When the media totally gets it wrong

When the media starts talking about a topic you are acutely aware of or one that's personal to you, you are more aware of when they get it wrong. In my case, birth advocacy and thyroid disease awareness are two subjects that are close to my heart and something I know a lot about.

So it's utterly depressing and maddening when you come across an article that is just so bad and misleading that you want to scream at the top of your lungs.

When the news does a terrible job covering a topic you're
intimately familiar with, it makes you wonder how
they handle all the other stuff.
Photo credit: jayofboy/freeimages

This one - The Daily Mail's "Australian woman gives herself a Cesarean section" - is pretty horrendous. You immediately conjure up images of serious peril; something has gone horribly wrong and she's in dire straits with no sign of help anywhere, right? Wrong!

Apparently, this is an article about a maternal-assisted cesarean (definitely not the same as performing the surgery on yourself, as the Mail implies), something that is verrrrrry slowwwwwwly catching on in the birth community. By slowly I mean probably at a snail's pace, because we still don't hear very much about it. The woman, disappointed over the fact that she could not have a VBAC with the twins she was carrying, decided that she wanted more of an active role in the birth and presented her case to her OB, who - not surprisingly - flatly refused. Apparently after he did more research, (gasp!) he changed his mind. (double gasp!)

"'(The doctor) was quite willing once he realized the risk of infection wasn't as high as he perhaps first thought,' Mrs. Wolffe said.'"

Amazing. An OB that listened the patient, while still yielding to necessary medical intervention, and they both had a positive outcome. I am speechless.

However, that's not the problem. Further down in the article, a video accompanies it captioned 'Live Cesarean: graphic 2013 video of birth broadcast on Twitter." Okay… except that's not the Australian woman's birth they're showing. In fact, it's from a hospital in Texas, something the Mail doesn't exactly explain beforehand and most people from their UK readership didn't pick up on (including, apparently, all the American accents in the room).

How this had anything to do with this woman's birth is beyond me, but it sure makes for great fodder for readers to totally attack her - everything from her looks, to her birthing practices, to a "DIY birth" (which it obviously was not). Some even criticized the weight of the babies, for whatever reason. At any rate, it did nothing to advocate for alternative choices in birth and only made the mother look like a total freak (if you trust the people commenting).

Thanks for totally misleading your readership, Daily Mail. Not that that's anything new, apparently…

Dr. Samadi's commentary on Fox left a lot to be desired,
namely the idea that there is more than one way of
treating thyroid disease - not to mention that many
doctors are neither well-versed in or willing to treat more
complicated cases.

January is Thyroid (Un)Awareness Month
Like bajillions of other Americans, I have thyroid disease, and it's a topic I've written about a lot. I've also basically forced myself to get educated on it in order to understand what was happening to my body, because I found that my doctors were not always that knowledgable. Apparently these guys are no exception.

Dr. David Samadi is apparently one of Fox News' resident doctor experts, which in and of itself isn't bad - except he's a urologist commenting on thyroid disease. Since the two aren't obviously related, I was puzzled why he was weighing in on the subject. While I realize they have time constraints on the broadcast, they really do reflect a serious problem with misinformation and an overall lack of education on the subject, which can often leave patients untreated or improperly medicated.

While I do give him points for mentioning more than just the TSH, it's important to know what to do with the results. Just this week I heard a patient say how enthusiastic their doctor was about ordering tests, even though she'd admitted there were some she had never heard of, but then also admitted she had no idea what to do with the results of the bloodwork. That doesn't help you very much as a patient, but at least she was being honest.

Another expert, NYU Medical School internist Dr. Mark Siegel, gives a very watered-down, extremely over-simplified and perhaps even dismissive explanation. His commentary also left a lot to be desired, and outraged a number of people in the comments who have firsthand experience with the disease.

"Here's the good news…[this] is so treatable… if you have low thyroid, I can give you something called levothyroxine. [It] just replaces the thyroid and you're back to normal. It's a great, great medication." 

Yes. Well. If you do well on levo, that's your business. Not everyone does, and while some prefer the name brand equivalent, Synthroid, some would rather choose neither and use Armour Thyroid instead - but you usually won't catch a single mainstream physician mentioning that in an article about hypothyroidism. Whether it's intentional or not, Synthroid is usually the only drug mentioned, which misleads patients into thinking Armour has been pulled from the market or simply doesn't exist anymore.

And wouldn't it be great if it were "just" that easy! Just pop a pill and you'll feel like a million bucks in no time. For some, it works great and they're on their way, but for others, it's a constant battle to get a physician to treat them adequately and even take them seriously.

When you catch them screwing up on a topic you're familiar with, it almost makes you wonder what they're telling you about all the other stuff.

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.

Doctors perform cesarean - on woman who wasn't even pregnant

This article made the rounds again on Facebook and reminded me that I still wanted to write a blog post about it. It's been a year, and Jill over at The Unnecesarean did one then too, but it obviously bears repeating: and a resounding "WTF?!"

How does a woman who only looks - but isn't really - pregnant just 'walk in' to a labor and delivery ward and attempt to have a baby without:
1) complete medical records from her pregnancy care provider
2) a vaginal exam to check for dilatation of the cervix
3) fetal heart tone monitoring after a two-day induction?
4) and once you check the cervix and don't detect a fetal head, no ultrasound to determine baby's position or
5) if there really even is a baby there to begin with??

What?!


Even people who've never given birth before can likely guess that there is something seriously messed up here. (Actually, for those who want a completely natural hospital birth, to be left alone for two days to labor might be a dream come true...)

She apparently showed up in their hospital "asking for a c-section" and they made the pregnancy diagnosis. Later, however, the resident was found to "not have enough experience to make the pregnancy diagnosis and doctors should have conducted their own exam." No kidding.

Most of us could and do easily make a "pregnancy diagnosis" - it's called buying a $6 pregnancy test and peeing on a stick. And if that doesn't do the trick, I bet any one of us could easily pick up that ultrasound transducer, slather our stomachs in gel and somehow figure out how to get a rudimentary image to pop up on the screen. So what happened here?

Of course, the group of residents and physicians in question received no other disciplinary action other than a stern warning and a "letter of concern" (said with booming authoritative announcer voice) and that was about it. Which says a lot about the state of obstetrics and maternity care in this country these days.

As one commenter - who happens to be a homebirth midwife - said:

And all they get is a "letter of concern"??? As a homebirth midwife, I would get my license yanked for far less. Just goes to show the double standard.

Preach it, sister!

It is a double standard. And the comments - as well as the almost lackadaisical approach the medical staff takes - is troubling to maternity patients who are otherwise said to be "demanding," "seeking attention," blah blah blah - as if it's all their fault. If this woman had a rare medical condition (a false pregnancy, or "hysterical pregnancy," as the article says) that fools her body into thinking she's pregnant when she's really not - who can blame her? Hell, sometimes I get weird flutters and sensations (that are no doubt gas bubbles) that would convince me, if I didn't know any better, that I was pregnant. The idea of calling it a "hysterical pregnancy" immediately conjures up women who are desperate, mentally ill and out of control, running around in circles around the unit with their arms waving madly, "I just need to have a cesarean! Agggghhhh!"

And not only does this take a turn that suggests this woman is clearly at fault and to blame, but if she is mentally ill, there is that stigma as well: and therefore reason to issue a complete lack of sympathy for her. As if to say, Oh, first she thinks she's pregnant - now she's crazy! *snort* Crazy hormonal women! 


Per Wikipedia:

"Research shows that 18% of women with pseudocyesis were at one time diagnosed as pregnant by medical professionals. 

The hallmark sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (60–90%). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size.

The second most common physical sign of pseudocyesis is menstrual irregularity (50–90%). Women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present (50–75%). Other common signs and symptoms include gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor."

Apparently some women even have a positive pregnancy test. 

This article mainly focuses on the psychological aspects of it - women who have tried unsuccessfully for years to become pregnant; those who have suffered pregnancy loss; etc. The actual medical problems, like pituitary problems, are kind of glossed over - probably because when it comes to certain hormone-related illnesses, they are clueless. Chalk one up for the crazy lady again! 

It's amazing the number of comments passing this off as no big deal, blaming the woman for attention or just kind of blow it off and hope no one notices.

Dena Konkel, assistant director of public affairs for the medical board, said the case was "unique." "The board was mostly concerned about the management of patient care," she said. "It may have fallen below the standard of care." 

"Some would argue that this is not disciplinary in nature -- it doesn't limit their ability to practice medicine," said Konkel. But, "it creates a public record, something that can be looked up and read about what happened."

Yeah, that public record that future patients can look at that basically points in all directions to these clowns. And the sad part is that people will still trust them, still keep going to them, as if nothing happened. They'll likely read this story and think, "That woman was mentally ill - it's not really the doctor's fault." "Unique" isn't exactly the word I'd use to describe this situation; I think completely effed up is way more suitable. Using a word casually like that to categorize this event is completely ignoring the fact that yes, it "may" have fallen below the standard of care - by completely ignoring or bypassing all protocols in place to protect both the mother and the baby. Are they really that hands-off that they did no vaginal exams on this patient? I doubt it.

I wonder if perhaps this person just came in, perhaps in pain, and the resident took one look at her and didn't know what to do with her. I've had only one resident in my pregnancy care, while in the hospital, and I could read him like a book: he was young, uncomfortable, and wanted to parrot exactly what he was told to say and do from his superiors. When I presented him with my opinion, firm and respectfully, he backed down immediately, like he had the spine of a jelly fish. I wondered if he'd ever encountered an informed patient before that just didn't take his word for it?

The article indicated that the resident who dealt with the patient was trained in ultrasound. So why the heck didn't they do one? To at least check for the position of the baby's head, since it didn't sound like they had any prior medical records for her? No explanation was offered. Of course.

Something to consider, however, is that in some parts of the state - including those counties surrounding the area where this "birth" took place - there are as many as 5.5 percent of women seeking little if any prenatal care at all. This could explain why there were no medical records (we can assume) or why the seemingly blasé attitude towards the lack of records. Unfortunately this may not be all that uncommon in hospitals where certain factors (like lack of education, poverty and lack of health insurance) mean a woman has not sought proper care in pregnancy.

While this case happened in late 2008, it took the state medical board a year to investigate, and the public first heard about it two years after it happened. One physician still works in the facility, but doesn't deliver babies anymore; another has since left the hospital. It makes you wonder just what went on behind the scenes: was there more than a slap on the wrist? Why didn't the patient sue? Did her mental status have something to do with it? Her economic situation? Why haven't we heard anything from her - or at the very least, seen her on an episode of Jerry Springer? Her neighbors, her friends - surely someone would have seen that she looked visibly pregnant and now, has no baby to show for it. I hope it wasn't a case of her just being too embarrassed to say anything, perhaps for fear of even more stigma should it come to light as a psychological condition that makes her look "crazy." And consider the tone of these doctors - who don't want to come right out and take the blame - it almost makes it sound like they're blaming her and her "mental condition" for all of it.

A certain percentage of false pregnancies are due to mental conditions; but not all can be attributed to that. Some believe that a truly false pregnancy (as opposed to a simulated pregnancy, where the woman fakes it) originates from the pituitary and hormonal imbalances. This is, after all, where breast milk production generates as well, and why some women who were not even pregnant can breastfeed a child. In fact, I remember distinctly a client at the mental health facility where I worked who was lactating - and had never been pregnant. She was concerned, because she knew she wasn't pregnant - didn't want to be pregnant - hadn't even had sex recently. I'm sure the already-existing mental health problems she was already experiencing only added to the "it's all in your head!" ideology.

False pregnancies are apparently fairly common in animals - who knew? But they don't do it to seek attention or as the result of a mental condition. According to Wikipedia, "symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from it." We can give the doctors a pass for not knowing, but not the patient? Especially when a simple ultrasound could have avoided two days worth of expensive induction procedures and a completely unnecessary scar on this woman's uterus. 


More reading:
Doctors perform c-section on non-pregnant woman
False pregnancy

Scheduled 11/11 births should expose broken maternity system

Photo: Hilde Vanstraelen/
www.biewoef.be

Yesterday we heard of loads of special births on November 11 - from inductions to planned cesareans to doctors offering cash to patients if they'd deliver on that landmark occasion. Today, the details of these births surface: cue the Pitocin IVs!

A Groton, CT mom delivers her baby after her doctor "decided she needed to have her labor induced." The baby weighed just over 7 pounds. As the clock neared 11:11, her "sisters started yelling, 'Push, push!'" (Side note: they'd make great L&D nurses, I bet.)

A number of births were mentioned in this article, including two "natural" births and one planned cesarean:

But in Colorado, Cayson Childers’ birthday wasn’t left to chance. His parents ensured his arrival by scheduling a Caesarean section for Friday, and then doctors were able to make the operation work right at 11:11 a.m.

The casual attitudes about surgical birth mentioned here almost make me want to puke.

This Syracuse, NY baby was delivered because the doctors thought it was "big." The child weighed 7 pounds, 13 ounces. The delivery was originally scheduled for the following week, but was moved to Friday. Don't want to put on an additional six or seven ounces in the meantime, right? Way to play it safe.

Adriana Jones, of Baldwinsville, was originally scheduled to have her baby, via Cesarean section, next week. But because the baby was big, Jones’ doctor recommended the delivery take place sooner.

The planned C-section was rescheduled for 11:30 a.m. Friday, but Dr. Suzanne Bartol-Krueger was able to get Jones in a little earlier. How kind of you, doctor!

It's important for me to say that really, I'm not so much criticizing these moms. They made their decision to go ahead with induction or cesarean plans, no doubt at the advising of their physician. Did they make the best decision? That's not really for me to say. But stories like this, and the media's reaction to them, make me kind of shake my head a little because it does several things, in my opinion.

First, it is often met with very casual attitudes about surgical and induced births. Both can be perfectly safe, if done for the right reasons. Sometimes, those reasons are clear, and sometimes not.

Many of these articles often feel the need to clarify whether they were vaginal or cesarean births, which is something I suppose readers are dying to know: did this happen all on its own or what? In any other situation, no mom should really have to justify how her baby came into the world. Some would argue that these women shouldn't either, but it should raise some eyebrows about what constitutes "medical necessity" these days. And when a birth wasn't cesarean, the media usually says it was a "natural birth," which we can probably translate as simply a vaginal birth. Is it news when the IV is hooked up and mom is pumped full of Pit in order for that baby to be born, practically dragged kicking and screaming into the world? Or when mom is laboring normally on her own after going into spontaneous labor? While some people will say, "Who cares?" it's clear there is quite a difference.

I can see how these timely births would start a new Mommy Wars debate: Why can't I schedule a birth on a special day like this? Does it have to be natural to count? Why not have a repeat cesarean because of this? Many argue that mom should have a choice of how she gives birth, even if it means something like a planned cesarean section for no reason other than she wants one. Fine, as long as you are well-informed of the risks and benefits of doing so, and get your information from someone other than a well-meaning but clueless friend or a doctor who is happy to oblige because it means he can finally go on vacation. Of course, you'd do it anyway, I suppose, but I can at least respect a truly well-informed decision. Doing it simply because you're effing miserable and 36 weeks and "It's time! The baby is practicing breathing movements!" is just stupid. But to each her own.

Really what this does is expose the often suspect practices in modern maternity care that have escalated exponentially in the last few decades. My mom told me of my 1974 birth, "The doctor told me he absolutely would not induce because of the risks and rushed in from a dinner party to deliver you while wearing a tux." Nowadays we hear, "Induction is perfectly safe. I don't want to have to come from my dinner party and deliver you while wearing a tux." What a change in thinking.

Are we accepting a woman's right to choose where and how she gives birth, but only to a point? If she wants to put her baby and body at risk, there are probably no shortage of physicians willing to accommodate her wishes. I hate to be a party pooper, but blasé attitudes about surgical and pushed births are what makes people say, "So what? Who cares? So she wants to have a cesarean for absolutely no reason. Isn't that her right?" Like in my last post, I think the birth of a baby is always something to be celebrated, but these kinds of births so far remove us from the frame of 'normal' that we don't even know what it means anymore. We can schedule hair appointments, meal reservations and oil changes: why not birth?

OB bribes mothers to deliver babies on 11/11

"I'll pay you if you give birth before midnight tonight!" 

As we approached the landmark "11/11" this week, I'm sure all of us were waiting to hear "miraculous birth stories!" of babies that "happened" to be born on November 11, 2011 at 11:11 a.m. (or p.m.) Most of us are jaded enough to realize that no, usually none of these babies just happen to come into the world at such an auspicious moment all on their own, and when you read more details on many of these births it's no surprise that they are either planned cesareans or inductions. Yay.

The birth of a baby is always a joyous occasion and something to celebrate. But I cannot imagine actually planning the date, no matter how close I was to my due date, just to have a "fun birthday" like this. Kind of takes the magic and suspense out of it, you know?

So one Iowa OB has decided, back in February, actually, to put money into a savings account for those patients who delivered on 11/11. Oh, how nice! Helping baby to get a good start in life with a tidy sum saved up in an account just for Junior. Excuse me while I go vomit.

So far, he's had two scheduled cesareans lined up and one induction. Surprise!

In just reading between the lines, I get a few creepy suspicions about Dr. Valone. Two of his patients are repeat cesareans because "they delivered that way in the past," which sounds like he is not very pro-VBAC. Perhaps his idea of informed consent about surgical births and the dangers of VBAC includes, "Well, I could pay you to deliver your baby by repeat cesarean on November 11. How about that?" His fees, according to the article, range from $900 to $2,000, "depending on the case and the insurer." Financial incentive much? Does this almost sound like "the better insurance you have, the more I charge" to you?

Further down in the article, it says he will deliver two more women by induction "whose pregnancies have reached full term." Full term, to most people, is 37 weeks. His comment, "We're doing it proactively rather than just waiting to see what happens" sounds like he pushes the big baby scare tactic. How much do you want to bet this patient is not very close to 39 weeks? $2,000, maybe?

One of his patients, a young 20-year-old mother has passed her due date by THREE DAYS and is awaiting induction today. This is her first child. I fear for this woman, for many reasons. I hope she has a vaginal birth, but honestly - who can say? The article also says things like, "Natural birth proponents urge women to avoid the medications that induce delivery unless there is a strong medical reason to take them," but Dr. Valone assures us all that "it's safe" and you're better off if they go that route (meaning, "Take the Pitocin!") rather than trying to start their labor at home.

No sources, no nothing that indicates that Dr. Valone perhaps is a c-section, induction-happy doctor who is basically bribing women to give birth before the clock strikes midnight (or five p.m., which is probably the end of his shift). And these women are eating it up like candy, which is nauseating, at best. Yeah, it's their choice, but when you're presented with the possibility of a wad of cash and the assurance that "It's safe and you're better off!" how can you resist?

I would hope that offering financial rewards to patients in order to force their births to take place (or coerce them) would be considered, at the very least, unethical. When you blab in the media about doing such a thing, you'd better be willing to offer sound proof that they do, in fact, have some medical condition (besides a prior uterine scar) that means this induction or cesarean was necessary; otherwise all those hospital bans on elective inductions and cesareans don't mean a thing. I'd love to think an official from ACOG, and perhaps the Iowa State Medical Board, would be questioning this doctor on his choice of practices and perhaps taking a look at medical records. But then again, I doubt anyone will bat an eyelash.

Didn't have to dig very hard to find this one.

Michelle Duggar - Pregnant again!

It's positive!

So, the Duggars are expecting their 20th child. Wow (she says with a glazed-over expression...)

It's not that I'm not excited for them; in fact, I think that if that's what they want, great! I'm just waiting for more nasty comments to fly, since it seems that no one has anything nice to say about this family.

Every time they announce a pregnancy, more myths, rumors and stupidity surface. It's things like this that just further ignite controversy over a woman's uterus, I think - the old idea that when you're pregnant, you're not thinking rationally and therefore that gives others - including complete strangers - the right to make decisions for you, make statements about your moral character, mental status, financial situation, family size and physical health.

I really think the biggest cause of vitriol is because fewer people have larger families anymore. That's it. Not that they're "killing the planet" by single-handedly overpopulating it, but because they have all those kids and are well-adjusted and appear to be reasonably sane. Because no one else wants more children, surely these people shouldn't either, and by all rights should be criticized for daring to think outside the box. Quiverfull movement aside, no one can understand why you'd want "more mouths to feed" and will criticize and label you, no matter what religious persuasion you happen to be.

Case in point - there is a large family (I think at last count they were on child #9) floating around town, the mother sort of dressed in Bohemian style, with the most beautiful hair. Her many daughters, all while maintaining their own sort of individual eclectic style, have long hair like hers, and therefore they are quite recognizable even from a distance. I've been seeing this family - in the grocery store, at the library - where mom usually has the youngest in a sling and is happily tooling around with her homeschooled bunch. No one is freaking out, yelling or fighting and everyone looks happy and well-adjusted, despite the fact that the oldest will often be seen holding one of her many baby siblings and looking totally okay with that. I have on many occasions wanted to stop her and just say, "I think you have an awesomely beautiful family!" and photograph them in all their splendor. I thought about this the last time I saw them, as I was out for a morning walk and noticed them up ahead of me on the sidewalk. I was sort of stalking them, I guess, admiring how they plodded through town like the von Trapp family.

I remember at one point hearing rather disparaging comments about them from my neighbor, who said something like "They all sit up front at mass" with an eyeroll, like they are the poster children for stereotypically dutiful Catholicism. Why the religious reference? I thought. Maybe she just wants that many kids, and there's nothing wrong with that.

I get so sick of the "Oh, the perfect family and you're done!" crap; the bullying, both overt and subtle, that goes on when someone decides to have more children than what our culture deems "necessary." And that's exactly what it is: bullying. We as a society are so set against it and want to teach each other how to love, respect, and all that crap - yet the minute we see someone with more than the prerequisite number of kids coming our way, we immediately snap to judgment. There is such negative bias against larger families, even those with far fewer than 20 kids, because we are now living in a "two-kid world." Anything more than that is often considered a burden or an inconvenience.

An editorial recently ran in Shine magazine about a woman who is childless by choice, and wants her friends, family and strangers to stop asking about when she's having kids, especially now that the population toll has reached 7 billion. Great - I can respect your choice and think if you don't want kids, don't have them. Do the responsible thing and go to great lengths to protect yourself from pregnancy; I wish everyone could be as responsible as that. But some of the comments were, as they usually are, disgusting - implying that people who wanted kids were stupid breeders and totally ignorant.

I find some of the comments about Michelle Duggar, though, as ignorant as some of the her harshest critics say she is - worrying about her pre-eclampsia, birth defects, leaving her children motherless, blah blah blah. You stand just as much chance of having a child with birth defects at age 20 as Michelle Duggar; statistically more women have children with Down Syndrome at a younger age, even though the risks of it go up after age 35.

A childless friend commented on the Duggar story and remarked that 'she didn't even carry the last baby to term.' Perhaps, but that almost makes it sound like she had an abortion. And it's not like all of her children were premature; her premature baby was no different than any of the millions of others born in this country every year, for various reasons - it's just that we heard more about it because of the media's focus. Should that be a reason for her to stop having children? I have a friend who has three children and had complicated pregnancies and pre-term births every time. Does that mean she shouldn't have any more?

With the current crisis of forced abortions in China, why are we worrying about this? When a family can stay together, under one roof and raise a family without outside assistance - not to mention they can raise them to be loving, conscientious and productive members of society - who are we to criticize when in other parts of the world there are women who are forced by their own government to undergo abortions when they want to be pregnant and have a family? And even if you aren't financially stable, does that mean you have no right to have a family?

Bottom line: Reproductive rights don't end with abortion. Everyone is so concerned about Michelle Duggar's health, which is great - but something tells me she has it under control. She has support from her OB, which is amazing, especially considering the overwhelming lack of support some OBs seem notorious for. When you start invoking China's horrible one-child policy and saying things like "Remove her fallopian tubes!" you are still attacking her basic human rights.

Birth as performance art? Why not!

Is that a trophy I see? Why yes, yes it is.
Photo credit: AP. 

It's being talked about all over the birth community: a "performance artist" has just given birth to a baby boy inside an art gallery. Weird, perhaps. Maybe it's the Nyquil haze I'm living in today, but somehow the more I read this story and think about it, the cooler I think it is.

The blogger at Mama Birth and I joked that we'd both like to do posts about it (she beat me to it LOL) and here's her take. I don't want to repeat too much of what she just said, but yeah. What she said.

Something we both noticed were the comments - horrible, as usual. It seems that whenever birth is talked about there's something nasty to say, usually from other women. I don't even remember all of them, but the general feeling I got was How dare you birth somewhere "non-traditional?" How dare you go against the grain and do something that is supposed to be so painful and horrible and make it look ..... easy?! The audacity - to shower, move around normally, get into whatever position you want, no epidural... You are a @(%&&!!!*#^%^@ and deserve to die and have CPS called on you!" 

Okay, the CPS comment came from the comments section about the pregnant marathon runner who gave birth within hours of running a race. I think this birth falls into the same category: that somehow, there are people that think because you birth outside the norm or dare to do anything weird while pregnant, that they have some emotional claim to stake on you, your baby and your birth experience.

What Marni Kotak did was probably weird, but like Mama Birth pointed out in her blog post, not really that different than what they have been doing for years on A Baby Story (hello, since 1998?!). 16 and Pregnant - I've never seen that one, but honestly it sounds like utter tripe. I'm sure we can count the reasonably accurate, normal birth scenes we've seen in TV and movies on one hand.

I'm sure people were even more furious when things went well and the child was actually born. Of course, if things hadn't, they would no doubt declare smugly how "hospitals are where all birthing women belong," and how stupid/selfish/much of a whore she was for deciding to even have children in the first place, or something equally hurtful and bizarre.

For some, this is the closest thing to normal birth that they'd ever see. And it's not like she had an audience, per se - not like birth shows do - because she and her husband allowed no video cameras or photography. If she feels comfortable sharing it with a few people whom she knows care about birth (and her work), then so be it. How is that any different than mom calling so and so's step-sister's aunt's neighbor's daughter into the room (and all her girlfriends and close co-workers) while she's nearing the pushing phase? I don't get that, either, but that's their choice. Just like, I guess, it's Kotak's choice to show others that birth can be normal. That perhaps it's not her that's wrong or weird, but they are, for thinking that a normal birth doesn't exist, can't be done, is dangerous, selfish, blah blah blah. Somehow, though, when people watch birth on reality television they don't spout off about how much these women are trying to grab attention, but when someone like Kotak defies the "rules" they have no shortage of nasty things to say about it.

While my eyes were closed pretty tightly while I gave birth, my husband said there were quite a few people in the room during my VBAC. Not because it was an emergency or things were going badly, but, I'm guessing, because people wanted to see it happen. (Not trying to flatter myself here) but perhaps because they wanted to see a woman come in to the unit in active labor, doing a VBAC and refusing an epidural. Pretty straightforward, over and done within a little over three hours after arriving. While I was busy doing my thing, I couldn't help but notice the almost surprise in the nurse's voice when she did an internal and found that my water was almost ready to break. I thought, What is she used to seeing, then? Good heavens.

I couldn't help but notice in the thumbnail picture of Kotak that she had a trophy next to her bed. That made me laugh. It's like thumbing her nose at all of those women who sneer, "You won't get a medal for giving birth naturally!" I guess in this case, yes, you do.

Related posts:
The pregnant woman as public property

The pregnant woman as public property

Marathon runner Amber Miller gave birth within hours of
finishing the Chicago Marathon. The way people criticize
her, you'd think she gave birth along the way and kept
running with the baby still attached or something.
Photo credit: Griska Niewiadomski.

I was all set to finish my series of posts on vaccines when this story grabbed my attention: marathon runner Amber Miller gave birth to her second child within hours of finishing the Chicago Marathon. Pardon my ADD postings, but reading about this amazing lady was just awesome! Until I got to the comments section, that is.

Of course - whenever there's a story in the news about a pregnant woman doing something, there are sure to be a plethora of stupid ass comments to follow. Remember when a pregnant lady walked into a bar?... almost sounds like a bad joke. Unfortunately, it wasn't: back in January, a story hit the news about a woman who was eight months pregnant walking into a bar with friends. She had flown into town for her baby shower, and her friends convinced her to go out for a few hours with them.

But her effort at late-night fun lasted a whopping 15 minutes. No sooner than Lee had arrived, a bouncer at the the Coach House Restaurant told her she had to leave; no pregnant women allowed.

Too bad she wasn't drinking anything stronger than water. She was seen at the bar with a friend who was doing shots. Perhaps she was keeping track for her, who knows. Whatever the case, even though law enforcement said there is "no reason" she should have been asked to leave the bar, the bouncer escorted her out.

I'm sure the bar is concerned about rowdy patrons and bar fights like you see in the movies. However, one can easily surmise that they would do the same thing they did to this woman: ask the offending patrons to leave the restaurant. And no where in the article does it mention anything about a scuffle, flying beer mugs or overturned tables. Really, though - if that kind of thing were going on while this woman was inside, don't you think she'd do what most reasonable pregnant women would? She'd leave the area. It's not like she's going to body slam someone and join in.

The woman did not partake of any alcoholic beverages, and it can be assumed that just like everywhere else, there is no public smoking in restaurants in the state of Illinois, where this took place. And even if she had a glass of wine - which is, according to some, okay for a pregnant woman - who are they to decide for her whether she is using good judgment or not? Since when does that give strangers the right to police our actions once it's obvious we are pregnant? What are you going to do - give every woman of childbearing age a pregnancy test before she enters the bar area, just in case?

Just like in Amber Miller's case, there is a familiar pattern here: treating the pregnant woman like public property, as if she is incapable of making decisions for herself and her unborn child.

It seems like once you are visibly pregnant, people feel the need to comment endlessly on your condition, touch your belly, and step in and make decisions on your behalf. I'm not sure what it is about pregnancy that makes perfect strangers feel the need to treat us like helpless idiots who have no brains, feelings or an original thought of our own.

Several years ago (before the days of officially no smoking inside public buildings) I worked in a pharmacy with a pregnant woman. Our boss would sit behind a partition during his breaks and smoke. Somehow I don't remember the smoke being that bad, but at least one customer felt the need to comment curtly on how she didn't think pregnant women should smoke. While now I think our boss should have had the courtesy to go outside and do it, Tara didn't seem to mind and just gave that customer a sweet "Go screw yourself" smile and moved on. (Tara also worked her last shift before maternity leave all while having contractions, and when her shift ended she calmly proclaimed, "Okay, I'm going to the hospital now to have the baby. See you in a few weeks." Wow, that's my kind of woman. I think she had the baby less than an hour after getting there, with no epidural.)

Amber was, according to several articles, in excellent physical condition - she'd have to be, in order to run a marathon only ten months after her first child was born. People called her stupid and selfish, and some suggested that her baby should be taken away by child protective services! Many questioned the authority of her doctor for even giving her permission to run it in the first place.  Of course, if she had done it without his permission, they would have raked her over the coals just the same. Amber walked and ran the race, so I'm sure she realized her obvious limitations and didn't try to push herself. It's not like she was in a dead sprint the entire time. Some use foul language and call her names - you'd think she was doing crystal meth on the sidelines or something.

The pervasive myths about pregnancy continue, as usual: that a woman is in a "delicate condition" and must be treated like a piece of glass about to shatter. I'd love to talk to Amber and see how her labor went - she apparently gave birth little more than two hours after getting to the hospital (before stopping on her way to get a sandwich, though). I don't know what her philosophy on birth is, but I'd say she did everything right: kept herself in great physical shape, remained upright and moving and ate while in labor - all of which can help speed up labor and make delivery easier. The comments that demonize her are based in the ignorance that a laboring woman needs to be shackled to the bed with continuous monitoring, tubes and wires - not have the audacity to keep moving, and even (gasp!) eat a sandwich. When the only thing you know about pregnancy and birth comes from "A Baby Story" it's not a wonder the comments she received were so inane.

Amber, I want to tell you that you did everything right and congratulations on your baby and your marathon! I can't wait to read about then next one. :)

More reading:
Photo finish: Woman gives birth after running (and walking) marathon - chicagotribune.com
Woman gives birth after running Chicago Marathon - CBS News
Woman gives birth after running Chicago Marathon - Chicago Sun-Times

Technology and birth: Should a robot perform your cesarean?

I don't think Bill Gates realized he was about to open a huge can of worms when he recently speculated, among other things, that robot technology could be used to perform c-sections. The birth nerd community responded, horrified, and the general consensus among my FaceBook friends was that it would basically dehumanize the birth process even more than it sometimes already is.

I think we can all agree that sometimes, technology in giving birth is a lifesaver. And then there are those gray areas, like electronic fetal monitoring, that have a shady, somewhat dubious past, and yet are used constantly even though they have actually been shown to lead to more cesareans, instead of fewer. In some cases, the very thing that's supposed to detect cases of cerebral palsy actually fails to do so, thus also failing to identify which babies are truly in distress and do need to be delivered immediately. In the other half, it leads to more cases of distress that are questionable , oftentimes producing a newborn who is quite pissed off to be so violently thrust into this new world.

I think, therefore, that we need to be vary of our use of technology, especially in surgical births. Having a robot do your c-section might sound cool to Bill Gates, until it's you lying on the table, already feeling like a slab of meat and having that inanimate object hovering over you. If you are distressed or emotional about the birth ending in a cesarean, the robot cares even less than your physician might. It doesn't care if you're crying, upset, or having birth trauma. It can't hold your hand throughout or ask how you're doing. It can only, with another machine, check your vitals, see that you're doing okay, and proceed as usual, completely disregarding any emotional or psychological aspects that can't be registered with a machine.

When I had my first cesarean, their routine choice of medication administration was a PCA (patient-controlled anesthesia) pump. This requires an IV be inserted and the patient then decides when to inject herself with pain medication. According to nursing guidelines in the hospital where I gave birth, I was allowed no more than 10 doses in a one-hour period.

This might be all fine and good, and I can understand why a PCA pump can be helpful, if used properly: it allows the patient to determine her level of pain, while the nurse can tend to other patients. But shortly after being wheeled into recovery - probably the minute the spinal wore off - I noticed that I was in increasing pain, and the PCA pump didn't seem to be doing anything about it. Off and on throughout the middle of the night, the pump would routinely beep at me - and I knew, from my experience calibrating pumps as a pharmacy tech - that that meant there was a problem. The nurse would come in every so often, adjust something, tut about this and that, and then leave the room. A half hour or so later, she'd come back for a repeat.

After the first full day, I had tried injecting myself and nothing happened - except a horrible burning sensation up the length of my arm, which had been happening since I was in recovery - and the nurse scolded me that I had reached my maximum number of doses for medication per hour and couldn't have anymore. The pump had counted the number of doses, and it told her I had already had enough, and that was that. No doubt everything else looked good, and she didn't bother asking me why I was still in pain, even with that much medication supposedly flowing through my veins.

Finally, after my hand swelled up like a blown-up latex glove, the nurse noticed and quickly remarked how they 'had to get that thing out of there.' I had told them, numerous times, that it wasn't working, and that I felt more pain from injecting myself than anything else, at this point. I repeatedly asked, "Is it supposed to burn when I do this?" after another dose of Demerol. It was only after that that I realized the line had infiltrated at the injection site and the painkillers were leaching into my tissues, which offered little, if any, pain relief. No explanation, no apology - I only managed to figure out later that that's what happened.

I consider this episode a major technology fail. A machine can give you so many doses of something and then tell the nurse, in a nice digital printout, how much you've had, when you're due for another, and so on and so forth. It cannot, however, tell the nurse why you're in pain, or that there might be a problem. Only she can do that. And she can only do that if she listens to you as a patient.

I had tried speaking up and no one really listened. If they had been listening, perhaps they would have pulled the entire thing out from the beginning and tried again. Another technology fail lies in the fact that, with increased technology, nurses are then able to spend more time tending to other patients, and thus take on a greater caseload. Additionally, when someone does need something that only a human can respond to, they often become resentful or irritated when you do speak up and express a need that the machine failed to address. Perhaps this is why some OB's are perceived - whether for right or wrong - as cold and callous, because they expect the machine to do their jobs, to some extent: to give them results so they don't have to. In many situations, technology - as we see in the case of EFM - has replaced human judgment, which is an art form that is dying quickly, it seems, when it comes to birth. As a result, greater technology has helped patients, while at the same time, hurt them - by destroying the nature of the one-on-one patient-caregiver relationship. No robot can take the place of that.

More reading:
Bill Gates and Robot Cesareans - The Unnecesarean