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.

OB complains about patient on FaceBook

This happy little post has made the rounds today over at Jezebel.com - an obstetrician is openly venting her frustrations (well, now her wall is private) over a patient who has shown up late repeatedly for her prenatal appointments, and is now three hours late for her induction. The physician snarkily asks, May I show up late to her labor? (Gee, I think it's been done before...)

Apparently, she tells her friend, the only reason she's been putting up with it is because the woman has a prior history of stillbirth.

Hmm... On one hand, showing up late is not such a good thing. On the other, perhaps this mama doesn't want an induction. Doesn't like you as her doctor, but is afraid to tell you. Who knows what her issues are. All I know is, it seems like doctors have the market cornered on making people wait, often without any explanation, and you're just supposed to sit there and deal with it? What, like my time isn't important, too?

Someone said they had seen other posts on the good doctor's wall, including comments trivializing circumcision and complaining about having to return to the hospital later on in the day to do one. For some reason, her wall was public - duh! - and I hope her patient didn't happen upon it. How heartbreaking.

It kind of irritated me how both her friends and the commenters on Jezebel blamed the mother and acted as if the physician's time was way more important. "If it's elective, cancel the induction!" one friend trumpeted. I kind of agree. She might be better off if you do.


More reading:
Being censored: By your OB? 

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.

OB bribes mothers to deliver babies on 11/11

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

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

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

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

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

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

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

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

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

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

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

I am the 32 percent - but should anyone care?

Photo credit: Kirsten Ferree. 

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

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

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

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

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

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

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

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


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

Everything in moderation - even birth advocacy?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Words of discouragement

I woke up this "labor day" and began thinking about my own labors - my Labor Day-ish baby will be five in two days. I picked up Tina Cassidy's "Birth" and read a passage about influential but misunderstood obstetrician Grantly Dick-Read and how he, along with Dr. Joseph deLee, both though fear could hinder and negatively transform the birth process.

I thought back to my pregnancies and how fear took hold, both in pregnancy and labor. A negative attitude or word of discouragement not only gave me doubt about my body, but doubt in my care provider. I never received a "You can do this!" or "Good decision, you'll be thankful!" at any time during my care, except perhaps when I naively decided to have a repeat cesarean (I later changed my mind). It was only after the fact, after the VBAC that went well, that I heard "Good for you!"

"I do not want to be doing this." That is what one midwife told me before my second birth. She spent more time talking about how much she liked my haircut than the philosophy of birth, and didn't hesitate to tell me that she felt my decision to VBAC would be exposing her to more risk. I was taken aback and thought, What if I can't do this? What if something happens?

"I do not know how to do this." These were the words of a resident who 'attended' me during my last labor, during which showed a footling breech baby and a cervix that was fully dilated. While I could understand his nervousness, later I thought I should have yelled at him, "Yeah, so maybe you should LEARN!" You always hear stories of laboring women yelling at their birth attendants - I wished, for once, that I could have been one of them in that situation. I pictured him sitting in a classroom, full of other clueless students, and wondered if the dying art of breech birth would just slowly, quietly go away and no one would be the wiser. What would he do, I later thought, when a woman comes in with precipitous labor of a breechling? In other words, what would he do if he got more 'crazy' women like me?

I think of the women who had traumatic, difficult births and how those transformed them, fearfully: the women who wanted more children, but decided not to because things were handled so miserably. I have waffled back and forth since the birth of my last child on whether or not to have another baby, at one point resigning myself and saying "I just do not have the mental energy to fight the good fight anymore." Then something would change: I'd see a mother out and about with her brood of kidlets, or hear an empowering story from someone who had an amazing birth with confident care providers that supported her in every way possible. Last night my husband and I scanned the list of names in our phone book for an endocrinologist and ended up finding an OB who advertised that she specialized in home birth. That gave me a ray of hope - but of course our insurance doesn't cover her services.

The journey is an uphill battle the whole way, as I feared it would be the moment I had an unintended repeat cesarean. The nurse told me, moments before I was wheeled back to the OR, "You can have this baby vaginally, you know." A glimmer of hope, but at what cost? I wasn't mentally or physically prepared for that eventuality, and I'm not sure she was, either: was she prepared to see me through this birth by herself, in the wake of physicians who - with more power than she had - were not? Was she silently hoping I would speak up and advocate for myself in ways that so many others had not? I'll never know. I'd like to go back and ask her, though, if only I could: How were you planning on helping me?

That uphill battle, I am realizing, has more than one hill: the biggest being, do I want to try this again? I knew I wanted to lose weight in an effort to start out better than before, but hadn't really done much about it until nearly 2 1/2 years after my last birth. I realized that, had I been more serious about it, I probably would have dropped the extra pounds and been pregnant by now, if that's what I really wanted. Then I think, Well, maybe not - I consider this time one of reflection not on just "Do I want another baby?" but "How can I gear up for this process? Am I ready to climb those hills?", of which there are several. The biggest fight of all is finding a supportive care provider who is willing to climb those hills with me. After hearing so much discouragement, I wasn't sure if that was even possible.

I know Drs. DeLee and Dick-Read said that a woman's fear in labor can negatively impact her birth. But I also know a care provider's fear, transferred to the patient, can too. I wonder if I wouldn't have more confidence, and less fear, if I were cared for by someone who "gets it" and doesn't allay her fears and insecurities to you. Instead of hearing "I do not want to be doing this" you hear, "I want to be doing this as long as you do, and I will be here for you."

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)

Seeing dollar $igns

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

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


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

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

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

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

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

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

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

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

The $64,000 question: Why do you "need" Pitocin in labor?

Photo credit: Brian Hoskins

A few months ago I posted this article from a labor and delivery nurse who admitted the real reason why you "need" Pitocin: to free up hospital beds. Over 200 people shared it, and I don't think many people were happy about her piece. When this article was posted on the mothering.com forums, it got the discussion thread shut down. So I guess Nurse Jenna created quite a stir!

I reposted this article on FaceBook yesterday and have been thinking about it ever since. The use of the word "need" irritates most people, including me. But there were some other things that set me off.

It underscores, among other things, the absolute garbage medical practices that pervade in obstetrics that not only put mom at unnecessary risk, but her baby as well. What Nurse Jenna's article does is unintentionally admit that often the best interests of both mom and baby are not in the forefront. In the very opening paragraph of her article, she sets a rather condescending tone:

Many women come to labor and delivery fearing Pitocin, loathing Pitocin, and swearing up and down that “over their dead body” will they have Pitocin to augment their labor.

Truth be told, if anyone knows how miserable Pitocin can be, they've probably heard it from other women who have been there, done that. This winter my niece was facing a (basically unnecessary) induction and everyone on her FaceBook were telling her to "avoid the Pit! It's miserable! You'll hate it! Don't do it!" You would have thought she was contemplating suicide, their tone was so adamant. Did she listen? Nope. (Because, after all, we were a bunch of "uneducated women" and her doctor "knew best.") She ended up getting induced and having a horrible labor, although I still haven't heard the details and am not sure I really want to.

Nurse Jenna sort of tries to absolve the doctors and nurses of their guilt over improperly administering Pit by taking the "blame the mother" approach: moms don't stay home long enough, want pain medication in early labor, and in the comments section, moms "insist" on being admitted before they're actively laboring. No where does she really say that doctors are doing it all wrong, but rather, "We want the mother to stay home as long as possible." She mentions how "we" want you to labor comfortably at home in the early stages, where you have access to food and fluids, supportive family members, a bathtub, etc. Seriously?! (Because we all know that once you enter the hospital, all of those things are often restricted to you, even though they can help progress your labor tremendously.)

While I agree that staying home until you no longer feel comfortable is the best idea, a) this seems to contradict what hospital staff often tell us and b) it doesn't necessarily mean you won't be given Pitocin, regardless of whether you need it or not. According to Dr. Roberto Caldreyo-Barcia, former president of the International Federation of Obstetricians and Gynecologists, "Pitocin is the most abused drug in the world today."

Because there is such widespread misuse and abuse, patients often think it's totally normal. Few are going to tell you "Hey, you don't really need this stuff, you know. You can refuse," and instead make you feel like the bad guy if you don't do it. Your baby is the weapon of choice against you, and a powerful one at that. Nurse Jenna's article also highlights how trusting some are of the medical profession and just put everything in the doctor's hands. Many mothers, especially first-timers with no prior experience, will take their doctor's advice as the gospel and comply, even if it goes against their better judgment or wishes. They don't want to be seen as difficult, and if you appear to be questioning your doctor's judgment it could be a long haul for you as the patient. Of course she doesn't mention fetal distress, the rising rate of cesareans and how induction can contribute to that, especially in first-time mothers. And the idea that, even in a woman who is laboring well on her own, maybe with an irregular pattern of contractions (or not even) you might still stand a good chance of getting it. I wonder if this is less about freeing up beds and more about "Ok, let's get it over with so we can move on to something else."

(Case in point: my neighbor had her second child in May, this time going into labor on her own. Labor had slowed down, apparently, and her well-meaning mother-in-law told me that she was given Pit and "the baby was born 20 minutes later." What?!)

Nurse Jenna's post illustrates the problem our maternity industry has in general: more beds are needed, so let's rush things along over here to make room over there. That is not good medicine, and treats the patient like a number or as if they're giving birth on an assembly line. (Which explains why some maternity units are unaffectionately called "baby factories.") How many women do not even get to this point because their due date falls near a holiday, someone's vacation or other important event? People have criticized the idea that "OB's golf, so they need to induce you so they can be there for tee off." Maybe not golf, but the idea that they do not want to be "waiting around all day/all night for you to deliver" is pervasive, so don't kid yourself. The days of your OB rushing in at 11:30 at night in a tux (like my mom's OB did in delivering me) are long over.

While Nurse Jenna blames mothers on "insisting" they be admitted early, I wonder how common this is. It seems more commonplace to keep mothers who should be sent away because you'll simply Pit them into oblivion. I've also read accounts where they aren't "allowed" to go home, even though they want to. Staying home longer is probably key in reducing your risk of getting Pit, but how many of us have heard, "Well, you don't want to deliver in the backseat of your car/on the toilet/in a public place, now do you?" Many women who are in the advanced stages of dilation but not in active labor are sent directly over to the L&D unit ("Do not pass go, do not collect $200!") to be induced when they don't even want to be, including a woman commenting on Nurse Jenna's post. Just because you're 4 cm doesn't mean "it's time," and even though it's not what mom wants, she somehow feels compelled to cave, often because of pressure from her physician.

I'm sure doctors and nurses grow increasingly frustrated at patients who know little and "insist" on care they think they should be receiving, when really, there is an alternative. Instead of accusing, though, healthcare providers should be informing, and telling patients why you should go home - but I think that would reveal other faults on behalf of the hospital and they're not willing to admit to unnecessarily aggressive induction practices. Conversely, it seems that if you know too much - enough to question and refuse - you're treated like crap then, too.

More women probably stay because they don't realize they have a choice, rather than because they "insist." In my time both as a hospital employee and a patient in L&D, I have never witnessed a mother becoming belligerent because she can't stay. And never, in all my talks with mothers, have I heard someone say "I insisted on staying in the hospital because they were threatening to send me home!" Usually, mom thinks there's something going on, hospital staff say no, and she's sent home, tail between her legs. (Yet all the while with the threat of "You don't want to give birth in the car!" hovering in the back of her mind, right?)

Basically, Nurse Jenna is part of the greater conundrum of "modern" obstetrics: don't stay home too long, don't get here too early. If you want to walk, stay home (one L&D nurse's comment). If you walk while in the hospital, it means you can't be hooked up to monitors and machines, but it could progress your labor - but still, don't walk. If you get here too early, going home is not an option anymore. If you labor at home, you'll be punished for not seeking medical 'care.' If you come to the hospital too early, you'll be punished for seeking medical 'care.' So deal with it. Either way, you can do nothing right and it's your fault. 

Some of the comments on Nurse Jenna's article are interesting, and very telling:

The pitocin seriously made me want to kill myself, even after having the epidural.  It truly was awful.

Unfortunately this woman had come in for induction because her baby had died. After 30 hours of hell, she ended up with a cesarean. (!?)

A failed induction, but hey, thank God for the Pitocin!

i had come in for an induction and had pitocin to get things moving faster the next morning...i didnt care, im not that anal about stuff like that! i know there were other women that needed a bed too! and i am grateful for the pitocin post-delivery/csection to help my uterus contract.. 

At 4 cm but not in labor yet? Who cares! Let's just induce!

I got to the hospital at 4cm, but would have much rather still been at home.  I had a severe headache, and dizzyness, and called the dr's office and they sent me in to have my blood pressure checked.  I wish they would have let me go back home since my blood pressure was fine (I only live 5 mins away), but instead once they checked me and I was a 4, they called the dr., and he decided to just come break my water.  I was so frustrated, because he broke my water and started pitocin and the contractions practically stopped for about 3 hours.  But I could get up or anything since they'd already broken my water.  I was so irritated because it was not my choice to go to the hospital yet.

One commenter kind of blows Nurse Jenna's argument out of the water, and probably many of us can agree:

I certainly was told about "Pitocin-passing" by a nurse.  I was in a car accident when I was 24 weeks pregnant and moving to a new city.  While they monitored my contractions in the hospital I had a great chat with a nurse who gave me the low down.  When I told her I wanted a completely drug free birth she told me which hospital to avoid (named the baby machine hospital because they do so many births and regulate with Pitocin) and which drs. would be sympathetic to a drug free delivery. 

And probably the best comment EVER:

Who is we? The God's of the delivery room? NATURE decides when the baby will come! I'm glad I was informed and confident in my birth not to let a dumbass like you [be] in control!