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.

The ultimate litmus test: vaginal birth or cesarean?

You can tell Jessica Simpson is getting close to her due date - the "Will she have a cesarean?" question comes up. Apparently there is a story circulating the internet (and has been for months) that says Jessica wants to have an elective cesarean to avoid childbirth pain. Is it really true? Who knows.

The thing is, before we go off on a tangent, we need to realize a few things: first, it's her body, right? It's her choice, whether it's an ill-informed one or not. Secondly, the same thing was said of her sister Ashlee - and we still don't know, after two years or however long it's been, whether she had a vaginal birth or cesarean. It's almost like the tabloids picked up the old story and just switched the names.

Ultimately, it doesn't matter. And yet it does. Beyonce went through the same thing - even drawing criticism over whether she was really pregnant - and we find ourselves back in the same place. The entire birth community came down on her for one reason or another, and then had to backtrack when they realized they had fallen for a story that wasn't even true. Does it even matter? It's not our story, we don't own Beyonce or any other mother, and I hope it didn't steal her joy. Jessica is probably facing the same thing - people who question her decision and judgment, starting another battle that proves the mommy wars are alive and well and says, "Welcome to motherhood!" I won't even say it's the natural birth community that's jumping on her case - it's women in general. It doesn't matter in that it's her decision to make and not ours; it does matter in that it might send a message (as if that hasn't been done for decade upon decade) to women that trivialize cesareans and their risks. It doesn't matter in that, in the end, a baby is born and will take its place among the millions of other babies - and there are plenty of celebrities and influential people who don't want to electively have a c-section. It doesn't matter because, in six months, we'll be focused on something or someone else - the next flavor-of-the-month will get pregnant and we'll be asking the same questions about her, too.

After awhile all the questioning starts to sound like a litmus test to prove your worth as a woman and mother among other women and mothers. What next? Proof that she delivered in a particular way? Do we want to see the scar? The episiotomy? It sounds disgusting, but seriously, that's what it's starting to sound like. If she has a cesarean, I suggest we use this time to reserve judgment and instead gently advocate - instead of turn it into a virtual slugfest between people who think they have the monopoly on childbirth, whether it's "I had three cesareans and turned out fine!" or "I had three totally natural births and turned out fine!"

It's her body, and her choice. Whether we like it or not.

On birth suites and breastfeeding: what a busy week!

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

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

Photo: TMZ

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where's Maria when you need her?

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

Birth Diva

More on Celine Dion, who is expecting twin boys sometime within the next few weeks: apparently there are reports that she has already scheduled her c-section date for October 22, which her husband claims is false. He adds that doctors want her pregnancy to go on as long as it possibly can, that they do not have a date scheduled, and that Celine (like most of us moms, geez) would "never intentionally endanger her unborn children by scheduling a birth early like this."

(There's also talk that she's not having a cesarean, but I'm not sure how accurate this is yet. I certainly don't think it means she's attempting a VBAC, just that she hasn't scheduled her c-section yet.)

Perhaps Celine is well-aware that some twins come early, and yet that some of them are coaxed/induced/nudged/forced into the world early because of doctors' preference when it comes to multiple births. Iatrogenic prematurity, or prematurity of the baby brought on by physicians due to either maternal/infant problems or just plain old miscalculation, is a big problem with multiple births - really, singleton births as well. While I'm sure Celine knows when she conceived because she went through IVF, lots of doctors simply don't believe a woman who insists that her dates are right/wrong based on irregular menstrual periods, ovulation and other factors. They like to say that few women really know when they conceived, but honestly, we were there when it happened, right? You, Dr. Due Date Wheel, were not.

"Reports" (whatever that means) claim that, along with the phantom due date scheduling, Celine "has exhibited diva-like behavior at the Florida hospital where she plans to give birth." Wow. I'm sure hospitals aren't used to that for a change: the mother calling all the shots! Celine has, apparently, been requesting specific nurses (you go, girl!) - that makes her a diva?! (Apparently her husband is denying that, too.)

Hello -  if true, this could be Celine's way of saying "Some nurses are nicer than others, and I don't want unsupportive, judgmental Nurse Ratched anywhere near me." Actually, plain old laboring you and me can request specific nurses at the hospital, if you get someone you don't like. Don't be afraid to stand up for yourself and fire your nurse - or your OB! - if they aren't supportive of you in labor!

Personally, I think all laboring women should exhibit "diva" type behavior when having their babies. Not in an arrogant way, or in one that puts them or their babies in danger, but in a way that says, "I am the laboring mom here, not you, and you will respect my rights. You will not treat me like an object, a cow that's to be gutted for the slaughter. You will not do things to me without my permission, and I will not allow you to mistreat me, or subject me to risk without a good, sound explanation. You will treat me like a person, and realize that I, too, have emotional and physical needs, that it's not all just about the baby. Because when I am cared for like a human being, I can care for others around me all that much more."

Rock on, birth divas!

Read more here.

Stars who 'ditched the epidural'

A few months ago I posted a link to a study that suggested poorer, less educated women refuse the epidural.  When you see a list of celebrities who are opting out and choosing natural birth, it makes you wonder how accurate that study really is.

Granted, I know they're not in the majority. But it's refreshing to see celebs choose a more user-friendly approach to birth. And young women, too - I think that's awesome. They are sending a message that yes!, this is possible and no, you don't have to grow your armpit hair long and braid it or eat Grape Nuts cereal every day in order to want a natural birth.

Among the list are:

Gisele Bundchen - At the top of the list is supermodel-turned-birth-activist Gisele Bundchen. Everybody's heard about her bathtub home birth, and while some are riled about it, who gives a crap. She should be at the top of the list - but I'm not sure many people understand why. Given the fact that in her home country of Brazil the c-section rate is around 36 percent, and she chose an unmedicated home birth, I think this is of the utmost importance. We can only hope that her fellow countrywomen are looking on from afar, thinking, "Hey, maybe a vaginal birth isn't such a bad idea." I'd love to hear what Brazilians think of her as a result. And the reaction elsewhere? The Daily Mail says, "Gisele claims son Benjamin's birth didn't hurt." Claims? What, do you think she's lying?

Nicole Richie - The actress refused "even an aspirin" in labor with her daughter, which the author describes as "hardcore." Considering Nicole is a recovering drug addict, I can see her reluctance to have pain meds. What makes that "hardcore"? I think it's smart. This is probably one gray area that is often ignored - the addict who is managing pain of labor. I remember reading (maybe on The Unnecessarean?) about an addicted mother who refused pain meds, and the nurse made sure to come in early and often to badger the patient into getting an epi. I can't think of a more humiliating experience - having your addiction thrown in your face, especially when you're trying so hard to overcome it. 

Jessica Alba - This young, first-time mom had a very 'zen birth' with daughter Honor and apparently 'didn't make a sound.' The author's comment: "Ok, somebody's lying." Huh?

I found that vocalizing during labor helped, but it's different for everyone. Many women make noises, many are quiet - it's not all the way you see childbirth portrayed on soap operas. I've heard women claim that screaming is a 'sign of weakness,' which I think is complete garbage: we know that for some, vocalizing can help them manage pain and works as a release, of sorts. I tell people, "I screamed in labor not because of the pain, but because it was freaking hard work!"

Joely Fisher - Carrie Fisher's younger half-sister gave birth to daughter True Harlow Fisher-Duddy at home, in the company of doulas, midwives, and a doctor, according to mom. The author's comment: when we can't think of a jab to make about her opting out of pain meds, let's say something creative, like "Maybe each person got to pick one of the baby's million names?" What?

Interestingly, the article's author mentions a friend who'd recently had a baby and felt that she was manipulated into having a c-section for fetal distress. Of course, when the baby was born, it was perfectly fine. The author even mentions Ricki Lake's movie "The Business of Being Born." And yet, the overall tone of the piece is that women who choose to opt out of the epi are somehow crazy, liars or "hard core," which attaches sort of a freak label to the whole thing. For some who might be curious about a natural birth, this association alone might be enough to completely scare them away from the idea, and 'poor and less-educated' seems to have little to do with it: "Women who give birth without drugs are out to prove something, and are completely nuts."