A Quiet Advocacy

Of the few friends I have who have either VBACed or had a homebirth, I've never understood why they aren't more outspoken advocates of their experiences. Maybe they just don't have the time to devote, or the desire, seeing their "alternative" birth as a once-and-done experience and are ready to move on to something else. In my circle of friends, I seem to be the one loud-mouthed person who is writing about it, reading about it, talking about it, and I wish that could change.

When I was pregnant with my second, I had no intention of having a VBAC at first. A woman from my church quietly took me aside and asked if I had ever considered having one, and I said I wasn't sure and they sounded too dangerous, blah blah blah. In fact, I had never done any research on them at that point, and just thought a repeat cesarean was my only option. She herself had had a long, arduous vaginal birth, bargaining with her doctor to be allowed more time to labor, finally delivering a baby boy with a nuchal hand. In short, a real "birth warrior" who was exercising her rights and being her own patient advocate at a difficult time. After that, though, probably because she was done having children, her interest in advocating childbirth choices seemed to fade into the background, at least until she spoke to me.

Little did either of us know that, in my 37th week of pregnancy, I'd be calling her on the phone at 10 p.m. to ask about her VBAC. Not what either of us ever expected!

I liken those parallels to some of the celebrities we know of who have had either a natural birth (more on that later) or a homebirth. There is no shortage of them, and websites galore list them. If you were to picture a mental list of celebrity homebirthers, Ricki Lake and Gisele Bundchen would probably top the list. And that's okay - they're both outspoken and educated about it, passing on that information to any and all who can benefit from it. Gisele does have a blog, and while her primary focus seems to be on the environment, she does devote some space to childbirth.

Some would argue that perhaps the reason we're so familiar with Ricki's stance on birth is because, thank God, she's made a movie about it. Whatever it takes! It got our attention (whether good or bad), and people know she's a staunch advocate of homebirth and choices in childbirth. But where the heck is everyone else?!

Dozens of celebrities have had homebirths, and only one I can think of has VBACed - Kate Winslet. I remember reading awhile back how she lied about the birth of her first child because she felt ashamed or a sense of failure over her c-section. Not uncommon, sadly. However, I'm not sure she really tooted the VBAC Horn, either, and I think even made mention how she "quietly VBACed" with her second child. Not sure if that means it was boring and uneventful, or if she just didn't want to talk about it. While she probably has strong opinions about VBACs, it's not like she's talking about it regularly or encouraging other women to have them.

Julianne Moore, Kelly Preston, many entertainers (Nelly Furtado and Ani DiFranco, to name a few) and the wives of many male celebrities all had home births. Remember Kenny Loggins, a folk/pop singer from the 70's? His wife gave birth at home unassisted, albeit by "accident," because of a precipitous labor. Meryl Streep had all four of her children at home. Pamela Anderson had both of her sons at home, and apparently is a big advocate of long-term breastfeeding. Really? Who knew? I know she walked down the catwalk pretty much nekkid to promote PETA, of all things, but why not do it while having an infant at her breast?

Perhaps a little extreme. But sometimes I just wish these people in positions of "clout" would promote their successful, safe "alternative births" more - like, the way they talk about PETA or environmentalism. Wouldn't that be a wonderful boost for the cause?

One midwife's website that I recently read stated that Gisele was the next celebrity spokesmodel for homebirth or something like that - "move over, Ricki Lake!" I frowned and thought, no need to move over - there's room for many more.

The Best Answer

At least one of my regular readers is familiar with Yahoo! Answers, where I often go when I'm bored or hoping to encourage that certain pregnant someone who is on the fence about things or just needs advice. I'm no expert, obviously, but I try my best to be forthcoming and honest, as well as offer my personal experience. So my antenna went up the other day when the question "C-section vs. natural birth - pros and cons?" came up!

I checked my email today and found that the asker had chosen me as best answer! This is why I do this - this blog, this advocacy stuff: so that someone, even if it's just one person, can be more informed and know her options. Be encouraged to ask more questions and demand answers. To know that she's not alone, and yes, you DO have a choice.

The mom had a rather bad experience with her first, a vaginal birth, and was wondering if a scheduled c-section wouldn't be better for next time. I wonder if that isn't the reason for some of the c-sections scheduled today - because the experiences that first brought them into motherhood were so downright horrible that they never want to relive them again. What a way to gain passage into one of the most rewarding jobs ever.

She thanked me for my lengthy answer LOL and I even got two thumbs up. Which means people are reading and agree. Which means the information is getting out there. She might never read anything by Ina May or watch Ricki Lake's movie. But hopefully she will have been helped by my post, somehow. Yes, I tend to be long-winded, but it's just so much more than a yes or no answer - it's so multi-faceted and really, the more information, the better.

Celine Dion pregnant with twins

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

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

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

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

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

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

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

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

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

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

When a good doctor gives bad advice

In my reading lately, I came across an article from urologist Jennifer Berman's website about her scheduled c-section. Although it's an older article, it still pertains to our current 'birth climate,' and is an eye-opener about a couple of things: namely, how dysfunctional birth has become the "norm," and how even doctors are unwitting victims (although some people would laugh at that term) of the broken maternity system.

Ironically, I was just reading about Dr. Berman's "Why ruin a perfectly good vagina?" comment in Jennifer Block's "Pushed," which made me nearly want to vomit. She may tell "friends" this, but does she give this kind of crappy advice to patients? (Does it even matter? Once they see a "real doctor!" saying this, they're all on board with it and automatically demand their c-section, now!)

I've read about obstetricians who are clandestinely sneaking off on their own to give birth at home, simply because they know the way their industry works and don't want to be subjected to it. At risk for criticism - even to the point of being ostracized - by their peers, they have chosen home birth - or at the very least, gentler birth - as an alternative to the over-medicated, pushed, rushed option that has become what most women associate birth with.

So what about those who don't choose that alternative? How do they give birth?

No differently than any other woman, it looks like. After reading Dr. Berman's account of her first child's birth, I would guess that a buttload of Pitocin (although she doesn't mention it or an induction) might have had something to do with it. She does admit to 'getting the epidural too early,' which she says slowed down her labor (wait a minute - I thought that wasn't supposed to affect labor?!). Her son's weight was estimated (read, "supposed to be") within a certain range and he was larger (nine pounds), and had shoulder dystocia, which resulted in a difficult birth. So, when she got pregnant a second time, she decided to avoid the unpleasantries of a vaginal birth (such as urinary incontinence, prolapse, etc.) by having an elective cesarean.

Part of her reasoning for doing so came from, on her admission, her work as a urologist, where she "saw women who suffered the effects of incontinence and prolapse. These effects are directly related to vaginal delivery."

It sounds like Dr. Berman had the typical dysfunctional birth - pull your baby out as soon as possible, even if your body doesn't have the urge to push, the mother of all episiotomies cut - resulting in a baby that's delivered vaginally, yes, but under forced conditions. Dr. Berman probably hasn't attended any of the births these women experienced to see how the use of forceps, directed pushing, lithotomy positions and vacuum extraction had on their "perfectly good vaginas." I'm sure that at some point in her life, Dr. Berman has experienced constipation. And as a urologist, she knows that prolonged straining on the toilet can cause all kinds of bad things to happen, the least of which is a bowel movement when you don't have the urge to go. Think of that bowel movement as a seven- to eight pound kid. If you have no urge to push out a bowel movement, it's easier to wait until you do, right? The same applies to a baby.

Had I known this, I would have refused to push when told to. Instead of working against my body, I know now that I should have worked with it - waiting, and yielding to the urge when I got it, instead of when a bunch of nurses told me to - and pushed a baby out with much greater ease.

Dr. Berman mentions how her incontinence continued for several months after her son was born and returned later in her second pregnancy. This kind of made me laugh. What urologist doesn't consider that the weight of your unborn child sitting on all your organs is going to cause you, and every other pregnant woman, to leak urine? I think back to before I had ever experienced a vaginal birth but was pregnant with my second child. Had I had a vaginal birth yet? Nope. Was I experiencing bladder leakage? Yep. (Heck, you can still pee your pants even before you've ever given birth!) Dr. Berman didn't mention kegels (or squats, which are actually more effective) at all. Maybe those didn't work? (eyeroll)

Dr. Berman did go on to say that if she has a third child, she will choose a section. That is, if the scar tissue built up allows her to become pregnant. But wait, she didn't mention that, either. And so what - women are only having two kids anymore these days, right?

It saddens and frightens me to think that Dr. Berman openly admits that, had she seen cases of urinary incontinence and prolapse before her first child was born, she would have chosen an elective cesarean then, too. So your urine leakage, however brief it might be, is more important than the health of your child? Avoiding the risk of something that might never happen, or really, in the general scheme of things, might not even be that problematic, is more important to you - to the point that you're willing to expose yourself and your child to the risks of surgery?

Studies have shown that age, and not necessarily just a vaginal birth, can cause incontinence. There are lots of other factors at work - like genetics, the number of children you've had (we all know that those muscles don't work as well as they used to when you're on baby #4) and obesity, so it is totally inaccurate to say these things are "directly caused by vaginal birth." Nor is it accurate to assume that this is even a necessary consequence to having a vaginal birth, but rather reflects how abnormal birth is considered normal in our society. There are ways to mitigate those risks, like by pushing when you're ready and not lying flat on your back, for instance. But, because those two things are so engrained in our idea of how birth should be, it is considered normal to see problems of incontinence and prolapse in women. I wonder: if a good portion of Dr. Berman's patients were home birthers, where, you can assume, the use of Pitocin and epidurals, suboptimal birthing positions, episiotomy and directed pushing are not the norm, would she say, "Hey...wait a minute..."?

What percentage of her patients were overweight? Had a family history? Had several children? Had never had children, maybe?

Ironically, urinary incontinence happens in men, too. But...they don't have vaginas or a uterus. Is Mr. Dr. Berman being counseled by his wife to have some form of surgery to avoid a possibility of this happening to him, too?

Stay tuned ... maybe we'll see them both shopping in the Depends aisle of the grocery store in about 25 years...

Should OBs be investigated for insurance fraud?

It's no secret: our economy (and our healthcare system, as a matter of fact) are in the crapper. Companies and insurance carriers are looking for ways to cut costs and save money. I remember back several years ago when, while driving on the turnpike, I would always see the same sign: a jail cell and something accusatory about committing insurance fraud and how it can drive up everyone's premiums.

Perhaps the finger of guilt is being pointed in the wrong direction. It's not really the consumer who is defrauding the insurance carrier; in the case of a typical hospital birth, maybe it's the physician.

The standard of care in obstetrics is to perform the same excessive battery of tests, monitors and other expensive interventions - that normally would be performed only on a high-risk patient - on every pregnant woman, often whether they need it or not. Suddenly everyone is high-risk. And I'm sure those interventions come with a hefty price tag.

And correct me if I'm wrong, but don't some OB's balk at attending Medicaid-covered patients because a government payor is less likely to pay for certain procedures than a traditional insurance carrier? Wait a minute ... maybe I do want the government running my pregnancy healthcare after all...

I switched OB's for my third pregnancy, and typically under my health plan, all prenatal visits are covered. On three separate occasions, I was billed a copay: once during my first visit (I don't remember ever having to do this with the old guy) and again when my doctor and I had a "conversation" about a VBAC - which basically consisted of her lecturing me in a nice way and feeding me inaccurate information. I considered this part of my pregnancy care and planning, together, the birth of my child; she considered it a consultation.

The third time, they noticed some swelling in my lower extremities and that my blood pressure was elevated. Nothing new from my last pregnancy (and I wasn't billed for it then, either), and apparently not that uncommon in the rest of the pregnant population. But no - this was considered "outside of the scope of prenatal care" and I was again billed. (But apparently that brief hospitalization for observation was considered part of regular prenatal care, because I never saw a bill for that one. I mean, isn't everyone admitted briefly for observation during their pregnancy??)

After awhile I was beginning to wonder if my doctor was nickel and diming me to death just to eke out as much money from me as he could in addition to what the insurance company was paying out. I realized later that, because they were so overbooked, she had charged me a copay because I had questions. And actually wanted answers. Which was much more than I got from the other guy (Me: "I wondered about why I never had the urge to push during my last labor." Him: "Oh, don't worry about that. We'll help you with that when the time comes."). If he talked any more to me, he'd have to charge me for it. Because, when you're herding a dozen or more pregnant women through the door every day, time is money, you know!

I can't imagine if I had been completely new to pregnancy and birth, with no information whatsoever, trusting my doctors implicitly and feeling like I had no need to question them. They basically have no time to tell you anything of consequence except weigh you, collect your pee, measure your belly and dismiss you.

Fast forward to the birth: again, no time to wait on things like slow labors, broken waters with no sign of labor in sight (one site, albeit an article published in 1999, suggested inducing if labor hadn't started within four hours), or first time mothers who are slow to dilate. You get the idea. The clock is ticking! As a result, the inevitable unnecessary induction is scheduled, often leading to the ubiquitous unnecesarean.

Enter insurance fraud.

Personally, I think doctors with high rates of induction and c-section should be investigated. Unless you're a high-risk doctor (and really, everyone is now, no doubt, because isn't pregnancy a risk?) there is no reason why doctors like the one mentioned on the Birth Sense blog (Aka "Jack the Ripper," God help us!) should get away with such abuse of their power and the tools to carry it out. Do you ever wonder if someone who is processing the claims these doctors submit thinks, "Wow, Dr. So and So induced nearly a dozen patients in X amount of time," or "Dr. So and So sure does a lot of c-sections."

We know that a c-section costs more to do than a traditional vaginal birth, as it should. But consider this: when you tally up the cost of anesthesia, the supplies, this that and the other that are all part of a claim, it is expensive. Multiply that by the number of women having c-sections these days (around 32 percent), and you have a booming "industry."

And since a vaginal birth tends to be cheaper, there are easy ways to quickly run up the tally: IV fluids. Induction of Pitocin, several doses. Epidural or similar anesthesia, several doses. Introduce complications such as shoulder dystocia or fetal distress, use of monitoring (which is pretty much done to everyone, regardless), drugs to revive or resuscitate the baby, etc. and that's more money that's ultimately tacked on to the bill. Some of it's warranted - saving your baby after a uterine rupture during a, let's say, non-induced VBAC, for instance. (i.e. something that inherently could not be helped and was not caused by either a medical error or unnecessary intervention)

Not to mention that in the case of a complicated vaginal delivery or c-section, you will probably require more monitoring from nursing staff, as will your baby, and usually a longer hospital stay. Perhaps even minor surgery to repair damage caused by such a traumatic, rushed birth. Multiply that "cascade of interventions" by the number of women who are induced - sometimes for real reasons, sometimes not - in this country, and again, you have a booming business. CaChing!

Not long ago The Unnecesarean posted about billing costs in pregnancy and delivery. Many readers who commented through the FaceBook link remarked how their c-section births were upwards of $45,000. (Yes, that's thousand.) Still others said they or their insurance companies were getting billed for procedures that never happened in their births:

After my DD was born, I received the actual itemized list of charges that the hospital submitted to my insurance company. I was at the hospital about two hours before she was born and left 23 hours later. The only intervention I had was a heplock. I was charged for pitocin I did not receive and I was charged for anesthesia I did not receive. I called my insurance company about this, and they just shrugged it off.

If this isn't insurance fraud, I don't know what is. And even more alarming is that her insurance company couldn't have cared less that she was attempting to save them several thousand dollars.

If more OBs were penalized for excessive interventions and surgeries that weren't warranted, perhaps it could open some eyes in this country about the abuses going on in maternal care. (Unfortunately, I realize the lines are blurred in what's considered truly 'necessary' and what isn't.) In a perfect world, it might help, in some way, to lower the c-section rate because now the people responsible for paying the bill are starting to pick up on how much over-billing is occurring. (I'm convinced that if it were any other division of medicine, this investigation probably would have already happened by now.) They've already been talking of 'de-incentivizing' certain maternity costs that mean the OB would get paid the same, regardless. While this might stop some abuse, I'm not sure how well it's working, and do think that surgery should cost more because of the level of skill involved. But it certainly shouldn't be used to the point that it is.

Birth as Art

I'm not even sure how to title this post, other than I've been seeing birth images in fascinating places lately.

I had the pleasure of finally making the trek to the Corning Museum of Glass this weekend and seeing some amazing work. A mixture of science and art, glass and its history have always fascinated me. You would expect to see sculpture and other artists' renderings on display in a museum, and this one is no exception. Except this particular work stopped me in my tracks and left me speechless for a moment.

I immediately wanted to know: who was this artist? Was it a man or a woman? Was it "cesarean art," as I have seen here and there? Cesarean art kind of used to disturb me because, before I had my second section, I couldn't fully comprehend the frustration, the exasperation, the sometimes empty feelings, or whatever the artist was trying to express, in her artwork. Whatever it was, I just didn't get it. Yet.

I then wondered, if it really was considered cesarean art, would the museum accept such a piece? Even though this particular exhibit featured modern art, were they really ready to open such a can of worms?

The piece is titled "Omagh," done by glass artist Clifford Rainey, who was born in Northern Ireland. At first I was perplexed, not knowing what to take this for. I had no idea whether it pertained to cesareans or birth and a feeling of desolation or violation in that sense, but when I went home, I googled it to get more information.

Omagh, which roughly translates into "the virgin plain," is the site in Northern Ireland of the IRA bombings in 1998 that killed dozens of people, including a mother of four who was pregnant with twins. I immediately realized that this statue must have been memorializing that tragedy and probably this woman in particular, I could guess, although I don't know for sure. Without having any sense of perspective - whether seeing it for what it was supposed to represent or for what it represented to me - I sensed that some people thought it bizarre, probably disgusting, and had no idea what they were looking at or why. The moment was lost on them and they simply moved on, probably in a hurry to catch up with their tour group.

Apparently the statue is part of a group of pieces he has done that feature the female torso. I don't know if Rainey has any idea of the profound effect his work has, albeit for completely different reasons than what he probably intended. This piece, titled "Hollow Torso," has more significance in name alone to some than most people would care to admit.

Another piece that has been on my mind for several years now is this simple glass flower. Sometimes they create them at CMOG as part of a class or public display of glass blowing and I believe you can even do it yourself. I saw one on display several years ago after the birth of my second child, and found it breathtaking - but for totally different reasons. To me, it looks like an umbilical cord, the flowering part where the cord attaches to the placenta. I wanted one, perhaps to somehow remind me of my VBAC and that beautiful, strong, amazing cord of life. (photo courtesy of cmog.org.)

Once I realized what the Omagh statue probably really symbolized, I almost felt bad - as if somehow I was completely overshadowing the pain and tragedy of that event with my own situation. If ever there really was an appropriate time to say "at least you have a healthy baby," I suppose this would be it. But then I realized that art is subjective; obviously what means something to one person might mean nothing to someone else, or take on a completely different meaning than what the artist had intended. I realized that what the viewer took away from it transcended the true meaning of this piece, whatever that may be. Whatever the case, I realized that to some women, this is what a cesarean - or even a forced, hurried vaginal birth - feels like. Physical pain and scars, emotional pain, feelings of terror or trauma in subsequent births, all because of that one event, or series of events. To think - some women have never experienced a childbirth that wasn't like this.

What I've been doing instead of blogging ... (pics)

I can't believe it's been like two weeks since my last post. I think that with the onset of summer weather, my brain has checked out for the duration. Garage sales are top priority now that my husband's done with teaching, and I've spent so much time outside it's sickening.

It all started when I was mowing the lawn one day. I've been eyeing that Neglected Flower Bed for over a year, and gradually advanced over to it with the lawn mower. Just a clip here, a nudge there. Before I knew it, 75 percent of it was gone. What a liberating feeling.

The Neglected Flower Bed started out as a giant kidney-shaped monstrosity in our back yard that literally took up most of our lawn space. Together with Neglected Flower Bed #2, we had a strip about 6 feet wide in the middle and literally a six-foot wide bed around the entire back and sides of the garage. My poor son lamented that he missed our old house because of the yard. I reflected back on the poor lazy-#*% loser who used to live here and thought, Yeah, once you start a job you should really finish it, ya know? Instead of leaving it for the next guy.

Something more painful than childbirth:
digging out 10+ years of someone
else's crap.

Over the year my husband has dug up more invasive, ugly-looking perennials that I can think of. Entire beds of pachysandra, the most widespread crap ever. In fact, Neglected Flower Bed #1 and #2 had probably the top three invasive perennials - vinca, pachysandra and Solomon's Seal, all of which I see at roadside plant sales and think, "I want to pay someone to get rid of this stuff, not buy more of it!" My father-in-law thought we should leave it and that it looked nice; I wanted to hit him over the head with the shovel and hide the body in the weeds, but decided that would be wildly inappropriate. (After being 7 months pregnant and moody that one summer and letting him talk me into planting ugly evergreens, which I hate, never again am I letting him give me gardening advice.)

So, back to the mower. The stuff reminded me of - sorry, it's disgusting! - untrimmed pubic hair, and I could finally stand it no longer. I have yet to spray RoundUp or anything similar, and was under the insane impression that digging up clumps of carpet-like roots would somehow do the trick. After a good rain, the ground is nice and soft, but those roots are still there, waiting underneath the surface to sprout once again and choke the life out of my new plants. And those trees there? The big ones are ancient pines; the smaller ones with lots of leaves are, I'm pretty sure, weeds that have gone to seed. Lovely, no? That other one in the middle I'm hoping is not a walnut, which are notorious for killing just about anything planted next to them. (Well, not entirely; obviously vinca thrive next to them!)

Two years ago: The Yard from Hell. Pachysandra to the
left of me; vinca major to the right...here I am, placing
an order for 10 gallons of RoundUp. 

I dug up an old picture from two years ago when we moved in: you can see the craziness and major weed trees and other unidentifiable ugliness going on in our midst. After looking at this photo, I'd forgotten just how heinous it looked. The picture's kind of dark, but I think you get the idea.

Ironically the campus that we live on decided the front corner and one side of the house looked bad, so they hired a landscaper to take care of it, but decided to leave this hot mess for us. WTH?!

And now ...

Sorry for the awful window screen in the way... You can barely see an outline of where the Neglected Flower Bed #1 and #2 used to be. It looks like we dug up a swimming pool or something. The brown spot in the bottom right corner is where I'm currently digging. But at least you can see - and get to - our garage now. Who knew there was a nice little brick and stone path under 20 years of crap?

So that's where I've been...just to prove to myself that I do have other interests besides birth. :D