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? 

Everything in moderation - even birth advocacy?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Words of discouragement

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

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

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

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

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

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

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

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

The new mommy wars

Lately I have found myself caught in a strange time warp, of sorts. Often when I read certain blogs or hear about new FaceBook fan pages popping up, it's like my old, worn-out 36-year-old self has been magically transported back to seventh grade and I didn't even know it.

In my cluelessness, it took me awhile to find out about sites like The Feminist Bragger. A completely weird, bizarre parody designed to basically do nothing but make fun of The Feminist Breeder, I read a few posts and then moved on. Whatever. That was interesting, for like two minutes. Next?

Then last night I stumbled in to the virtual cesspool of "Birth Without BS," a fan page dedicated to cutting through what some people consider woo and getting to the heart of the matter, I can only guess. Fine, that sounds like a good place to start. While there's lots of information, blogs and other stuff out there, obviously it's not a one-size-fits-all deal, and much like shopping for a house or car, we can all choose what we want and don't want.

However, there's one problem: those who don't agree or like certain things have decided to start fan pages and blogs to talk about it. That one kind of left me scratching my head, and I considered it a very ballsy move. Is this what we teach our kids about conflict resolution and how to treat people we don't see eye to eye with?

While I might not agree with everything one blogger says, I don't start an entire blog dedicated to bashing that person and all the stuff she says or does. Who the heck has time for that? I think many women are smart enough to realize what they want or don't want, and I get so tired of hearing how so and so is "promoting" something - like unassisted birth, for instance - with the dreaded anticipation that scads of women are going to blindly follow suit. That expectation is about as bad as the "sheeple" mentality some people have, only in the other direction.

I guess I figure if you don't like it, don't read it. Move on. Do something else. But above all, be respectful of another person's decision or choices.

So now anyone who is different is labeled "BS." (I guess one person's woo is another person's BS. So it's all relative, right?)

Blogs like The Feminist Breeder, Rixa Freeze of Stand and Deliver, Birth Without Fear and Gloria LeMay have been nitpicked and criticized. It leaves me wondering, just who's side are you on, anyway? I find it profoundly strange and sad. And it only makes people like Dr. Amy briefly stop and reload while on her mission to bash anything and everything she doesn't agree with. (At least Dr. Amy has the guts enough to use her real name when attacking people.)

I just wish the drama would stop - it only stirs up more crap and leaves behind those women who are on the fence about birth choices and really need help and support. Instead we should be behaving like the powerful, strong women we are - instead of the childish, petty little girls we should have left behind years ago.

A bitter birth nerd

The other day I posted this question as my FaceBook status: "Do you ever think sometimes that you just need to step back from birth stuff for a moment or you'll explode?"

I was kind of surprised that some wholeheartedly agreed yes - although I'm not sure why I was. Normally I love the writing, the reading, the interacting with others - but sometimes I just get so bummed by the situations of people around me - people I don't even know - and don't know how to put my finger on those feelings.

I lie awake and think, What is wrong with me? I can feel a tension, an undercurrent, and I'm not even sure what it is. I realize that I worry, for other people. Women I don't even know. I can't read "certain blogs" (ahem) before bed because I will stew and seethe fitfully through an entire night's sleep. I lie there and wonder, How am I impacting anyone? Who am I really helping? Why does it seem that so few women agree and that so many women are sucked into the vortex of unnecessarily abnormal birth? How can they not see it? 

Sometimes I think, Will my blog just keep going on forever? What will there be to write about? What kind of advocate will I be in 10, 15 years or will I even be one? I like to consider myself a "birth nerd," not a "junkie," mostly because I know certain people (the same people who write those "certain blogs") consider that statement laughable, perhaps derogatory (even though they themselves live, eat, breathe birth, just a different kind of birth). I never started out on this path intending to be anything other than a mom, and somehow careened into something else. I never dreamed I would come to this point.

Knowing what I know now, and in sharing the experiences of other people, it's hard not to be bitter and hopeless about things sometimes. Especially in the comments I received on my last post, I was disturbed by the responses I got. I feel angry for these women, wondering why some of them aren't angry, too. Thankfully, some of their husbands stood up for them and confronted the doctor. But then what? What did it change? If we keep hearing how this happens, how it's legitimized, what has it really changed?

It's hard not to get defeatist or angry over other people's decisions, knowing that it's a decision I would never make for myself. But then I remember, they're not me. So it doesn't matter what they do. It ultimately doesn't matter what I think.

My niece just gave birth to her first child, and as usual, the end of her pregnancy was miserable. Just like it is for just about every woman. I know many women suffer in physical and emotional ways that are far above the norm, and I don't want to make light of their ailments. My niece was uncomfortable, but said she did not want to induce without a medical reason. I took that as a good start and offered advice, as did many of her friends: avoid Pitocin. I tried to encourage her the best I could, offered tips on how to manage labor and blah blah blah. The usual "Your baby will come when he's ready" stuff that us Birth Nerds like to tell everyone, which sounds crummy and well-meaning to her, but hey - it's the truth.

When she posted pictures of herself on FaceBook after she had the baby, I found myself scrutinizing them closely. A shot of her husband standing next to a sterilized cart of medical instruments, no doubt "just in case." I thought, I am being an idiot, but honestly - I do it all the time. I'm not sure if this is good, bad, normal or what - but I wondered, Did she get a cesarean?! I was so hoping not, that she had gone into labor on her own and just let the baby do his thing.

My mom called the other night and asked me if "I'd heard." Apparently they never told any of our side of the family, until my sister blabbed. Of course, I had a sinking feeling when I saw that picture of her, smiling, hugely pregnant and in her hospital gown. Few women in true, active, unmedicated labor look like that, I thought. And if they're medicated, they don't look like that, either. My mom sounded kind of disgusted, which secretly pleased me: "She got induced."

I knew it. My heart kind of sank.

I told her I had tried to help and knew she was uncomfortable, told her that it could potentially raise her c-section rate, and her group of friends and I told her to avoid the Pit. I kind of thought, Geez, why even ask for advice and sympathy when you're just going to ignore it? She suffered just like the rest of us do, and then later I read status updates on how awful she felt and what a "rough recovery" it was. Yeah, no kidding, honey. I don't want to say, I told you so, but ... well, I told you so. I can even picture a possible scenario (God I hope not): I tore so badly with my last birth, why don't we just schedule a cesarean this time and avoid all that?!

It's hard not to get too caught up in other peoples' decisions. My mom even told me, "Don't take it personally." I try not to, but I still can't help looking at pregnant women in public and wonder, Where are they giving birth? I bet she's had a cesarean. I wonder if she'll get an epidural? It's the most absurd conversation ever, and yet, I bet I'm not the only one who does it.

Sometimes in conversation with strangers we'll start talking about babies, their upcoming birth and whatnot, and something will slip: "Oh, I'm due on July fourth." I immediately picture the woman on the operating table, told her "fluid was low, baby was big!" kind of crap perhaps because her doctor had a Fourth of July picnic to go to that was more important. You can't just open up a can of worms with strange women in public like that. At least not unless you want them looking at you like you've grown a dozen heads and suddenly started talking in Pig Latin. I wish I could tell them. So much to say, so little time. So few people who really want to hear it.

I know my niece, and many like her, made a decision. Was it the right one? I don't know. I don't know if even she knows that. I don't know how much she knows about birth, or why she's feeling like she is, like she got run over by an 18-wheeler. I don't know if she'll make that connection the next time she's in labor, if there is a next time.

I don't know how much of her choice was really hers, in the end. I'm not sure if she's knows that either. She may have read some books, asked some friends, but in the end, did it matter? Maybe she thought, That's not what my doctor is telling me, or That's not what the pregnancy book I read said. Just some crazy relative talking out of her ass, that's all.

I know I can't make decisions for other people, and that every birth is unique. I'm not feeling their emotional pain from having weaned themselves off their antidepressants and rounding the corner into a possibly monumental bout of postpartum depression. I'm not feeling the physical pain of SPD. But I have felt the physical pain of cesarean, the emotional pain that everyone tells you to get over because you should "just be happy you have a healthy baby!", the psychological stress of wondering how much I'll have to fight for the birth I desire, should I ever get pregnant again. And I can see what might lie ahead for my niece and others like her, because I've already been down that road and don't want someone else to go down that path, either. At least if they don't have to.

Some thoughts that sum up what I wish I could tell people, that I wish they could understand:

When we treat high risk women with all that we have to offer, we lower their risk. When we treat normal women as high risk, we make them sick. - Michael Klein, MD

Any decision that is made without research and education, is NOT a fully informed decision. It is a decision based on fear and/or one that relies on dumb luck. - Health, Home and Happiness

Gullibility and the Pacific Northwest Tree Octopus

The Pacific Northwest Tree Octopus: perhaps you've heard about it. Does it live in the water? Does it live in a tree? Does it even exist?

Apparently this 'endangered species' is extinct - because it's not even real.

A study was recently published by the Pearson Publishing Company that suggested kids were being dumbed down because of the Internet, and weren't able to discern if what they were reading was real or not. The group set up a fake website and asked seventh grade students to research the octopus, and no one realized the website was a hoax. Some students apparently refused to believe it was fake even after the study's leaders revealed the truth about it.

In the comments section for this article, people were quick to jump all over our legendarily poorer performing students and essentially blame them for not having enough critical thinking skills. I disagree. Perhaps the people who conducted this study aren't familiar with the Snopes website?

I feel badly for these kids, because many at that age level are often brainwashed with ideas about environmentalism and politics by their teachers. Parents are one thing - you are entitled to raise your kids with whatever ideology you want. But it is not the teacher's job to tell the student what to think, merely how to think. There is a big difference. Nor should the teacher be injecting his or her personal feelings into the argument. (I know some teachers who do this, and can't believe they still have jobs.)

One mom piped up and said her child's school was repeatedly showing Al Gore's An Inconvenient Truth in class. If environmental issues are your thing, that's fine; but skeptics are quick to point out that Gore's movie is not all "truth." Separating the wheat from the chaff, so to speak, doesn't appear to be a problem only among kids. And if it's coming from the mouth of a teacher or other school official, they're probably more bound to believe it, simply because that person is "trusted."

I think the kids' hesitation in realizing the whole thing was a hoax comes from two different things: one, kids are taught that most adults are to be respected, and that they have authority; that they are right. What kid wants to believe that an adult would intentionally lie to them about something so serious an issue as this? Secondly, animal endangerment and environmentalist issues are currently hot-button topics that evoke a lot of emotion and passion from both sides, and kids want to feel - like anyone else - that they can make a difference in such a popular concept. My personal take, as a parent, is that no one is telling us we shouldn't be good stewards of the Earth; but sometimes I think it's taken to an unbelievably ridiculous level at times: like in the case of the parents who killed both themselves and their child (the second child survived a gunshot wound to the chest) because they were concerned over their "environmental impact." Crazy, or just extremely gullible?

Perhaps you've heard about Orson Welles' famous science fiction hoax War of the Worlds, a radio production that convinced thousands of people that Martians were invading the planet. Sure, we couldn't Google it to look it up - and with no TV, you certainly wouldn't see reporters on the scene, giving updates every twenty minutes. But while this broadcast was being aired, millions of people were literally freaking out. And for what?

I've also read that TV viewers would often approach actors who played doctors on television and ask them medical questions. Or that when the popular Dick Van Dyke Show went off the air and Mary Tyler Moore starred in her own self-titled series, that they purposely made her character single, because the writers were afraid viewers would think she had divorced Dick Van Dyke. Seriously? Can we not separate fact from fiction at all here?

Or how about commercials that feature medical "products" that come with a disclaimer that "the doctor portrayed in this broadcast is a paid actor." Because you're more inclined to believe what they're telling you if it comes from a doctor (or at least someone who dresses like one) - someone who is usually esteemed and upheld as a paragon of trust and knowledge. Yeah, right.

We see the same kind of behavior among many pregnant patients and their obstetricians. Because that guy has a white lab coat on and a degree hanging on the wall of his office, it means he's right - even if what he's saying doesn't quite add up or is completely false, unbeknownst to us, it sounds better, more right, if it comes from him. So some crazed madwoman with a passion for natural birth has no medical degree - but can shove reams of paper under your nose that directly contradict what your doctor is saying - and she's the one who's wrong?

The words "just talk to your doctor" make me cringe. Because often when we do, we hear things like:
• "20 to 25 percent of women can't dilate to 10 centimeters."
• "[If you eat and drink while in labor], your poop could be sucked into the vaginal canal..."
• "Come in for a vaginoplasty...we'll make you tight as a teenager again."
• "The vagina is a very dirty place for a baby!"
• "It's illegal everywhere but maybe New York," to a mother interested in a VBAC.

No word on whether these OB's were that gullible (or just dumb), or were just hoping their patients were.

More reading:
Mythbusters - the only guys (and a girl, too) with enough guts to prove how adults are sucked into thinking nonsensical crap is true, too.

The Obstetrical BS Series: "He's the doctor ... you have to listen to him."

When I was 22, I visited the Dreaded Gynecologist for the first time. I was young, naive, and totally stupid when it came to seeing the OBGYN. My doctor proceeded to tell me two things: That doctors should always put gloves on before examining you, and that they should always tell you - or ask - before they did something to you.

For some reason, people would never tolerate having someone aggressively approach their genitalia in any situation - but because you're at the OB's office, whatever he does to you is suddenly okay.  It's like your care provider has free reign over your body parts, and it's just too bad if you don't like it.

While we should be able to trust our physicians, I'm no longer under the delusion that I necessarily can. As a result, I've become increasingly skeptical when hearing "emergency" birth stories and in dealing with my own OB.

Many people are under the impression - especially when it comes to labor - that doctors are always well-meaning, know what they're doing, and are doing whatever it is to you because it's necessary. I'd like to say that were always true. Unfortunately, largely because a lot of people are totally uninformed about birth, they don't know what's truly necessary and what isn't. Sometimes even when you are informed, it doesn't make a difference and you get railroaded into something terrible. I hate to say it, but that aspect of birth advocacy really depresses me.

Because of that lack of information, and the blind trust in the physician to be overseer in all aspects of our care, some people think that mothers who consider their experience 'less than perfect' are going to extremes when making claims of birth rape or assault. They think you're exaggerating, that you are being dramatic, that you care more about the "experience" (gah - I hate that description) than a "healthy baby!" Fervent anti-natural birth advocates like Dr. Schizo often make those claims, as do those diehard women who run in her circles. To say that a healthy baby doesn't matter to any pregnant woman is utter BS. But to some of us, the process of getting there means more than to others, and can greatly shape our definition of "health" both for mother and child. I hate how those "anti" people tend to completely disregard the emotional and physical well-being of the mother in favor of the baby, as if it means nothing. How can we even consider for a moment that mom's overall emotional and physical health don't play a role in how she cares for her newborn?

Many times I've run across comments like, "Just listen to your doctor, he knows what he's doing," or "You are not a doctor and you can't possibly know anything." Totally downplaying mom's (completely relevant) fears and concerns as if she's some kind of idiot. When she dares to question the doctor, suddenly she's treated with disdain, as if to say, "How could you" One mom, when confronted with the comments of a knowledgeable labor and delivery nurse, basically said, "You're not a doctor, and I won't listen to you." That degree and white coat mean so much to some people that they're totally willing to overlook huge red flags, like My doctor treats me like sh!t, belittles me, makes me feel like my concerns are meaningless, and doesn't treat me like a human being.


Our often well-meaning, completely birth-stupid culture devalues mom and her individual labor and birth needs, essentially seeing her as nothing but a vessel - an incubator who holds that baby in for 10 lunar months and suddenly ejects it in any way possible, whether she likes it or not. Then they either turn around and accuse you of being uninformed, or being selfish - even though your baby is no doubt just fine.

OB:  “If I’d known the baby was so big, I would have done a cesarean section.”

Mother:  (holding her just birthed baby) “I wouldn’t have let you!”

OB:  “It wouldn’t have been up to you.”  (Courtesy My OB Said What?!?)

So, mom is perceived as selfish and superior because she would have had the audacity to question her doctor. And her doctor is basically implying that he would have done a cesarean without her permission. Many women called it as they saw it, except this one:

"u ladies need to be a little less sensetive, hes an OB.. part of their job description is to come into contact with female genetalia.. birth rape? give me a break.. i have had 5 kids, and have suffered some pretty traumatic birth experiences ((ie. heamorraging and having the OB use her hand to mannually remove the clots from my uterus))… but thats birth, its dirty, its hard, and its not pretty… if ur not ready for that, then adopt, or buy a puppy…get over yourselves…."

So in other words, even if your vagina was forcefully entered into with a hand, fingers or other tool, or even the mere suggestion was made of doing something without your consent, you're just supposed to get over it. Because he's the doctor.

Yes, an OB's job is to come into contact with vaginas and whatnot. But it's the contact part we need to examine: did he ask first? Did he tell her what he was planning on doing before he did it? Did he preface it with a comment that suggests her rights were completely irrelevant to him, as the above post suggests? (As a side note, I bet you ten bucks that the second commenter's "traumatic birth" was likely due all or in part to her overzealous physician. What say you?)

Further down in the comments section, another poster mentions how yes, it's assault; but it would be awfully hard to prove in court. Of course it would, because we have a whole generation of sheeple who think the doctor is always right and only does what's good for you.

Awhile back I read the comments of a mom who was nervous about her doctor inducing her with Cytotec. She was planning on standing her ground if the doctor insisted on using it, but "didn't want to make him mad." I nearly swallowed my teeth.

As usual, the old "He knows what he's doing" crap came out. And while I was happy that she had done some reading on Cytotec and the concerns surrounding it (more than likely because she's used to hearing about Pitocin and this sounded different, thus prompting her research), I'm sure she had no reservations whatsoever about Pit and didn't question that one iota.

Your OB is not the boss of you. He is not God. He is not your dad. He is a medical advisor, and you are free to seek another opinion regardless of what he says. Yes, sometimes unpleasant and painful things must be done to us for the safety of ourselves and our babies, but he or she should do so with compassion, dignity and respect. And if he's not giving it to you, then you need to demand it, because it's your right.

Do not let anyone tell you to disregard or ignore your feelings of inadequacy, spiritual, emotional and physical pain, and other complications that might be hard to concretely identify but you know they're there. You are not just a holding tank for this child; you are a human being with feelings, emotions, and rights.

The Obstetrical BS Series: Redefining Normal

What is normal birth, anyway?

Whenever I have conversations about birth with people and see comments on pregnancy forums, I'm saddened at how our definition of "normal" has totally been taken off course. I don't know why I'm surprised by this, but am continually amazed at some of the lies, misinformation and half-truths that lurk out there, and how the Reality of Childbirth is one big rumor that just won't let itself be put to rest.

When people think of the "history of childbirth," they probably think that there isn't any: how can one woman getting pregnant and delivering a baby be any different than it was 100, or even 1,000 years ago? How can there be a 'history' to a basic biological function that has taken place in millions, even billions, of women since the dawn of man?

I've decided to compile a few of the things that I consider "BS" when it comes to obstetrical practices, starting with our perceptions of what "normal" birth is. Much of it is rooted deeply in myth, some in fact that has been extrapolated (I love that word!) to include everyone now, even though they often present no symptoms and fit no risk categories. We fail to see ourselves as "birth consumers" and trust our doctors to tell us what we need to know, which in some ways we should. But because we often don't understand the mechanics of birth and how it relates to the capabilities of the human body, or the politics surrounding it, we often trust them in ways that we shouldn't. I suppose it's different for everyone, but I cringe whenever I hear people refer to a vaginal birth as "natural," especially when it's far from it. Natural in the sense that that's the preferred mode of delivery for humans. But that's about where it leaves off. Perhaps they should use the word "normal," but even that's a matter of debate.

If you're like most American women, you get pregnant, find an OB, and think that's the end of it. When it comes to delivery, you know that one of several things usually happen: you are either induced for a variety of reasons, or "allowed" to go into labor on your own time. Occasionally you are "permitted" to go overdue, but not without some level of concern first. You've heard that the placenta can deteriorate after a period of time once the baby reaches a certain gestational age, and it has you worried that you might go overdue .

You've long-since chosen your care provider. In your case, you probably have chosen an OB, because that is usually just the 'thing to do' when you're pregnant. You've heard a lot about midwives , but it just doesn't sound like a good idea to you. After all, what if there was an emergency? Your second cousin had a midwife and it worked out for her, but a neighbor told you that midwives don't know what they're doing and can't be trusted . You figure that's probably true, because so many people see an OB. Besides, your OB's practice doesn't allow midwives, and neither does your hospital. It's probably for the best.

As your due date looms large along with your waistline, friends start asking: "When is your doctor going to induce you?" One friend says she was induced at 38 weeks and two years later, doesn't know why, which leaves you scratching your head. Most of your friends agree that your doctor will only induce you if it's deemed medically necessary , or if you're tired of being pregnant or relatives will be in town . A few other friends say how they were induced and in all but one, had cesareans . "But that's just how it is," says one friend, shrugging her shoulders. "No big deal." You know that one friend was induced because of a baby they thought would be big , weighing a little over 8 pounds. You worry, but don't think too much about it and remain happily pregnant a little while longer, but you are concerned that something might be wrong when your doctor brings up induction at every appointment from 36 weeks on. You ask him about it and he shrugs you off like it's no big deal and says, "See you in two weeks!"

If you haven't been induced by now, you're probably laboring on your own. The next course of action is often to administer Pitocin, sometimes even if you have a regular pattern of contractions . This is often just to speed things up, even though you're doing fine. Assuming that both you and the baby's heart rate look good - detected through external continuous fetal monitoring, of course - you will be "allowed" to continue laboring, usually. If it takes a long time , though (and everyone's definition of "long" varies), other things might be considered, usually resulting in more Pitocin or eventually a cesarean.

If you haven't been sectioned by now, you might be experiencing stronger, more painful contractions. Your doctor might tell you "No, that's not any different than normal contractions," and if this is your first baby, you have nothing to compare it to, so you don't question it. You request the epidural, and you can't get up and move around now that you've been confined to bed. Your hospital dictates that you can't have fluids and food in labor , so you're near exhausted and just want this baby out. However, the epidural is administered - either it doesn't take and they have to give you another one, or you muddle through without it - flat on your back, in agony. The baby is starting to go into distress , which worries you. The doctor looks concerned and tells you it's time to consider a cesarean. At no point has anyone suggested turning down the Pitocin .

Finally it looks like progress is being made. At first you are worried because the doctor says you're "not progressing fast enough," even though you are a first-time mother who has only been laboring for less than 10 hours. You've been pushing for what seems like forever, even though you have no urge  whatsoever. You're seeing stars and getting light-headed from holding your breath and pushing when they tell you to , and it's so hard to push the baby out that the doctor begins to use vacuum extraction. You feel intense pressure and tearing that feels like your insides are being ripped out. And then, the baby is born and it's all over. Thank God!

You hold your baby for a brief moment and then she's whisked away to a warmer. They don't want her to get cold, and after all, there are those very important tests to perform to make sure she's okay. You want to hold your baby, but you know all those tests and everything are necessary, so you watch as nurses huddle around her in the isolette and swaddle and bathe her.

Then you're taken to your room and the baby is finally handed to you a little while later. You try to nurse, but it's kind of difficult because you're a first-time mother, after all. She's not very interested in breastfeeding, likely because you had several doses of the epidural after the first one didn't take. Finally she latches on, but a nurse tells you that you can't do it and your nipples will start bleeding and get excoriated and it hurts too much . What she doesn't tell you is that they've already given her a bottle of formula without asking because your baby's blood sugars were low , and you don't realize she has nipple confusion. The nurse is breathing down your neck, the baby is crying, and there is a huge bag of formula "just in case" you needed it. You decide to use it because the baby seems really hungry , or at least the nurse thinks so.

The doctor comes in and tells you you did a "good job," and that it might be advisable to have a planned cesarean the next time, just in case . You agree, because, after all, he's the doctor and knows what he's talking about.

Fast forward six months. You've had time to heal, you love your baby, and she is thriving. You're at a baby shower for a friend, surround by aunts, your sisters, female cousins, and coworkers. You're sharing stories with each other about birth - and they ask you, since you're the last one to have a baby - how it was. You tell them, frankly, that it was the worst thing in your life, terribly painful, but so worth it for this wonderful daughter you have. Based on your story, most of the room agree that when they have children, they are "definitely getting an epidural!" One says, "My mom had c-sections with me and my brother, I'll probably have to have one, too." Another says, "Yeah, my grandmother had a vaginal birth with my uncle and she nearly died!" Still another says, "I had a natural delivery. They had to give me Pitocin and do an episiotomy, but all I had was Demerol while in labor. It wasn't too bad."

The seed of doubt has been planted. When everyone you know has had the same "normal" experience, not realizing that it's anything but, it suddenly takes on a life of its own. The idea that our bodies are somehow defective has taken hold and runs rampant, like a bad rumor that just won't die and go away.

And so is our definition of "normal" childbirth.

More reading:
Tabby Biddle: Women Speak Out About What's Gone Wrong with the United States Birthing System
Melissa Bartick: Peaceful Revolution: Motherhood and the $13 Billion Guilt

Birth Faith

The blogger at Birth Without Fear has been writing some wonderful, heartfelt posts lately about the upcoming birth of her fifth child, which she is planning to do unassisted, like her last. While I have never had an unassisted pregnancy or birth, I can relate to what she is saying on so many levels, and I find her writing to be quite wonderful.

She has recently written about her desire to have an ultrasound, even though she is presumably doing the rest of the pregnancy, and hopefully the birth, unassisted. She confides in us that she has been having unexplained fears and some thoughts about the baby and upcoming birth and feels that she needs to have an ultrasound to make sure everything is okay. While I don't know ultimately whether she will get one or not, or already has, she has been getting some flak from some in the birthing community - that perhaps say she isn't trusting enough in the birth process or in the ability of her own body to birth a baby. Part of the criticism, I think, is because she's considering relying on technology that is considered, to some people, to be wrong, dangerous, or unnecessary.

I find this kind of sad. As I said on her FaceBook page, I think sometimes other birth advocates can be a tremendous source of support to each other, and at times we're our own worst enemy . To some, BWF's decision to birth at home unassisted is foolish; to others, it's brave; and to still others, it's the only way to go.

I can't say I'd ever intentionally do an unassisted birth, and yet I have day dreams about setting up the back of my husband's 1996 Safari van as a little haven just in case I should happen to give birth while en route to the hospital. I picture the baby coming out perfectly, and bringing him or her to my chest - no separation, no interference, just me and my husband. I can see, especially given the traumatic births some women have experienced, why they would choose home or even unassisted birth. I imagine that takes an amazing level of faith in oneself and calm that some people cannot understand.

For me personally, my birth faith is not so much derived from myself, but from my belief in God. I've always wanted to write a post about the spiritual aspects of giving birth, and was never sure how it would be received. I realize not everyone shares the beliefs I do, and I'm not even sure some Christian mothers experience the feelings that I did. In my experience, I know the intuitions and feelings that BWF is experiencing, and some are no doubt just plain old normal fears that come with being a mother, and some might be founded. While some people think the idea of God speaking to them is crap, I don't: I know that many of the intuitions and feelings I had while pregnant and in labor were that still, small voice in my head telling me, 'Do this, don't do this.' Somehow, it all worked out for greater good and events fit together like puzzle pieces.

While in labor with my VBAC baby, I stayed at home as long as I felt comfortable. Something told me to eat before leaving the hospital - I had been up since early morning and had not felt like eating. I was beginning to feel nauseated and emotional for no reason, and in hindsight, this may have been the beginning of transition. I ate two pieces of buttered bread and a small glass of orange juice and was on my way to the hospital. Before getting there, though, something made me want to stop at the grocery store to stock up on magazines and water for my labor/hospital bag, and I paced and walked through contractions. Something told me to keep moving and remain upright. When I got to the hospital, I was about 6 cm (pretty good for my first vaginal birth!) and delivered about three hours later.

While pregnant with that child, it was a tremendous leap of faith, some would say, just to reach the point to decide to have a VBAC in the first place. There was nothing saying that, even with no interventions, that I wouldn't have another cesarean or that something catastrophic wouldn't happen. I prepared myself physically and emotionally, as well as spiritually: I prayed every chance I got, while walking, while rocking, while sitting on the toilet, even. I prayed that God the Divine Physician would give me confidence and strength to know when to make certain decisions, and that he would guide me through labor. I prayed that he would put his hand over my scar and protect me. And he did.

When I was pregnant with my third, I was again planning a VBAC. At one point during my pregnancy, I sat quietly - probably on the computer! - and a clear voice in my head told me, "This child is a boy and will be born by cesarean." I had no reason to believe either - we had not found out the gender and the baby was head down, so things were looking good for a vaginal birth - and I kind of frowned to myself and forgot about it. As I approached my due date, I was having trouble with elevated blood pressure and rather unsupportive OB's, and - surprise! - my baby had turned transverse and later breech. Even after being admitted for observation and refusing a cesarean then, I trusted my body - and God - to tell me when it was time and when it was not, and to guide me to make the best decisions for my baby and myself. I decided to go home and rest, wait to see if the baby would turn, and let him or her pick the day to be born. I also prayed I had a quick, painless labor and an easy vaginal delivery.

As the day approached, those intuitions kicked up again. The night before, something told me, "Don't finish all your dinner." I was kind of hungry, but had no desire to eat. I left most of my plate untouched and tried to rest. By 10 p.m. I went to bed but was having mild contractions that kept me awake much of the night. I do know I managed to sleep and even dream, but by 4 a.m. I was now in full-blown labor and had lost my mucus plug. Not knowing what position the baby was in, I packed up my stuff, ate my usual bread with butter and orange juice, and left for the hospital.

By the time we got there about 35 minutes later, I was fully dilated. My water had narrowly missed breaking all over our freshly-detailed interior. When they did an ultrasound to verify the baby's position,  the baby was breech. I was more worried about them accidentally revealing the gender right before the birth than the impending cesarean. And while a nurse confided in me that my baby could be born vaginally, I knew in my heart that I was not willing to risk it if my unskilled doctor hadn't delivered a footling breech baby in probably a decade or more, and told her as much.

When they delivered my son by cesarean, I thought back to those words I had heard in my head and knew my intuition had been correct. It was like a warning bell that prepared me for what was to lie ahead, even though I had tried to ignore it. What I knew was that I had trusted God to let me know when to do what, and trusted my body as a machine created by him to do great things. But it is not perfect.

I often think back on how I was perfectly ready to have my baby at home, with just the EMS squad - who I knew have not delivered a baby before. I wonder, how would we have handled the birth?

We are blessed with mother's instinct and intuition for a reason. While I am a strong advocate for natural birth - as much as reasonable or possible - it is important for us as advocates not to be so arrogant or too trusting to assume that things can't go wrong even when there are no interventions present. In the end, you can trust birth all you want, but unfortunately things can go wrong, babies die, sometimes whether their labors have been "tampered with" or not, and some people are unwilling to admit this. Things can happen, but this doesn't necessarily make birth inherently dangerous. But it's a fine line to walk.

You might find that, had you not acted on your suspicions or feelings, something terrible would have happened. You might also find that nothing whatsoever is wrong. And then again, you could be feeling great the entire time and not see for a minute that something is around the corner. Sometimes an intervention can prevent things, sometimes not; but to say that "had you only had a cesarean, your baby would have lived!" is often misleading and wrong. You cannot live your pregnant life in a bubble, hooked up to monitors and machines the entire time to catch such a rare moment, should it happen. You should not be made to feel like you're doing something wrong for judiciously using that same technology, even if it is just to make sure. Nor should there be an approach that suggests "nothing bad will ever happen, because I can do this!"

I don't think birth is dangerous or safe - there is a variable there that can only be measured on an individual basis and we can't always assume that it is or isn't for everyone.  We can't always assume that X happened because a doctor did this, nor can we say that nothing bad will happen because you're under a doctor's care, either. Not always can we predict the unpredictable, and if your innermost feelings are telling you something, then perhaps it would be wise to listen.

Related posts:
Home Birth Death: Are Pieces of the Puzzle Missing?  
A Journey to Homebirth: Part 2 
Where I Stand Now: Birth after Cesarean 

The myth of the emergency c-section

It seems like when you're talking about a c-section, it often comes down to a question of semantics. The word "emergency" gets thrown around an awful lot, and I can't help but wonder if there's any validity anymore to the "If I didn't have a cesarean, my baby and I would have died!" argument.

Nowadays it seems that everyone has had an "emergency" cesarean. Come to think of it, depending on who you ask, I've had two of them.

To some, it seems like if labor has started and it's obvious a vaginal delivery won't take place, it suddenly becomes an emergency. I read one comment on a birth forum about a woman asking what happens when you go into labor before a scheduled cesarean, and the response - from a labor and delivery nurse, no less - was, "Your scheduled cesarean becomes an emergency cesarean. No big deal." Aren't emergencies usually a big deal? And what about this is indicative of an emergency?

In my situation, I went into labor before a scheduled cesarean. I came to the hospital in plenty of time, and was 4 cm upon arrival. Even if they had left me sitting there for a few hours, I probably would have been just fine. Was this an emergency? Not really.

Even after my second cesarean, when a nervous soon-to-be-new dad asked me if it was an emergency after hearing the hairy details of the birth, I sort of shrugged. "Yeah, I suppose you could say it was emergent," with an air of hesitation. I was already fully dilated when I got there, but had no urge to push and no little feet were sticking out. Emergency? Probably not.

Nothing confirms my suspicions about the true nature of emergency cesareans more than this comment from My OB Said What?!?:

“It’s extremely urgent we do the cesarean now before your baby goes into stress and it becomes life-threatening. Let me just deliver the woman across the hall and then we can get things ready.”

Seriously? If you have that much time to wait, then it must not be an emergency. If this comment had come from anyone else (assuming that most contributors to MOBSW "get it" and see it for what it really is), I'd probably smile and nod and walk away muttering something. It seems like once you throw the word "emergency" in there, suddenly everything comes to a grinding halt and "your baby would have died had you not had that cesarean!" Are you sure about that?

I've heard countless comments like that from so many people and wonder what the real back story was. I wasn't there, obviously, but the minute they mention the words "induction" or "Pitocin," I cringe inside. They don't even realize their "emergency" was likely brought on by the actions of their physician, who either meant well or was deliberately putting them at greater risk for his or her own purposes. Putting on a sympathetic face and frowning while saying "You're going to need an emergency cesarean!" sounds better than, "I need to catch a plane and I need you to push out this baby." (Although some physicians no doubt don't bother to cloak it in concern and just tell it like it is.)

I read one such account from someone commenting on a blog post about a teenager who was in labor, and the doctor was pressuring her to consent to a cesarean. As the physician walked out, this person overheard her say, "Thank God she finally consented. Now I have just enough time to catch my flight." Unfortunately, because of this experience, this young mother will forever have the word "emergency" emblazoned on her mind and think her body failed, and it was the only way. Which is a lie.

It's hard, as a birth advocate, to hear these stories. I think for some, it's a mixture of several things: pride, ignorance or misinformation, and a blind trust in their physician. They do not want to admit that they believed their doctor would tell them everything and that he lied. They do not want to admit that perhaps they made a decision that could have turned out better had they only known more. Or they just had no idea that things could be different. Birth stories are something that are shared between women, even strangers, who otherwise have little if any connection to each other and yet are willing to talk about those intimate moments with a woman they don't even know. And thus not only is the birth of a child talked about, but the birth of a myth is, as well.

One mom I know told me that when she delivered her only child in the 1980s, she was induced. Her baby went into distress and she had a cesarean. Another mom had AROM with her first, which produced cord prolapse and an emergency cesarean. (She was, however, able to VBAC twice after that with the same doctor.) Still another talks about how a friend is going in for an "emergency" cesarean at 37 weeks because the baby is "small" (estimated at five pounds, three ounces by an ultrasound, which can be a pound off, either way). (What baby isn't small with three to five weeks to go?!) This mom tried to birth vaginally after being induced, but her doctor, from the looks of it, rushed her into a cesarean after she was dilated to 8 cm after only two hours with a posterior baby. Now she feels like a failure and that her body is "defective." How can you explain to someone that perhaps your "emergency cesarean" was an "iatrogenic emergency cesarean"? That sounds a bit clunkier and hard to pronounce, and still few are ready to listen when told their doctor might have been the initiator.

I posted these terrific articles recently about a hospital in Minnesota that has a very low c-section rate because they use midwives. They show a mom laboring in a tub, without pain medication, and also talk about midwives repositioning a mom in order to birth her baby vaginally. Yet, based on the comments from some people, they still don't get it. Another article - this time from England - talks about the "myth of too posh to push," and still others don't understand. Most are probably in denial that their doctor, the person they have trusted, could ever do something to hurt them or their babies. Many like to put the onus of elective cesarean on the mother and her choices, and to some extent, we can't discount that. But I can't stand the mentality that no doctor will ever do an unnecessary cesarean in the US, because that's obviously not true. If only we could better discern which ones were true emergencies versus those in which the doctor only said they were, for dramatic effect in encouraging you to make your decision faster (i.e. the "Catch my plane" cesarean mentioned above).

When looking at cesarean rates over the last few decades, they have increased steadily just within the last 20 years, in which time we've still had "modern" obstetrics to save us from ourselves in case of just such an emergency. Considering the rates are continuing to climb, what does that mean? That we're evolving into a species that suddenly can't give birth vaginally? That suddenly birth is much more dangerous than it used to be only two decades ago? I wonder, if people bother to look at the stats, if they even for a moment think about the absurdity of what they're saying. And can we quit blaming the mother for everything - from her "preference" to her weight and stature - and for once look at how her labor and delivery are managed by her doctor?

We use the term "emergency" so casually - paralleling the casual attitudes towards surgical birth in general - and water down its meaning until we don't even know what is normal and what isn't, or how to define a life-threatening situation. These attitudes, myths and misconceptions have totally changed not only our attitudes about what constitutes a real reason to have a cesarean, but clouded our view of birth as a whole.

Technology and birth: Should a robot perform your cesarean?

I don't think Bill Gates realized he was about to open a huge can of worms when he recently speculated, among other things, that robot technology could be used to perform c-sections. The birth nerd community responded, horrified, and the general consensus among my FaceBook friends was that it would basically dehumanize the birth process even more than it sometimes already is.

I think we can all agree that sometimes, technology in giving birth is a lifesaver. And then there are those gray areas, like electronic fetal monitoring, that have a shady, somewhat dubious past, and yet are used constantly even though they have actually been shown to lead to more cesareans, instead of fewer. In some cases, the very thing that's supposed to detect cases of cerebral palsy actually fails to do so, thus also failing to identify which babies are truly in distress and do need to be delivered immediately. In the other half, it leads to more cases of distress that are questionable , oftentimes producing a newborn who is quite pissed off to be so violently thrust into this new world.

I think, therefore, that we need to be vary of our use of technology, especially in surgical births. Having a robot do your c-section might sound cool to Bill Gates, until it's you lying on the table, already feeling like a slab of meat and having that inanimate object hovering over you. If you are distressed or emotional about the birth ending in a cesarean, the robot cares even less than your physician might. It doesn't care if you're crying, upset, or having birth trauma. It can't hold your hand throughout or ask how you're doing. It can only, with another machine, check your vitals, see that you're doing okay, and proceed as usual, completely disregarding any emotional or psychological aspects that can't be registered with a machine.

When I had my first cesarean, their routine choice of medication administration was a PCA (patient-controlled anesthesia) pump. This requires an IV be inserted and the patient then decides when to inject herself with pain medication. According to nursing guidelines in the hospital where I gave birth, I was allowed no more than 10 doses in a one-hour period.

This might be all fine and good, and I can understand why a PCA pump can be helpful, if used properly: it allows the patient to determine her level of pain, while the nurse can tend to other patients. But shortly after being wheeled into recovery - probably the minute the spinal wore off - I noticed that I was in increasing pain, and the PCA pump didn't seem to be doing anything about it. Off and on throughout the middle of the night, the pump would routinely beep at me - and I knew, from my experience calibrating pumps as a pharmacy tech - that that meant there was a problem. The nurse would come in every so often, adjust something, tut about this and that, and then leave the room. A half hour or so later, she'd come back for a repeat.

After the first full day, I had tried injecting myself and nothing happened - except a horrible burning sensation up the length of my arm, which had been happening since I was in recovery - and the nurse scolded me that I had reached my maximum number of doses for medication per hour and couldn't have anymore. The pump had counted the number of doses, and it told her I had already had enough, and that was that. No doubt everything else looked good, and she didn't bother asking me why I was still in pain, even with that much medication supposedly flowing through my veins.

Finally, after my hand swelled up like a blown-up latex glove, the nurse noticed and quickly remarked how they 'had to get that thing out of there.' I had told them, numerous times, that it wasn't working, and that I felt more pain from injecting myself than anything else, at this point. I repeatedly asked, "Is it supposed to burn when I do this?" after another dose of Demerol. It was only after that that I realized the line had infiltrated at the injection site and the painkillers were leaching into my tissues, which offered little, if any, pain relief. No explanation, no apology - I only managed to figure out later that that's what happened.

I consider this episode a major technology fail. A machine can give you so many doses of something and then tell the nurse, in a nice digital printout, how much you've had, when you're due for another, and so on and so forth. It cannot, however, tell the nurse why you're in pain, or that there might be a problem. Only she can do that. And she can only do that if she listens to you as a patient.

I had tried speaking up and no one really listened. If they had been listening, perhaps they would have pulled the entire thing out from the beginning and tried again. Another technology fail lies in the fact that, with increased technology, nurses are then able to spend more time tending to other patients, and thus take on a greater caseload. Additionally, when someone does need something that only a human can respond to, they often become resentful or irritated when you do speak up and express a need that the machine failed to address. Perhaps this is why some OB's are perceived - whether for right or wrong - as cold and callous, because they expect the machine to do their jobs, to some extent: to give them results so they don't have to. In many situations, technology - as we see in the case of EFM - has replaced human judgment, which is an art form that is dying quickly, it seems, when it comes to birth. As a result, greater technology has helped patients, while at the same time, hurt them - by destroying the nature of the one-on-one patient-caregiver relationship. No robot can take the place of that.

More reading:
Bill Gates and Robot Cesareans - The Unnecesarean