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.

Is America being brainwashed by formula ads?

Yesterday someone on Facebook posted a lovely article about babies' development of facial expressions in the womb. Too bad I couldn't get past the hyperactive web banner at the top that screamed "70 PERCENT OF BABIES WILL HAVE FEEDING ISSUES IN THE FIRST YEAR" or something to that effect. Before I could click or do anything, it magically morphed into an ad for infant formula. It was, basically, a call to action that you should be running around with your arms in the air, screaming hysterically, "I must put my child on formula or she will die!"

I must have refreshed my screen several hundred times and that ad never came up again, something I found interesting. I did manage to get a screen shot of the second half, though:

Since I skipped infant formula altogether, perhaps I'm a big dummy - but doesn't soy formula often lead to more stomach upset - not to mention constipation - in babies? And for some infants, it's often an allergy trigger. Not only that, but some worry that the phytoestrogens (a group of chemicals found naturally in plants that can often act like estrogen) and isoflavones (organic compounds that often act as a phytoestrogen in mammals) can be harmful to developing babies. Although the jury is out on whether or not it's harmful, there has been little research done on it - which doesn't necessarily mean it's totally safe.

In the link referenced above, a mom named Janet nervously poses a question to Dr. Ianelli, and says that:

"I am very upset because I have 3 boys who have had to take soy as infants on the advice of my pediatrician and a daughter 2 mos old currently who is having feeding problems while breastfeeding presumably secondary to dairy in my diet and is on soy presently."

Janet, what you need to do is this: save your hard-earned money and change your diet, honey! We want the best for our children. So why aren't more people willing to sacrifice milk and cheese while nursing their babies? Because it's just easier to put them on formula?

I went through this with my second child, who regularly spit up, vomited copiously and screamed halfway through bedtime because, as I found out, she was so miserable. I was determined to find the source, and so, as the Enfamil ad above suggests, I asked my doctor. Turns out, she didn't know squat about what to do and suggested this: "You could put her on hypoallergenic formula for three days and see what happens."

Thankfully I had already done some research on Kelly Mom and realized this would do little, if any, good - for a number of reasons. Namely because if I don't change my diet, then what difference will it make when I started nursing her again? Little did I know, the majority of infant formulas out there are made from cow's milk protein, the very stuff in my breastmilk that was making her so miserable.

Was I broken? Was my child somehow "allergic" to my breastmilk?

Nope. She was sensitive to the stuff in it, and that meant I had two choices: drastically change my diet or put her on formula. I knew one of those definitely wasn't gonna happen, so I took the Mama Bear approach: I totally cut dairy and all its forms (not just lactose) out of my diet, and voila! In ten days (not three), she was a new baby and we were happy. No butter for nine months, but hey, it was worth it and by then it had become more of a minor inconvenience than anything else.

For those babies who routinely are fussy, etc. I bet they too are sensitive to cow's milk proteins, like many babies would be up until around a year - cows milk is often hard for little ones to digest, and if you fed it to them straight before they're ready they'd often up end up projectile vomiting/pooping clear across the room. Is putting them on formula the best answer? Apparently Enfamil thinks so. (And chances are your pediatrician probably would too.)

How many nursing mothers with protein-sensitive babies are told "You have to put your  child on formula!" just because the baby is fussy? How many are encouraged to make dietary changes, or even know that they can, and furthermore - that it might help, or totally solve the problem?

When I googled "side effects of soy formula" I found an article through the Livestrong.com website, and scrolled down to read a conveniently-tucked away ad from Enfamil again - this time suggesting you try Nutramigen, a "hypoallergenic formula for babies' milk protein allergies." Dietary changes for mother might be a pain in the ass, but a few months' worth of Nutramigen - at around $30 per can - sounds even more painful on my wallet. No thanks.

I find the sway of advertising particularly amusing, if not frustrating, when it comes to infant formula. Many of them have names like "Good Start," "Nurture," "Premium" (as if the non-premium stuff is made from glass shards) and "Advance." Funny, but if I didn't know any better, I'd think they were talking about breastmilk!

What they don't say, at least

not very loudly: "DHA 

supplemented infants 

exhibited better visual acuity

than that of non-supplemented 

infants (equivalent to one line 

on the eye chart), and similar 

to that of breast-fed infants." 

Most advertising seems like a clever ploy to get mom to feel better about her decision to use formula. No one should guilt her into doing or not doing anything, but at the same time one should realize the infant formula's role in cementing the idea in our collective minds that "breast is best, but..." (and that's a big but) or that somehow, you are incapable in some way. While that may be true for some, it certainly isn't for all!

The sad truth is that even after a well-meaning visit from your doctor, you might not come away with all the answers. If you happen to land one who knows a thing or two about nursing, great! But not all of them do, and many get loads of freebies from these same companies who are actively undermining your breastfeeding relationship in an effort to get you to buy their product. Plain and simple. In a normal business setting, this would generally be called a "conflict of interest."

That conflict can taint the ideas of health care professionals who either advise you on breastfeeding problems or take care of your newborn. It's not completely unheard of for mothers to practically insist, to the point of near-violence, that they breastfeed their NICU babies, and will often find the nurse has "just fed the baby" a bottle of formula after they rush in to nurse their own child. Mothers are often told inappropriate things to convince them that breastfeeding is not a viable option and handed a bag of samples "just in case." Perhaps this is borne out of ignorance about breastfeeding; and perhaps it's based on the cultural institution that breasts are for pleasure, not infant feeding. And maybe, just maybe, they're brainwashed by the formula companies who tout their product like the Liquid Gold it is not. (The sad part of it is, infant formula manufacturers have been heavily marketing their product for decades, which can probably why breastfeeding rates have often taken a nosedive in our culture.)

Case in point: product reviews for ProSobee on Enfamil's website.

"When my son was born, he was in NICU for 16 days and he wasn't able to breastfeed..."

 "I have always used Enfamil for my children. Being a Registered Nurse I know how important it is to give your baby a quality formula." 

I have to wonder about that last review, since infant formulas all have to be pretty much standard fare as it is. In fact, previous lawsuits filed against Enfamil have found them guilty of making false claims about store-brand formulas and misrepresenting their product through false advertising.

We already know that US hospitals get a pretty crappy grade when it comes to promoting breastfeeding in new moms. Is it any wonder?! (This link is actually from 2008, and the same articles were surfacing this year - which means not much has changed!) According to the article, the highest score a hospital received was 98 - the lowest was 12. 12?!

 "About a quarter of hospitals reported giving formula or some other supplement to more than half of their healthy, full-term newborns. The practice was common even when mothers were able and willing to breast-feed, Dee said.

Of hospitals who gave supplements, 30 percent gave sugar water and 15 percent gave water.

Experts say there are no good nutritional reasons to use those, but it is commonly done to quiet crying babies separated from their mother."

To me, this means one of several things: they are separating mothers and babies for all those "essential" newborn tests for no reason, which results in hungry babies that need to be placated some way. Therefore, they feed him useless sugar water or infant formula, and by the time he gets to you, he no longer wants to nurse because he's been fed. Even if you express an interest in nursing, they'll often give your baby a bottle anyway - without asking you first. Add nipple confusion, and voila! You're no longer a nursing mom.

Way back in 1981, the World Health Organization developed the International Code of Marketing Breast-Milk Substitutes, which outlined strict advertising guidelines for formula manufacturers. In some countries, like the United Kingdom - which has the lowest breastfeeding rates in Europe - infant formula ads are illegal, although this doesn't include the "toddler formulas" that have come out since the Code was adopted. Not surprisingly, the US does not follow the code. The Baby Friendly Hospital Initiative, begun by WHO in 1991, was a similar program to promote breastfeeding in hospitals. While breastfeeding rates in these specially-designated hospitals was nearing 80 percent, fewer than 100 hospitals nationwide (around five percent) had this designation as of 2008. Roughly half of all infant formula purchased in the US is subsidized by the government through programs like WIC. Consequentially, breastfeeding rates among WIC participants is lower than other groups.

Some of the interesting formula ads I've come across lately...

I love that little 'tilde' ~17 symbol, which basically means,
"We don't really fully understand the wonderful
properties of breastmilk yet, so we're just gonna guess."

These interesting web searches yielded interesting results, according to the PhD in Parenting blog. While the header says "breastfeeding support," you are guided to Enfamil's website and encouraged to try their product. How sweet of you.

The blog also noted how another popular website was offering breastfeeding tips, all while readers were being bombarded with formula ads:

This bag is really cute, but how much do you want to bet the
one they give nursing moms is really boring and ugly? 

Scare tactics and fear-mongering 101:

Only a parent who really cares about
their baby's immune system gives them
Similac!

This vintage ad for the Enfamil Nursette is interesting - not only do they paint a picture of the idiot dad who can't screw the nipple on the bottle correctly, but they go on at length about how great their product is. When you're encouraged to 'ask your doctor if it's really as good as we say it is,' you're told, "It is." End of conversation, so take our word for it and don't even bother questioning it, 'kay?

During the 60s and 70s, when this ad probably ran, around 75 percent of babies were formula-fed.

This 2006 magazine cover incensed some readers, one of whom proclaimed "breasts are breasts - they're sexual" and shredded the magazine after feeling the need to shield her son from it.  

Yet this one is considered perfectly acceptable:

More reading:

From the PhD in Parenting blog

Similac and Babble team up to dupe breastfeeding moms - PhD in Parenting

Breastfeeding advocate asks Babble to remove her "Momination"

When a company goes from very good to very, very bad: The Evenflo Story

Past posts:

Cultural shifts in breastfeeding trends

Gettin' your baby fix on, Similac-style

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."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There's a hurricane (and a baby) a comin'

Rock you like a hurricane: Who knew giving birth during
one of the worst storms ever could
be such a normal, natural experience? 

As the nation tenuously waits for Hurricane Irene to make landfall on the east coast, I can't help but think of all the expectant mothers, nervously waiting for their due dates to arrive and praying that it will pass uneventfully: will the baby come during the storm? Will I make it to the hospital in time? Will I be stranded somewhere?

I wouldn't be surprised to hear of a slight increase in the number of cesareans or inductions in the days prior to Irene's arrival, as doctors and patients took a "just in case" approach to avoid any such incidents from happening. It also reminded me of a passage from Jennifer Block's book, "Pushed," regarding Hurricane Charley in Florida - an F-4 storm that was the most powerful they'd seen since Andrew over a decade before. The storm lasted nearly a week, with winds topping out at 150 miles per hour. Pretty scary stuff.

With limited electricity, the hospital was facing measures to treat labor and delivery patients more efficiently given the lack of resources they had. Tracy Lethbridge, a nurse working on the unit during the 2004 storm, was on duty.

"...Hunkering down that evening was a minor interference compared to the week that followed. The hospital's emergency generator kicked in, but, like the rest of the town, the facility lost main power until the following Friday. With only enough generator capacity to run essential functions, there was no air-conditioning and no lab capabilities. That meant that the 13-bed labor and delivery ward wasn't a very comfortable place to either labor or deliver, nor did it have the lab setup required to manage epidural anesthesia safely. Lethbridge and her colleagues had to treat their patients much differently."

With limited power and no access to epidurals, what do you do?

 "We canceled all labor inductions," recalls Lethbridge. Normally, two beds a day would have been reserved for inducing women into labor, an often lengthy process that begins with drugs that "ripen" and dilate the cervix (Cervadil or Cytotec) and contract the uterus (Pitocin). Normally, even women who arrived in early labor – when the cervix is minimally dilated and contractions are several minutes apart – would often be encouraged to stay and would be administered Pitocin to hasten contractions. Lethbridge observed that under normal circumstances, the vast majority of babies were delivered during the day. 

 –––

"We only admitted women who were in active labor – regular contractions and progressive cervical dilation," says Lethbridge. "If they were not in active labor, we'd send them back home." 

Block speaks of this new, relatively unusual situation as an "altered universe" and writes that the nurses on duty during that period started noticing some surprising changes.

"Women were delivering within hours of arriving, even first-time mothers, without any Pitocin," says Lethbridge. ..."We had no cases of fetal distress during labor and no respiratory distress of neonates following delivery..." "We had an incredibly low cesarean rate. Amazingly, the babies were about evenly distributed between day and night shifts."

 "What happened was, women were going into labor all on their own, having good labor courses, and delivering healthy babies. Even the women who were scheduled to be induced that week, three-quarters of them came in and delivered anyway. And basically, they did better than if they had been induced. We thought, wow, this is amazing!"

Block notes that nurses, including Lethbridge, observed during the week period that among the 17 women who gave birth, "one was induced, two had scheduled repeat cesareans, and just one had a cesarean for 'failure to progress.'" Block states, "That works out to a cesarean rate of 17%; excluding the repeat cesareans, it was 6%."

Perhaps this almost informal "study" reveals that yes, birth can be a normal, physiological process if only it's allowed to proceed as such. That, instead of a "94 percent of births are complicated," it's quite the opposite - that 94 percent of births are over-managed, which has completely skewed our idea of what "complicated" means. In other words, that we're treating it as an accident waiting to happen and sometimes creating or precipitating that accident in the process.

As a result of this little experiment, surprised nurses reported their findings back to the charge nurse and hospital officials - who were relatively blase´ about the whole thing. The hospital's lack of action spoke louder than words: "this is not the way we do things because it doesn't make us money." You can't bill a patient for an induction, Pitocin, epidural and cesarean if she doesn't have those things, instead laboring naturally at home and letting her labor unfold by itself, with little to no interventions. Because Mother Nature is completely free - and perhaps not quite as flawed as they want us to believe. Technology can be very useful and life-saving, but only when used appropriately and wisely.

For a number of reasons, including what Lethbridge felt were safety concerns as well as the hospital's lack of support of normal, physiological birth, she quit her job - mostly precipitated by what she saw in women during Hurricane Charley. Within the year, many of the nurses she worked with left their jobs as well, perhaps completely jaded by the system. I don't blame them.

Pushed: The Painful Truth about Childbirth and Modern Maternity Care - Jennifer Block
Why You Need Pitocin in Labor

My response to Free Advice Legal Forums: Childbirth issues

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

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

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

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

Here is my response:

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

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

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

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

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

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

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

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

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

I'll anxiously await a response. *eyeroll*

The "Truth" about Pelvic Organ Prolapse

I'm not a Dr. Oz fan, but couldn't help noticing that he was talking about something not many women like to discuss: pelvic organ prolapse. I also was intrigued not only because of my birth nerdiness, but because I share some of these complaints and wondered: does anybody else?

Supposedly the "last taboo topic" in gynecology (nah, I think that'd be having a homebirth) I was curious, because I too was hesitant to talk about it. With strangers, sure; but friends - I wasn't really anxious to share that info with people I went to high school with (which is why I don't advertise my blog around casual acquaintances - I really don't want them knowing the intimate state of my vagina.)

Anyway, Dr. Oz revealed just how common pelvic prolapse - when your reproductive organs come out through the vagina - really is. The crowd was hushed as women in many age groups looked like they were hanging on to the edge of their seats. We all cruise through the female incontinence aisles at the grocery store (on our way to somewhere else, right?) and know those problems exist, and that they're actually pretty common. (There's even an entire company devoted to sending you your incontinence products, in discreet packaging directly to your house, so as to avoid being spotted at the grocery store.)

The primary risk factors are childbirth (especially after having several children), weight, and age. The problem is, Dr. Oz - and pretty much everyone else outside the birth advocacy circle - don't tell you that how you give birth can impact your risk factors.

If there's one thing I'd like to change about my vaginal birth, it's directed pushing. As one article on Dr. Oz's website said, "You take a genetic predisposition, a 9 pound baby, and three hours of pushing" and it's not a wonder we have these problems.

Back up a minute.

Three hours of pushing - even the one hour and ten minutes I pushed - is probably more common than it should be in hospitals. From my experience, I know I had absolutely no desire to push. Laboring down was not an option, and I wish I knew better to just wait for my body to do it on its own. Even if you were knocked unconscious, your body would still involuntarily contract and push that baby out on its own, but who has time for that anymore? It's rush rush rush to get the baby out (even in the absence of problems) and move on to someone else.

Consider what happens when you're constipated and trying to have a bowel movement. Pushing and straining - much like during childbirth - are probably going to do little more than produce a wicked case of hemmorhoids and even rectal bleeding. But if you wait until you have the urge (which is involuntary, much like pushing out a baby) it's a lot easier with a lot less work. So even though I personally detest the phrase 'it's like taking the biggest crap of your life' to describe childbirth, in some ways it can be compared, yes.

In the process of laboring down, the body can actually stop the labor process altogether, sort of as a last-ditch effort to conserve energy for the big event. And like a bowel movement, most women describe the urge to push as uncontrollable and something they just had to do. Unfortunately, I have never experienced that feeling, the feeling of knowing my body is doing something on its own volition because that's what it's supposed to do - not push a baby out at lightning speed just because somebody told me to.

In reading about the subject, some physicians simply blame childbirth in and of itself for prolapse, while others say traumatic childbirth is a cause. I'm not sure women realize there is any other kind, which is sad. Things like cord traction - literally pulling on the cord to get the placenta to detach from the uterine wall - is another risk factor. Forceps deliveries, episiotomies (again, largely unnecessary but done anyway) and prolonged, directed pushing are other causes, and yet all are considered standard procedure in many labor and delivery wards. In other words, we've experienced this crap for so long that we don't even know it's the cause - and that it's not really as normal as we think it is. We're normalizing the abnormal.

Many times, in an effort to avoid postpartum hemmorhaging after birth, they use cord traction to avoid a "retained placenta" - and cause even more bleeding as a result.

"Retained placenta" is another term I have a problem with. While the standard seems to be around 30 minutes after birth, it seems that, like everything else, it's different for everyone. While I'm obviously not an expert, I'd guess that in the absence of bleeding - and with the presence of breastfeeding right away - leaving it more than half an hour is probably okay. When I did some quick searching on it, I found several who said an hour, two hours - even 30 hours - and she lived to tell the tale. *gasp!*

More often than not it seems doctors are too quick to expect the placenta to come out and rush it with cord traction, which is often quite painful and dangerous if too much force is applied. I've also talked with people who agree their doctor was way too eager to detach the placenta and literally yanked on it - which can cause the very complications you're supposed to be preventing.

One study has shown that injections of oxytocin into the umbilical cord vein does not decrease the need for manual placenta removal; however, you're back to that murky definition of 'retained placenta' again. According to the article, retained placenta is more likely to happen to women in "wealthier nations." Not surprisingly, the study found that among women in the UK, Uganda and Pakistan, the women in the UK were more likely to have a retained placenta:

The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).

Many are quick to point out how dangerous it is to give birth in third-world nations like Pakistan and Uganda. While there is no doubt some truth to that, giving birth with overloads of obstetrical interventions - like in the UK - is probably just as bad. (Side note: not surprisingly, Uganda is the only nation of the three that doesn't have a relatively low rate of breastfeeding, which is often a good way to encourage the placenta to detach by itself. Incidentally, the CDC has determined that most US hospitals are severely lacking in their breastfeeding support, which could be further contributing to this problem. Add to that the frequent, often prolonged separation of mother and baby immediately following birth and it could add to further reliance on active management of the third stage of labor.)

Ironically, many in the UK scratch their hands and wonder why women in the UK are experiencing this problem, despite having access to all the best care and resources. Dr. Andrew D. Weeks of the University of Liverpool thinks prolonged cord traction might be an issue. Ya think?

Some sites list things like "unusually large babies" as a cause - perhaps it's more the interventions perceived as necessary in delivering that "large" child (and the idea that everyone has a different definition of what a large baby really is) that are key here. It's not uncommon for someone to have a very actively managed labor with a larger baby that results in significant trauma to the pelvic floor. Conversely, we hear of many women successfully delivering bigger babies with little if any tearing - which can depend on the birth setting. (Home birth? Natural hospital birth?) and the attendant (midwife vs. doctor? Someone who is more pro-natural birth?)

Sadly, doctors like Dr. Oz and urologist Jennifer Berman might hand out less-than-helpful advice because they've never actually seen a normal birth in progress. They often see the end result of years worth of obstetrical manipulation and intervention and chalk it up to just plain old childbirth itself, perhaps recommending an elective cesarean to avoid all that damage (even though studies have shown it doesn't). Yes, some women will be prone to this - for a number of factors besides childbearing - despite having an intervention-free birth. Some women get it and they've never even given birth. But until you can compare what often is and what could be, you have no real idea that the process is totally tampered with.

In doing some reading, I came across a very sad post by a nurse who experienced a pretty difficult birth, no doubt precipitated by the fact that she was induced at 37 weeks. The baby sounds like it just wasn't ready, but doctors attempted every means possible to get that child to come out, resulting in some nasty-sounding results. She wondered if she had a case against them because of everything she went through.

Some of the answers she got were quite shocking. Daring to call the normal 'abnormal,' she got berated, told she was a liar, and that what she went through didn't happen as she said it did. She was told that "controlled cord traction" was basically no big deal and an "acceptable practice." Maybe so, but it shouldn't be, especially in the absence of other complications. In the end, another forum user piped up and said "You think you had it bad??" as it to get into a virtual pissing contest about who could tell the most Horrible Birth Story Ever. I felt sad for the woman, not only because these women attacked her for questioning the status quo, but because they echoed what our legal system tells us: that unless you have something permanently wrong with either you or the baby, that you should just shut up and get over it.

After seeing some of the audience members on Dr. Oz's show, you realize that women have basically been giving birth violently for decades, perhaps even more than a century. I didn't see any hippie mamas standing up in the audience saying, "Well, I had a natural home birth and mother-led pushing in any position I wanted to, so I don't have that problem." She'd probably be stoned to death if she did. That, and the number of what we could call near-failed inductions - those where a vaginal birth happens but I'm not sure I'd call it successful, exactly - probably means more women are continuing to suffer.

While Dr. Oz's segment was titled "Suffering in Silence: The Shame of Pelvic Prolapse," I really think the people who should be feeling shame are those who insist on continuing these practices even though it's not in the best interests of their patients.

More reading:
Diagnosis and management of retained placenta after vaginal birth - Dr. Andrew Weeks talks about the risks and complications of retained placenta, but admits:

There is no consensus worldwide as to the length of the third stage after which a placenta should be termed "retained" and intervention initiated.

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial - This study suggests the use of CCT is beneficial and says that a continuous infusion of oxytocin were given to each patient after delivery of the placenta. I'm curious, though, what percentage of mothers breastfed immediately after birth, and how long were their placentas retained before someone decided to manually remove it?

Controlled Cord Traction During Third Stage of Labor - This study seems to contradict what the previous one said, in that

"Controlled cord traction (CCT) is actively promoted in combination with prophylactic uterotonics for the prevention of PPH. While the administration of uterotonics has been proven effective, there is no evidence of CCT being beneficial or safe. 

The purpose of the study was to determine: 

1. In women having term, single vaginal deliveries in hospital settings, in whom the third stage is managed with prophylactic oxytocin, does CCT produce a clinically significant reduction in the incidence of postpartum blood lose? (sic)
2. In these women, does CCT produce a clinically significant increase in the incidence of severe complications, including uterine inversion or the need for subsequent surgical evacuation of retained placental tissues and membranes (curettage or manual removal)?

Injections Aren't Solution for Retained Placenta: Study - ABC News
Management of the Third Stage of Labor - Medscape

The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. A leading North American obstetrics text devotes only 4 of more than 1500 pages to the third stage of labor but significantly more to the complications that may arise immediately following delivery.^[1] One respected author states: "This indeed is the unforgiving stage of labor, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster."

While that may be true to some extent, why do our bodies have these built-in mechanisms to aid this natural, physiologic process?
Postpartum Hemorrhage - Wikipedia 

A Cochrane database study^[5] suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour reduces severe maternal bleeding and anemia compared to expectant management. However, the review also found that active management reduced the baby’s birthweight and increased the mother's blood pressure, afterpains, nausea, vomiting, and use of drugs for pain relief. The number of women returning to hospital with bleeding also increased. Another Cochrane database study^[6], focusing specifically on the timing of the administration of the uterotonic drug oxytocin as part of the active management of the third stage of labour, suggested that administering the drug before the expulsion of the placenta did not have any significant influence on the incidence of postpartum hemorrhage when compared to administering the drug after the expulsion of the placenta.

 Eight Ways to Avoid Pitocin in Labor and Why You Should - Birth Sense blog