreds of dollars per dose. Multiply that by the number of WellPoint's patients alone who are induced, whether for medical necessity or not, and I bet the figures add up very, very quickly. Or perhaps look into the number of unncesareans that are performed on their patients daily.

The difference between these types of patients is obvious: breast cancer is an illness that needs to be treated. Pregnancy is not. But either way, women are forced into neat little boxes, absolutes that are black and white. We know that the more interventions in pregnancy and labor that are performed can sometimes put the mother and baby at elevated risk, and are often extremely costly to the insurance provider. Instead of instantly dropping both groups of patients from their care, why aren't they taking initiatives to find evidence-based ways of saving money? In the case of labor and delivery, all the information is already out there, but few doctors put it into practice on a wide scale.

One thing I'm curious about: how do their treat male patients? No word on that yet. Especially those rare men who get breast cancer, because it does happen. Are they immediately dropped from their insurance carrier? Either way, it looks like women lose out again on this one.

Defiance: Part 2

As a follow-up to my first post on this subject, last night I checked emails and found updates on the discussion over VBACs that I had been having at the BabyCenter birth forums. I really shouldn't read this stuff before bed, because it gets me so riled up. (As I lay there trying to get to sleep, I kept telling myself, 'Just think about shoes....just think about shoes...." LOL)

Remember Dr. So and So? You know, the one I said sounded pretty fair and stuff? Yeah. Well, I change my mind. He's a jerk, just like all the rest. He posted on the message board that he 'welcomed healthy debate,' but I think he avoids it - runs from it - just like everyone else. And in the end, he won another mom over to a repeat c-section, even after all the facts and differing opinions had been offered.

Granted, if you've done your homework about VBAC, and it's still not a choice or risk you choose to accept, that's great. I can totally respect that, as I am sort of in the same boat: if I have another baby, I'm not sure I want to try another VBAC after two sections. And I know that plenty of women have done it before. But for me, at least, I think it would depend heavily on my care provider: if I found someone pro-VBAC who would take me on as a patient and support me physically and emotionally, my mindset would no doubt be completely different. As would this mom's, if, say, Dr. Stuart Fischbein were the contributing doctor and not Dr. So and So.

But if your 'research' consists of Dr. So and So's one-sided drivel, the horror stories of gum-chewing girlfriends and the 'pregnancy bible' (GAG) What to Expect When You're Expecting, then you are ignorant.

There. I've said it. That I think some women truly are ignorant. And arrogant, in assuming that crunchy birth advocates are wrong or crazy; and especially so in assuming that nothing could ever happen to me, because I trust my doctor. Why listen to the opposing side? I know all the facts; I asked my doctor! What could possibly go wrong?

I'm sure I come off as arrogant to some in my fervor over birth. But I think the difference is this: I'm not trying to suggest that I know more than any doctor, that's for sure. They do know a lot, but it's a matter of what they're willing to share with others. That is where Birth Nerds like me are different. We want to share with you both sides, instead of the biased garbage you'll hear from your physician. He only wants you to hear what he wants you to hear. We are all told, by our friends, family and doctors, how different we are as women, how different our pregnancies are, as we waddle through those nine-plus months. Then, when we get to labor and delivery - BAM - suddenly we're all the same! And yet, when a doctor gets a patient who isn't, he treats them the same as the 100 other 'ignorant' women who walked in the door that morning. Dear Doctor, please stop treating me the same as those women who want to be induced, just want that baby out of there, looking at you with stars in their eyes as they worship you like you're God. I worship one God, and let me tell you, you're not Him.

I posted a huge diatribe in response to Ms. Board Owner at how insulted I was that she assumed that I knew less because I was just a patient, or that I was trying to assert that I knew more than a doctor. And this is the response I got from Dr. So and So:

Here is an interesting plan by an Ob doc from the state of Washington

Do a VBAC if a patient or her insurance agree to pay the true cost of attempted VBAC.

Catastrophic rupture during VBAC occurs ~1 in 200

Average liability pay out of $750K not counting the cost of litigating the law suits, average > $3750 per attempted VBAC

Average labor ~ 11 hours and would cost an additional $8250 to cover the cost of dropping all other Ob/Gyn care & being immediately available to perform emergency C/S. This could be more or less depending on the actual duration of labor & cost @ $750/hour.

If C/S was required, that would be an additional charge.

Healthy debate, my ass.

I haven't responded, and don't know if I will, but considered saying this: "Save your money and hire a midwife and have the birth you deserve."

Defiance

I admit it - I often defy authority (bats eyelashes). If someone tells me I can't, or shouldn't, do something, that often only makes me want to do it even more. So when I again submit myself to routine punishment on pregnancy and birth forums like the one on BabyCenter, I probably come off as quite pushy and bitchy, I'm sure. 

Ahh...BabyCenter. About as bad as Yahoo! Answers. It's often like the internet version of The Learning Channel's "A Baby Story," often very one-sided and equally frustrating. 

I was engaged in "conversation" on a VBAC thread there a few weeks ago (before I dropped off the blogosphere for awhile due to the Sinus Infection from Hell) after a mom had posted awhile back on whether or not to have a RCS or attempt a VBAC. The post was old, she'd already had her baby, but I commented anyway, thinking that other women in the same situation could possibly benefit from it. 

To them, it opened a can of worms. The original poster jokingly said "I wish this thread would just die!" The board owner said (half-jokingly) that she wanted to ban VBAC threads because they created such controversy. I kind of blinked at the screen like, "Wha....?!" There were some good stories on there from women who have VBACed, those who needed support and were thinking about it, and then the one that pissed me off royally: "No VBAC for me! I love my baby!" The original poster felt that "c-sections were more mundane," and therefore more predictable, a sign that they were 'safer,' I'm sure. 

The kicker, though, is that there is a doctor who apparently devotes his time to answering questions about certain topics. Dr. So and So weighed in and offered his opinions, most of which presented uterine rupture at its highest estimate and made it sound like insurance companies were the ones solely to blame for the lack of VBAC options available. I respectfully questioned him, only because I thought his estimate was high, and was able to back it up with evidence (which he, and the other posters, ignored). This didn't go very well, either. Apparently, if you're not a doctor, you can't possibly know anything about birth, apparently.

The board owner then responded by saying 'women' (me) come on here and try to be teachers, etc. to other women, and her bet was 'with the doctor' because "he's a doctor." Apparently by questioning him (which is against board rules, by the way) I was somehow out of line, even though Dr. So and So said he invited healthy debate, which I think this was. By posting another differing statistic, suddenly it was perceived that I thought I knew more than he did. 

I wanted to ask Ms. Board Owner, "Do you go along with everything your doctor says? How about your kids' pediatrician? Hasn't there ever been something you've respectfully questioned, even though you're just the patient?" Give me a freakin' break, lady. 

Yes, it's great that Dr. So and So devotes time and energy to a lowly pregnancy message board full of hormonal women. But these are our bodies, too. Our babies. And that should mean something. 

The latest post on the Talk Birth blog tells women how they can be  better educated birth consumers by learning all they can. The question is, how can we help others to be better birth consumers? Certainly not by cramming it down their throats. But I find it troubling that so many of them don't want to be, it seems. And by their behavior, they are effectively encouraging other women not to be, either. Or harshly criticizing those who are, and who do encourage other women to be as well. 

Some of these women were basing their decision solely on the opinions of one doctor, who, actually seemed somewhat fair, but of course was protecting his best interests as a physician as well. I pointed out that he was just one opinion, and not the be-all end-all supreme authority on VBACs. (Well, you can imagine how that went over.) 

I guess in the meantime I'll just have to keep crashing message boards, one at a time....(respectfully, of course) :P

Does your c-section make you feel like less of a mother?

It's become a legendary topic of debate, right up there with formula vs. breast, co-sleeping vs. crib. I stumbled across this blog post from repeat c-section mom, Amy Hatch, who laments why certain people make her feel like she's less of a mom because of her choice to have a cesarean . She also was riled at how a doctor at the recent NIH VBAC conference referred to a vaginal birth as 'normal,' making her feel like her births were 'abnormal.'

I won't go so far as some people did and say "get over it." I can't put myself in her shoes, and honestly, on one hand I can see how it would be easier emotionally if we didn't find it as important as we do. But on the other hand, as one person interviewed for The Business of Being Born put it (God help me, I can't remember her name, but it was familiar) to some a c-section is as routine as clipping your fingernails. I couldn't agree more.

I would never willingly make someone feel inadequate because of her choices on birth. But it's such a fine line. I guess in my passionate "birth Nazism" (how I hate that term) I only think women should make those decisions not based on one five-minute, one-sided conversation with their doctors, but some dedicated research to the topic. But I can't force someone to read books about it, nor can I force them to care as much as I do about it.

Hatch goes on to say that:

it's even A-OK with me if you want to pop a squat in the forest and have your kid while someone braids your hair and sings "Kumbaya." 

*Sigh*. There it is again: the perception that moms who insist or are passionate about vaginal birth are hippies, somehow freakish in nature. Someone else in the comments section also made a reference to this, too.

Since I can't keep my big mouth shut, I had to chime in. (I've decided that I don't really need coffee in the morning, because reading some of these birth forums would get the job done just as easily.)  I offered this:

Now see, you're insulted by the 'you're less of a woman if you had a c-section' vibe that you get from certain people. Most of us who are very passionate about vaginal birth are equally annoyed with the "squatting in the woods while singing kumbaya and having your hair braided" references. Why is it that women who feel a vaginal birth is important, not to mention without an epidural, are treated as freaks?
....
I think by and large that a lot of OBs practice "fear-based obstetrics" not only to save their own butts, but to discourage us from making them go out of their way to "allow" us to birth in the manner of our choosing. Sometimes yes, squatting is effective in order to better position the baby, but many doctors see it as offensive to get down on our level to help us deliver. And what did your doctor tell you about the risks of c-section when you were planning your second? Did he discuss VBAC? Like mine, probably for two seconds, if only to make it sound like the most dangerous thing I'd ever do and only carried risks. Which is crap. And then, we as women who like to talk to our friends about "girl stuff" like pregnancy and birth, perpetuate the myth that our bodies are broken, deficient and incapable of giving birth. That women who don't want interventions or drugs during labor are stupid, crazy or 'think they're getting a medal.' 

One woman said that "VBACs carry risks." As if to say that c-sections do not? Are you kidding? And on another forum, I actually heard this: "No VBAC for me! I love my baby!" As if to imply that those of us who choose a VBAC don't love our children? WTH?!

I think perhaps the debate stems from people realizing that maybe things didn't have to be the way they were? I don't know. I continually realize that it has to be a kick to the gut to suddenly be told "you should have known better," or "could have made better decisions if only you had known the facts." That's great, thanks for telling me now. I know my VBAC could have been "better" (no amniotomy, for instance, or insisting on changing positions, no Nubain, etc) but it was my VBAC, and I own that experience. There is no going back and changing what happened, but, if you're lucky, you can try to prevent it from happening again, should you have more children. And even then, there are no guarantees. In the meantime, I have chosen to be an advocate for women who are having more children, even if I myself never have another one.

Ironically, I have never met a woman who made me feel inadequate or questioned me for having two sections. I pray that I don't make others feel that way, either.

Where to go for important VBAC information

I have to remember that not everyone visiting my site is a seasoned "VBACer" and might be just starting out in their search for good, basic information, even on birth in general.

I was visiting the ICAN (International Cesarean Awareness Network) website yesterday in search of VBAC-friendly providers . In a nutshell, we are considering moving out of state, and I'm not sure I'm done having children yet. On the site you can find very useful information on VBAC-friendly hospitals as well as those who ban it outright, and those who have a 'de facto ban,' which basically means the hospital has no formal ban policy in place, but there are no doctors who would support your decision.

Also included in the search criteria is what the hospital's stance is on it should you show up ready to push at a VBAC-banned hospital. If you click on the hospital's name, it shows a date for when the information was obtained, and what their policy is on VBACs. Many that don't allow them stated up front that you would be transferred to a larger hospital more equipped to handle your delivery (many base this on how far your labor had progressed when you arrived) and some say that should you show up and labor is imminent, they will let you deliver the baby vaginally.

I am not a doctor and therefore not willing to dispense crazy medical advice, but I have heard of many brave women laboring outside the hospital or in the lobby, and then show up at L&D when the baby was crowning. (But you didn't hear this from me.) While this might sound like an insane idea, it only drives the point home that in places where VBACs are "banned," it could possibly drive women to take chances that care providers might consider risky, and could create even more potentially dangerous situations should women feel threatened by care providers who won't let them attempt a VBAC.

Since I don't know any of the women who read my site, I am a bit concerned that my post on a VBAC gone wrong has been coming up in search criteria and I wanted to make sure no one was basing their decision on reading that post alone. Granted, if you want to do a VBAC that is just one facet in the entire bigger picture, but again, since I'm not sure where some women are in their "birth journey," so to speak, I didn't want them to possibly get scared away from even considering one.

No one is, or should be, making you feel like less of a woman because you decided not to attempt a vaginal birth. The information is out there, but many care providers will discourage you from even thinking about it by giving negative stories, skewed statistics and misinformation that does nothing but cloud your judgment, sway you towards your doctor's opinion, and make you think that VBAC produces nothing but bad outcomes. In fact, the opposite is usually true, but many women don't realize this or even consider the possible dangers of having a repeat c-section.

If you have a supportive care giver who is willing to accurately tell you both sides of the story, then you probably need to look no further. But please understand that many, many physicians and midwives will initially support you in your decision, only to turn around at the last minute and change their minds, which can be a crushing blow to many women who have their hearts set on a vaginal birth.

It's unfortunate that you have to go searching for your own information simply because your doctor isn't telling you everything. Again, I am not a medical professional, but have experienced first-hand some of the negativity and bias of physicians, I have had a VBAC, and have done a lot of my own research through invaluable sites like ICAN and others. I only offer information to women with the knowledge that they can do with it what they choose, but at least want them to know that they do have a choice. No one is dispensing "badges of honor" for having a vaginal birth, but just information that can possibly help you to make the most informed choice possible.

Other websites to check out, that can help both with a VBAC and a vaginal birth in general, can be found here: VBACfacts.com , vbac.com , and Giving Birth Naturally .

The media doesn't know crap about childbirth

OK, to some of us this is no surprise. I mean, if you model your ideas of childbirth after an episode of Friends, then you're in trouble.

While scanning the blog roll today my eyes fell upon this: CrunchyDomesticGoddess' post  about how the Today Show was airing a live c-section. The gist of the story is that the mother was having a repeat c-section because 'babies ran big in her family,' she was past due (by what, 12 hours?) and this child was 10 pounds at birth. Ummm...'kay. The doctor said that with those indications, a c-section was a lot 'safer than a vaginal delivery.'

He then went on to lie that if the mother had another child of a 'normal weight' she could 'absolutely choose to deliver vaginally.'

Hahahahahahahahaha...(this is me laughing hysterically.) Because if this mom already couldn't do a VBAC with her second, what makes her or anyone else think this doctor would support her possible decision to VBAC after two cesareans? I mean, sure, it's possible, but most doctors don't want you to actually know that!

And Meredith Vieira, in her divine wisdom, piped up at the end how 'they chose the right way to deliver.'

Oh Meredith. You brainless puppet, you. This part almost makes me want to start swearing, and I don't want to do that.

If you read my post about the mom who sued her insurance company because of a botched VBAC , you'll see what I mean: a "news" report that is so one-sided, so ill-informed that it makes me want to puke. But this is the only part people see, if those little alarm bells don't go off in their heads and convince them to do their own research. Sickening.

And even in their series on "The Empowered Patient," CNN's coverage of controversial VBAC mom Joy Szabo didn't even mention how she'd already had a prior VBAC before she had to fight to get a second one.

Before I left the workforce to become a mom, I wrote for a major newspaper. Whenever I did a story, I did tons of research and tried to give the most thorough information I could that told both sides of the story. I felt that was my duty, especially because whoever was reading might know otherwise, and I didn't want to be caught 'not doing my homework.'

I shudder to think of the number of women who might have chosen a home birth, a VBAC or just plain refused unnecessary interventions in labor until they saw one of these very one-sided reports. Perhaps the best thing that could have happened was for Szabo to voice her opinion in a very unique way. Because when she talked, it got people's attention. It raised awareness of a very real problem.

It's such a disappointment to those of us who are informed and know better that Meredith didn't do her homework. I only hope that thousands, maybe millions, of women watching could take her to task for it. Because there are so many women out there who base their decision on the half-truths and skewed facts of their doctors, and Meredith, honey, you do nothing to help.

CORRECTION: Because I'm anal, care about my work and was probably too heavily caffeinated,  I will add that Crunchy Domestic Goddess has informed me that this was the mother's first c-section, not her second. Which is even sadder: she hasn't even been allowed to experience labor, and just went straight to the assumption that her body couldn't handle it. How very, very sad. I hope this mom finds a new doctor if she plans on having any more children.

Positive VBAC Story: Sarah's birth

It dawned on me that, after blathering on about successful VBACs and what not, that I had really neglected to tell my own birth story. And after posting the video of the "VBAC gone wrong," I was concerned that people visiting the site might decide they don't want to VBAC based on the bad experience of someone else.

I began my second pregnancy set to do another c-section, although my doctor initially offered me the choice. I think he was silently relieved when I decided to do a repeat section. I don't remember him going into any details whatsoever about the benefits of VBAC, just the risks - which made me not want to do it immediately. Nor did he tell me any risks about a c-section when my first child was born. If he had, I think I would have gotten up and ran away right then and there.

But back up a moment. When my first child was born, he was breech - most likely due to the fact that I have a bicornuate, or heart-shaped, uterus. This can be a problem for some, depending on the degree of defect. In serious cases, it can cause intrauterine growth restriction or even infertility, because the uterus is so divided that there isn't enough room for a baby to grow. In my case, it merely meant that, depending on the position of the baby, it might not allow enough room for him to turn, and he'd be stuck in a breech position. Which he was.

When they did the c-section the first time, he was stuck. Really stuck. His head was mostly lodged in my ribs the entire second half of the pregnancy, and at one point, I felt very violent motions like he was attempting to turn but just couldn't do it. Of course, my doctor never offered an external cephalic version, and being the idiot that I was at the time, I didn't ask. I just knew that breech vaginal births carried risks (like everything else, it seems) and I didn't want to do it, especially if my doctor hadn't performed many births like this in a long time. (As a side note, an ECV is usually not recommended for a woman with bicornuate uterus.)

Anyway, fast forward to my second birth. I was adamantly against a VBAC and thought it was just too dangerous. Somewhere along the way, my baby decided to be head down, something I found interesting, considering I thought that all of my babies would be breech because of my uterus' shape. I had also been very active on www.babycenter.com's birth forums, and one poster who routinely contributed on VBACs and home births (she was preparing for an unassisted home birth) got me thinking. At first, I'll admit, she boiled my blood a little bit, but something in me decided to research VBAC and give her a second thought. And once my baby was in the right position, it got me thinking.

When I told my doctor at 37 weeks that I was considering a VBAC, I thought he was going to swallow his teeth. Of course, he went on and on about the risks, and how he'd seen two ruptures. He almost got away with completely downplaying the risks of a repeat c-section until I decided he wasn't going to mention it at all, and I respectfully ripped him a new one with the information I'd done about it. I hired a doula, read all I could, prayed and waited. Despite having a few discouraging words from my care providers, (one midwife told me flat out "She didn't want to be doing this!") I pressed on.

I approached my 39th week and we did the routine vaginal exam at my prenatal appointment. Of course, there was no dilatation or effacement at all, which had me a bit discouraged. But I realized that this really didn't mean anything, since I had been about 3 or 4 cm dilated for weeks before I went into labor with my first baby, who wasn't even head down. A week later, I was in the hospital having my baby!

My labor began on the morning of a full moon LOL - I distinctly remember having trouble sleeping and looking out the window at the moon. Early in the morning I had back pain and was uncomfortable in bed, often changing positions and getting down on all fours to relieve the discomfort. After a few bowel movements in the middle of the night, I thought maybe something was going on. (I have ulcerative colitis, which can flare up under stress, so the bowel movements at 3 a.m. were not a sign to me right away that I was in labor. Merely I just thought, 'Oh great, what a wonderful time for this to start!!') Duh. LOL

Once I realized I was in labor, I stayed at home for a few hours and showered, puttered around and paced, which I always do while in labor. I was having some back labor, which we anticipated because we could see my daughter slightly turned on an ultrasound I had just had to check for position. Aside from my mom asking dumb questions during this point LOL, I managed to get through them okay. I decided to eat a piece of bread with butter on it (contrary to the 'starve yourself of food and water' theory in labor) and we decided to head to the hospital. We actually stopped at the grocery store on the way and picked up a few things for my labor bag, and I think the walking around helped me to dilate more.

Upon arriving at the hospital, I realized we had totally forgotten to call the doctor. LOL Whoops! I walked into labor and delivery and announced I was a VBAC, which they needed to know. I do feel kind of bad about not preparing them ahead of time, but perhaps that ended up being a good thing - because it possibly discouraged them from treating me like an anomaly or a problem, but rather like any laboring patient. Hospitals will often ban VBACs, but really, as long as they have the capability to do an immediate c-section on any laboring woman, what difference does it make? You can have any number of emergencies arise during a traditional vaginal delivery!

I labored for about three hours in the hospital before giving birth. The nurse checked me at my arrival and announced that I was six cm dilated and waters 'were bulging.' The doctor did break my water, which can cause an increase in prolapsed cord. Did he inform me of this? No. I should have researched it beforehand, probably, but at some point our physicians need to give us this information, too, as our healthcare providers. In fact, I don't even remember him asking me if he could do it.

I never felt the need to push (with any of my labors), nor did my doctors explain to me why I didn't. Had I known even more about it then, I probably would have waited until I did have the urge. I had no epidural; I remember thinking I might want it, and then decided it was too late. I wanted to see how far I could get without one, and seem to have a high tolerance to pain as it is. I did get Nubain, which the nurse accurately said 'won't do anything for the pain,' which it didn't. But since I had been awake since about 3 a.m., it helped me to rest in between contractions and gear up for the next round of pushing. My daughter was born after about an hour of pushing.

If anything, my labors - all different - taught me how to appreciate the powerful abilities of my own body as it was designed. I learned what I was capable of doing, and it was an amazing experience. It also opened my eyes about the maternity care in our country (world, maybe?) and how few of us are really willing to be our own advocates -- not only for ourselves, but for our unborn babies. So many women are adamant about not even taking Tylenol in pregnancy, yet submit - without question - to tests, poking and prodding, and endless interventions during labor. Why is that?

As they say, 'knowledge is power.' I'm hoping to encourage other women to seek that knowledge and use the power they gain from it.

Other positive VBAC stories can be found here:
http://www.mothering.com/discussions/showthread.php?t=330288
http://www.pregnancybirthandbabies.com/vbac%20stories.htm
http://www.birthrites.org/stories.html
http://www.essentialbaby.com.au/parenting/community/my-vbac-story-20090526-blkb.html

Is the rising c-section rate in this country going ignored?

The current c-section rate in this country is hovering at about 33 percent. I don't expect everyone to know the exact percentages, but it would be nice if some people for whom this might pertain would at least know and understand, simply, that it's definitely on the rise.

I had a conversation yesterday with two friends, one of whom has had two vaginal deliveries - both induced - and the other, two sections due to breech presentation. One woman has a sister currently five months pregnant with her first child, and she's scared to death of having a c-section. "Well, the current c-section rate in the US is at about 33 percent," I said, stating that her fears were completely founded. Both women looked at me in complete shock and had no idea that that many sections were being performed.

How can you not know? Based just on the experiences of our common friends, it's so obvious it's like a slap in the face. When several of us were each expecting our second child, our friends held a baby shower. I recall thinking during that shower that all four of us had had c-sections, and three out of the four of us were on either our second or third section. I was the only one who had a successful VBAC. (One woman, a nurse, had attempted one with her second but was unsuccessful due to fever during labor. At least she considered it as an option, though!) Another of us - one who was also on her second section - mentioned to me that her doctor actually admitted once, somewhat tearfully, that she "loves surgery." Well, I wanted to say to her, no shit she loves surgery. This woman is on the American College of Gynecology Liability Committee, so VBACs are definitely a no-go in her book!

I live in a unique community. My husband is a teacher, and we're required to live on campus with other couples and families, many of whom are near my age and have small children. So in a sense, we are all 'victims' of the modern obstetrical system and all have similar stories. Of those women who are older - say, those who are over 50 - their birth stories are dramatically different, and reflect the days in which doctors had knowledge and experience at avoiding a cesarean. Breech vaginal births, twin vaginal deliveries - none of them, that I know of, had c-sections, and know even less about the current trend in surgical deliveries because they are far-removed from their childbearing years.

All these women my age, then, reflect different levels of income, education and backgrounds. Most of us have different obstetricians and some of us have labored in different hospitals. And even though I obviously haven't talked to every pregnant woman in the US, we reflect that trend of an increase in c-sections. How can that not be troubling, or even obvious?

When I think of the people I know who have had children in the last 15 years or so, I am one of three women who've had a VBAC. I know of only two women who have dared to have a successful home birth. And yet, I know 17, including myself , who've had c-sections, all but one of them repeat, and from what I can tell, only one was truly a matter of life or death (the mother had advanced HELLP Syndrome). That figure could actually be substantially higher, but I haven't discussed birth with all of them, so it's hard to say.

It seems that obstetricians aren't held very accountable for the increasing rate of sections they are performing. Yes, there are a number of reasons for them - some of them even legitimate - but it makes you wonder about the not-so-good reasons for them, and why OB's are still getting away with it. The World Health Organization recommends that the rate not be above 15 percent, and our rate is more than double that - and yet no one is waging a mass offensive to change this. That's not to discount the groups, individuals, bloggers and organizations who make it their life's passion to educate people about this - but, even with their efforts, there are still large circles of women who either think people like Ina May Gaskin and Henci Goer are "fruity," or don't even know who they are. ("Ricki Lake? She had that talk show, right? What's she got to do with this?" *sigh*)

Essentially, the increasing rate of cesareans is going unnoticed by the people it should matter most to: those who think VBACs are extremely dangerous and yet don't bat an eyelash at having their second, third or fourth c-section. Those whose doctors still get away with inducing for convenience because their baby had the grave misfortune of being due near a holiday weekend. Those first-time mothers, past their due date by 48 hours, who are sectioned after the Pitocin drip failed to work because their cervix wasn't ripe yet and only were allowed to labor for a measly eight hours. And now with the revelation that some health care providers are refusing women who elect for a repeat section - no doubt at the dire advice of their doctors - it appears clear that, no matter which choice women make, they are being punished, instead of the people who are really to blame. When a fear-mongering doctor builds his practice around half-truths and misinformation in order to protect his bottom line instead of yours, it's not a wonder.

A Dangerous "Procedure" known as VBAC

I don't know what it is lately, but it seems like this is VBAC week on my blog. I was doing some reading and came across this video posted on pinkyrn's blog site about a VBAC gone horribly wrong. The video is a news broadcast from some California news station that was posted on YouTube by none other than a birth injury lawyer. 

Unfortunately, along with the hole in this woman's uterus, are tons of holes in the logic of this story. While I feel very badly for her - as uterine rupture is probably the worst nightmare of every laboring woman attempting a VBAC - I just can't wrap my head around this story. The woman is suing her insurance company - not her doctor - because they didn't warn her about the dangers of a VBAC. Apparently, the baby was deprived of oxygen for TWELVE FREAKING MINUTES (and that's the insurance company's fault?!) and, not surprisingly, suffered permanent brain damage. The laboring mom, to her credit, no doubt knew something was up and asked for an immediate c-section, to which her doctor apparently answered, "Shut up." What?!

I'm puzzled why, then, the doctor himself isn't being sued for malpractice. Where were medical staff during that 12 minutes? Hunting down an anesthesiologist to do a crash c/s? Going out for coffee? Who knows. I don't want to sound too critical, because a mother and child were severely injured in this incident. But unfortunately, because of the crappy reporting this news station did, and the nature of this whacked out lawsuit, it paints a horrible, although unrealistic, picture here. 

I'm also curious what part Pitocin played in this birth, since it can cause more painful, stronger contractions that can increase the risk of rupture in a laboring woman with a prior uterine scar. (In fact, they can happen even before labor begins, in a woman with a prior scar.) My own doctor tried to scare me with stories of rupture when I told him of my plan to VBAC, saying he'd had at least two patients experience a rupture. I then asked, "And did those women receive Pitocin while in labor?" He didn't have much to say in response and brushed off my question, saying he didn't remember. With all the births I'm sure his practice has attended, and so few of them resulting in rupture, you better believe he remembered. That's not something you very easily forget, I'm sure. 

I would like to know where this attorney is when countless women are basically forced into having unnecessary c-sections, for failed inductions their doctors know won't work; for suspected 'large' babies who end up being born hovering at around 6 pounds; for women who fail to progress because some overbearing doctor with the bedside manner of a goat has his fingers up your you-know-what while you're trying to relax and forget your surroundings and dilate enough to give birth, all while in a timeframe that suits his golf schedule. Where is this attorney then, representing all those women who are essentially coerced into giving birth according to how the doctor wants it done, instead of being allowed to let their bodies do what they were created to do?

Of course the sensationalist reporting of this news broadcast does nothing to further the cause, only cement in the minds of women within the viewing area that 'the procedure' is a dangerous one and is to be avoided at all costs. Never mind that c-sections can also result in traumatic damage to a woman's body, and babies can die as a result of bad sections, as well. 

Unfortunately this case leaves me with a lot of questions that will no doubt go unanswered, since I couldn't find any information on it. On Dr. (yes, doctor) Fagel's website, it doesn't mention a whit about what his prior experience was in the medical field, only that he graduated from the Illinois Medical College of Medicine (huh?) in 1972 and then received a law degree in 1982. Exactly how much medicine did he practice, then, in that ten-year period, what with going to law school during that time? My guess is not much.