Why I don't go to the OB anymore

As the news of team doctor Larry Nassar's sentencing makes headlines and his victims are finally being heard, it makes me fearful of their futures as they potentially enter their childbearing years. How will they ever trust a doctor again to care for them?

Awhile back I visited my gastroenterologist for a yearly follow up, and the assistant taking my medical history gasped when I said I hadn't been to an OB since my eight-year-old was born. She asked me why and I'm not even sure I responded. A friend gasped when I told her the same thing, and that I hadn't had a mammogram despite being 43, and she said her doctor has been ordering them for her since she was 35 despite being low risk.

To the intake nurse who was shocked and probably thought I was being irresponsible with my health: do you really want to know why I haven't gone? How much time do you have?

My very first gynecologist when I was college-aged was nice, she took the time to answer my questions and explain procedures. She also treated one problem effectively; the other, not so much. Not much questioning going on, just creams and this that and the other that made it worse.

The second guy, more cream. A cream that basically makes it feel like you're lighting fire to your skin. Not even sure what he felt he could accomplish with that. When I relocated out of state and saw someone else, the nurse gasped audibly when I told her what he gave me and couldn't imagine why he did that.

Soon I would start having children. The next practice I was in involved a doctor who had only recently had his license reinstated, I found out later, because he had made inappropriate sexual remarks to a patient. He's also the same guy who inaccurately told me that my child was vertex, even though I knew he wasn't, and argued with me. This was probably a major turning point in my pregnancy because we could've likely attempted a version at this point (they never offered, not once). But no, he remained breech, undetected, until I was about 37 weeks. Another physician in the practice did an internal on me - which now I wonder was really her stripping my membranes despite my child not being in a head down position - and determined that he definitely was breech, which was confirmed by ultrasound two weeks prior to my delivery.

When I had the baby, the first thing I said when my primary OB checked on me in the hospital was, in a super groggy state, that "all my children would have to be born this way." How naive and uneducated I was, and he knew it, because he didn't correct me.

When I got pregnant with my second, I was still naive and uneducated. He presented me with a choice at my first appointment: have a repeat cesarean or try for a VBAC. What little I had heard about VBAC sounded dangerous, and I told him so, that I felt I would just have another cesarean because "that was safer." He didn't correct me.

When I was nearing delivery with my second, I had an epiphany. Not only was she not breech like her brother, but I was more informed in my delivery options and just pissed off enough to exercise them. I remember vividly the appointment where I told my husband he had to come with me to break the news to my physician, who would not be happy. As if he was my daddy or something. The doctor already had a bit of a nervous stammer and it came out even more during that appointment. My husband was not pleased and shortly after that expressed his outrage and hatred for the doctor, who literally told me "I have one patient on her fifth cesarean and she is doing fine" when I confronted him about why he was downplaying the risks of repeat cesarean and making VBAC sound so terrible. That was his idea of informed consent. In response to this mystery patient that probably didn't even exist, I said, "Well, I don't want that to be me."

One of the midwives in his practice, upon hearing my plans, said, "I do not want to be doing this." Whatever happened to those caring, supportive midwives I kept hearing about?

I finally left that practice at the beginning of my third pregnancy, when another midwife in the practice basically made it sound like it was "my choice" to go through with it, despite the possibility of catastrophe. In other words, my fault. I left there in tears and never went back. It was not my first horrible interaction with her.

The next physician's group employed no midwives. Just doctors who bullied, coerced and lied. The lead physician in the practice examined my "little problem" and immediately tested me for herpes, even though I knew it would be negative. It was. He also didn't tell me what he was doing it until he had literally torn a piece of my labia off and it was over. He billed my insurance, I'm sure, but never asked me for permission to do the test.

At one point during that pregnancy I felt there was one doctor in the practice I could trust. That trust quickly eroded when, during a particularly lengthy conversation, she was having a tough time getting me to give up my hopes of avoiding another cesarean and then admitted she herself had had three of them. And then billed me for a 'consultation,' despite not having told me of what she was doing and the fact that my insurance was supposed to cover my office visits in full. This same office had billed me one other time for observed swelling as being "outside the scope of pregnancy care," despite it being quite common in pregnancy, in summer, and especially after the patient is being forced to wait in the lobby for over an hour to be seen.

One doctor in the practice worked hard to get me to consent to a cesarean for high blood pressure a week before my due date. I really wanted my baby to come on his own, hopeful that it wouldn't be a surgical birth. I quickly refocused and hoped it wouldn't be a cesarean done by her, praying that she wasn't on call. She had already scared me into thinking he was big after taking almost no time to measure me properly, sending me for an ultrasound where the lovely technician basically told me very politely that my doctor was full of crap.

When I was admitted for observation, the same doctor called my room repeatedly to harass me. When I finally answered the phone after several tries, she angrily asked, "Do I have to come down there?" like I was a disobedient child.

A resident had been counseling me yet again on the dangers of VBAC and told me the rate of rupture was 10%. I cringed inside and found myself shriveling in fear, as if I couldn't possibly stand up to their tactics. I remember thinking to myself, if I am going to preach to countless women about being advocates for themselves and their babies, it needs to start with me. I then told him he had his decimal point in the wrong place.

This same practice also had at least one nurse on staff who was downright nasty, even making a negative comment about my baby after he'd been born. I don't even remember what she said, but knew it must've been bad if the old lady receptionist apologized on her behalf, embarrassed.

When I came back for my six week checkup, I felt off. Not depressed, but just blah. The physician blankly stared at me and asked, "Are you depressed?" "Not that I know of," I answered, but wasn't exactly sure what to tell him. He told me he was obligated to ask and then ordered bloodwork and went on his way. The blood work revealed that I had a thyroid problem, which he also didn't know anything about, and I went untreated for probably another 18 months.

So I haven't been back. It's been over eight years and I know I should go, but I'm terrified. Waiting to be asked, "why'd you wait so long?" and subjected to a battery of bullshit I probably don't need, same as before. Only now it's a new game to play: when can we schedule your mammogram? I hate to tell that friend who's doctor ordered them at age 35 - but that's not even evidence based care. So when you transition out of childbearing to perimenopause, you're basically trading one set of fears over bad care for another.

When my online friends would talk about having a close-knit relationship with their OB or midwife, who is caring and listens to them so well, I realize I have never had that, not once. That I can't relate to that on any level whatsoever and now have an overwhelming sense of needing to watch my back. As if navigating the waters of "birth outside the box" wasn't stressful enough, now you have to worry about menopause and cancer this and cancer that. Being subjected to the same crap time after time despite countless studies - some of which that are at least a dozen years old - that suggest it's not really the best way, but seemingly take decades to implement, all the while receiving gasps and stares because you're dangerous and irresponsible. It makes me want to punch the Susan Komen Foundation in the face.

So this is what I want to tell someone when they ask why I don't go. And there are millions of women who have had it much worse than I. I know there are good, caring and supportive care providers out there but as of yet, I just haven't found them. I'm hoping that Larry Nassar's victims will.

Reply turned post: The Beauty of OB

You often see posts like "Confessions of a Labor Nurse," or "Why You Need Pitocin in Labor" (I think poor Nurse Jenna removed that post a long time ago) and they're supposed to be touchy-feely, feel good pieces that make you come away with a renewed sense that childbirth is such a special time, that your care provider really does care about you and your child and they only want the best for you. Which sometimes comes at a high price, we know. Sometimes an induction, a cesarean, difficult labor and delivery - they all can happen and are often a rite of passage before entry into motherhood. 

It's hard for me not to be cynical about it. But to cut to the chase, sometimes I think the true beauty of OB is that women still want, and manage, to give birth at all after being subjected to the institutional abuses and misuses that are so typical of modern obstetrics. 

That isn't to say I'm critical of lifesaving measures, or that I'm saying, "All cesareans are unnecessary!" I'm more critical of abuse of care and intervention that is misconstrued as good care, when really, it's excessive and sometimes pointless, sometimes causing the problem you're trying to prevent in the first place. 

But I feel like all these posts have an overtone that says, "You should be thankful. Now shut. up."

The author of this article over at Huffington Post is an L&D nurse. I'm not, and I'm not trying to compare my experiences with hers. But as I see so often in these posts, they really don't get to the heart of the matter. They sort of gloss over, or completely miss, whole areas that are often untouched in our culture of women. The idea that women often come home without a baby, or sometimes never come home themselves, is incredibly tragic. No one is arguing with that. Modern obstetrics has saved many lives, both mothers and babies, and yet the place we are in today is proof of how its overuse can taint our perception of things so much we can't see what's really going on. 

Often the women who are missing, shattered or empty, as the writer mentions, are not only the ones who never survive childbirth or come home to an empty crib. They are often women who look normal and whole on the outside, with perfectly healthy children. We cannot discount their experiences and just assume that everything is perfectly normal and right because we can't see anything broken, or lost. If a woman is subjected to horrible treatment in labor, sometimes resulting in physical injury, how many times does an attorney refuse to handle her case if she seeks prosecution? Because she and her baby both appear healthy and happy on the outside? If no one is physically maimed or dead, they don't even want to talk to you. 

The author mentions staying healthy in pregnancy and waiting for active labor as ways to have a healthy delivery, avoiding induction unless for a medical reason. But unless you know what some valid medical reasons are (and more importantly, aren't) anything that comes out of your doctor's mouth is therefore a 'medical reason' and before you know it, the Pitocin is flowing. Staying healthy is relative, unless you're an illicit drug or alcohol user, and even the healthiest, most informed women can still be subjected to dubious care at times. Oftentimes it never seems to be enough. And often has nothing to do with you and everything to do with an impatient, overbearing care provider who is set in his/her ways and refuses to change. 

She mentions the case of a teenage mother who was induced, with no success, and then sectioned. As a result, she hemorrhaged and her uterus was removed. They lamented, rightfully so, over the fact that she would never have any more children. Do they ever lament over how some teen mothers are degraded and insulted because they're young and often unmarried? Or do they consider for a moment that this young mother's complications were caused in part because of the induction, which carries a risk of postpartum hemorrhage? Why do these happy sunshine articles never, ever candidly discuss what goes on behind closed doors, the whispered conversations or blatant remarks when they don't think a patient is listening - or when they don't care if they are? 

Yes, it's great to do all the "right" things in your pregnancy to encourage the best outcome possible. And sometimes, those things happen despite your best efforts. But when you look at these figures, it's hard to see the "beauty" in OB, only the ugly side that makes it seem like the deck is stacked against you. 

For the original graph and accompanying post, click here. 

Source: Evidencebasedbirth.com,  Rebecca Dekker, PhD, RN, APRN 

Childbirth education is important!

Someone shared this meme on FaceBook and I totally loved it, because it was so true: (click here for full text)

It's been said that women spend more time researching and shopping for major appliances than they do their birth options. And when it comes to your wedding day, you go to great lengths to make sure everything turns out just so - even though it sometimes doesn't - spending countless hours in preparation.

I once heard someone say how when a wedding doesn't turn out as planned, when a detail doesn't work out the way you wanted or it pours down rain during your beautiful outdoor ceremony, people are sad for you. They express regret and sympathy for you that "your big day" might have somehow been marred. Yet, when your plans for childbirth are totally derailed or you feel that you were denied something during the process, they basically tell you to "deal with it!" or "Get over it, you don't get a medal!" "That's just the way it is, so what?"

They wouldn't tell you that if your bridesmaid ditched you a week before the wedding, or if the cake was the wrong flavor.

With a good childbirth class, it can not only help you prepare for that big day, but fully realize just what your body is capable of - as well as help you realize that sometimes, the routine practices in maternity care are not always evidenced-based, or the "best" thing for everyone.

Would you want a cake decorator to say, "You must have a chocolate cake. That is the only flavor that's any good, and even though you're allergic to chocolate and don't like the taste of it, I'm making you a chocolate wedding cake!"? Probably not. Just like flavors of a wedding cake, there are options in childbirth; you just have to know what they are.

There are all kinds of childbirth classes. Fortunately I had a great one with a nurse midwife who herself had had normal births and a VBAC. She discussed a wide range of options, the realities of choosing them, advantages and disadvantages. What she did not do was paint a picture that said, "You are a bad person for choosing to have an epidural!" Nor did she act like they were terrific and every woman should have them and no woman can ever make it without one.

I chose the long, six-week whatever class, because there was a lot to learn! Some choose the condensed, intense version that is over and done with in a few hours. Personally, when you consider that it seems like many women don't fully understand the process of childbirth and what it entails, it sounds like the long version might actually be a better option. It's hard to work that out with busy schedules and work, etc. but this is your body - and your baby - we're talking about here.

Would you buy a brand new car or go on a cruise without spending time and effort researching it? Hopefully not.

When it comes to birthing options, especially VBAC, it seems that not many women know they do have options. Studies have shown that women often choose the mode of delivery that's preferred by their doctors - which likely means a lot of physicians are influencing their patients to choose a repeat cesarean. Unfortunately, many are limited because of the hospital they plan to deliver at, where VBAC is either banned or there is a de facto ban (meaning, the hospital "lets you" attempt one but no doctor will agree to attend you. Especially with regards to cesarean section and induction, childbirth education can mean all the difference. What are the risk factors? What does the procedure entail? Sometimes you cannot always count on your doctor to tell you this information up front. And I can't even begin to tell you how many people I've heard say, I'm being induced tomorrow and I have no idea what to expect! Does their doctor not tell them anything? Do they do any of their own research?

I once sat in on a childbirth education class and was extremely disappointed to find people talking and chattering amongst themselves when the instructor mentioned risk factors for cesarean section. Ladies, don't ever think "This will never happen to me." Sometimes it happens for very necessary reasons that are beyond our control; sometimes it could have been avoided. I think prevention is key - and sometimes the very things we consent to in labor can often be risk factors in cesarean delivery. It's hard to focus on future births and how they might be impacted by decisions and choices you make today, but that's pretty much how it often works. How can you truly give informed consent when you aren't fully informed?

I don't ever want to blame a mother for not being "educated enough" about the process. Sometimes you have all the facts and it's still not enough to prevent something from happening. But being educated about the process and feeling capable of making informed choices and educated decisions can often help tremendously when it comes to accepting with the outcome.

Did you take a childbirth class? Did it help you or not?

I can has cheezburger? Rethinking the "nothing by mouth" rule

I can has cheezburger (in labor)?

For decades it's been common hospital practice to restrict women from eating or drinking during labor. The ubiquitous cup of ice chips has probably been featured in every movie and sitcom featuring birth, but do we really know why - or even when - this "rule" came about?

In 1946, Dr. Curtis Mendelson studied the medical records of over 44,000 women and found that 66 of them experienced pulmonary aspiration - the process of taking food, fluids or secretions into the lungs, essentially. Forty of those women aspirated liquids; only five aspirated food. Only two of the women died.

One of the risk factors for aspiration is anesthesia - which causes the normal protective reflexes such as swallowing or coughing to be diminished. Therefore, Mendelson surmised that because that danger is there, common practice should simply be to cut off all food and fluids to a laboring woman, just in case. Another risk factor is the lithotomy position, the manner in which probably every laboring woman during Mendelson's stint in obstetrics gave birth.

In Dr. Mendelson's day, general anesthesia was widely used in childbirth, even in vaginal deliveries. Therefore there was greater risk - but as you can see from his study of the 44,000 women, the risk even then was still quite low. Today, few women receive general anesthesia during birth - somewhere between 3 to 13 percent of women undergo it for a cesarean section - and it's much safer and used with greater knowledge and skill today than 65 years ago. So why do we still follow this outdated rule?

Studies have recently shown that prohibiting food and drink in labor serves little if any benefit. What it can do is practically starve the laboring woman, especially if her labor is a long one, during a time when her body needs crucial energy. Maternal exhaustion can be a factor in many long labors that end in cesarean.

In other countries, such as the UK and The Netherlands, many care providers leave the decision to eat and drink up to the mother. A majority of hospitals in both countries do allow the woman to drink, and about a third allow both fluids and food. In US hospitals, it's more commonplace to be restricted to just ice chips, although things are changing - slowly.

The common alternative to the "nothing by mouth" rule is to administer fluids intravenously, which has it's own set of disadvantages. Being hooked up to an IV pole can severely curtail movement, which limits your ability to cope with pain and probably means you'll want an epidural if you're confined to bed. Although it's possible to just trek around the hospital hallways with your IV pole in tow, I think in my childbirth experiences I've only ever seen one woman do it. Some that I talked to said they basically weren't allowed to walk the hallways at all. Excess fluids can pose problems, including fluid overload. It can also impact what is perceived to be newborn weight loss if a mother has received lots of IV fluids, which might hamper breastfeeding relationships if care providers fail to take this into account.

Some studies show no difference in outcomes between the groups who were allowed to eat and drink freely and those who weren't. Other studies show that it shortens labor and reduces the need for Pitocin. And still other studies found that among those who drank large amounts of fluid, they actually experienced failure to progress more frequently (no word on whether they were allowed to empty their bladders, though, which can make a difference in some women).

Other concerns that some obstetricians have is that eating and drinking can cause nausea, even though at least one study showed that none of the participants experienced nausea (all women drank fluids and 85 percent of them ate food). It's also common for women to experience nausea and vomiting anyway because of transition, which is a totally normal process of labor.

While many women might not want to eat anything, the choice should still be left up to them. I personally made sure to eat something simple - a piece of bread with butter on it and a glass of orange juice - before leaving the house to head to the hospital. In my VBAC labor, I drank bottled water but didn't feel hungry, even though I gave birth close to lunchtime. I ate the same thing prior to my last birth, which ended in cesarean, and the anesthesiologist was excessively worried about the lone piece of bread I ingested over an hour before. It wasn't a problem, but ironically I had a bad reaction to the Reglan they gave me for nausea. We have to ask ourselves: what about risks among the general non-pregnant population? Should we make everyone eat nothing for six to eight hours prior to getting in their car simply because they might get into an accident and need surgery? Of course not!

It will be interesting to see if more OB's, hospitals and even patients get on board with this idea - and realize the notion of limiting oral intake for every woman, regardless of risk, is more outdated obstetrics than "modern."

More reading:
Should we eat or drink in labor? - by Robin Elise Weiss, LCCE
Mendelson's Syndrome
Oral Intake During Labor: A Review of the Evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My response to Free Advice Legal Forums: Childbirth issues

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

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

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

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

Here is my response:

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

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

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

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

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

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

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

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

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

I'll anxiously await a response. *eyeroll*

Always the pessimist

"We HAVE to do this
stuff to you because you
just MIGHT die during
childbirth. It's VERY
dangerous, you know!"

It seems that as pregnant women, we spend a lot of time worrying about things that might never happen. We're treated as fragile time bombs waiting to explode, and every medical test and ultrasound imaginable is ordered "just in case." (Conversely, it seems that when mom is truly worried about something happening and shows significant signs and symptoms, she's pretty much ignored.) Such is our climate of "fear-based obstetrics," where risk can be assessed in a nice, neat little box.

I've decided that in obstetrics - really, in most medical fields - our doctors are often very pessimistic. Classic examples include:

• "Well, your baby might get too big, so we'd better induce now." I didn't know that ultrasound machine was also doing double duty as a crystal ball!

• "You will not be able to birth a baby over 8 pounds." Really? How do you know? As our mothers always told us, "You never know until you try."

• "If you attempt a VBAC, you just might have to have a cesarean anyway." What a vote of confidence. When "attempting" a VBAC, women need to know accurate statistics so they can mentally prepare themselves, because nothing shoots down your plans more than being told there is a such-and-such rate of "failure." Just the way they word it, it makes it sound like few women are lucky to succeed (probably because few women are even allowed to) and the rest spontaneously explode. Technically, I had one failed VBAC attempt, because my baby was in an unfavorable position upon delivery - BUT I labored well and without pain medication on my own up until being prepped for surgery.

• "You better supplement with formula, just in case." Someone might have told you your nipples were too big, too small, or that "You'll never..." this that and the other just based on your physical appearance, which is obviously a load of garbage. Just because a certain percentage of women come in to their hospital and then don't nurse doesn't mean you won't - and who would want to with breastfeeding "support" like that?!

• "You should get the epidural since you'll never be able to have a baby without one." Again, that old "You never know until you try" adage. If more women knew how to cope with labor pain, and that many hospital policies actually make your pain greater, they might think differently about it. And if you're a first-time mom (and even if you aren't), you might find that it's really not as painful as everyone made it out to be.

• You're considered high-risk  just because you're 35. Never mind if you are healthy, active, don't smoke or drink and are in excellent shape. Just your age can mean - gasp! - that you're perceived as broken and treated like you'll never, ever get pregnant or that it will take you years. Once you reach that "magic" age you'll probably be bullied into more and more invasive tests (I know I was) even though you are healthy and have no other problems. Sure, certain risk factors increase with age, but that doesn't mean it's a given. Certain procedures such as amniocentesis carry more immediate risks to the baby than just having the baby already, so many women might be better off forgoing it altogether - but that's your decision.

Speaking of which, I recently read about "Kate Middleton's pregnancy plans" now that she and Prince William were married. The doctor basically says that they're not getting any younger, and now is the "perfect time" to start a family since she is approaching her 30s. He then went on to outline the "possibilities" of what can happen if women wait too long to get pregnant, including old eggs and lack of cervical fluid.

We don't know what Kate's "pregnancy plan" is or even if she has one. Technically speaking, it's none of our business. Who knows - she might have three sets of triplets before she turns 35. Who cares?!

• "Birth is the most dangerous thing a woman can do and is like an accident waiting to happen!" This is sort of the all-encompassing thought process of the majority of OBs. Do we walk around in a body cast just in case we get in an accident? No. How about driving in cars, going to the mailbox to check our mail, just living our lives? We do that every day - no problem. If a problem arises, monitor it and if necessary, treat it - but otherwise leave me alone. More interventions to head off potential "problems" often only end up creating more problems in the end!

You may have risk factors, but does that mean it's going to happen? Should you be treated like it's already happening even when it isn't? Nope!

And if it were really as dangerous as they say, then where are all these babies coming from?

More reading:
"Childbirth is one of the most dangerous things a woman can do today" - My OB Said What?!
Mama Birth: Your care provider is psychic! 
A Better Beginning with Natural Childbirth: Munchausen Obstetrics (scroll down)

The Girlfriend's (misguided) Guide to Pregnancy

"Or everything your
doctor won't tell you."
(Oh, if only that
were true.)

I vaguely remember when I first heard about this book - that and Jenny McCarthy's Belly Laughs were pretty popular, and I figured it would be a nice alternative to those books that depicted pregnancy as all flowers and sunshine.

What I wasn't prepared for was the tone (of either book) to be the verbal equivalent of a cheese grater. I read a few passages of Jenny's book and thought, Ok, this is going a little too far in the opposite direction. (She obviously has never been known for her grace or demure behavior.) While not necessarily that bad, Vicki's book struck an uneasy chord with me on much the same level. 

This book is probably one of the biggest reasons I would hesitate to rely on  something written from the author's perspective. (Unless she's like Robin Elise Weiss, who is on like her eighth child: that alone gives her a bit more leeway in that department.) Iovine rubbed me the wrong way on several topics, namely:

• Home birth. Her perspective on it is somewhat sad, and reflects the notion that only doctors are capable of handling a birth. Not only that, but it sounds like she did little - if any - research on it, and relates the story of her friend Kathy, who transferred from a home birth to the hospital.

"....[Kathy's] midwife did everything from make her herb teas to walk with her in the hills ... to bring on regular contractions. The nurturing and reassurance were extraordinary... Unfortunately, Kathy found labor longer, more painful, and more frightening than she had anticipated..."

I'm not exactly sure how to interpret this passage. What is she saying? Have a plan? Be prepared for it to fail? The way she describes it, the midwife must not have been that reassuring.

Iovine says she "gleaned three lessons" from her friend's experience: you can never get to the hospital too early, (oh yes, Vicki, you certainly can!), save the "homebirths, midwives and underwater deliveries for the second, third and fourth babies" (because you have no idea what to expect or how to manage labor when it's your first child), and "never elect to have a child where you have no access to medication, or God forbid, real doctors."

(I think here is where Vicki just figuratively smacked the collective group of home- and waterbirthing women across the face with her book. Ouch.)

I don't really get the mention of water birth - which can be done in the "safety" of a hospital with "real doctors! Gasp!"

She says that "childbirth is as messy as a pig slaughter," and wonders who would want to 'sacrifice' their beautiful sheets and other linens for such a thing. She recommends giving birth in a four-star hotel, where the maids can clean up afterwards. Seriously?! 

So much for a real, meaningful or educational dialogue on home birth. No wonder it gets so much flak!

• Regarding pain management and epidurals:

"You will tell yourself from now till labor begins that you intend to try delivering without an epidural, but I can't think of a Girlfriend who didn't take it when it was offered."

What the heck kind of thing is that to say?

So don't even bother, because no one else does, and you're weird if you think you can actually try to get through this without it. Just go ahead and try, because I bet you can't! Honey, I think you need different friends.

(One Amazon reviewer noticed this too, and said Vicki was "downright hostile" towards moms who don't have epidurals and "chastises women who are disappointed to end up with c-sections." While she emphasizes the 'natural' changes in your body such as weight gain, the reviewer notes, she "has no use for the natural process when it comes to birth," and "thinks everyone should induce labor at a convenient moment.")

As far as childbirth in general, she concludes that:

"A delivery that results in a healthy mother and baby is a gift from God, no matter how that delivery was achieved. Period. Childbirth is not like a visit to a spa: It is not designed for your personal enjoyment and fulfillment. It is not an opportunity to demonstrate your abilities or fitness....I think this feeling of being "gypped" by a birth experience that doesn't match our expectations is one more example of that yuppie self-centeredness that is none of our least attractive characteristics." 

This passage .... this part made me mad. Right after I thought my eyeballs were going to pop out of my head, I then felt like barfing. So, all you ladies who feel victimized, used, abused, betrayed or otherwise treated like crap by an OB, you better just get over it. Because all that matters is your baby was born healthy, okay? Your feelings don't really mean much, in the broad scope of things, now do they? (sarcasm off)

It's this kind of behavior that makes women feel like their thoughts, feelings and emotions surrounding childbirth are completely invalidated, and that is so not fair. Who are you to say another person has no right to feel the way she does?

As far as the whole "personal enjoyment and fulfillment," I bet there are loads of women - both of whom had epidurals and those who didn't - who would definitely beg to differ. For many of us, it definitely is about fulfillment - of your role as a mother, as the giver of life.

And as more women are realizing, sometimes those interventions that are supposed to help us have a "healthy baby" do more harm than good, and we would oftentimes be better off without.

Ironically, a few pages back she talks about her primary cesarean with a baby conceived through IVF, and how let down she was by the experience of not having a vaginal birth. So much so that she had her next three children by VBAC, because she says that she "felt so robbed of something my soul had yearned for." (At least one Amazon reviewer said Vicki frequently contradicts herself, and I guess this is one of those moments.) She goes to on to mention two of her friends and their husbands, who, at the time, were planning on all natural births. (emphasis mine)

Both of them labored for more than twenty hours. They were in the kind of pain that only fear and no end in sight can create....I call these husbands Golden Retrievers because they continue to act sweet, loyal, and dumb even when all evidence is making it abundantly clear that everyone in their little family had been unimaginative in how big and long and scary the pain of childbirth can be. 

Finally, it was the insistence of their doctors that got the laboring moms and their clueless husbands to surrender and release their stressed babies via the zipper. 

The babies were "scandalously healthy and robust," she adds. So maybe that means they weren't so stressed after all? I feel badly for her friends, who I bet aren't anymore after that one.

So basically it's okay for Vicki to feel "robbed of an experience," but no one else should be because she says so. "Period."

I don't know if I can go any further, honestly.

Ladies, you have every right to feel "robbed" of an experience if that's what happened to you. Taking into account that not every birth can always turn out the way we'd like, that "experience" can be very important in deciding the outcome. As the person giving birth to this child, it can be about you and your wishes too, without compromising the "healthy baby" part. It's important to realize that some of what is done and isn't done in labor - that can either add to or take away from the "experience" of birth - is key in the healthy baby equation. Don't let Vicky Iovine or anyone else tell you to just get over it and move on; a true girlfriend would never say that. 

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

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

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

Hot towel, anyone?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Birth Day

Well, it's been over three weeks since my last post. Little did I know that the very night I last posted, I would go into labor and have such a crazy, yet wonderful, experience that would test my human strength and intuition. I was putting my faith into action, while God worked behind the scenes on my behalf!

Several hours after I blogged that Tuesday night, we ate dinner - something told me not to eat too much. I went to bed but couldn't sleep because of random, painless but uncomfortable Braxton Hicks contractions and some back ache. I think I slept for probably an hour, because I do remember having strange dreams. By the time I got up and walked around for the millionth time, the pain suddenly went up a notch - and then I lost my mucus plug. Because we didn't know what position the baby was in, we headed to the hospital about half an hour after labor started in earnest. 

We arrived at the hospital around half an hour later and headed for L & D. As I was signing the insurance papers, my water broke in a tremendous gush everywhere. For a split second I panicked, like the fact that I had made such a mess was my fault, or that now it was really gonna hurt. They wheeled me into a room and I got undressed and took a shower, which helped a bit. As I was coming out, the nurse took one look at my belly and told me she didn't think the baby was in the right position. 

While we were waiting for the ultrasound machine, they checked me - I was already 10 cm dilated! I was blown away. Here was the test to see how far I could get without pain meds and what my body could really do. I'm sure after doing the internal exam the resident could tell the baby was not in position, because it wasn't without a bit of urgency in his voice that he announced I was completely dilated. Then they wheeled the ultrasound machine in and confirmed what we had all suspected - the baby was footling breech. For some odd reason, like my last labor, I had no desire to push - which was a good thing in this case. And as soon as they told me the baby was breech, I knew it was a boy - neither of my sons could find the right way out! 

I was a bit let down, but knew in my heart of hearts - I was disappointed but remained calm while they proceeded to stick me nearly half dozen times to insert an IV line. Meanwhile, my husband was beside me nearly turning green at the prospect of another c-section. One resident shakily said he didn't know how to perform a footling breech delivery, and I almost laughed. While the nurse asked me if I wanted to attempt a vaginal delivery, I said no - I know that OB's just aren't as knowledgeable or equipped to handle such a birth anymore since they almost always do an automatic c-section. In fact, the only such people truly capable of performing such a feat are midwives. Since there wasn't one of those around for quite a ways, I decided not to take my chances and signed the release form. 

When Baby A arrived, we found his cord wrapped around at least twice - which is a testament to me, at least, that the Lord had a reason for him being in the position he was in. Perhaps the frozen Brussels sprouts encouraged him to turn in the wrong direction, we'll never know; but whatever the reason, it must have been a good one. I thought back to my months' old 'premonition' that this baby would be a boy born via c-section and kind of laughed to myself - perhaps that still, small voice was preparing me early on and I just wasn't listening? My ultimate prayer of a safe, healthy delivery was answered, and also one for a healthy child. I kind of like to think the Lord compromised with me on this one. 

"DON'T give up!"

I received strange, yet powerful words of wisdom, from my 2 1/2-year-old daughter the other day. 

With squinched face and pointing finger, she demanded of me, "DON'T give up!" Not quite sure where she heard that. But it resonated in my head as I have been preparing for this upcoming birth journey that is really a continuation of her her birth journey. Really, all three journeys are strung together in one long, epic story over the course of five years. 

Lately we've been resting, planning, praying and praying some more as we approach "The Day," whenever that is. A bag of frozen brussels sprouts ("sprubble brouts," as my daughter calls them) and a borrowed blood pressure cuff have been my best friends. I have daily, if not hourly, talks with God, in hopes that this baby turning is His will, but ultimately that whatever happens, it goes well and I can come to terms with it. So far He has already answered one prayer in keeping my blood pressure lower and stabilized, for which I am so thankful. And I also found out last night that my son or daughter does not like having a bag of frozen food placed on its head, as the head is definitely not in the same position it was before. I've been down on all fours, cleaning my daughter's room, anything I can think of - to get this baby to turn. So we'll see ... only a last-minute ultrasound can really reveal the truth.

It would be easy to just give in and assume that the baby won't turn, my pressure will be too high, blah blah blah ... and do the c-section already. Most women would have already done that and been over and done with it and home recovering right now with their babies. But I guess I'm not most women ... I'm not sure if that's good or bad. Time will tell, though. I don't feel like this is a gamble so much as me allowing my body time to do what God intended, or at least try. In a world where we're trained to want answers now without having to wait and are awarded instant gratification, I'm hoping that the end result will be a much sweeter reward for having waited. 

Hopefully my experiences and story will make it that much more encouraging to someone else in my position. In the words of my daughter, "DON'T give up!"

The Fight To Give Birth in the Age of Fear-Based Obstetrics

As I quickly approach the 40-week mark in my pregnancy, I am thankful for many things: namely the fact that my body has essentially "proven" itself to not only me but to my OB's. I am preparing for my second VBAC (Vaginal Birth after Cesarean) and while my journey has been fairly uneventful thus far (I won't say totally uneventful, because that's not the truth), it is nothing less than a tooth-and-nail fight for thousands of women to do the same all over the US. 

I am also thankful that my only reason for having a c-section was breech presentation of my first child - not failure to progress, a "small pelvis," or failed induction of labor. I went into labor on my own even then, and had already progressed well despite the fact that we knew the baby had to be delivered via cesarean. With my second pregnancy, to my OB's credit he did offer me the choice to do a VBAC initially (which I declined, knowing nothing about it) and I think he was secretly relieved when I said no. But as I approached 37 weeks, my baby was heads down - something I wasn't even sure my children could do because of a physical defect of my uterus - and realized quickly that I really didn't want to go through the painful recovery of another c-section. 

I consulted with my OB, whom I thought was going to stutter himself into oblivion at my choice. I had since done lots of research, lots of praying, and lots of reading of very positive birth outcomes that I felt was essential to the preparation process. I couldn't believe what I was about to embark on, but with God's help and my husband's support, I could get through this. And I did. Beautifully!

I'm not totally against c-sections: of course I think there are instances where they are totally necessary. Breech presentations, multiple births (although not necessarily with twins alone, as long as they present correctly), severe prematurity, dangerous pre-eclampsia, and fetal distress are all obvious red flags, at least to me. But with a c-section rate of roughly 30 percent in this country, you have to wonder if those reasons are really why women are having c-sections?

More common reasons that the c-section rate is so high is because OB's want to practice "daylight obstetrics" - they want the baby out in time for dinner, essentially. With the ability to control so many facets of our lives, why not birth? Anymore if you go one day past your due date, you seem to be a candidate for induction. Pitocin-happy doctors willingly try and induce (more like coerce) a baby out even if it's not ready. Unfortunately it seems that fewer and fewer women are sent home as a result and are almost definitely candidates for c-section. Pitocin can bring with it a cascade of interventions that can sometimes alter or stop labor completely - increased use of epidurals because of harder, stronger contractions is not uncommon, which can, in turn, stall labor - leading to an increased number of c-sections. 

Insufficient pelvis size is another common reason many women are encouraged to have a c-section. Scores of women are even told their babies are too big to deliver vaginally just by an estimate on ultrasound, which further scares them away from attempting a vaginal delivery. Sadly, there is no definite way to know how big a baby will be until they're born and put on the scales - and ultrasound measurements can be off by as much as a pound either way. Many, many petite women give birth vaginally to "large" babies (according to the March of Dimes, anything between six and nine pounds is considered average) and do just fine. Even many babies deemed to be "stuck" can be birthed vaginally provided the medical practitioner knows to instruct the woman to change positions to facilitate further widening of the pelvis (known as the "Gaskin Maneuver," named for renowned midwife Ina May Gaskin). 

Because of the high rate of c-sections in the US, many women are faced with a two-fold problem: if they want more children, do they deliver them via cesarean too? 

Not necessarily. The mantra "once a c-section, always a c-section" is thankfully being disproved by women everyday in this country, although we still have to fight for the right to do so. But unfortunately few women choose this option - whether because they're uneducated about the risks, their doctors scare them out of it, or they have no interest - which is their right. I would never advocate a woman do a VBAC if she really doesn't want to, but neither should I think women should be scared into repeat c-sections for no reason, either. 

One reason many women are scared away from VBACs is the phrase "uterine rupture." It is possible, but is rare, provided you have a low, transverse incision (bikini incision). Also, your chances of receiving Pitocin to induce labor are less - because it can increase your risk of rupture. To many women, the risks of a c-section, if they even know what they are, are somehow more acceptable than the risks of a VBAC, even though the percentage of complications is about the same. 

Risk of VBAC, with non-induced labor, include:

• uterine rupture - this is rare, and the rate is around 1 percent, depending on which source you site

• risk of needing emergency c-section, should the same complications arise as in the first birth

• if you can't go into labor on your own, induction is not recommended 

Risks of cesarean section include:

• increased blood loss and chance of infection

• respiratory complications in the infant because of spinal anesthesia

• increased risk of scar tissue adhesion, especially after several c-sections (which can cause pain and sometimes infertility)

• premature birth because due dates are off 

• risk of uterine rupture (without even going into labor) (although small, still a risk)

It all boils down to which risks you are more comfortable in taking - because don't kid yourself that a repeat c-section isn't without significant risks, too. Neither of them are decisions that should be taken lightly, but unfortunately many women shrug it off as though it's nothing. This unwittingly affects birth outcomes and choices for thousands of women they don't even know, because they either don't care or aren't willing to fight their doctor for the right to give birth. And if you don't fight it, nothing will change. 

http://www.ynhh.org/healthlink/womens/womens_11_01.html

http://www.vbac.com

http://www.vbacfacts.com

http://www.mothering.com/articles/pregnancy_birth/birth_preparation/inducing.html

http://www.buffalonews.com/248/story/573154.html

http://www.msnbc.msn.com/id/17796664/