On birth suites and breastfeeding: what a busy week!

I've been slacking - I'm supposed to be writing posts about thyroid awareness, but considering the busy week the entertainment industry's been having, I couldn't help but get distracted!

Beyonce's Birth Suite
First, Beyonce had her baby. Woo. I know, I'm like the 400th person to write a blog post about it, and really, it doesn't matter to me whether she had a natural birth or a cesarean. Well, in some ways it matters, yes - but not in the way some people think it does. Without rehashing too much of what everyone else has said, I do think how a woman gives birth matters: in the sense that surgical births are completely downplayed and approached with almost a blasé attitude, to the point where vaginal births - normal ones, anyway - are almost considered "old-fashioned." If she got the birth she wanted, then great - either way. When the entire world thought she had a cesarean at 37 weeks for breech, though, I wondered aloud, "What if this is the best information she had at the time? Many of us, including myself, have been there."

Photo: TMZ

Anyway, once photos of her birth suite were leaked, it got me thinking: why does someone have to be of "celebrity" or important status to have a comfortable, homey-looking place like this? Why do the rest of us get relegated to a double room with a complaining, loud roommate and plastic furniture?

I thought back to my own births. I gave birth to three children in two hospitals. My first was a cesarean, I was ill-informed, scared, and alone. My husband wasn't allowed to stay overnight with me, despite the fact there was a very empty bed next to mine the entire time I was there. Nurses ignored my repeated requests for pain medication, despite the obvious fact that something was wrong, and it was just a miserable experience overall. When my baby was born, he was quickly shown to me and then taken out in the hallway to be weighed and measured - which my husband witnessed - as I lay on the operating table, hearing his first cries. I thought to myself, I've just given birth, but this is so freaking surreal. I want to hold my child. When my husband cried tears of joy, they actually asked him if he was going to be okay, like something was wrong with him. Seriously?!

When it was time to get up and move around for the first time, I was in such pain I felt like my body was being seared in half. The nurse was unsympathetic. They actually told me to go get my own breakfast. I was confused, half-drugged with drugs that only half-worked, wondering where I was supposed to go to get it. Someone felt sorry for me and brought me a turkey sandwich. I thought this was odd, considering when I had my VBAC two years later (the birth I could have done cartwheels after) they brought me all my meals. What? 

For many women, just to have an unmedicated birth, they have to practically fight tooth and nail for it. Many are laughed at when they walk into the doctor's office with a birth plan. Many don't want anything all that special, except to maybe keep vaginal exams to a minimum, dim the lights and let them push in a position that feels comfortable to them, instead of to the doctor. In other words, they want their personal space respected as much as humanly possible, instead of be made to feel like a human science experiment, especially when it isn't necessary.

It's sad that we can't afford more laboring women the comforts of home within the "safe" confines of a hospital setting, since most people think hospitals are the best, safest place to give birth. Fine. Birthing centers seem to offer the best of both worlds, if you can find one. I know my city doesn't have any, that's for sure.

I think only within the last four or five years did my hospital convert their maternity rooms to private. In fact, there are those that can be reserved - as if you're a celebrity - but of course there's so few of them that they often get taken first. Birthing tubs and jacuzzis? Only four, available first-come, first-serve. I was denied access to them with my second birth because I was having a VBAC. Whatever. Apparently waterproof dopplers hadn't yet been invented in 2006. *eyeroll*

(Although they do mention CPMs, how they can lower infection and cesarean rates, fewer complications and healthier outcomes, based on WHO recommendations. So I'll give them that.)

Although hospitals go through expensive remodeling projects and blab endlessly about having expensive equipment to 'ensure you the best outcome,' it seems like they pour all their money into technology - which hasn't been shown to improve outcomes - and ignore some of the basics, like getting rid of that damned plastic furniture.

Seeing Beyonce's birth suite photos just reminds you of how in the Dark Ages many hospitals are when it comes to serving laboring women. And consider this - roughly only five percent are considered "Mother-baby friendly."

Sesame Street and breastfeeding in public
Like it hasn't already been done before, some think that breastfeeding should be "brought back" to The Street. I don't say that in a sarcastic tone - but mainly to say to all the haters, "It's already been done before. Twice. I don't remember hearing a lot of hoopla over it then or since, until now. One viewer remembers in retrospect:

Buffy breastfed Dakota in one episode; a former Canadian politician recently commented that "I remember seeing that and thinking about how proud she made aboriginal women because nursing is a part of our culture. During those days it was kind of a hidden thing, so to see Buffy doing it on Sesame Street was really something."

I've been embroiled in a heated, rather idiotic debate on Facebook over the last few days with some people who think it's wrong. I have repeated myself at least three or four times: "It's already been done before, twice, and no one raised a stink about it then." Someone complained, "Our tax dollars at work!" I corrected him and said, "Actually, the US government subsidizes half of the infant formula consumed in this country." No response. I don't think anyone actually bothers to read any of the comments before issuing their own thoughtful gem. What a bunch of idiots.

Some argued that that kind of thing "should be taught at home," and compared it with bodily fluids and functions (as usual) - even going so far as to say, "What next? Abortions? Conception?" I mean, come on. The reason these people don't see many women nursing in public anymore is because numbskulls like them have effectively driven women to either choose formula because they don't want to run the risk of their baby getting hungry in public, or they are currently feeding their child in a disgusting toilet stall somewhere.

And how can you teach something at home when that behavior, for whatever reason, isn't modeled at home? That's just the way it is, unfortunately. Kids are less likely to learn about something they're never going to see.

Many of the people who complained have probably never seen a woman nurse in public, or if they did, they didn't realize it. When they hear the word "breast" they immediately think "full frontal nudity," pasties and dancing around like you're a stripper.

I pointed out that, until formula started heavily being marketed to mothers, women nursing in public, tops open, was not unusual. As the formula industry moved into hospitals at an alarming rate, the sexual revolution gave way to an attitude that changed our ideas about what breasts were for, and, I think, the porn industry found new and more convenient outlets to reinforce those ideas. Before, public, open breastfeeding was normal and seen every day, and sex was not. Suddenly, those roles were reversed: sex was brought out into the spotlight, de-shamed, and breastfeeding was relegated to the back closet as old-fashioned and "dirty." Now people argue that if you're a breastfeeding mother, you should just "stay at home." But if you want to flash cleavage at all times for no reason, well - that's okay, I guess.

Where's Maria when you need her?

More reading:
You're my baby (bottled-fed version) - Sesame Street
Does breastfeeding belong on Sesame Street? - San Francisco Gate

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?

Everything in moderation - even birth advocacy?

I have always stood firmly in the middle when it comes to birth advocacy. I am not in the "trust birth!" camp, because I feel that birth can still be predictably unpredictable; our bodies, for all their wonderment, can still betray us and so, sometimes, can our births. I am not a person who believes that every doppler and every ultrasound is bad, nor do I believe that birth is "an accident waiting to happen." I also don't agree with the mantra "Just trust your doctor!", because being burned by doing so is probably what leads many women to seek a home birth (or at the very least, an alternative birth experience) in the first place.

Yesterday I read three articles that stuck in my brain - one, about the Australian midwife Lisa Barrett whom the 10 Centimeters blog lambasted for her seemingly reckless midwifery; one written by labor and delivery nurses on how to have a "natural hospital birth," and one from none other than The sOB about The Navelgazing Midwife's transition out of the NCB community. (That one was especially bizarre, most of us agreed.)

If what the writers over at 10 Centimeters are saying is true, Lisa Barrett has had four baby deaths on her hands recently, two of which occurred very close together. I haven't read much on the subject, but I agree that something sounds weird about that. I question those who align themselves with her, simply because overall her attitude sounds very cavalier, almost. The Navelgazing Midwife commented about the situation and further distanced herself from the "NCB crowd," something I can understand - because it seems like The NgM was very judicious in her practice and someone I respected for her cautious approach to bringing babies into the world (something that has drawn both praise and criticism).

As far as Barrett's behavior, I don't know what to say - I wasn't there. If it's true, then I don't know how birth advocates can support her. I get the feeling that it's very easy to blame the mother (for hiring her), in some bizarre way, blame the baby (because, admittedly, some babies die anyway, right?) - instead of blaming a cowboy-type attitude of the birth attendant (which you see in hospitals, too). I've often wondered how women can not intervene and tell the obviously whacked midwife not to get the F out of the way because I'm calling 911 whether you like it or not, but again, I wasn't there. I wasn't inside mom's head to understand what she was thinking, or even if she really had time to think. The words "I trusted her" come to mind, much like they do for many women in hospital births who feel helpless, powerless to question the authority of a doctor who might be behaving in much the same way, only in the opposite direction. I am not saying no cesarean is every unnecessary, but you do have to step back and question for a moment why 1 in 3 babies are born this way.

On the other hand is the article written by two labor and delivery nurses - who give pointers on how to have a great natural birth while in the hospital. Yeah, that's all well and good, but perhaps the realist in me is coming out. The first one on the list is to "plan your birth," whether you write it out officially or not. That's a good idea, in theory, but as most people will tell you, not all births work out the way we want them to. There's a Catch 22 there, though, because for some women having a "plan" doesn't change the outcome - how many times have we heard that having a birth plan is almost a guaranteed cesarean? Is it because mom's plan is too rigid? Or because her physician sees it as an attack on his knowledge and authority?

That's where the idea of "finding a physician you can trust!" comes in. This is true; but for some, it's harder than others. Some go through multiple physicians and still can't find one who doesn't see birth as potentially catastrophic. What if you're living in a remote area and have one doctor to choose from? Then what?

Other points on the list include "asking for the right nurse" and "bringing your own doula." As they put it,

“There are some nurses who cannot stand to hear a woman screaming and it kills the nurse NOT to put in an epidural." 

Oh, I'm sure it "kills her." Perhaps. And then there are those who just want you to STFU and stop your whining already because you're being a royal pain just by allowing yourself to be in pain, like these:

"There is good reason for birthing couples to be wary. Our hospital epidural rates run over 90% and in most hospitals, over 95%. The nurses in general not only do not know how to support a laboring women, but have no desire to do so. They would scramble to take other patients first, leaving the "natural" moms for whoever was "unlucky" enough to not be at the board first. They sabotage natural childbirth at every turn ("There's no need for this suffering you know--they don't give out medals for this," and on and on). I saw moms thwarted at every turn--no help, no support, no suggestions until moms finally begged for the epidural and the nurses responded with comments like "See--now you'll know better than to try this next time." I helped where I could, but couldn't take every mom wanting a natural childbirth. (Read the entire article here.)

As far as the doula part, they say, "...doulas can do the things we'd love to but can't." Well, that may be true, to a point. But there are lots of hospitals and doctors who don't like doulas, don't want them anywhere near the patient, and don't consider them a help but rather a hindrance.

One that really stuck out was "Be prepared to follow hospital procedure." Then that basically means, be prepared to surrender your rights in some cases, and have a far less chance of getting the birth you want. I guess this is one of the parts that makes me a moderate - while I know you're there for help should you need it, I also realize that much of the hospital's crap policies and procedures make that desired natural hospital birth next to impossible.

The article asks, "What keeps women from having a great birth experience?" The nurses say it's the idea that women are not accepting enough of themselves, and often blame themselves when things don't turn out perfectly.

“We tend to be pretty controlling beings. Having a baby is a rare situation for us [as individuals] because we’re not used to the lack control. For most women, this is their first experience in a hospital or in any real pain.”

That idea of control sticks with me, somehow. I do think that women should be permitted to exercise control during their labors - to a point. You should be able to control some aspects, but if the true need for cesarean arises, you have to surrender some of that control to the physician, unless you plan on doing one on yourself.

It's when sometimes over-the-top advocates over-analyze the experiences of others and tell them what could have been different, what you should have done, this that and the other that I start to be glad I'm sort of sitting on the outside of the advocacy circle, sort of like watching the debacle unfold while sitting on the curb. I think we've all done it, and sometimes it's quite clear what happened and where things went downhill. Sometimes it isn't, though. I've had at least three people feel the need to almost justify their experiences - prefaced with a "I know it's basically everything you disapprove of" - and this makes me bristle. Disapprove? As if I am somehow the Final Judge of All That Is Holy and Right concerning your birth. Not. Although, in explaining the situation, I've realized there is often a lot more going on behind the scenes than I know, and can often understand their position. And sometimes I don't agree (like my neighbor who likely had two births unnecessarily over-managed simply because it was a holiday) but crap, I'm not going to say anything. What business is it of mine? Not my body, not my baby, not my doctor, not my anything. And likewise, I will use my somewhat crazy birth experiences to inform others that yes, there is an alternative. You can still think I'm nuts, but that's your problem.

It's important to be very careful when questioning the experiences of others. There's a fine line between coming off as a know-it-all and basically telling them they're dumb for doing it by the book and simply, respectfully, informing them of their various choices when it comes to birth. I know after having my VBAC and second cesarean that things could have been different - it was after this last birth that I read that "breech and nuchal cord are not necessarily cause for cesarean." Yeah, that doesn't really help me after the fact, though. And who the hell am I to force my doctor to deliver a baby in a manner that he hasn't been skilled in since I was probably a child? No thanks.

One thing I simply cannot stand is the idea that all natural birth advocates are the same: the group at 10 Centimeters does this, as does The sOB. Surprisingly, she had a change of heart about The Navelgazing Midwife after hearing that Barb was leaving the midwifery community because of her disagreement over their somewhat radical views. Strangely, she is now almost aligning herself with Barb.

I was once lambasted in the comments section of The sOB for a post I did on gullibility and the "Trust your doctor!" ideology.  Someone questioned my idea that because it comes from a doctor's mouth, it must be right and true, and asked "How can we stop this?"

I guess this is just another way in which I am a moderate: blindly, completely trusting your doctor is often not a fool-proof way to have a great birth. Neither is throwing all caution and reason three sheets to the wind. There has to be middle ground. I try to be realistic but not scary and ridiculous; I find that some like to practice "fear-based obstetrics" in both directions: there has to be more to the argument than "all birth is dangerous" or "home birth/unassisted birth is the only true option." Many women have been betrayed by their bodies during the birth process; just as many have been betrayed by overzealous midwives who want them to have a natural, intervention-free birth seemingly at any cost; by nurses who sabotage their efforts to have a "safe," natural birth in a hospital; by doctors who knowingly put them at increased risk to either get it over with already or teach them a lesson. By lumping all natural birth advocates together, by shunning those who disagree, or by aligning ourselves on the extreme ends of either spectrum, we are ignoring - and doing a great disservice to - all of those who land somewhere in the middle.

Related posts:
What the "other side" is saying about NCB literature
A bitter birth nerd
He's your doctor...you have to listen to him
My doctor will tell me everything! Part 1
The myth of the emergency c-section
Birth faith

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My response to Free Advice Legal Forums: Childbirth issues

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

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

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

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

Here is my response:

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

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

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

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

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

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

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

Consider your rights and options should you have another child (maybe you've already had one) and at least know that you have them. I'm glad someone mentioned ICAN; they are a good resource for support. Your lack of trust in doctors is not uncommon and you should not be made to feel like a freak because of it - you were violated and had things done to you without your permission. If this had been a sexual rape, would those same people tell you to just "get over it?" Is it simply okay because this was a physician, someone we should trust and respect, who did it instead? It's still a violation of your body and your rights and has changed the course of the way you birth future children FOREVER.

Sally, who thinks your birth was the worst ever and you didn't sue, no! This one's for you.

I'll anxiously await a response. *eyeroll*

Seeing dollar $igns

With all this talk about President Obama raising the "debt ceiling," you have to wonder where the spending cuts are being made (or if they're being made). Politics aside, I can't help but think of one way the government could definitely save money: reduce the cesarean rate.

It's estimated that the US could save $3.5 billion a year in healthcare costs if the number of medically unnecessary cesareans were reduced. I don't know if that's just for the surgery alone, so perhaps the figure is much higher when you account for everything that takes place up to the cesarean. Think about the way a typical birth unfolds in the US:
• Mom is approaching 39 weeks in an otherwise normal pregnancy. Since her doctor is telling her it's "dangerous" to go past her due date, she decides to go ahead with an induction. After numerous doses of Cervidil and Pitocin, her labor finally starts, but is slow and very painful. Perhaps pain relief from the epidural is spotty, or they just need to keep giving her boluses because her labor is so long. They finally agree to do a cesarean for fetal distress. After birth, they decide the newborn must spend time in the NICU because her dates were off and the baby is showing signs of prematurity. He spends a week in the NICU and then goes home. Oh, did we mention this mom was giving birth in a military hospital? 
• The mother has already had a prior cesarean, and is scheduled to have another "elective" repeat cesarean. 


(This is just based on some of the stories I hear from mothers. While it obviously doesn't always go this way, it's not that uncommon, either.) 

While it's been said that Medicaid won't pay for unnecessary cesareans, I'm sure they can find other reasons to do them. When you don't even know what constitutes "necessary" anymore, it's probably not all that hard.

As of 2009, certain states were working hard to eliminate any financial incentives for doing cesareans. Washington State was one of them, and saw a 14-48 percent c-section rate, which obviously alarmed some. Before the policy change:

On average, Medicaid pays $5,000 more for a C-section than for a vaginal birth, and private insurance pays a far greater premium. You don’t have to be a cynic to wonder if that could have something to do with the rise in unnecessary C-sections.

Because of that lack of incentive, there is probably more accountability when you are receiving money from a government agency. I won't say there still isn't some form of fraud going on, but it's no doubt easier to get away with if your patient is privately insured. Additional health care costs probably come from extra items tacked onto your bill. Didn't receive an epidural but it's on your bill? Your health insurance company will probably pay for it anyway, even though you've called to complain. One West Virginia OB faces up to 340 years in prison for her part in billing patients for things they never received. Those little "extras" can really add up.

Statistics have also shown that you are more likely to get a cesarean if you give birth in a for-profit hospital than a non-profit one. They have to make their money somehow, right?

While it's glaringly obvious, at least to birth advocates and those who simply want a choice in their births, lowering healthcare costs in this way would require the obstetrical community to basically change the way they practice medicine, which I don't think is going to happen anytime too soon. Our health care industry is increasingly moving away from focusing on the patient and rather seeing dollar signs every time you hop up onto the exam table, for a number of reasons. They have to make their time "worth it," both because of their own personal pursuits and because of rising insurance costs for them that otherwise wouldn't justify them continuing to practice medicine. You are just the little fish - albeit probably one of the most important ones - in the food chain.

More reading:
Take away the incentives for too many c-sections - Crosscut Seattle
"Whatever you try is just going to end in a cesarean section" - My OB Said What?!
"If a baby hasn't engaged by 37 weeks, we need to do a cesarean section" - "My OB Said What?! (same doctor)
Should OBs be investigated for insurance fraud? 
All about the Benjamins? TennCare's call for lower cesarean rates - The Unnecesarean 

The new mommy wars

Lately I have found myself caught in a strange time warp, of sorts. Often when I read certain blogs or hear about new FaceBook fan pages popping up, it's like my old, worn-out 36-year-old self has been magically transported back to seventh grade and I didn't even know it.

In my cluelessness, it took me awhile to find out about sites like The Feminist Bragger. A completely weird, bizarre parody designed to basically do nothing but make fun of The Feminist Breeder, I read a few posts and then moved on. Whatever. That was interesting, for like two minutes. Next?

Then last night I stumbled in to the virtual cesspool of "Birth Without BS," a fan page dedicated to cutting through what some people consider woo and getting to the heart of the matter, I can only guess. Fine, that sounds like a good place to start. While there's lots of information, blogs and other stuff out there, obviously it's not a one-size-fits-all deal, and much like shopping for a house or car, we can all choose what we want and don't want.

However, there's one problem: those who don't agree or like certain things have decided to start fan pages and blogs to talk about it. That one kind of left me scratching my head, and I considered it a very ballsy move. Is this what we teach our kids about conflict resolution and how to treat people we don't see eye to eye with?

While I might not agree with everything one blogger says, I don't start an entire blog dedicated to bashing that person and all the stuff she says or does. Who the heck has time for that? I think many women are smart enough to realize what they want or don't want, and I get so tired of hearing how so and so is "promoting" something - like unassisted birth, for instance - with the dreaded anticipation that scads of women are going to blindly follow suit. That expectation is about as bad as the "sheeple" mentality some people have, only in the other direction.

I guess I figure if you don't like it, don't read it. Move on. Do something else. But above all, be respectful of another person's decision or choices.

So now anyone who is different is labeled "BS." (I guess one person's woo is another person's BS. So it's all relative, right?)

Blogs like The Feminist Breeder, Rixa Freeze of Stand and Deliver, Birth Without Fear and Gloria LeMay have been nitpicked and criticized. It leaves me wondering, just who's side are you on, anyway? I find it profoundly strange and sad. And it only makes people like Dr. Amy briefly stop and reload while on her mission to bash anything and everything she doesn't agree with. (At least Dr. Amy has the guts enough to use her real name when attacking people.)

I just wish the drama would stop - it only stirs up more crap and leaves behind those women who are on the fence about birth choices and really need help and support. Instead we should be behaving like the powerful, strong women we are - instead of the childish, petty little girls we should have left behind years ago.

What birth stories can tell us (if we listen)

Every birth story is important, and we need to listen
carefully: What does it tell us about ourselves? And
of our past and present birth culture?
Photo credit: Jennifer Lasseter

Every so often, I talk to women who's birth story - or in this case, lack thereof - stick with me and really have an impact, whether for their joy or their profound sadness. I think of these women and wonder, if in a different time and place, things would have turned out much differently for some of them.

Mary, an elderly lady with whom I used to attend church, told me a fascinating if not altogether creepy story of how her doctor intentionally turned her first child breech in the womb, resulting in a breech vaginal birth. I wondered how poor Mary fared and if she ever questioned the "expertise" of her seemingly odd doctor, considering that probably nearly all the women Mary knew had babies who came out head-first. It's a wonder that she went on to have two more children after that.

Later at one of my OB visits while pregnant, I mentioned Mary's doctor to my OB, who dismissively said, "Yeah, that sounds like Old Dr. So and So." No word on what his crazy theory was supposed to mean or what results it was supposed to yield, other than making for an unnecessarily painful, most likely difficult and probably traumatic birth.

Another friend, Andrea, didn't have a birth story so much as she had one taken away from her: she confided in me that she had been diagnosed with bipolar disorder and depression. She was married for fourteen years and has struggled off and on in relationships. Her doctor told her that because of her bipolar disorder, she should never become pregnant. She reluctantly followed her doctor's advice.

Maybe Andrea's doctor was right; maybe not. I do know some perfectly competent mothers who are bipolar and manage with proper medications, monitoring and support. I can't help but wonder what Andrea's doctor's goal was: to keep her from "breeding" and passing on her "defective" genes? To somehow "spare her" the trials of motherhood?

Sandy, the mother of two grown sons, gave birth to her second son - on the heels of his older brother almost exactly a year later - and didn't want or feel she needed any pain medication. Sandy got into the delivery room just in time for the baby to crown, yet the nurse was adamant on giving her pain medicine.

I've had this post mostly finished in draft mode for months, and something sparked in me when I read a recent blog post from Birth Without Fear, who recounts the story of Zelda from Peggy Vincent's book Baby Catcher that unfolds much like Sandy's. Zelda was a black woman laboring on her own terms, vocalizing and doing great - until she is forced onto a bed and given pain medicine that she neither wanted nor needed. What is the real point here? Were doctors teaching us a lesson? Saving us from ourselves, that surely birth must be painful for everyone (because either I say it's so, or I make it so) and you're no exception?

Judith, who had just delivered her first baby and was determined to breastfeed, was given hormone medication to take after her birth - which was actually quite common then. Later she realized the nurse had given her pills to dry up her milk, even though she had made it quite clear her plans to breastfeed. How is it that someone makes that decision for you, without even asking your permission? Sorry, but this still happens today - "Take this pill," without so much as an explanation. Hang a bag of Pitocin after birth in order to shrink the uterus, even though mom is successfully breastfeeding, no questions asked, no reason given. Before you know it or can even object, it's done.

Even in the not-so-great birth stories, they're still important - in helping us understand the rocky history of "modern obstetrics," as well as putting things into perspective. While straps were often used to tie down a patient to force them to comply, those straps have turned into IV lines and lead strips for EFM today. The tethers that were once present at birth to quiet a patient have now been replaced with epidurals. A quiet patient is a compliant patient, and when mom isn't hollering, yelling or vocalizing through the pain, hospital staff doesn't have to hear her or deal with her.

Our culture's tenacious hold on birth ignorance is stronger than any leather strap or dose of narcotics, and it's these people that need to hear these birth stories the most. We need to read between the lines, and educate ourselves: why was grandma's birth story so much different than mom's, or mine? How was it the same, and what needs to change? As we see in Zelda's story, the endless empty excuses and outdated ideas blend with modern medicine. The shackles are still there; they just look a lot different.

More reading:
Pushed: The Painful Truth about Childbirth and Modern Maternity Care, by Jennifer Block
Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First, by Marsden Wagner
Birth: The Surprising History of How We Are Born, by Tina Cassidy

The Obstetrical BS Series: "He's the doctor ... you have to listen to him."

When I was 22, I visited the Dreaded Gynecologist for the first time. I was young, naive, and totally stupid when it came to seeing the OBGYN. My doctor proceeded to tell me two things: That doctors should always put gloves on before examining you, and that they should always tell you - or ask - before they did something to you.

For some reason, people would never tolerate having someone aggressively approach their genitalia in any situation - but because you're at the OB's office, whatever he does to you is suddenly okay.  It's like your care provider has free reign over your body parts, and it's just too bad if you don't like it.

While we should be able to trust our physicians, I'm no longer under the delusion that I necessarily can. As a result, I've become increasingly skeptical when hearing "emergency" birth stories and in dealing with my own OB.

Many people are under the impression - especially when it comes to labor - that doctors are always well-meaning, know what they're doing, and are doing whatever it is to you because it's necessary. I'd like to say that were always true. Unfortunately, largely because a lot of people are totally uninformed about birth, they don't know what's truly necessary and what isn't. Sometimes even when you are informed, it doesn't make a difference and you get railroaded into something terrible. I hate to say it, but that aspect of birth advocacy really depresses me.

Because of that lack of information, and the blind trust in the physician to be overseer in all aspects of our care, some people think that mothers who consider their experience 'less than perfect' are going to extremes when making claims of birth rape or assault. They think you're exaggerating, that you are being dramatic, that you care more about the "experience" (gah - I hate that description) than a "healthy baby!" Fervent anti-natural birth advocates like Dr. Schizo often make those claims, as do those diehard women who run in her circles. To say that a healthy baby doesn't matter to any pregnant woman is utter BS. But to some of us, the process of getting there means more than to others, and can greatly shape our definition of "health" both for mother and child. I hate how those "anti" people tend to completely disregard the emotional and physical well-being of the mother in favor of the baby, as if it means nothing. How can we even consider for a moment that mom's overall emotional and physical health don't play a role in how she cares for her newborn?

Many times I've run across comments like, "Just listen to your doctor, he knows what he's doing," or "You are not a doctor and you can't possibly know anything." Totally downplaying mom's (completely relevant) fears and concerns as if she's some kind of idiot. When she dares to question the doctor, suddenly she's treated with disdain, as if to say, "How could you" One mom, when confronted with the comments of a knowledgeable labor and delivery nurse, basically said, "You're not a doctor, and I won't listen to you." That degree and white coat mean so much to some people that they're totally willing to overlook huge red flags, like My doctor treats me like sh!t, belittles me, makes me feel like my concerns are meaningless, and doesn't treat me like a human being.


Our often well-meaning, completely birth-stupid culture devalues mom and her individual labor and birth needs, essentially seeing her as nothing but a vessel - an incubator who holds that baby in for 10 lunar months and suddenly ejects it in any way possible, whether she likes it or not. Then they either turn around and accuse you of being uninformed, or being selfish - even though your baby is no doubt just fine.

OB:  “If I’d known the baby was so big, I would have done a cesarean section.”

Mother:  (holding her just birthed baby) “I wouldn’t have let you!”

OB:  “It wouldn’t have been up to you.”  (Courtesy My OB Said What?!?)

So, mom is perceived as selfish and superior because she would have had the audacity to question her doctor. And her doctor is basically implying that he would have done a cesarean without her permission. Many women called it as they saw it, except this one:

"u ladies need to be a little less sensetive, hes an OB.. part of their job description is to come into contact with female genetalia.. birth rape? give me a break.. i have had 5 kids, and have suffered some pretty traumatic birth experiences ((ie. heamorraging and having the OB use her hand to mannually remove the clots from my uterus))… but thats birth, its dirty, its hard, and its not pretty… if ur not ready for that, then adopt, or buy a puppy…get over yourselves…."

So in other words, even if your vagina was forcefully entered into with a hand, fingers or other tool, or even the mere suggestion was made of doing something without your consent, you're just supposed to get over it. Because he's the doctor.

Yes, an OB's job is to come into contact with vaginas and whatnot. But it's the contact part we need to examine: did he ask first? Did he tell her what he was planning on doing before he did it? Did he preface it with a comment that suggests her rights were completely irrelevant to him, as the above post suggests? (As a side note, I bet you ten bucks that the second commenter's "traumatic birth" was likely due all or in part to her overzealous physician. What say you?)

Further down in the comments section, another poster mentions how yes, it's assault; but it would be awfully hard to prove in court. Of course it would, because we have a whole generation of sheeple who think the doctor is always right and only does what's good for you.

Awhile back I read the comments of a mom who was nervous about her doctor inducing her with Cytotec. She was planning on standing her ground if the doctor insisted on using it, but "didn't want to make him mad." I nearly swallowed my teeth.

As usual, the old "He knows what he's doing" crap came out. And while I was happy that she had done some reading on Cytotec and the concerns surrounding it (more than likely because she's used to hearing about Pitocin and this sounded different, thus prompting her research), I'm sure she had no reservations whatsoever about Pit and didn't question that one iota.

Your OB is not the boss of you. He is not God. He is not your dad. He is a medical advisor, and you are free to seek another opinion regardless of what he says. Yes, sometimes unpleasant and painful things must be done to us for the safety of ourselves and our babies, but he or she should do so with compassion, dignity and respect. And if he's not giving it to you, then you need to demand it, because it's your right.

Do not let anyone tell you to disregard or ignore your feelings of inadequacy, spiritual, emotional and physical pain, and other complications that might be hard to concretely identify but you know they're there. You are not just a holding tank for this child; you are a human being with feelings, emotions, and rights.

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?

"He ain't creepy, he's my doula"

I've heard some buzz lately about a new Vince Vaughn movie due (no pun intended) to come out next year called "Male Doula." To some people, this might be the first time they ever hear the word, much less understand what a doula does.

My first exposure to doulas was back when I worked at a newspaper, and the reporter in the cubicle behind me was doing an article on them. I never dreamed I'd ever understand their importance during labor and birth, much less hire one myself one day.

Hot towel, anyone?

Although our conversation about male doulas on my FaceBook page was meant to be somewhat comical, a reader posted a link about real-life male doula Keith Roberts, who has been serving his clients for over a decade. He rides a Harley, brings a crockpot to warm towels, and helps assist a laboring mother just the way any other doula would, with one exception: he's a man.

This article recounts his time as a massage therapist, and how that segued into becoming a doula. He also tells the rather sad tale of being relegated to watch the births of his two children from behind glass because he, like so many other men in that time period, was barred entry to the delivery room.

There is, apparently, some controversy surrounding male doulas. Some - even members of the Canadian Doula Association, who has no male members - wonder if they are "sickos who get off on childbirth," according to the association's president.

Some find them creepy, and on some message boards I've read, women have said they wouldn't want a man filling that role. Some have even asserted that midwives should be female, too, which I find absurd. If they can offer talents and a level of skill that prevents you from unnecessary interventions and cesarean, and they just happen to be male, are you going to turn them down?

I find that so sad. Yes, there probably are some people who have their weird fetishes, but honestly - would they go to the trouble of getting themselves certified? Why is it that we automatically assume, as our predecessors of the 1960s and 70s, that men who want to support a woman in labor either can't possibly know what they're doing, can't be taken seriously because they don't have a vagina, or are a threat - and are therefore useless in the labor room?

Perhaps Mr. Roberts can provide support to the dad as well, who is often a sounding board for ideas and threats against mom's ability to labor. If there is a supportive male presence in the room to help bolster dad, then he can be a better support system for his laboring partner. When a doctor wants mom to give in to a particular intervention and mom isn't agreeing, they often look to dad in order to strong-arm the patient into consenting. If dad caves in, then mom sometimes follows.

One dad, whose wife had a 40-hour labor with the assistance of Mr. Roberts, said he didn't mind his presence and the couple felt they never would have had the natural birth they desired without Roberts' help. Dad also didn't consider it any different than having a male doctor.

And as it was pointed out, Dr. Biter - who has been nicknamed "Dr. Wonderful" - is very patient-supportive and often called a 'male midwife in disguise.' What's the difference? Dr. Biter, and every male OB out there, have never given birth; but it doesn't mean they can't give you quality care. And really, there are lots of female OBs who probably have never given birth either - so does that really have to be a qualification?

As far as care provider gender preferences, some people prefer a female OB because it's perceived that she is more connected to the pregnant patient by virtue of the fact that she's female, or because she has children, so that makes her a "better" caregiver. However, it's been my experience - and probably lots of other people - that that "connection" somehow gives her the authority to coerce or lead you into certain decisions because "I have a uterus, too, so I know what it's like." Um... not quite.

One man mentioned in the article was apparently barred entry into midwifery and prenatal yoga teaching classes because of his gender, which I find perplexing and sexist. Who's to say he doesn't have anything to offer his clients, even though he's male? I find it sad that our society assumes that there is something somehow wrong or sick with a man wanting to fill a role otherwise reserved for the stereotypically nurturing female. It reminds me of the British dad who was confronted by another female parent because he was photographing his children - and no one else's - while out in public, and she suspected he was a pedophile. Why? Just because he's a male? People often want men to be all warm and fuzzy and "get in touch with their female side!," and yet when they do, they're either perceived as "sickos" or homosexuals. Huh? Just because they're not grunting, standing glassy-eyed in front of the TV, beer can and remote in hand?

As for Mr. Roberts, while he was denied the privilege of supporting his wife Jane in the births of their children, he acted as a doula to his daughters during the births of his two grandchildren. Good for him!

Debbie Young, president of DONA International, thinks that "it takes having a warm heart, a passion for helping pregnant and postpartum women and the training [to make] you a good doula," not whether you're a man or woman, or even if you have personal experience giving birth. I agree!

Regardless of whether the doula is male or female, they've been shown to do tremendous good to the laboring mother. Anyone who can help you manage pain, possibly lower your chances of having a cesarean and just provide attention and support in what can be a somewhat chaotic, sterile environment, is worth it to me, regardless of gender. Who wouldn't want that?

More reading on gender bias and obstetric caregivers:
Burn the Male Midwife! - Rixa Freeze at Stand and Deliver