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. 

Michelle Duggar - Pregnant again!

It's positive!

So, the Duggars are expecting their 20th child. Wow (she says with a glazed-over expression...)

It's not that I'm not excited for them; in fact, I think that if that's what they want, great! I'm just waiting for more nasty comments to fly, since it seems that no one has anything nice to say about this family.

Every time they announce a pregnancy, more myths, rumors and stupidity surface. It's things like this that just further ignite controversy over a woman's uterus, I think - the old idea that when you're pregnant, you're not thinking rationally and therefore that gives others - including complete strangers - the right to make decisions for you, make statements about your moral character, mental status, financial situation, family size and physical health.

I really think the biggest cause of vitriol is because fewer people have larger families anymore. That's it. Not that they're "killing the planet" by single-handedly overpopulating it, but because they have all those kids and are well-adjusted and appear to be reasonably sane. Because no one else wants more children, surely these people shouldn't either, and by all rights should be criticized for daring to think outside the box. Quiverfull movement aside, no one can understand why you'd want "more mouths to feed" and will criticize and label you, no matter what religious persuasion you happen to be.

Case in point - there is a large family (I think at last count they were on child #9) floating around town, the mother sort of dressed in Bohemian style, with the most beautiful hair. Her many daughters, all while maintaining their own sort of individual eclectic style, have long hair like hers, and therefore they are quite recognizable even from a distance. I've been seeing this family - in the grocery store, at the library - where mom usually has the youngest in a sling and is happily tooling around with her homeschooled bunch. No one is freaking out, yelling or fighting and everyone looks happy and well-adjusted, despite the fact that the oldest will often be seen holding one of her many baby siblings and looking totally okay with that. I have on many occasions wanted to stop her and just say, "I think you have an awesomely beautiful family!" and photograph them in all their splendor. I thought about this the last time I saw them, as I was out for a morning walk and noticed them up ahead of me on the sidewalk. I was sort of stalking them, I guess, admiring how they plodded through town like the von Trapp family.

I remember at one point hearing rather disparaging comments about them from my neighbor, who said something like "They all sit up front at mass" with an eyeroll, like they are the poster children for stereotypically dutiful Catholicism. Why the religious reference? I thought. Maybe she just wants that many kids, and there's nothing wrong with that.

I get so sick of the "Oh, the perfect family and you're done!" crap; the bullying, both overt and subtle, that goes on when someone decides to have more children than what our culture deems "necessary." And that's exactly what it is: bullying. We as a society are so set against it and want to teach each other how to love, respect, and all that crap - yet the minute we see someone with more than the prerequisite number of kids coming our way, we immediately snap to judgment. There is such negative bias against larger families, even those with far fewer than 20 kids, because we are now living in a "two-kid world." Anything more than that is often considered a burden or an inconvenience.

An editorial recently ran in Shine magazine about a woman who is childless by choice, and wants her friends, family and strangers to stop asking about when she's having kids, especially now that the population toll has reached 7 billion. Great - I can respect your choice and think if you don't want kids, don't have them. Do the responsible thing and go to great lengths to protect yourself from pregnancy; I wish everyone could be as responsible as that. But some of the comments were, as they usually are, disgusting - implying that people who wanted kids were stupid breeders and totally ignorant.

I find some of the comments about Michelle Duggar, though, as ignorant as some of the her harshest critics say she is - worrying about her pre-eclampsia, birth defects, leaving her children motherless, blah blah blah. You stand just as much chance of having a child with birth defects at age 20 as Michelle Duggar; statistically more women have children with Down Syndrome at a younger age, even though the risks of it go up after age 35.

A childless friend commented on the Duggar story and remarked that 'she didn't even carry the last baby to term.' Perhaps, but that almost makes it sound like she had an abortion. And it's not like all of her children were premature; her premature baby was no different than any of the millions of others born in this country every year, for various reasons - it's just that we heard more about it because of the media's focus. Should that be a reason for her to stop having children? I have a friend who has three children and had complicated pregnancies and pre-term births every time. Does that mean she shouldn't have any more?

With the current crisis of forced abortions in China, why are we worrying about this? When a family can stay together, under one roof and raise a family without outside assistance - not to mention they can raise them to be loving, conscientious and productive members of society - who are we to criticize when in other parts of the world there are women who are forced by their own government to undergo abortions when they want to be pregnant and have a family? And even if you aren't financially stable, does that mean you have no right to have a family?

Bottom line: Reproductive rights don't end with abortion. Everyone is so concerned about Michelle Duggar's health, which is great - but something tells me she has it under control. She has support from her OB, which is amazing, especially considering the overwhelming lack of support some OBs seem notorious for. When you start invoking China's horrible one-child policy and saying things like "Remove her fallopian tubes!" you are still attacking her basic human rights.

Gardasil and the systematic destruction of Michele Bachmann

As the election season draws closer, there is a lot of media attention on Minnesota Republican Michele Bachmann - namely a systematic destruction of her career a la Sarah Palin - because of Bachmann's views on the controversial HPV vaccine, Gardasil.

Many were not happy when Texas governor Rick Perry voted to push through legislation that would make it mandatory for the vaccine to be administered to Texas school kids. Some, including Bachmann, criticized him for being 'sold out' by the vaccine's manufacturer for the tidy sum of $5,000. Perhaps, but I'm not so sure. I think he was just drinking the Kool-Aid prepared for him by Merck - the same crap doctors, nurses, and just about everyone else feeds to us when it comes to making informed decisions for our kids.

The other day I decided to flip on the TV and watch a little Fox News, only to see a group discussing Bachmann and her 'radical' views on Gardasil on Greg Gutfeld's segment. One contributor said she couldn't understand what the big deal was and called the vaccine a "wonder drug for women," and made a reference to schools requiring vaccines anyway - so what's the big deal about this one?

During a news break just a few hours before, the news anchor made Bachmann sound like a complete moron for daring to question "science." Everyone is trying to make her look as pathetic and idiotic as they did Sarah Palin, nitpicking and ridiculing at every turn.

She's the candidate everyone loves to hate - and no one wants to admit that they agree with. Dr. Manny Alverez, a Fox News contributor, stated his piece on their website that he has to 'side with Governor Perry' on this one, but doesn't agree that it should be mandated by the government. He also goes on to say that it isn't 100 percent effective at preventing or treating all strains, and thinks Perry made the wrong move by endorsing it. Well then, it doesn't sound like you are siding with Perry at all, does it? Did I read that correctly?

He latches on to her claim that a parent told her it caused her child's mental retardation after she received the vaccine. True or not, he isn't making any mention whatsoever of the potential side effects of this or any other vaccine, a completely legitimate argument not to vaccinate. Bachmann never said she personally made the claim, only related the story of someone else that did - and Merck immediately, unsurprisingly, went on the defensive.

Basically what I have noticed is that they are completely ignoring the issues surrounding Gardasil - whether they're political, philosophical, medical or spiritual - and ganging up on her to destroy her credibility and her reputation. No one mentions anything about side effects or potential complications, or that it ideally should be administered to children as young as nine years old.

Apparently Perry's legislation did include an opt out* for parents, but that also seems to be publicized little. Some argue that bureaucratic red tape could make it difficult or virtually impossible to refuse, combined with pressure from districts to go ahead with it. The word 'mandate' implies that parents don't have a choice when really they do, but I bet Merck and others involved want you to think you don't - sort of the "if you can't beat 'em, you might as well join 'em" approach.

What everyone except Bachmann seems to be missing is the idea that yes, this threatens personal liberty - that of the child in question and that child's parents. The state, to some extent, does intervene in our lives, in the sense that we would be arrested if we were doing our children bodily harm. Unfortunately to some, not vaccinating your child constitutes as 'bodily harm.' Where do you draw the line?

As a result, the State of California is giving children as young as 12 years old the power of informed consent to be given Gardasil, without their parents' knowledge. Groups that support the legislation include the ACLU, ACOG, and Planned Parenthood, and opposition is considered "largely faith-based." (I find it laughable that the ACLU, of all organizations, is basically saying only the rights of certain people - in this case, not the parents - count.)  I find this probably the most alarming, least-talked about aspect.

As parents, we know how hard it often is to refuse vaccinations at the doctors' office that we might philosophically disagree with, and are frequently pressured by pediatricians, healthcare workers, school nurses, friends and family to vaccinate for everything, without question. How then, do you expect a 12-year-old to adequately make that decision? And why are they essentially ignoring the rights of the parents? What happens if a well-informed child tries to refuse? And if children are fed scare tactics to get the shot, but know their parents don't approve, isn't this essentially a situation of the school district (and the state) pitting the child against her parents?

Apparently this legislation is part of an already existing bill that enables children as young as 12 to seek treatment and testing for STD's without parental permission. (Click here) The thinking is that those kids who are too afraid to talk to their parents will get the treatment they need. Unfortunately, I think that is only feeding the problem.

The core issue at the heart of the state-forced Gardasil vaccine is that parents are not often adequately talking to their kids about sex. Period. Kids know little information about what constitutes sexual contact, and parents admit to not having appropriate conversations with their children about it. The state, in an effort to curb STD and pregnancy rates in teens, has no doubt decided to do the parents' jobs for them - figuring that if they don't, we will.

The problem is, many parents do educate their  children about the reality of sexual relationships and the dangers of STDs. In many circles this vaccine, and our overall sheeple mentality on vaccines in general, is that it will fully protect our children 100 percent of the time. Even though some suggest educated teens do wait longer to have sex, there is still the idea that "teens are teens" and will do this sort of thing, so why not provide a safety blanket of sorts. Others think that safety blanket is not enough, and it might fool teenagers into thinking they have a green light to engage in even riskier behavior.

In order for the vaccine to work, it's suggested that patients receive three doses, and some are speculating that often the girl doesn't get the remaining two vaccines. You're considered more at-risk for HPV if you've had multiple sex partners, or been with someone who has. Additionally, the younger a girl is when she starts having sex can also increase her risk. The irony in this is that culturally, we seem to condone teen sex or even embrace and tolerate it in an effort to remove the stigma. Combined with the fact that many parents do not adequately inform their teens about the potentially life-threatening repercussions of sexual relationships, this is like setting a trap for our children and then pushing them into it. Even so, is that really up to the state to decide?

In the meantime, legislators had to disclose that Merck personally paid them to push legislation through. And at $360 for a trio of doses, that's a lot of money the drug manufacturer stands to gain.

The Gardasil problem joins a number of other ones surrounding our medical community. What once started out as an altruistic approach for the common good, now the boundaries are blurred as more and more people want to take initiatives to force that "common good" on others. Forced or coerced vaccinations are just the tip of the iceberg; it's not unheard of for women to be forced into cesareans by court order, or for cancer patients who refuse treatment to be ordered to do so. A UK woman with severe hospital phobia and "learning difficulties" has been the subject of just such a debate, and was ordered into surgery to save her from potentially fatal cancer. What does it take to deem a patient unfit to make their own medical decisions? Probably not a whole lot.

Because Bachmann is essentially questioning the motives of the medical community and others' blind trust in it, I think it will be hard for her to wade through the mire of opponents. I'll also be waiting to see if Merck personally decides to take action to shut her up already regarding her claims on Gardasil, or if the media will essentially take care of that problem for them.

I'm seeing an interesting turn of events, though - perhaps what will amount to parents on both sides of the political and faith-based spectrum siding with Bachmann because she is such an outspoken opponent of this policy.

More reading:
Judge criticizes council for trying to force contraception on woman - The UK Telegraph
One More Girl - Truth About Gardasil documentary
Bachmann's Vaccine Theory pulls GOP to Jenny McCarthy Territory 

*The Association of American Physicians and Surgeons, Inc. issued this statement on Perry's approach to state-mandated Gardasil, as copied and pasted from the blog, "A Time for Choosing:"

“Opting-Out” of HPV Vaccine WILL NOT WORK for Many in Texas

Governor Perry is misleading legislators and families in Texas by claiming that they will be able to “opt-out” of having their 6th grade daughter vaccinated with the vaccine for the sexually transmitted virus HPV. For many families currently, the exemption isn’t worth the piece of paper it is printed on. Besides the simple fact that parents should not have to get permission from the state to make informed consent medical decisions for their own children, here are four reasons why “opting-out” of state mandated vaccines doesn’t work for many families in Texas:

“Opt-out” or Conscientious Exemption to Vaccination Process is a Bureaucratic Nightmare

To get the exemption form, parents must first submit a written form to State Health Department in Austin which forces the disclosure of the child’s full name, birthdate, and mailing address. The Health Department takes those written requests and creates yet another form on which they print the child’s same personal information that the parent had to send to health department, and the Health Department sometimes takes weeks to mail out these forms inevitably disrupting the child’s school attendance. The Health Department only sends the forms by U.S. mail, and once the parent receives the forms, they must be notarized within 90 days of submitting them and then repeatedly resubmitted every 2 years even though there is no expiration set in statute.

[1] Because the Health Department further eroded parental rights by publishing more rules getting rid of provisional enrollment for exemptions, (families used to have 30 days at the beginning of school to get their paperwork in), now schools participate in aggressive misleading education campaigns touting “no shots – no school” while not informing families of the exemption or the instructions how to obtain it.

Private Schools Deny Admission

The Texas attorney general issued an opinion in April of 2006, ga0420, that states that private schools do not have to accept the conscience exemption to vaccination in Texas Law[2], and many private schools do not. For example, the Dallas Diocese for Catholic Schools policy number 5024 states, “Schools will comply with immunization requirements established by the Texas Catholic Conference Education Department. Conscientious objections/waivers are not accepted in schools of the Diocese.” [3] Every new vaccine mandate causes more children with valid legal exemptions to be denied their private school education.

Doctors Refuse Medical Care

Even though you may be able to get a piece of paper from the state health department affirming your right to refuse state mandated vaccines for your child, just try and find a doctor who will honor it! According to a recent study published in the Archives of Pediatrics and Adolescent Medicine, 39% of pediatricians surveyed said they would throw kids out of practices who are not vaccinated. [4] PROVE has documented this rampant problem of doctors dismissing families utilizing a vaccine exemption in Texas to the legislature in previous sessions. Please review our report entitled “The Erosion of Public Trust & Informed Consent through Immunization Harassment, Discrimination and Coercion” prepared for the House Public Health Committee in 2005. [5]

Insurance Rates Rise and Accessibility Affected

Responsible parents who have secured health care coverage for their children will be forced to pay higher insurance rates whether they want the HPV vaccine or not. Even if you “opt-out” of the HPV vaccine mandate for Gardasil by Merck by securing a conscientious exemption waiver, there is no way for Texas parents to “opt-out” of the corresponding rise in their insurance premiums. § 1367.053. (a)

(2) of the Insurance Code REQUIRES that any vaccine required be law must be covered by insurance. [6] This first-dollar coverage requirement results in corresponding direct hiking of insurance premiums to meet costs, and for a vaccine as expensive as this one, an HPV vaccine mandate risks putting premiums for basic health care coverage out of reach financially for even more Texas families. Additionally, we have received complaints from families where insurance companies are harassing parents with letters and discriminating on coverage based on whether or not the child has had all their state mandated vaccines.

Thomas Beatie must have a really good OB

Regardless of how you feel about the Pregnant Man, he must have a very supportive OB to guide him through three pregnancies.

From what I've read, it hasn't been easy . He and his wife Nancy went through nearly a dozen doctors before they found one to help them when they were seeking to become pregnant with their first child. Beatie told Oprah that doctors refused him treatment, citing "religious beliefs" (which I find an immense laugh) and that they felt uncomfortable about the whole thing. That's understandable, but it's not really your job to let personal beliefs and preferences get in the way of treating a patient, who, coincidentally, is a human being, regardless of gender.

So, does that mean it's okay for a pregnant woman to decline interventions based on religious reasons? Something tells me you can try, but it will be very difficult. My guess is they would see it as 'child abuse' (even though it might be hard to prove, i.e. the Laura Pemberton case) and you would be forced to comply.

During his first pregnancy, Beatie said:

“A few months and a couple thousand dollars later, he told us that he would no longer treat us, saying he and his staff felt uncomfortable working with ‘someone like me,’” he wrote. Beatie added that he and his wife’s situation “sparks legal, political and social unknowns.”

So the doctor basically took his money and then decided he didn't want to treat his patient anymore. I wonder, did he give Beatie a refund for wasting his time?

He continues that one doctor referred them to a psychologist to see if they were 'fit to bring a child into the world.' (Do they routinely do the same for drug-addicted mothers, or parents who obviously should not be bringing a new life into the world?) Beatie says they were refused insemination treatment by nine physicians, and that 'receptionists laughed at them.' From the experiences I've had with some of them, I can assure Thomas that it's not just him - some of them are always that rude to everyone.

Despite the reluctance from so many doctors to treat him first as a human being, and secondly, as a patient, he found one who would. Dr. Kimberly James told Oprah that the baby was totally healthy and it was a "normal pregnancy."

Uninformed non-consent

There seems to be a popular myth that a doctor cannot do, or never does, anything to a pregnant woman's body that she hasn't consented to first. Yes, in an ideal world, but this is the furthest thing from the truth. But in some cases, it seems that 'informed consent' is a relative term.

A baby is born via c-section in Brazil, where surgical birth rates are among the highest worldwide. 

While hopefully not the norm, this kind of stuff does happen. Even here, in the United States of America, the most wealthy country with all this knowledge, medicine and technology at our fingertips.

The other day on Yahoo! Answers I read a question about a woman who had received a tubal ligation without her consent. Her now ex-husband had ordered it after the birth of her third child, in the event that if they ever divorced she wouldn't be able to have children with another man, from what it sounds like. The doctor agreed, and thus the tubal was done.

It's important to note that this woman was posting from India, where reproductive rights are not what they are in Western countries. So I have no doubt that this woman was telling the truth when she presented her plight.

Women left and right answered her with a barrage of stupid, insensitive answers, some calling her a "troll," others assuming that there is no way a doctor could do that to her without her consent and suggesting she seek legal action. Yeah, sure, in a perfect world she could do that. But it is plainly obvious that women the world over, even in this country, are treated like nothing more than vessels to hold the baby, like they have no feelings whatsoever and are hormonal time bombs waiting to explode.

When I responded, I took notice of how the reproductive rights of women in her homeland were probably very different than in the US. I also noted, however, that women even in this country suspect they've been the victim of tubal ligation (and other procedures) without their consent. One particular website, that of a tubal ligation reversal clinic, features a forum in which several women have written in complaining that they inexplicably can't get pregnant after three children, and suspect that their doctors did a tubal without their consent. On another forum, thankfully one physician saw it for what it was: a felony and assault, if proven that the procedure was done without the patient knowing. But what are you going to do about it? (Read on to see that the woman in question reports that other patients in the practice suspect they had the same thing done, yet were totally okay with it.)

And even if the practice is consensual, many times the OB will ask a woman in labor if she wants a tubal while he's 'at it.' Surely you can discuss this beforehand or at the six week check up, when hormones aren't raging and the body's response to a painful birth isn't doing all the talking. Lots of women give in to a tubal at this point, and later come to regret it.

Another procedure often done for no reason and without consent is the episiotomy. The option is to tear or be cut, and conventional wisdom assumes that it's better to be cut in a 'controlled' manner than to tear. Thankfully my midwife asked me what I wanted to do, and I consented to be cut because I wanted the baby out. (I know... duh!)

People are horrified at the terrible acts of genital mutilation often practiced on women in African countries, yet a similar practice goes on in the obstetrical wards of hospitals every day in the US (and in other industrialized nations). One criteria for true female genitalia mutilation is 'non-therapeutic reasons,' and given that it's estimated that nearly 99 percent of all episiotomies are totally unnecessary, I'd say this definitely qualifies. And while Wikipedia, of all places, has an in-depth article on FGM as used in African cultures (including types that don't involve tissue removal, which I'd guess is most similar to a typical  'western' episiotomy), they don't mention anything about this phenomenon in American obstetrics.

Studies have shown it's actually easier to heal from a tear than from a cut. Some OB practices do them on every woman, whether they really need one or not. And sometimes it's done before the woman can even say anything, or even though she's already refused and has continued to do so immediately before the procedure takes place. I've read countless stories - including my own, I believe - where the mother has requested no pain relief during labor, which somehow cruelly translates to the OB, "Don't give me pain relief for an episiotomy."

And sadly, one of the most common obstetrical surgeries is often done without "consent" - a c-section. In this situation, I think it's important to define 'consent.' Consent under duress seems much more fitting - (Read it and weep. Literally.)

No one is arguing that sometimes a section is necessary, or that sometimes there is just no time to dilly dally and debate it. But in the case of a woman who is actively, successfully laboring on her own, can this interruption of normal labor be considered true consent?

In the case of Florida homebirthing mom Laura Pemberton , who was arrested during active labor and taken to the hospital in shackles for a court-ordered c-section, do you really think she had a choice? Was her consent given? Or this woman, who was in the process of a successful VBAC, nearly ready to birth her baby when the attending physician interrupted and insisted on a c-section ? She granted consent only after extensive harassment, which included the threat of not helping her deliver her child and discharging her from the hospital, even though she was moments away from giving birth.

It's sad and terrifying to think that women have to take such protective measures with their own health. And that the more educated about their bodies that they are, the more threatening their situation can become. The words "First, do no harm" have long flown out the window and been replaced with shades of grey.

For more reading on this subject, click here .