Improving birth by breaking the silence

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

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

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

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

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

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

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

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

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

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

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

More information:

Improving Birth - Advocates for Evidence-Based Maternity Care 

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

Maternity leave rates around the world

It may come as a shock to some, and not to others, that the US is one - if not the only - nation that does not offer mandatory paid maternity leave to new mothers.

It makes the US sound pretty darned bad to be stacked up against third-world nations who seemingly offer better for their women. Maybe, maybe not. Even working a dead-end job you hate is arguably better than no prospects at all. Some of the countries on this list made me wonder: What is it like giving birth in, say, the Democratic Republic of the Congo? What's it like living and working there?

My husband visited there last year and he could probably tell you better than I: if you are lucky to have a job, you will get, according to statistics, 14 weeks of partially paid maternity leave. Among the Congolese, however, about one in 13 women dies during childbirth, ranking them 17th in the world for maternal deaths. My husband was awestruck by the dichotomy of living conditions there: in the villages, at least one man took in many children (almost a dozen) who were either his own or orphaned, doling out food to the family and himself often not eating for days at a time. On the flight in from Brussels, only the wealthiest of Congolese could even begin to afford a plane ticket, and you would be sitting amongst only the upper crust of businessmen and women, not average citizens. In the city of Kinshasa, he noted the absolute dismal filth, and the children who would crush rocks and pebbles into sand to sell for a little extra money. He even got a tour of the local hospital (where Hillary Clinton once visited), which has a large wall around it to keep out the 'dregs.'

Yes, the same country that requires a woman's employer to grant her maternity leave and a part of her wages is also the same government that employs soldiers who help themselves to your possessions and house, because the military is grossly underpaid and pissed off that they can't feed their own families. They are also the same government that sanctions rape of their women, sometimes upwards of 100 victims at a time. In many aspects of life there, much of the female Congolese population are treated like shit. So who cares if they get paid maternity leave? (It's a wonder, really...)

One would wonder, then, especially among these poorest nations, what percentage of those women really get maternity leave? Likely precious few.

More reading:
Congo-Kinshasa: Where giving birth is deadly
In US, maternity leave benefits are still dismal
Women for Women International

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? 

Hyperemesis gravidarum: not your garden variety morning sickness

So the tabloids have finally broken the real news that yes, Will and Kate, everyone's favorite Royals, are really, truly, pregnant. This time it's for real! And wouldn't you know it, Kate is making headlines for yet another reason: because of her recent hospitalization with hyperemesis gravidarum.

HG is probably one of the most poorly
understood conditions of pregnancy,
and its sufferers sometimes find
themselves marginalized, ignored,
and made fun of or told to
"just suck it up." If you wouldn't
say this to a recovering cancer
patient, then don't say it to a
pregnant woman - who likely is
experiencing daily debilitating
and excessive vomiting and nausea,
weight loss and severe dehydration.
For more information, visit the
Hyperemesis Education Research
website at helpher.org.

Many pregnant women have suffered through it and can relate. Many of us, like myself, have not, and find just regular old run-of-the-mill morning sickness utterly a royal pain, if you'll excuse the pun. When I wanted a second child, two things worried me: the recovery (as I planned at the time to have another cesarean), and the morning sickness. I don't know what it is, but even while not pregnant, I cannot stand being nauseated. I crocheted a lot while pregnant and now, can't even think of crocheting because the thought of doing so makes me queasy. So Kate is probably pretty miserable right about now.

HG, as it's called, can be a nightmare for sufferers. Many women I've talked to or know suffered for months, sometimes the entire duration of the pregnancy. One friend was finally, to her great relief, hooked up to a Zofran pump (like an insulin pump) that helped her manage through the feelings of constant nausea, complete loss of appetite and many, many trips to the toilet. If you've ever suffered through a day or two of stomach bug, you know how easy it can be to get dehydrated. Now think how that would feel day after day, for months. 

When it gets bad enough, a hospitalization for IV fluids can sometimes be in order. In order to differentiate between it and just normal morning sickness, severity is a consideration: if your nausea and vomiting are especially bad, to the point of being able to keep nothing in your stomach, then you're probably the lucky winner. The author of this Washington Post article humorously noted (although probably not funny at the time, I'm sure):

"I have often told people that I knew my condition was bad when a helicopter flew over my home and instead of listening to its rumble to make sure it passed safely overhead, I thought to myself, 'Well, at least if it crashes into my apartment I won't have any more morning sickness.' Death would have been an improvement...I mostly slept, and carried a trash can wherever I went. All my husband wanted was an omelet, but the thought of eggs made me want to kill him."  

One of the women who commented on The Washington Post article said that her daughter had it - and was hospitalized for the better part of her first pregnancy. Unlike Kate, however, the traditional remedies (and we're talking the big guns here that you get only at the hospital) did not work. To top it off, she became pregnant again, only to have it worse than the first time, which resulted in TPN (total parenteral nutrition, a form of IV that basically gives you all of your nutritional needs in IV form. *insert completely horrified face here*.) That would basically make you never want to have any other children, ever again. (As a side note: I used to make that stuff for patients when I worked in a pharmacy, and it basically meant you were pretty sick.)

I was glad to see that it made news, though, because of one thing: this horrible, not-your-average-pregnancy symptom is often delegitimized by people who think it's just regular old puking and feeling yucky. They often say terrible things like, "Suck it up!" or "You're just doing it for attention!" Sadly, I've even heard things like that from labor and delivery nurses, one of whom basically said, "You were the one who wanted to have a baby, so deal with it." She didn't seem to believe that it could be debilitating. I asked on my fan page if anyone had dealt with it and if they could share their comments:

"It was debilitating. I had little to no support. I was told to eat crackers, sip ginger ale, and it would just stop. I vomited around the clock for close to 7 months. When it did ease and I could eat, I had lost a lot of weight and began to develop very severe pre-eclampsia...The comments which hurt the most were when I was told I was doing this 'for attention' and that morning sickness is "all in your head." I could have died, my son could have died. I *wanted* to have a baby. I *wanted* to enjoy being pregnant. Why in the HELL would I then bring such suffering upon us both for 'attention?' It caused a lot of heartache and created a rift in my family relations for a long time afterwards." - Rebekah

"I was unable to hold down water, let alone food. Even with meds I'd have to crawl into an E.R. once a week for IV meds and fluids....The worst is when the doctors don't want to believe you...not sure I could ever put myself through being pregnant again. Which sucks because I long for another child." - Noel

"Meds didn't work. I spent my whole day either throwing up or trying not to. I lost my job - had to be hospitalized for dehydration. I lost my baby as a result of being so sick...The comment that hurt the most especially at the end where I was still but knew the baby was gone was when everyone would say the baby would be worth it." - Robynn 

"I threw up daily around the clock for 88 weeks out of my three pregnancies...it was worse with each child. The puking and never-ceasing nausea is hard, but the time you lose being completely debilitated is the hardest part. Your children don't understand. Your mother-in-law doesn't understand or people think you are exaggerating. When people ask "How are you feeling?" you learn to simply say, "Hanging in there." Reading or looking at a computer screen might exacerbate it. Grocery shopping becomes a challenge - beat the clock before you hurl. Your ribs ache from dry heaving. You eat and eat because you are worried your baby isn't getting enough. Your partner stops being empathetic. It becomes "normal." You clean your own puke off the wall behind the toilet. There is no one to take care of you. You will have days where you will cry clinging to the toilet as you dry heave bile and over and over again say "I'm so glad my baby is healthy!" to keep your affirmations as positive as possible." - Green Births

"Green Births is totally spot on. Eventually no one around you cares or will even help. Honestly it's so emotionally, physically, mentally crippling. I feel so awful for my daughter who has no idea why mommy can't do fun things with her very often, the strain and stress it has put on all my relationships, I just feel miserable and helpless." - Aimee

"I was losing a pound a day. I had to leave university because I was constantly running out of class to throw up...most of my day was spent with my head in the toilet or laying on the sofa." - Catherine

"Favorite moments were pulling over to puke in front of a bunch of teens in town. Puking in my work car park and simultaneously weeing. Puking on my steering wheel because I couldn't get out in time. HG destroyed my life for 9 months." - Sian

What's really sad, is that for some women, hospitalizations are really the tip of the iceberg. For some, the meds do not work, and it's speculated that as many as 6,000 abortions a year are performed on women who are at their wit's end dealing with HG and just can't take it anymore. Honestly, if you are experiencing misery day in and day out for months on end and then someone comes along and tells you "just deal with it," wouldn't you be reaching the end of your rope, too?

Those who think it's "all made up" might need a little education as to what it actually is: that big-sounding Latin word might trip them up. Maybe they need to be shown? Who knows. If you were a cancer patient going through the rigors of chemo, would they dismiss you as creating drama and trying to attract attention to yourself and just "suck it up?" I highly doubt it.

My best to Kate - I hope she responds well to treatments and gets better soon.

More reading:
Our lady of hyperemesis gravid arum - The Washington Post

The pregnant woman as public property

Marathon runner Amber Miller gave birth within hours of
finishing the Chicago Marathon. The way people criticize
her, you'd think she gave birth along the way and kept
running with the baby still attached or something.
Photo credit: Griska Niewiadomski.

I was all set to finish my series of posts on vaccines when this story grabbed my attention: marathon runner Amber Miller gave birth to her second child within hours of finishing the Chicago Marathon. Pardon my ADD postings, but reading about this amazing lady was just awesome! Until I got to the comments section, that is.

Of course - whenever there's a story in the news about a pregnant woman doing something, there are sure to be a plethora of stupid ass comments to follow. Remember when a pregnant lady walked into a bar?... almost sounds like a bad joke. Unfortunately, it wasn't: back in January, a story hit the news about a woman who was eight months pregnant walking into a bar with friends. She had flown into town for her baby shower, and her friends convinced her to go out for a few hours with them.

But her effort at late-night fun lasted a whopping 15 minutes. No sooner than Lee had arrived, a bouncer at the the Coach House Restaurant told her she had to leave; no pregnant women allowed.

Too bad she wasn't drinking anything stronger than water. She was seen at the bar with a friend who was doing shots. Perhaps she was keeping track for her, who knows. Whatever the case, even though law enforcement said there is "no reason" she should have been asked to leave the bar, the bouncer escorted her out.

I'm sure the bar is concerned about rowdy patrons and bar fights like you see in the movies. However, one can easily surmise that they would do the same thing they did to this woman: ask the offending patrons to leave the restaurant. And no where in the article does it mention anything about a scuffle, flying beer mugs or overturned tables. Really, though - if that kind of thing were going on while this woman was inside, don't you think she'd do what most reasonable pregnant women would? She'd leave the area. It's not like she's going to body slam someone and join in.

The woman did not partake of any alcoholic beverages, and it can be assumed that just like everywhere else, there is no public smoking in restaurants in the state of Illinois, where this took place. And even if she had a glass of wine - which is, according to some, okay for a pregnant woman - who are they to decide for her whether she is using good judgment or not? Since when does that give strangers the right to police our actions once it's obvious we are pregnant? What are you going to do - give every woman of childbearing age a pregnancy test before she enters the bar area, just in case?

Just like in Amber Miller's case, there is a familiar pattern here: treating the pregnant woman like public property, as if she is incapable of making decisions for herself and her unborn child.

It seems like once you are visibly pregnant, people feel the need to comment endlessly on your condition, touch your belly, and step in and make decisions on your behalf. I'm not sure what it is about pregnancy that makes perfect strangers feel the need to treat us like helpless idiots who have no brains, feelings or an original thought of our own.

Several years ago (before the days of officially no smoking inside public buildings) I worked in a pharmacy with a pregnant woman. Our boss would sit behind a partition during his breaks and smoke. Somehow I don't remember the smoke being that bad, but at least one customer felt the need to comment curtly on how she didn't think pregnant women should smoke. While now I think our boss should have had the courtesy to go outside and do it, Tara didn't seem to mind and just gave that customer a sweet "Go screw yourself" smile and moved on. (Tara also worked her last shift before maternity leave all while having contractions, and when her shift ended she calmly proclaimed, "Okay, I'm going to the hospital now to have the baby. See you in a few weeks." Wow, that's my kind of woman. I think she had the baby less than an hour after getting there, with no epidural.)

Amber was, according to several articles, in excellent physical condition - she'd have to be, in order to run a marathon only ten months after her first child was born. People called her stupid and selfish, and some suggested that her baby should be taken away by child protective services! Many questioned the authority of her doctor for even giving her permission to run it in the first place.  Of course, if she had done it without his permission, they would have raked her over the coals just the same. Amber walked and ran the race, so I'm sure she realized her obvious limitations and didn't try to push herself. It's not like she was in a dead sprint the entire time. Some use foul language and call her names - you'd think she was doing crystal meth on the sidelines or something.

The pervasive myths about pregnancy continue, as usual: that a woman is in a "delicate condition" and must be treated like a piece of glass about to shatter. I'd love to talk to Amber and see how her labor went - she apparently gave birth little more than two hours after getting to the hospital (before stopping on her way to get a sandwich, though). I don't know what her philosophy on birth is, but I'd say she did everything right: kept herself in great physical shape, remained upright and moving and ate while in labor - all of which can help speed up labor and make delivery easier. The comments that demonize her are based in the ignorance that a laboring woman needs to be shackled to the bed with continuous monitoring, tubes and wires - not have the audacity to keep moving, and even (gasp!) eat a sandwich. When the only thing you know about pregnancy and birth comes from "A Baby Story" it's not a wonder the comments she received were so inane.

Amber, I want to tell you that you did everything right and congratulations on your baby and your marathon! I can't wait to read about then next one. :)

More reading:
Photo finish: Woman gives birth after running (and walking) marathon - chicagotribune.com
Woman gives birth after running Chicago Marathon - CBS News
Woman gives birth after running Chicago Marathon - Chicago Sun-Times

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?

The Obstetrical BS Series: Membrane sweeps without permission?

What your doctor - and everyone else - is essentially saying
is that because you're pregnant, you have no rights.
So "get over it."

This topic has come up every now and then: mom is going in for her routine (eyeroll) cervix check, but something is different about this one. It's taking longer, the doctor's really rooting his or her hand up in there, and it's wayyy more painful than what you're used to. What could possibly be going on?

Ten bucks says Dr. Pitocin is doing a membrane sweep. And unless he bothered to ask you what you thoughts were about having one, or bothered to explain what he's doing (before he does it!), he has no business whatsoever being up there like that. I repeat: no business. Your body, your vagina. Period.

Just today I saw this question come up in the Yahoo Answers pregnancy forum: "Unbearable pain from internal exam?"

this Dr came shoved her fingers in me really hard i was gona jump out of the bed!! it was soooooo painful and she kept pushing her fingers in and tells me to open wider! which i didnt, i was in so much pain! i couldn't even breath! she took long time checking i did felt her fingers inside my cervix the whole time. she said i am 1 CM dilated with long thick cervix, baby is not even engaged yet. so, why did she take that long to check my cervix and why was it breath taking pain???? now am way to scared to give birth! the pain was unbearable!

I think my blood pressure went up a few points after I read that one. I try so hard not to get furious, or at least not to let it show, slinging harsh words around, but it's so hard. Sometimes you feel you have to simply to drive the point home that this is not normal. Not even close. 

I was prepared to get a million thumbs down, and one reader told her to "suck it up." I wanted to reach through the screen and slap her into cyberspace. 

Thankfully someone spoke up and agreed with me - which made me breathe a sigh of relief that yes, someone else gets it and no, I'm not being alarmist or paranoid. 

I've heard a number of laughable, startling and downright hideous answers to this perennial question, like:

Yes, they can and they will. Do not be surprised that you are not consulted on any procedure. 

And why not? Are you any less human once you become pregnant?

Are you serious, or just looking for a way to sue for some free money because I don't think that a doctor would do that without consent.

This was after a woman asked if it was considered sexual assault. Because everyone knows women just make up stories about things their doctors have done to them, just to get attention.

This person seems to think there must have been something wrong with the mother, as if she were apparently stupid or something for not realizing what was happening:

I find it hard to think of a situation under which that would happen. Did you think he was doing something else? How do you have your membranes stripped without consent. Was he holding you against your will?

And at least this person realizes that it's not the sign of a "good doctor," but doesn't agree that it's assault:

I think that's a bit of a stretch. Its not a sign of a good doctor, but its definately not sexual assault.

Then what is it, exactly?

One woman, who had her baby at home, "dealt" with the OB at the six-week checkup, surprisingly:

My husband was the one that confronted him on the issue and he apologized.

(Yay for awesome husbands!) And just the fact that this OB apologized acknowledges that he knew what he did was wrong.

It's important to note that many - probably more than half - of the stories I came across were from mothers who weren't even 38 weeks pregnant.

Just because he's your medical provider, doesn't mean he has any right to do anything to you without your consent. You are more than just a pod ready to eject a foreign body; you are a human being, who is carrying another human being inside of you. If you don't want to be induced, don't want checks of any kind, then doing an uncalled for membrane sweep is a violation of your rights, as well as the rights of your baby: because it's done in an effort to basically evict your unborn child from its cozy, warm surroundings, where 90 percent of the time, it's better off anyway.

Unfortunately because people think "vaginal exam" when they think obstetrician, they consider this part of the job, and part of the highs and lows of pregnancy. Some of the time, the mother might not even know what's happened, and that kind of creeps me out. I wonder - if a physician does a membrane sweep but yet it hasn't been mentioned to the patient, and she doesn't really express concern, does it get documented? What if mom were to go back and look at her records?

Perhaps this is just another reason why many doctors are reluctant to show you your records: because they don't want you seeing that they did something without your permission.

If this woman were in an empty parking lot at midnight, loading her car with groceries and approached by a stranger who attempted to rape her, this would be assault. But because the man is her obstetrician, that's supposed to make it okay, I guess.

Just like with rapists, these "professionals" get away with it because no one complains. And in this case, the reason why no one complains is because much of the time, no one is quite sure what's being done to them is a problem. Or that it's really being done to them. Too much trust is placed in their hands, and just like a sexual perpetrator, they continue to abuse because they have your trust. I'm not comparing OB's with perps in the sense that they necessarily get off on what they're doing, but in a psychological sense, perhaps they do enjoy the sense of superiority it brings them. I don't think that's limited to obstetrics, but perhaps medicine in general. While there are very fine physicians out there in all fields, no doubt many of them do have a power-tripping God Complex.

No one would ever tell a rape victim to "suck it up." We realize it for the violation that it is.

It's also important to realize that by justifying these procedures as "part of the pregnancy routine," you are normalizing the abnormal: it represents an erosion of the pregnant woman's rights. This is not the first time such a thing has happened in obstetrics (or other medical disciplines), and certainly won't be the last, I'm sure. Take for instance:

• The case of Dr. Allan Zarkin, who carved his initials into the abdomen of a patient after her cesarean. While his lawyers argue that Dr. Zarkin was suffering from a brain disease that impairs his judgment, one wonders why, then, he was practicing medicine in the first place, especially considering he had shown strange symptoms and bizarre behavior up to a year before the incident. No one reported it. In fact, he was made medical director and continued to perform botched operations during his tenure, and was also granted hospital privileges somewhere else after Beth Israel Hospital in NYC revoked his privileges. According to one site, he continued to practice medicine after this case.

• The case of a Kentucky woman who sued her physician after he branded the initials of his alma mater ("UK") into her uterus and then had the nerve to show her the video footage of the surgery. Not surprisingly, many people commenting on the case think that the woman was only out to make a quick buck, and really didn't have a case.

• Dr. James Burt routinely performed disfiguring genital mutilation on patients for years, even after admitting to having done so without their consent or knowledge. This wasn't in some jungle colony where people practiced FGM as a matter of culture or religion; this happened in the United States. Burt supposedly chose "weak women" who were unlikely to press charges. Apparently a break came in the case when a retired nurse finally spoke up, after years of silence for fear of losing her job.

What do you do, when not only can you not trust your physician, but the nurses who work with him? The last line of defense in protecting you from dangers that you can't fight against, because you're not even conscious? And why did it take so long for patients to come forward?

The answer is probably as complex as it is simple: because we tolerate this kind of behavior among those in positions of authority, simply because they're in that position. Whether it's a simple vaginal exam or a surgery, it's essentially the same thing - a violation of your bodily rights and your trust.

• Just like you were taught when you were a child, no one should touch you inappropriately without permission. Not even your doctor. If he's worth his salt, he will explain to you what he's doing before he does it, not during.

• Don't assume that your doctor "would never do anything like that" to you or anyone else.  It sounds weird, ridiculous, maybe even paranoid. Ask yourself, "Why does his being a doctor make this okay? Just because he's a doctor?" Sorry, not a good enough answer.

• Don't worry about making your doctor "mad." Remember, he's not your daddy. He's not going to ground you for breaking curfew. The more you know ahead of time, the more it will help you to make the best decisions possible. You can change doctors up until the last minute, and do not feel badly for "firing him" as your care provider even while you're in labor.

• If your doctor does do something that you feel violates you, speak up. There is no reason why this stuff should be considered normal or acceptable, just because you're pregnant. Again, it helps to know what's truly normal and what's absolutely necessary before agreeing to something, but unfortunately you might not get the chance. Do not be afraid to say something, even if you think "it won't do any good." When OB's routinely do these things without so much as the blink of an eye, they probably never expect that someone would complain, and they usually don't - which is why they continue to get away with it.

• Practice informed consent, and if necessary, informed refusal. Just because your doctor says so, doesn't mean you absolutely must do something, no matter how unpopular it might make you become among him or his staff. If your doctor suggests doing a particular procedure, inform yourself as much as possible about it whenever you can. Would you undergo major heart surgery without researching it first? Would your doctor even entertain the notion before doing the surgery. Definitely not. Pregnancy and childbirth shouldn't be any different.

More reading:
A License to Rape - Birth Without Fear Blog
Dr. James Burt - Wikipedia 
Uninformed Non-consent - The Deranged Housewife
Doctor brands woman's uterus during hysterectomy - Owning Pink
Doctor sued for 'branding' patient's uterus (a different story from the Kentucky case)

Celine Dion pregnant with twins

I have sort of been following the Celine Dion stories about her struggles with infertility. The 42-year-old Canadian singer has apparently been trying for six years to get pregnant, and sadly suffered a miscarriage after one IVF attempt. She recently went public with her infertility problems on Oprah.

I was happy, of course, to hear that she's expecting and I hope everything goes well for Celine, who is due in November. But I think back to an article I read and one thing stuck out: she basically said she would keep trying , at any cost, to get pregnant.

Of course, when you're a celebrity, you can afford to do that. Apparently Angelina Jolie conceived her twins , Knox and Vivienne, with IVF not because she'd had trouble getting pregnant, but because she didn't have time to do it the old fashioned way. The procedure reportedly cost $12,000.

We can estimate that, if Celine Dion went through six IVF procedures, that it cost around $72,000, using Angelina as a baseline. It could have cost Dion more or less; who knows.

Thankfully, I've never had problems with infertility . Tons of other crap while pregnant, yes; but I've always been able to get pregnant easily. But I can't imagine the heartache, the worry, the financial stresses of the average working-class couple who is struggling with getting pregnant - the average married couple deals with many of these things as it is, minus the infertility. Both men and women can suffer depression as a result, not to mention the draining of savings in order to fund the procedure. Multiple failures or miscarriages can cause even more stress on a marriage or relationship, as well as the inevitable feeling of wondering when it's just time to give up and accept it.

Psychologically it can make both men and women feel like a failure, like it's something they're doing wrong that is causing it. It can also cause immense stress on a couple's sexual relationship when sex becomes a "chore" because timing is so important. Strangely enough, in one study of infertile couples it found that their rate of divorce was much lower than in the general population.

One couple I know chose to forego IVF altogether because of the possible stress it would put on her, and decided instead to adopt (which has its own challenges, including loss and financial pressure). I can't help but wonder to myself if they would have gotten pregnant from undergoing in vitro, but can understand their situation and just not wanting to put themselves through that physical, emotional and financial strain.

I wonder what other infertile women think about Celine's trials and her ultimate success - perhaps wishing they, too, could keep trying until they finally got pregnant, but knowing there was just no way that was going to happen. I can't imagine the heartache of knowing that, among other possible factors, money was keeping a much sought-after pregnancy from happening. Financial help is available for some, but not for all.

Back in November, Dion's husband, Rene Angelil, said they were "living the reality of the majority of couples who face these procreation techniques."

No, unfortunately for some, it's not even close.

Do-It-Yourself Pregnancy

*Disclaimer: I am not suggesting anyone be reckless, especially when it comes to their health or the health of their unborn baby. However, it is your body, and your baby, and you can - and should - essentially be able to do with it what you want. (Although try arguing that in a court of law...)

Anyway, I don't know what got me thinking about this lately, but while I was pregnant with my last I often would sit and daydream while waiting in the OB's office. What if I didn't seek prenatal "care"? Granted, I'm not exactly a good low-risk candidate, at least by my doctor's standards. After waiting upwards of an hour for one freaking five-minute visit where he just blows me off and his nurses do most of the work, I'd think, Why the hell can't I do that?!

Play along with me here for a moment. No one (usually) is there when you conceive. And you can walk into any drug store - even The Dollar Tree, if you're patient enough - and get a run-of-the-mill pregnancy test as cheap as ... well, a dollar. The ones your doctor's office uses really aren't any different (in fact, they probably got a better deal by ordering in bulk). So bam ... you're pregnant! You found out that information all by yourself, without any help!

Playing Devil's advocate, let's assume you have a healthy, normal pregnancy. No problems, no indications for a c-section. You've found out you're pregnant; the next step is to start taking your $4.99 a bottle prenatal vitamins from Walmart (or Target, if you prefer). While you're there, you can pick up a pretty good quality automatic blood pressure cuff for about $80 and you're set to take your blood pressure each month (heck, every day, if you want!) from here to eternity. Doing it yourself means you can get comfy in any position of your choosing, in the comfort of your own home, not having to worry about a nurse breathing down your neck asking you stupid questions like "Did you have a bad day?" when your readings are a little on the high side. (Whenever mine were, no doctor of mine ever offered me to lie down on my left side and rest for a few moments, which can sometimes help lower your BP.)

If you're like almost every woman in America, you have a bathroom scale. You'll be able to tell, just like anyone who can read numbers, if you're gaining weight and how fast you've gained. A good one will probably run you $30 or so, so chuck one in the cart while you're at Walmart. You can even get a fancy one that tells you body mass index and all that crap. Even your doctor's scale can't tell you that!

When it comes time to do the sugar test for gestational diabetes, you can go back to Walmart and pick up a home glucose monitoring system with test strips, if you choose. Diabetics do this all the time, and you can argue that really, if your pregnancy is uncomplicated, you'd only have to do it once if you were seeing a doctor. For probably less than $20, a box of urine glucose strips can detect protein in your urine, the same as it does at the doctor's office. (Tests you can take yourself, "in the privacy of your own home," touts the advertisement...)

Some argue that home glucose monitoring kits aren't as accurate, but in the case of the diabetic patient, they seem to work just fine for millions of people on a daily basis. They do have to follow certain manufacturing and accuracy standards and really, some would argue that perhaps the doctor's test isn't that much better. (Many women are often asked to repeat the one-hour test with a three-hour followup, often when the results are 'borderline' or even negative; one woman I know told me her doctor routinely ordered the three-hour test immediately, regardless.) While many doctors order the traditional nauseating 'flat orange soda' drink before a lab test, many OBs tell the patient to eat a candy bar or drink a glass of orange juice beforehand. Candy bar - less than a buck. Orange juice - around $3. Glucose tolerance screening test - $75-$85 (or more, probably depending on where you are). Think of the savings!

By now you're probably far enough along that you could, if you wanted to, have an ultrasound. Whether it's for fun, to check the gender, or look for fetal anomalies, you can have them done at "special" ultrasound places for a few hundred bucks. Normally I wouldn't recommend doing this because it's not a professional medical technician, and if they do see something wrong, they are not equipped to tell you so. But if you want to know that it's a boy, there you go. Maybe a quick check of baby's positioning just to make sure, even though Bub could still turn at the last minute. (But this is a normal, uncomplicated pregnancy, remember.)

If you're patient, you can just refuse the ultrasound and wait until the baby's born. After all, many reason that there are really very few things that can be done prenatally as far as birth defects are concerned, and many people just like to be prepared ahead of time. Assuming that you're having a normal, healthy pregnancy, this probably wouldn't even be a concern for the majority of the population. And you don't have to worry about hearing pressure from a care provider about what you'd plan on "doing" should something appear to be wrong with your baby. Added bonus!

The rest of the time is spent waiting. You can cruise through Babies 'R Us and while you're picking up the last-minute essentials, splurge on a fetal doppler monitor. Granted, some question the accuracy of these devices too, so remember it's just in fun. After about five months, you can even use a stethoscope to possibly hear the heartbeat, so maybe look for one at a garage sale in your spare time.

Now comes the hard part: labor and delivery. If you're smart, you'll stay home as long as possible until you feel that labor is imminent. If you're really brave, you'll have a do-it-yourself labor too, which many people have done. (My neighbors, a couple who are probably in their 50s, were planning an assisted homebirth in the 1970s and waited patiently for their doctor to arrive. When she didn't, dad had to step in, catching a healthy baby boy who lived to re-tell the tale.) Lots of people have unplanned unassisted births, spontaneously delivering while on the toilet, on the bathroom floor, in the car, on airplanes, and other random locations and do okay at it. (Notice how you'll never hear people tell you how dangerous unassisted birth is it were by accident: why not suggest confining a pregnant woman to a hospital bed once she hits 36 weeks, just in case?)

Option B would be to labor at home and call the fire squad. No doubt they have basic medical training when it comes to delivering babies, and they even get a fancy badge if they've done so, too. They also have quick access to medical equipment, just in case, but remember - this is a normal spontaneous delivery.

Option C would be to rush to the hospital when birth was imminent, ready to push. No time to argue over the over-administration of Pitocin, pushing flat on your back, or threatening to cut an episiotomy - just push that baby out! I'm sure this'll make you popular with caregivers, so beware.

If you should choose option A or B, you'll eat your own food, wear your own clothes, and sleep in your own bed. No free formula feeding bag, no blood pressure checks every hour on the hour when you're told to "rest." No Pitocin to induce contractions of the uterus; you've got boobs that can do that automatically, and for free!

Sure, I'm being facetious. But we've all heard stories of women who didn't know they were pregnant quite far into a pregnancy, sometimes even up until delivery, and manage, somehow, to have healthy babies. How does that happen?! They didn't see a doctor! Now that basically everyone is labeled high-risk (even though they really aren't), how can we possibly be trusted to care for our own bodies? If diabetics can do it, and people with other illnesses, (and pregnancy isn't even an illness) then why can't we?

I know we can't see into our crystal ball, but really, what percentage of pregnancies and deliveries are basically complication-free, spontaneous vaginal deliveries with *really* no need for intervention? Probably more than your doctor would like to admit.

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. 

"So, when's this baby going to come?"

That's what I heard at my last OB appointment yesterday. I joked, "Well, I've put in my request." "When are we going to do this c-section?" he asked, not at all joking. Now that's just not something you say to a woman hoping to VBAC and expect her to take it lightly or think it's even remotely funny. 

At nearly the 40-week mark we've had some interesting, if not startling, revelations. After my OB appointment I spent more than three hours in the hospital for observation of high blood pressure and moderate ankle swelling, only to find out the baby was transverse. Not exactly what I wanted to hear, and it definitely puts a monkey wrench in the works. 

But the good news: I'm still pregnant. Barely. 

After an animated discussion on the phone with one of my doctors in the hospital, I nearly had to beg and plead with her just to let me remain pregnant until this baby chose it's day, malpositioned or not. Her insincerity and total lack of hesitation to pressure me into an immediate c-section was surreal, considering I had the same complications with even higher BPs and swelling in my last pregnancy and was definitely not admitted for observation. I basically told her this, and was in no way going to let her scare me into making an immediate decision. I wanted to go home and rest, think about it, and do some research. 

I feel lucky, considering the millions of women who seem to get duped into taking their obstetrician's word that it's a definite emergency and worthy of panic. I've also heard women say how their reluctance or outright refusal to follow their doctor's orders can result in being treated harshly or ignored, which is inexcusable. I wanted to ask my male doctor why it's only in obstetrics patients get treated this way - as if their bodies are not their own and they are at the mercy of some stranger to make decisions for them, or are completely incapable of making those educated decisions themselves. I wanted to ask, "If you went for a prostate exam, do you think the doctor would say, 'There's a chance you could get prostate cancer. Let's just remove the prostate, and while we're at it, cut off your genitals, too.'" No way would they say that, and no man would tolerate it. Neither should women!

I'm not blaming my doctors for this baby's position, but I can't help but feel ripped off slightly in the whole process. I'm trusting in God to take care of this baby and allow it to turn if it's His will. But in the meantime, it's hard to get over the anger of being made to feel inferior, like you're an idiot, and can't make your own decisions. The lack of support is overwhelming and does nothing but tear down your confidence and spirit - which is unfortunate, considering I have done this before. One nurse at the hospital told me "Good for you!" when she'd heard I had already had a VBAC, and I told her, "You don't normally hear that when you tell someone you've had one." You find yourself clinging to that one word of encouragement in a world full cynicism, apprehension, fear and indifference: as my labor doula put it, "They don't care what happens to you after the baby is born, especially if you have to come to taking care of three children after a c-section." As I told Dr. Congeniality on the phone, 'if this baby turns, I don't want to have had to go through all that for no reason.' 

My only prayer is that women everywhere else don't have to, either. You can't expect your doctors to fully educate you on the risks and benefits and be your advocate by suggesting, "Hey, why don't you do a VBAC?," or "Let's do what we can to avoid a cesarean." Only you can do that, and you owe it to yourself to keep your rights and stop giving them away to someone who only wants you in and out in order to move on to the next unsuspecting patient. 

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/