Improving birth by breaking the silence

The topic of childbirth is one that women - often those who don't even know each other - often freely engage in. We find ourselves sharing the most intimate details with strangers on what is often the happiest day of our lives. And for some, one of the most traumatic.

But it seems like if your outcome is anything less than happy, women suddenly don't want to hear about it. And when you question the actions of your doctor, or express anything less than total and complete gratitutde to your doctor, then you're attacked, criticized, made to feel like you're selfish for wanting something more or think you're smarter than the physician.

And yet, sometimes these stories still make it out, have a voice, are heard above the din. When "Kelly," the mom who had an episiotomy and was cut at least a dozen times by her physician, told her story, many women did come out of the woodwork. They shared their equally horrifying experiences, told her she wasn't alone, said the same thing had happened to them. It was terrifying and yet vindicating at the same time, knowing that finally these women are confident enough to talk about what happened to them. And with the number of them growing as more and more comments were added and the article continued to be shared, it was clear there were more of than them than not. And it was abundantly clear, even to those who are not involved in birth advocacy, that there is a shocking pattern of abuse in obstetrical care.

If you ask your mother, grandmother or great-grandmother what her birth story is, she may or may not be able to tell you. She may not remember any of it, drugged into oblivion with medication she may have felt at the time she neither wanted nor needed. While things have improved somewhat since then, it's not all that much, considering you still hear these horror stories. Women were given few choices then and to some extent, still aren't, with sometimes well-meaning and sometimes downright cruel care providers making choices for them on their behalf. These pictures continue to give us evidence of that.

I have seriously told women who were not
comfortable laboring at home to either labor in
the parking lot or the lobby but not necessarily
check in. That way you're close to the hospital,
but still on your "own time." How pathetic is it that
women even have to resort to doing this?
I can totally understand where she's coming from.
Photo used with permission from ImprovingBirth.org

Isn't that the truth. Remember Nurse Jenna's
post lightyears ago about "why you need
Pitocin in labor?" This was basically her
justification of it - they need to free up
beds. It's all your fault that you're not
laboring at home longer, even though
we care providers make you feel like it's
the most dangerous thing in the world to
do so. (To read the article, click here.)
Photo used with permission from ImprovingBirth.org

Coercion can often be another hallmark of abusive practices. And as some find out, they agree to the procedure only after much pressure and bullying, only to read in their chart later something entirely different.

The "maternal request" cesarean is often the result of
mom agreeing to a c-section after finally giving in to
bullying, scare tactics, and tremendous pressure to do so
from her physician.
Photos used with permission from ImprovingBirth.org

I am not at all surprised that this is a female physician. I
had similar experiences with one in my OB's practice and
found many of them to be far more condescending and
rude than the male doctors.
Photo used with permission from ImprovingBirth.org

When people say "Just trust your doctor" I think
of situations like this one and it makes
me want to throw up.
Photo used with permission from ImprovingBirth.org

I urge you to go through Improving Birth's FaceBook gallery. Maybe there is a situation that speaks to you or you have one to share - please do so. Maybe you personally have never experienced this and were completely unaware that such a thing existed. It is time for women to stop being shamed into silence and forced to accept something that is "normal" when it really isn't.

More information:

Improving Birth - Advocates for Evidence-Based Maternity Care 

Submissions will be accepted again soon - to submit your entry, click here. 

Bi-polar and pregnant: One woman's story, part 3

As a birth advocate, I am a moderate - I don't feel that birth is a 'one size fits all' experience; neither do I think that every epidural, every cesarean, every induction is a horrible very bad thing. We can whine and complain and write about how maternal-choice inductions and cesareans are a bad thing that put mothers and babies at risk, but in reality, sometimes they're the best option at the time - for a variety of reasons.

In talking to Em about her birth experiences, I realized that sometimes, there are those unseen reasons that no mother likes to talk about - things that really, are no one's business even though they are not visible on the outside. And your choice may tick some people off - especially those who don't know the full truth - but that's just too bad. In short, she and her experiences have taught me a lot about my birth advocacy and how I can use it to help other women.

After losing our daughter, I had my breakdown, I had my meds back, and I was armed with research. I found that my meds were a C class drug. No definitive danger to my baby and they would help me tremendously with the turmoil ahead. My psych told me flat out -NO. I had pages of research, he said NO again. He told me I had to drop this, as it was making me upset to talk about it. No, asshole you flat out patronizing me is what was aggravating me. I left. I called my insurance asking for a new psych referral. I was referred to the head doctor of the hospital’s loony bin. He couldn’t take me on but referred me to another psych that did specialize in women during their reproductive years. Hallelujah.  She agreed with all my research, was pleased to have an informed patient and we decided on a direction for treatment of my bipolar disorder. Team member #2 was on board. My talk therapist has been with me since before my pregnancy with our second child. 

I asked my M/F doc for a referral to a new OB. My previous one left me less than impressed, we shall say. They didn’t see me till I was being discharged after our loss and then patronized me about psych drugs during my follow up. I was seriously given the speech about post-partum depression and to call when I needed drugs. They knew I was bipolar and had a doctor to cover that area of my health. Plus after they basically called me crazy for saying something was off, I couldn’t trust them. My M/F gave me the name of my new OB. We met and I liked her immediately. She knew my history and was willing to take on a mentally ill woman with a single-minded need to have a child. Team member #3 was on board.  

Shortly after we conceived again. I had this driving urge to be pregnant again and wasn’t in the mood to wait. I did wait long enough to have the autopsy confirm it was an infection, as we wanted to make sure what risks we faced in the future. I could tell you details, but really they don’t help. I felt by having a team in place I could get on with conception. So we did. From the moment I peed on the stick I knew everything was going to be ok, I knew it in my heart and soul. My pregnancy was less than ideal - I gained so much weight (55+ lbs total), I slept, and I ate like a teenager. I was moody and had emotional outbursts but refused extra meds. The less I took the safer my baby was. I was in Hell but as long as the baby was ok I could cope.

I again consented to the Nuchal fold test (I wanted to see my baby), but not the AFP. My OB agreed and didn’t push. After all I had the history of a false positive. I then had my 20-week ultrasound, which confirmed a very healthy baby boy was nestled in my womb. The tech was so cool and gave us a free 3-D scan. He slept just like his sister. I fell in love. My M/F doc came in and confirmed the healthy happy news. He had some residents and let them get a feel for the U/S on my belly - hey, it was more face time with Almond. He then tried the instruction of placing an amniotic needle and promptly got punched. He knew why and then explained that I was that patient, the 1 in 500. I can’t win the lottery but I got that one.

At my 34 wk appointment I looked at my OB and asked for a C-Section. After my previous two experiences it couldn’t be worse. I was huge and swollen and flat out miserable. She calmly looked at me and promised my next birth will go much easier and all will be ok. It is a testament to her diligence with me that I trusted her and let it go. The magic 37 weeks hit and I am 90% effaced, 3 cm dilated. We are feeling that by week 38 I will be holding my son. Week 38 hits and I am 95% effaced and 4 cm. No baby. 38 wks 4 days I headed into L&D - our son had been asleep for hours with no movement. I panicked and headed to the hospital. I get to L&D and it started - the breakdown. They were originally going to place me in the room we were informed of our daughter’s passing - nope that wasn’t happening. So into another room I go, get hooked up and bam - heartbeat blasting through to everyone but me. I began begging and crying to be induced, I was so scared my son would die in my womb. I was hearing his strong beautiful heartbeat and was crying. 

It was at this point in the conversation that I asked Em, given her need for medication as her due date approached, if she was suicidal. She responded, "Yes." Unfortunately, this is one "medical reason" that many women don't wear on their sleeves, or in their swollen ankles and discomfort: one that is often met with disapproving glances and harsh comments from people who have no idea what's going on on the inside. I felt badly and thought to myself, Have I ever questioned someone's decision like this? Have I ever rushed to judgment like this before? Probably.

My OB was called and stood by her guns; she wouldn’t budge - no induction till 39 weeks. Then the Bitch Nurse, as I can call her nothing else, said to me that I should thank God my child died in my womb where I could offer her the most comfort. She continued to go on and on, saying I needed to come to peace with her death, accept God into my life, and basically listen to her. She’d been in my shoes and knew better. No, she didn’t know better. Until you are in the exact place (which let’s face it, doesn’t happen) you can’t tell someone that you know better. I began crumbling fast. 

I continued to try all the tips to go into labor - membrane sweeps, spicy foods, labor cookies, sex, walking, you name it I tried it. My son was not moving; he was comfortable and stubborn. I (headed) to my psych who noticed I was in a bad place and started Prozac to help bring me out. The problem is that Prozac isn’t that safe for pregnant women. She asked how much longer I would be pregnant, to which I replied he would be born within 10 days, even if I needed an induction.  

Christmas passed and so did the next week. I checked into the hospital to have my induction. They were crowded with women wanting babies before the end of the year; I wasn’t there because of that but, because I desperately needed strong psychiatric drugs that might harm my child.

Em said that once the Pitocin started and the epi was placed, she progressed quickly. She requested to sit upright - which she said surprised them - and within a few minutes her son was born.

We could see the crown of our son’s head. I decided to take a look. They brought down the mirror so I could push and watch my son enter the world. (By the) third contraction and each push brought him closer to my arms. After the third contraction and the ninth push, he was born. I couldn’t make out his face for all the tears in my eyes. I pushed for all of 10 minutes. He was immediately placed on my chest to warm and nurse. He was perfect and he was here. 

My third time at the rodeo and I finally got it right. His birth cleansed me. Healed me. Made me whole again. Every moment I look at my son he heals me. His mere existence is amazing to me, as is my daughter’s. Yet when I think back on his birth is it with great joy and happiness, not the fear and apprehension I had at my daughter’s birth. I could go through the experience of birthing my son a million times over and it wouldn’t be enough for how amazing it was. My medically controlled birth, with the most interventions - and it was the best one. Not because of the medical interventions but due to the OB and her ability to do what was right for me and our son. 

To see him born was a singular moment for me. Is this birth for everyone? No. Was it right for us, given the circumstances? Yes. I cannot put into words how amazing I felt after my son was born. I stood up after his birth and felt as I did at 14 weeks post partum with his sister. Everything about our son’s birth was joyous and healing. 

So now you’re asking what was the point of my posts?  I don’t know. Maybe it’s to shed light onto how the same woman can have vastly different experiences. Maybe it’s to tell women that even if one birth scars you, the next one could heal you. And maybe it’s just to share. Maybe it’s so that there is a positive out of all of the dark. I know most birth advocates don’t get behind inductions, but mine was needed. Not because I was physically miserable - which I was, but for the fact my mental health was slipping fast and I needed stronger drugs. I wasn’t going to risk his exposure to my meds any longer than he had to be. I feel it’s important to say this - I was perfectly poised for an induction. My cervix was ripe, I was 39 weeks 6 days, and I was on medication that could prove harmful to my child if fully exposed. I had heard enough about possible complications and c-sections during the induction prep. Mine wasn’t one of these. I have an amazing OB who listened to me in the beginning and followed through with what we decided on in the face of my bipolar rage. I learned through all this that open honest communication with your health care provider is a must. If you fear a reaction from your doctor- you need a new doctor. There is no place for silence and fear in your relationship to your health care provider. 

Thanks for reading and sharing my experience. - Em.  

If you or someone you know is pregnant and experiencing symptoms bipolar disorder, depression or other mental health problems, there is support and help available.

Managing Pregnancy and Bipolar Disorder - NAMI
My Bipolar Pregnancy blog
SafeFetus.com - drug database for pregnant or nursing mothers
Infant Risk center - website of pharmacologist Dr. Tom Hale at Texas Tech University Health Sciences Center

Read part one and two here.

Bi-polar and pregnant: One woman's story, part 2

After a somewhat difficult birth and recovery with her first child, my friend Em continues her journey with her second pregnancy: which would prove more difficult than she ever imagined.

Warning: Em wanted to share her story, and both she and I felt that it might present triggers to those who have suffered through traumatic births or a pregnancy loss.

When my daughter turned two, the baby bug bit hard. So off the meds I went and started the baby making. I knew my Psych’s position and figured it worked so well the last time, we could do it again. I was wrong, so very wrong.... 

For some strange reason, I felt I was never going to hold this child; I was in constant fear of the other shoe dropping. I chose a new OB, one referred to me by many moms in my mommy group. I proceeded to have one complication after another with my bipolar this time. I was severely symptomatic. I was borderline bonkers for lack of a better term.  I screamed, I cried, I raged. I was unable to gain any weight, I was constantly sick with a cold or flu. We did the AFP (which I did with my daughter) and Nuchal fold test - this was new to me and I was super excited to get to see my baby so early. We were going about our business, trying to be positive in the midst of my hurdles. My spouse and I focused on the miracle in the womb. I could handle anything as long as my child was safe.

Then I got the dreaded phone call - my AFP results were positive for Down’s. Or I should say that my chances were 1:45. I lost it, not that I had it to begin with. The shoe had dropped. I was heavily guided and suggested to have an Amnio. I agreed feeling it would be important to have a team ready to care for my baby when he or she was born. I can tell you today I was strong-armed by that genetics counselor that day. I was told the risks were minimal; I was told 1:500 experience a complication. I thought, ‘oh that one won’t be me, it will be ok. They know better than me’. 

We went into a holding pattern after that. I was trying desperately to remain calm and centered; after all I had a 2 year old....Our first appointment was with a genetics counselor, went over our decision, and signed the consent waiver. I was told we could back out after the U/S if everything was good and we felt that was enough. Then we get to the ultrasound. This is always one of my favorite things - I get to see my baby. They did an in-depth level 2 test, checked all vital organs and systems, perfection. We were told to expect a baby girl. I was excited about having two girls - sisters. Yet I was dreading the teen years already, who wouldn’t with two girls? The doctor confirmed we wanted to do the amnio, and we nodded. So began the prep work. He joked about my navel ring and how the pain from the amnio would be less than the piercing. One stick and I had a contraction so we had to do a second sac puncture - I was in pain by that point. The test ran smoothly after that. Went home and rested, napped, checked Facebook - you know, the usual time wasters. I had zero pain, was relaxed and thought we’d get great news on our perfect daughter.

By midnight I had fever and chills, shakes and tremors. I managed to fall asleep thinking I was just cold. I felt as if I was freezing. I woke up alone in the morning feeling off. I couldn’t place it but I felt wrong. I called my OB and begged to be seen, so they squeezed me in. They had the hardest time finding a heartbeat, but swore they heard her moving so all was well. Checked my injection site and stated there was no infection. I had the flu and to go home and drink water, sleep....By 3 in the afternoon I started having pains. I waited, but called in about 4:15 when I realized they were rhythmic and regular - 12 minutes apart. They said I wasn’t resting enough. I got pissed and called the clinic where they did the amnio. Got my maternal fetal (referred to as the M/F doc) doc on the line and he was highly concerned. He told me 600 mg ibuprofen and sleep. So I slept. When I woke 45 minutes later, pains were worse. Then the blood. A tiny amount but I lost it. Called the M/F doc on his personal cell, which he freely gave to me, and he sent me into L&D....got settled, in the gown and the residents start(ed) listening for a heartbeat - with headphones. The second resident arrive(d) to do more of the same. Then they bring in the U/S machine. 

This is that moment, the moment when your life shatters. He looked at me and said, “I am sorry but there is no heartbeat.”  I went into shock and asked what that meant. We all know what that meant but I had to ask. We had lost our daughter.

At this point in editing Em's post, I stopped. I had never experienced these things before, and wasn't sure if the graphic nature of her post would help others or hurt more. I am so in awe of her openness to share this experience - after all, just this last week marked the anniversary of her daughter's death. What should I print? How should I say it? I felt like, even with Em's permission, that I was pushing the edge of an invisible envelope somehow.

I wanted to leave my body. I didn’t want the memories ahead of me, I didn’t want the pain I was feeling  inside my womb and in my heart. I was 75% effaced and 2 cm. Contractions were 6 minutes apart. I was told there were 2 options. Option 1) was to deliver my baby. Option 2) a D&E - this is one step up from a D&C and would require full anesthesia. 

I desperately wanted option 2, I wanted the pain gone. Then we asked the most important question of all - why? To get that answer I would have to deliver my daughter vaginally. 

Em wrote, in detail, the images from her birth: an unmedicated delivery of a baby that was 18 weeks. Perfect. In every way. She felt the urge to push before the epidural was administered, and, as Em put it, "There she was." It was at this point the physician realized - her baby had died from an infection via the amnio. His response: "Shit."

He knew immediately the why. She had died from an infection, introduced via the amniotic needle. I have no memories past this point, I blacked out. I know they put pain meds in the epi so the M/F doc could retrieve the placenta. Yet I have no memory till I woke an hour and a half later.  

That night is the single worst of my life. I woke off and on, crying, screaming. Finally about 6 am I got the courage to hold my little Angel. Tiny and perfect, she was wrapped in the smallest blanket I have ever seen, in a tiny bonnet and dress. Oh how I cried. I kissed her and begged forgiveness for not protecting her....This was my natural childbirth. This experience taught me many things. I learned I am stronger than I ever knew I could be. I learned that questioning everything was the only way to make an informed choice and if I didn’t like the answer to keep digging until I found one I could be at peace with. I also learned my body, my choice, and my decision.

Continued here.
Read part one here.

Bi-polar and pregnant: One woman's story, part 1

It's amazing how different each pregnancy - and each birth - a woman has can be completely different from each other. No more is that more apparent than with my friend Em, who has had three pregnancies and two live births. "My path is like many others, yet vastly different from most," she writes. "These posts are not a defense of my choices. They are my choices made with the most knowledge I had at the time. I can wish for different outcomes, but each experience shaped me in a way I needed to be shaped. Nothing is without pain and my path to today is no exception."

Warning: Em wanted to share her story, and both she and I felt that it might present triggers to those who have suffered through traumatic births or a pregnancy loss.

I have been very lucky - I have given birth to all three of my children vaginally. I have had two spontaneous labors and one induction. I have had three vastly different birth experiences.  My first was scary and painful, this one I call the bad. The second was the ugly, more on that later. The third was cathartic and cleansing and amazing. I ended my child bearing days on a high note. In fact I could relive my son’s birth a million times over. 

Let’s start with the major hurdle ahead of us - I am bipolar. This is important to know as it plays a massive part in the pregnancies ahead. I was 30 when diagnosed and felt reborn to have a name to the weird things in my head. I have a team when I get pregnant - my OB, my psychiatrist, and a talk therapist. Bipolar plays a role in everything I do, whether it is by conscious thought or my sub-conscious. My case is quite severe. I could write endlessly about how messed up I am but alas this blog is about birth, not mental health. So on with the show.

"The Bad"

We decided the time to start a family was right so I consulted my psych and was told no drugs. OK. I was scared and knew how sick I became off the meds, but I wanted a baby so no drugs. I am beyond lucky when it comes to conceiving my children, simple temping got me pregnant. We conceived our daughter easily and I started reading books.  I wanted to know what was ahead, both pregnancy and delivery wise. I dutifully read my books, feeling they made me knowledgeable. Never once did any one refer me to Ina May Gaskin. I promptly tossed “What to Expect” (LOL!) and focused instead on the Mayo Clinic book and the Week by Week book. Given my health history I had been taught to count and trust my doctors. They were the one with the medical degree not me, right?

I had a fairly easy, uneventful pregnancy.... I met all the doc’s in the practice so I wouldn’t have a stranger between my legs. I hired a Doula to get me through labor without pain meds, I had my birth plan. I was armed with knowledge. I have neck issues and was required to have an epi placed during labor or in early labor since I can’t get a breathing tube down without me being awake to swallow it, so I asked for the unheard of saline block. Sounds like I was heading for an amazing birth experience right? Yeah no. 

Em's first was a typical vaginal birth - 38-week membrane sweep that turned into what sounds - or reads - like a baby vs. doctor tug of war, in a way.

I am not one to follow all the rules and neither is my daughter. She got tired of all the poking and prodding and started labor. That was 2:50 p.m. By 3:30 I am writhing and screaming in pain, my daughter does nothing half-way - I was contracting every two minutes for 80 seconds. The nurse immediately says time for Nubain. Pain did not go away; I just stopped caring about it. From there the glorious epi was placed, with drugs. I had lost all my will and had zero support to go all natural. My husband panics when I am in labor.  He will stand there or stay in the room watching but he can’t get out of his own head to help me. I continued to progress steadily without the pit. Or if there was pit I was uninformed.  

.... I was told to start pushing, because being a 10 means you’re ready, right?  So I pushed, and pushed, and pushed some more. I pushed for an hour before I felt the urge to push. So like a good obedient patient I listened and kept pushing till I felt pain, burning tearing pain.  It felt like there was a Ring of Fire, as a friend of mine calls it. I was told to hold it and stop pushing when the pain was at its worst; I politely said “F*** that” and pushed my daughter into the world. They whisked her away to clean, weigh and Apgar her. The OB proceeded to start the stitching process which took approximately 25 minutes.  I have no clue how many stitches were placed but if she averaged a stitch a minute - 25 stitches sounds close enough. They we’re all internal, only three external. I looked - it hurt and I wanted to know why. They wouldn’t let me hold my daughter until I was done being stitched. They offered a bottle and I said no. My breasts were ready for her. I immediately placed her on my breast, and there she got her first meal. She was perfect and beautiful. She was then whisked away to the nursery for her exam. 

All was great until they stood me up to use the bathroom for the first time, and I can tell you I have never felt pain like that. I literally thought my uterus was going to hit the floor, I couldn’t move. Well, obviously that didn’t happen, but the pain was beyond my imagination. I sat on a plastic doughnut for three weeks till I popped that poor balloon. At my six-week post partum check I was cleared and “healthy." I was cleared to begin relations with my spouse and like a moron tried. I ended up in tears it hurt so badly. I still was in loads of pain and proceeded to find a new OB, whose nurse diagnosed a RAGING bacterial infection that took four rounds of antibiotics and seven weeks to heal. I swore a C-section couldn’t have been worse at that point - 14 weeks healing time total.

From what I have heard this is the typical experience. Yeah well, it isn’t a positive one, it sucked. I mean seeing and holding my daughter was amazing. The healing from this was awful and left me scarred for the days ahead. To say my post partum period was one of pain is an understatement. I thought there is no way I am doing this again. That thought lasted two years.

Continued here.

A (surprise!) breech birth story

A few months ago, I posted a breech birth link on FaceBook for my non-birthy friends and was very surprised at the answers: many of them were born breech, knew someone who was, and one even had twin siblings both delivered breech. Many made jokes about their choice of presentation coming into the world, but by and large, they all considered it a totally normal, if not slightly old-school way to be born, and something to be proud of. Some seemed completely surprised that nowadays, cesarean section is usually the general rule of thumb (at least in the United States).

So when I saw that one of my readers had a breech vaginal birth, I got excited! Having two breech-presenting babies myself, I wanted to hear how it went and have been dying to post her story. Farrah has her own blog here, but has graciously offered to let me borrow her story so you'll see it here, too!

One of the topics I have hoped to touch on in my blog is natural childbirth. Most people are amazed at the birth story of my youngest child who is now 14 months old.

People thought that Joe and I were crazy when we conceived our third child when our daughter was just a few months old. Maybe we were. I don't know, but I do know it felt right (and still does). From the beginning, we had tossed around the idea of a home birth, but I went back and forth about it my entire pregnancy. 

Fast forward to my 39th and most miserable week of pregnancy. I went to visit my midwife, to find out that my baby was breech. Of course, the medical standard is that breech equals an automatic c-section. I wasn't just going to give in and accept that. I told her that I was still a few days away from my due date and I felt that I could give him a chance to turn. She offered some suggestions such as inversion. I decided to visit a chiropractor who specialized in the Webster Technique, which is known to help breech babies flip. I also used techniques from Spinning Babies.

After some belly mapping and a medical opinion, we were convinced that the baby was now head down. I decided against any sort of medical induction and decided that I would go into labor on my own at home. My labor started at approximately 8pm and my water broke by the early morning. Now I was induced twice in the past (once for true medical reasons and the other was an elective induction), so maybe that is the reason I'm used to my babies coming out within 15 minutes of my water breaking. That didn't happen this time. I can't say that I was intending on staying home through the whole thing, but I froze up in the midst of active labor from lovely vomiting and pain that I just couldn't communicate that it was time to go to the hospital. 

I remember wanting to push and there was vernix and meconium coming out. It dawned on me that the baby had flipped BACK to breech. And I thought what a stubborn child this would be (and he is). We called the paramedics and I needed to push in the ambulance, but they kept wanting me to hold him in. To this day, I still find that ridiculous. It did cause problems because he needed to come out and needed oxygen after he was born. 

My breech baby was 8lb 15oz and was 21.5 inches long. It was just about as painful as a pitocin induced birth (I've never had a epidural). But it is an experience that made me stronger. I do hope to see more childbirth professionals educate themselves on the "hands off" breech technique and realize that breech babies CAN be born vaginally. I don't know if the United States is starting to change (I doubt it), but I know that in Canada, they have said that mothers should be allowed to try to birth a breech baby vaginally instead of automatically doing a c-section.

Farrah did say the birth was pretty painful; she could feel contractions going all the way down her legs and was "seeing stars." I am in awe of her intuition to head to the hospital when she felt the pushing phase was taking too long, and realized that yes, her baby was breech! She said that on the way to the hospital, medical staff was alerted to her baby's position and quickly "read up" on how to deliver a breechling. She said, though, that "within 20 minutes of arriving at the hospital, I was pushing him out." Wow!

Despite needing oxygen shortly after his birth, she says that her little boy nursed like a champ and was very healthy. "He's an amazing, content, breastfed, and intact baby boy. I love him very much and his birth was a very healing experience for me."

More reading:
Keep Your Hands Off The Breech, by Mary Cronk, MBE
No more automatic c-section for breech births, says OB/GYN Society

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

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*

Book Giveaway and Other Cool Stuff!

I've discovered the best way to beat the winter doldrums: go shopping!

I pre-ordered a copy of Ina May Gaskin's new book Birth Matters, which is due out in March. When my FaceBook fan page reaches 250 "likes," I'll give away this book to a lucky fan! (If you pre-order your copy before March, Amazon.com will give you a discount price.)

The UK version of
Ina May's book, from
Pinter & Martin LTD.

The first thing I noticed about this book was the cover: the British versions feature a photo of Ina May next to a nekkid kid, umbilical cord clamped, little doinky in full view of the world in all its newborn glory. In the US version of the book, this portion of the photo is cropped - perhaps to preserve this child's dignity, or because it's perceived as child pornography in the eyes of discerning US censors (or perhaps they're a little uneasy at the sight of an intact penis). Whatever the case, it almost seems like they're heading Ina May off at the pass - the title of the book is, after all, "Birth Matters: How What We Don't Know About Nature, Bodies, and Surgery Can Hurt Us." (emphasis mine.)

My next purchase was inspired by Birth Without Fear's blog post on Peggy Vincent's Baby Catcher. So far it's an easy, thought-provoking read and I can't wait to really get into it. I love her description of her own labor: wracked with pain and trying desperately to adhere to the advice of the Lamaze pamphlet ("the little blue book of lies") and her own humiliation, even as a childbirth educator, in asking for drugs during her labor. Vincent chronicles many of the births she's attended throughout her years as a midwife, and one thing is for sure: birth stories never get old!

I also picked up a copy of Marsden Wagner's Born in the USA, which I've been meaning to check out for some time. I haven't had much of a chance to really delve into it, but the introduction caught my eye over morning toast:

"Much of what is in this book will come as a shock to women and families in America. There are two reasons for this. The first is that accepting that our present maternity care system is as abusive as documented here is a hard pill to swallow. No society wants to believe itself capable of putting its most vulnerable members - pregnant women and their babies - at such risk. The second reason is that the American obstetric profession has managed to keep a big secret from the public for fifty years."

Right on, Dr. Wagner.

I also snagged a second copy of Tina Cassidy's Birth, just in case. Perhaps for a future book giveaway, perhaps to lend to someone who needs to read it. Come fall, I'm seriously considering suggesting this to my book club - I chickened out last time and wished I hadn't. Why? Because I was concerned that for some women, it might highlight the vulnerability they perhaps experienced while pregnant and laboring, maybe even bring back memories of past bad birthing experiences. While I want people's eyes to be opened, if they're not as birth-nerdy as me, they might take it as an affront to the choices they made while laboring, and I don't want it to end up that way. (But mostly now, I think the word needs to get out, so if they have issues with reading it, let the chips fall where they may.) If we do read it, I'm really interested to see what kind of discussion comes out of it: especially since I think women who otherwise don't discuss such intimate details with each other flow like Niagara Falls when it comes to discussing their births of their babies.

And because I just couldn't help myself, I stopped over at Barnes & Noble and picked up a copy of Swedish photographer Lennart Nilsson's "A Child is Born." I remember seeing photos that this miraculous photographer has taken over the years, and even caught part of the Discovery show's TV special on it. Unbeknownst to my husband and I, the very process of fertilization was taking place in my body, almost as if it were being orchestrated with the broadcast. We found out about two weeks later that we were pregnant with our first baby.

When I  gleefully brought the book home to show my husband, he cried. (He tends to be a very emotional guy as it is; when it comes to babies, he's a big ball of blubbering mush.)

Wow. Just...wow. 

Nillson started taking pictures in utero in the mid 1960s, including well-known photos of pregnancy on a cellular level - which astounded everyone (as it should!). Also included in the book are wonderful photos  - mostly emphasizing normal birth. One image shows mom pushing on all fours; and while analgesics are mentioned, nearly all of the photos of laboring mothers are free of IV tubing and monitors. The book does extensively cover preemies, and shows beautiful shots of moms (and dads!) in skin-to-skin contact with their babies, including plenty of images of babes at their mama's breast.

The book has been updated several times since its first publication in 1965, to include advancements in medical technology like IVF. There is also quite a bit of coverage devoted to artificial insemination, and interestingly enough only one page is devoted to cesareans. Among the reasons listed for them is "fear of childbirth," which in some ways is true, while in other ways isn't. I think the photographs are more representative of the normal birth culture in Sweden, where I assume most, if not all, of the photographs are taken. In this blog post, a dad talks about the process of midwives assisting throughout the pregnancy and birth and why he and his wife feel it's superior to giving birth in the US. He also mentions that Sweden's cesarean rate, not surprisingly, is around 17 percent.

While perhaps some of the text is out-of-date (the cesarean rate in the US is reported to be between 20 and 25 percent) that can easily be overlooked due to the amazing photographic content. While at first I was hesitant to buy this book, I thought of my kids and how soon they would be wondering, Where do babies come from? I figure this is a good place to start: with pictures of normal pregnancies and normal birth. When they're ready to be intrigued by naked boobies and body stuff, I want this to be the book they turn to.

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