Review: VBAC Facts Class with Jennifer Kamel

Image: VBACFacts.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What?!


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

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

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

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

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

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

Preach it, sister!

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

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


Per Wikipedia:

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

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

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

Apparently some women even have a positive pregnancy test. 

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

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

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

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

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

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

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

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

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

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

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


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

Scheduled 11/11 births should expose broken maternity system

Photo: Hilde Vanstraelen/
www.biewoef.be

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OB bribes mothers to deliver babies on 11/11

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

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

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

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

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

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

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

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

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

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

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

I am the 32 percent - but should anyone care?

Photo credit: Kirsten Ferree. 

The current cesarean rate in the US is hovering over 32 percent - and in my household, right now the rate is 66 percent - but as one doctor asked, Should anyone care?

Obviously a lot of people think you should care, for a number of reasons. Interestingly enough, several very good, informative articles have been done in mainstream publications about the rising cesarean rate, including Huffington Post, Time and others. (And perhaps rather ironically, I 'overheard' a conversation in the comments section on The SOB blog about how HufPo has become 'woo' in discussing childbirth matters, something that is probably far from the truth. And since when is telling people about the reality of high c-section rates 'woo?' Speaking of The SOB, her readers nearly swallowed their tongues when she wrote a post about the rising cesarean rate correlating with inductions. I guess they, too, don't want to believe the truth.)

When a doctor implies that he doesn't care about a particular aspect of his patient's care - especially something so serious as major surgery - it scares me. It makes me think of women who are pregnant with their first child, who may be relatively new to (or completely unaware of) the idea of "modern obstetrics" and many of the double standards and fear-mongering that many women are exposed to. Surely they've been to a doctor before, but something changes once you are expecting: as if the life inside of you means you have no individual rights of your own. If they come into it with little information or knowledge, like many of us have gained only through our own good or sometimes horrible experiences, it can be especially tricky. I hate to instill fear into the minds of people who are going through what should be a wonderful journey, not a fight; but how can I not tell someone, "You should be afraid of having a cesarean. And here's why."

"At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium went up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter."

"I watched mine with my
second, asked them to
keep the curtain down and
they said no...I watched it
through the light...and
listened to them talk about
me like I wasn't there. That
is why I think they want the
curtain - so they can pretend
like I don't exist." - Jade,
who had two cesareans

Since not everyone is into the Occupy Wall Street movement, I figured I would create a meme, of sorts, that some of us could identify with, if on another level. While the majority of people expressed how much they liked the image (if "like" is really the word), some were offended. One commented that it seemed to reduce us to percentages - and that's true. I agree, in that it does women reduce to 'just a number' to those doctors who are "dispensing" cesareans with a casual attitude. When you consider that a roomful of doctors laughs at the idea of caring about a 32 percent cesarean rate, where does that put us? Do they really care about your birth plan, or your wishes in labor? Do they really care that you don't want to be cut, or that, even more, you might not really need to be cut - that they hold the ultimate knowledge and power over you that says, 'I am going to do this, whether you like it or not'? Or that you trust them implicitly to not put you at additional risk unless it's truly necessary?

I'd like to think that what those physicians should have done was look to the two doctors who raised their hands and ask, "What are you doing differently?" The answers might be interesting, if only they'd listen.

When a room full of physicians laughs out loud about the high cesarean rate, it does reduce us to numbers, in probably the most callous way possible. It reduces us to a slab of meat on the table, a science experiment, a non-entity who provides entertainment, a conversation piece, a way to make a living, and possibly not much else. It certainly doesn't elevate us to mother of a child or human being. 


Related Posts:
The Myth of The Emergency Cesarean
My response to Free Advice Legal Forums: Childbirth Issues
Spreading the word on 'cut-happy' doctors

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

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*

Another cesarean? This time, I'm doing it my way

It's been almost ten days since my youngest turned two. On his birthday, I thought back to where I was - and how much of my birth story I still find triumphant, some parts completely dissatisfying and frustrating. From the time he was probably less than twelve hours old, the seed was already planted in my mind: I wanted another baby.

But was it for a do-over? Was it for the right reasons?

I still think what I thunk before: I want another baby. And I must resign myself, if I ever get to that point, that I might have to have another cesarean.

The moments leading up to and following my son's birth still leave me frustrated with myself and completely hollow inside: I felt no joy when I first saw him. I only realized later that an adverse reaction to the anti-nausea meds they had given me prior were what made me feel like I was having a panic attack, a feeling of intense anxiety and a weight pushing down on my chest. The only thing I could do was thrash my head back and forth, since I was numb from the chest down. No one noticed; I asked my husband later if he remembers me doing that, and he said no.

I resigned myself to the idea that if I had another cesarean, I would want it done my way. More attention paid to me as the mother, rather than standing over me having a conversation that didn't even pertain to me. Somehow making me feel like more of a participant, instead of just lying there like a dead fish. Perhaps asking me if I wanted to see my baby being born, or at least be able to hold him immediately following the surgery. Keep him in the room with me as they're cleaning him up, where I can see him, instead of in another room where I can only hear and just imagine what is going on. And the ability to hold him skin-to-skin, and nurse as soon as possible, with no immediate separation for newborn testing.

It's sad that you even have to ask for such things to happen, rather instead putting up with things like having your baby immediately whisked away because it's a matter of course, rather than something really being wrong. I've heard many expressions of "You've waited this long to see your baby, you can wait another couple of hours." The immediate hours after my first cesarean were such a blur that I don't even remember where my son was most of the time, and their idea of separating us so "I could rest" is the biggest bunch of bullshit I've ever heard. A half-attentive nurse was popping in and out over the course of several hours to check my beeping IV, which she had inserted improperly, causing that very important post-surgery pain medication to actually leach into my tissues, instead of into my veins. Nurses didn't believe me or even take notice when I said it hurt just as badly to inject myself with pain meds, and actually told me I couldn't have any more because I'd already gone past my ten-dose-per-hour limit. Not, "Are you still in that much pain?" or "Let's see if there's something wrong."

Ironically my VBAC in the same hospital three years later was a totally different experience. I had no epidural, so was able to walk around and move freely, and felt great. My labor was pretty short upon arriving at the hospital, and I was in a post-partum room with a matter of hours. The nurse brought me my food (they told me after the first baby that I was responsible for getting my own, after just having had major abdominal surgery). I was puzzled, but am still curious why I got better treatment after a vaginal birth than I did a cesarean. I decided before my third was born that I would never give birth in that hospital again.

Not that long ago, a friend shared her link with me on "Gentle Cesareans." Curious, I realized it was basically a "Cesarean, My Way" plan, that involves the mother more in the birth process and makes it feel more like a normal birth. (I hesitate to call this "natural," because, after all, if surgical birth were truly natural we'd all be born with zippers on our abdomens in addition to a perfectly working vagina, in my opinion.)

Like this article, I ask many of the same questions: Why do our arms need to be strapped down? Why are we so shielded from ourselves, and why aren't we asked - which I never was - whether we wanted to watch our baby being born?

Taking my history into account, if I should become pregnant again I'll have to consider my options carefully: I've had two cesareans, a history of late-onset PIH, and two prior breech presentations. I know that decision might come sooner rather than later, if the baby is breech - either I find a care provider who will deliver me anyway, or I consent to another cesarean, this time on my own terms:

I want to see my child being born.

I want my child to be cleaned, weighed and measured where I can see. (My first wasn't even in the room with me while this was happening.)

I want the baby to be handed to me immediately, and as much skin-to-contact as soon as possible.

I want the baby to be with me, or nearby, if I can't hold him, at all times.

British obstetrician Nick Fisk "pioneered" this "groundbreaking approach to surgical delivery," in an age where many doctors are clinically-minded and all about speedy deliveries. In a case of distress, that is obviously of the utmost importance - but in a scheduled delivery? And why do you have to ask specifically for this type of delivery - why isn't it done, whenever possible, to give the mom the very best birth experience possible? (And perhaps by acknowledging the "gentle cesarean" are they essentially saying that there is more to the birth experience than just a healthy baby?)

As Fisk started to examine the conventions of surgical delivery, he was struck by how easily they could be challenged. Why, for example, did they need to be done so quickly, when slowing them down would give the parents more chance to participate in their child's delivery and might give the baby a gentler experience of coming into the world? Why, too, was it so important for the parents to be screened off from the mother's abdomen? And was it really essential for the baby to be whisked off for an immediate medical examination, rather than delivered into the arms of his mother?

What I want to know is, what took them so long?

Do you need a doula?

When most people think of labor support, they conjure up images from movies and sitcoms: the idea of nervous dads and meddling mothers-in-law, in a scenario of total chaos where everyone freaks out so much they pay little attention to the laboring mother. I've talked to a few people who, if they even know what a doula is, think they're a waste of money and would never hire one, because they have their husband, after all. This is really quite unfortunate.

I'm not downplaying or underestimating dad's role as labor coach. Some dads are terrific - rocks of strength and support for their laboring partner. Some are not - quivering, uneasy blobs of jelly who hit the floor the moment the first real contraction hits. And some are on the fence - they want to support their partner in labor, but often fall prey to the hospital staff who sometimes use fear and scare tactics to get mom to comply.

This is where a good doula comes in. Perhaps not just to support mom, but both parents in labor.

A few days ago a most disturbing blog entry was posted on My OB Said What?!?. A mom was going over her birth plan with the OB, and requested no pain medication. The OB responded, "That's okay, we'll just get your husband to sign the release and give you an epidural anyway."

I can't think of anything more repulsive.

I'm not even going to join the "at least they were honest" crowd, because regardless of whether it's a bad joke or not, it's downright despicable. And clearly it's obvious that this doctor willingly uses dad as a pawn to manipulate the mother into things that she doesn't want and might not even need.

Some OB's, in discussing birth plans or other details with the female patient, will completely overlook mom and make eye contact with dad instead. As if he's her overseer; her boss, her daddy, if you will. This is why it's so important for both parents to be on the same page about birth wishes. And if they're not - if dad is on the fence - I strongly recommend a doula, who will help both mom and dad in the process.

This is another reason why it might not be a good idea to have dad, or another family member, as labor coach: they love you, they don't want you to suffer or be in pain. If dad, or mother-in-law, or whoever, is quavering even a little bit, that fear comes out and someone will tap into it: whether it's an overbearing nurse or a doctor who just wants to get it over with and move on to someone else. Having a neutral third party there, if doctors and nurses are unsupportive or blase about mom's birth plans, is essential.

I also recommend hiring a doula if you you have no labor support. Mothers whose partners are deployed, or where family is far away, could greatly benefit from having a doula. Think of all the inductions that take place simply because mom is waiting for parents, grandparents, sisters, etc. to roll into town. Just because of this perceived lack of support, mom now puts herself at greater risk of cesarean section and a whole host of other potential complications, and for what? I often think that if women and their loved ones knew what an induction entails, and the complications that could - and often do - arise from them, they would never want you to go through all that just for their sake.

If you desire a natural, normal birth like the woman mentioned above - with no induction unless absolutely necessary, no Pitocin and no epidural - then hiring a doula is probably the best thing you can do. While there's definitely no shame in asking for drugs if you need them, you should not buy into the illogical farce that you absolutely need drugs to get through labor, because you might not. It's the doula's job to remind you of that, much to the chagrin of the OB. While some hospitals are completely supportive of natural birth, many are not, and those women who truly want that experience might find it hard to combat aggressive nursing staff or the idea that they are stupid, uneducated or ill-informed because they recognize the risks of pain meds and want to forego it if they can.

Mothers who are attempting a VBAC or twin vaginal delivery would likely benefit from having a doula as well, mainly because women in these situations are finding increased pressure to perform a cesarean because the medical establishment sees these scenarios are increasingly seen by the medical establishment as "dangerous" or impossible

Another group of women who could benefit tremendously from a having a doula are teen mothers. There is already so much negativity and bias towards young mothers while they're pregnant that it often makes it very difficult for them to find support while in labor. Their youth, coupled with the possibility of being completely uninformed about the birth process, as well as their rights and choices in childbirth, can make it a disastrous situation that no doubt ends with more primary c-sections. Not to mention it further embeds a very abnormal view of birth in their minds, which is hard to erase or change.

Yesterday I had a wonderful conversation with a friend whom I am going to lobby hard for this year to become a doula. She has been the labor support person at almost all the births of her grandchildren, and attended nearly two dozen births while working as a crisis teen pregnancy counselor. She told me one interesting story of a young mother who was in active labor, and the nurse wanted to give her Pitocin.

ML showed up at the birth and the nurse demanded to know who she was. Nurse Ratched then told her that the patient needed to be put on Pitocin, and ML demanded to know why. "What do you know about Pitocin?" the nurse asked defensively. In other words, How much can I get away with telling you before you'll realize I'm giving you a load of crap?


The nurse explained that they needed to free up more beds on the L&D floor, to which ML replied, "This girl is already in active labor. Go speed up somebody else's contractions."

As far as ML is concerned, I think she'd make a great doula. She is compassionate, caring, and yet outspoken. Even if you don't know the ins and outs of something like a doctor or nurse would, just asking questions - "Why do I need to do this?" - makes a world of difference. And if they can't give you a good answer, chances are you don't need whatever they're selling.

ML affirmed my opinion that teen mothers - who are already in a position of vulnerability - are often the scapegoat of frustrated care providers who are out to "teach them a lesson" because they got pregnant so young. No one needs that care and support more than someone who is not that far out of childhood herself.

Studies have shown that doulas can actually decrease the rate of epidural use and cesareans (although they most certainly can attend you if you do have a cesarean). Although I kept an open mind about pain relief when I had my VBAC, my doula was - literally - a focal point for me while in labor. She talked me through it, was supportive and focused on me, and I focused on her. It was literally like having an extra person there to guide my husband in his support for me, too, so that the care and attention he paid me was more productive and meaningful. (In other words, he didn't look at the monitor and say, "Looks like another contraction is coming!" like he did during my first labor, God bless him.) Following the doula's lead can encourage other family members who might be present not to contribute to the general freak-out factor when they see how things can progress normally, without such a sense of urgency.

Unfortunately, some doctor practices forbid the use of a doula, which in a strange way I find sort of comforting. Not only does it tell you that perhaps your control-freak doctor might not be the right fit for you, but it effectively admits that the doula can be a symbol of peace and calm, yet power all at the same time. Because of her neutral advocacy, she is there to remind you that yes, you can do this! and provide mother-focused care that the OB might not, which means you just might get the birth you want and deserve.

More recommended reading:
Doulas of North America (DONA)
Statistics on doulas and how they can help in labor
He Ain't Creepy: He's My Doula