Another quick I'm-not-dead post

... and a truly excellent link: Pit to Distress This kind of garbage goes on at my hospital all the time... it's just never been given a formal name. Women ought to be up in arms over this-- it's one thing to go after mamas as easy targets, but when the OBs start in on babies...

The gloves are off. Please, mothers, daughters, sisters, aunts-- fathers, brothers, grandfathers-- everyone who cares even an iota about mamas and babies-- take up the call. Women of Earth, take back birth!!

Barbarism, 2009

Let's play pretend. Let's say that there's an operation that everyone undergoes at age 21-- removal of the left pinky finger, for example. There's no reason for it; it's just something everybody does. There are ostensibly scientific-sounding people who point out that people with left pinkies have 100% higher risk of left pinky finger cancer than people without left pinkies. Besides, everyone does it, and most people agree that people who've had the procedure are just more attractive. It's neater, you see-- more streamlined, more aesthetically pleasing.

When you reaches your 21st birthday, you goes to your-- oh, let's say, dentist. Doesn't make a lot of sense, but you're probably getting their wisdom teeth out too, so it can all be done at once. And the longer it's put off, the worse the recovery, so-- there you are. The dentist straps your left arm down-- and your right too, for good measure. He stabs you a few times with the novacaine hypodermic, which has no time to take effect because he follows immediately with a big scalpel. He hacks off your pinky while you scream bloody murder and the assistant offers you a sip of sugar-water to calm you down. It's over in a minute or so-- the dentist holds some pressure, then checks the site to make sure it's not bleeding, then wraps some vaseline-soaked gauze around it. "Leave that there till later today. Then you can rewrap it with some more vaseline later."

You slump in your seat while the assistant removes the restraints and pats you on the shoulder. "See, it wasn't so bad... you're not even crying." You look at her dazedly; you're in shock, and couldn't produce a sob to save your life. But it's all over, and you're grateful. Your parents got through it. Your siblings, friends, coworkers... everyone manages, so surely you'll be all right. They all say you won't remember when all's said and done... and now you look just like everybody else.

Well... there is that one whack-job at work who insisted on keeping his left pinky. Weird. He says he came with ten fingers, so why forfeit one just because it's what's done? But he's in the minority and clearly insane-- no one keeps their pinkies except for certified granola-crunching flower children, after all.

Your head is swimming and your hand aches. You ask feebly for some pain medication, but the assistant, who keeps coming back to make sure your stump isn't bleeding, shakes her head. "Sorry," she says with sympathy, "I can't give you anything. You might get an infection, and anything I give you for pain could mask the symptoms. You'll be okay." Pat, pat.

You close your eyes, sick to your stomach. All you can do is pray for sleep and time to ease your pain.

Sound ridiculous? Unnecessary? Downright stupid? Of course it does. No one would volunteer to have his finger chopped off, "just because." Certainly no one would think of inflicting such a procedure on a person who could not consent, could not even understand what was happening or why. And yet... we do it every single day, to defenseless baby boys who have no choice in the matter whatsoever. And we wonder why our society is getting more violent by the day?

I am sick to death of circumcisions. There, I said it.

It's not like my position on them is vague or unspoken-- everyone who works with me knows where I stand. I despise them. I think they are barbaric, horrible, hideous, disgusting, and appalling on every level. I loathe having to assist with them in any way, and I absolutely cringe when I have to clean up the mess afterward. It infuriates me that we allow people to perpetrate this kind of violence on helpless newborns!!

This morning, one of the OBs came in to circumcise two babies. He had a 12-year-old boy with him, shadowing him for a school project. "Now, Thomas," Dr H said to the boy, "I did this to you, remember. You sure you want to see this?" Thomas insisted that he did. One of the lactation nurses was passing and commented, "That's awful, how can he subject a little boy to that?" EXCUSE ME?? How can we subject INFANT BOYS to that??!?!?!

Seriously... it's grotesque. I know people say it can be done humanely, but I humbly beg to differ. There is nothing humane in mutilating the body of an hours-old baby: strapping him down on a cold plastic board, letting him scream his lungs out, offering no comfort but sugar-water on a pacifier or a gloved finger, providing nothing for anesthesia except-- maybe, and not even usually-- inadequate injections of lidocaine or a smear of EMLA (topical lidocaine that is, by the by, not recommended for use on infants under 1 month of age), and then brutally clamping his penis in a device that looks like it was developed by sadistic Inquisitors during the Dark Ages and hacking away one-third to one-half of the skin of his most sensitive organ. Don't believe this is what happens? Don't take my word for it.

And for what? There is no medical indication for routine infant circumcision: so says the American Academy of Family Physicians, so says the American Academy of Pediatrics, and so say I. So why do we do it? Because it's "cleaner"? (It's not. And cleaning an intact penis is no more difficult, and no harder to teach someone to do, than cleaning an ear.) Because it "prevents cancer"? (It doesn't. There's no evidence that an intact man who practices even minimal hygiene will induce cancer in himself or a partner.) Because we want baby "to look like daddy"? (That's important... why?) Because "the other boys will laugh"? (Not if they're intact too. And not once they find out what they're missing without their foreskins.)

With the overwhelming evidence falling squarely on the side of not circing, why is it still such common practice? This is something I simply can't figure out. Are people so brainwashed that they're willing to sacrifice their sons' physical (and eventually sexual) wellbeing to a misguided standard of social acceptance? I don't think parents wake up sometime during pregnancy and say to each other, "I know, honey! Let's mutilate our beloved baby boy as soon as he arrives!" I think they genuinely believe they're doing what's best for-- or at least, they're not harming-- their infants. I honestly believe that if these parents were given true informed consent on circumcision, if they really knew what their little guys would endure, most would choose to leave their sons' penises intact. Maybe if they were required to watch this video, produced in informative (and graphic, so be warned) detail, the appalling statistics would change.

I wish I could convince every expectant parent to thoroughly and comprehensively educate themselves about circumcision. I've seen some of the most informed parents-- loving, caring people who would no more put their children in danger than they would club baby harbor seals for sport-- who still opt to circ, with no more convincing rationale than "that's how it's done" or "hey, his dad survived it." I've seen a disturbing trend among immigrant families, whose home cultures have never routinely circumcised their infants, choosing the procedure in order to give the impression that they're really assimilating into American society. Most new parents give it no more thought than whether they'll choose to diaper their infant (bearing in mind, by the way, that there are those who don't, but the sad fact is that circumcision is not the benign procedure it's painted to be. Mishaps happen; there are risks. Moreover, allowing a surgeon to remove the prepuce of a male newborn is circumventing that new little person's right to bodily integrity. Does anyone honestly think that a brand-new baby boy, if we could ask him, would-- if given the choice-- declare with enthusiasm, "Sure, lop it off!!"

Blogging by Proxy

I'm being lazy, but this is the best, most concise summary of the whole cesarean situation that I've seen, thanks to the wonderful and always well-informed Kmom.

Check it out!

Brilliance That Cannot Be Improved Upon

Check it out here. There's no possible way I could add to this or make it any better. I wish every VBACing mama-- every pregnant woman-- every single person who's concerned with her rights to bodily integrity and selfhood would print this out and take it to her OB.

Giselle, I applaud you. Brilliant!!!

Mother's Day Thoughts

I was wondering what on earth to write about this week... my muse has winged away yet again (she's most definitely the restless sort, not one to hang around endlessly) and I'm somewhat at a loss. It dawned on me that today is in fact Mother's Day in the US, and since I'm a mother... who works with mothers... and takes care of new mothers... it's at least a place to begin. ;)

We have a small crew today, nurses and mothers. Only one delivery, at 6 o'clock this morning-- a beautiful baby girl with a head full of silky dark hair-- has joined us so far, bringing our census to a whopping seven: three mother/baby couplets and one baby who was supposed to go home today but will stay one more night for observation. There are two nurses on the floor and one in the nursery: decent staffing, for once; we're not running our legs off, which makes for a nice change. There are no particularly galling tales to share of mismanaged birth-- also a nice change. Two moms are recovering from cesareans, but they're both doing well, up and around and caring for their babies. All in all, it's (knock wood) a quiet, peaceful Sunday on the postpartum unit.

The downside to such a day is the interminable lag. The clock slows to a crawl. The silence becomes almost oppressive at times. Phones aren't ringing off the hook; call lights aren't beeping. I hardly know what to do with myself! I do need to go make a bed... on the other hand, that mama wanted a nap...

What's really odd, given the recent storms, the full moon , and the time of year (spring is typically a high-census season for us), is that Labor & Delivery is empty. No one laboring since early this morning, no one scheduled to come in this afternoon or this evening for a Cytotec induction. It's almost... spooky. But it's arguably a good spookiness: if we have another Mother's Day baby here, it will be one who arrives in her own good time, because she was ready to be born and decided today was the day.

I'm tempted to stop there, since I can't think of much else and topics like motherhood steer me dangerously close to maudlin sentiment. I could veer off into reminiscenses about my own experiences as a mother-- my oldest is almost ten years old now, so I think that qualifies me as at least a journeyman, if not a master-- in the craft-- but really, I've found that my children and their antics are far more fascinating to me than to anyone else. Of course I think they're brilliant, amazing, talented, extraordinary-- and I defy anyone to tell me differently-- but it doesn't follow that anyone else would be the least bit interested. (If I had a scanner,it might be different: I could upload some of my six-year-old's drawings and let you judge his genius for yourself!)

I think I'll just close with today's Stone Soup, by Jan Eliot:



I wish all the mothers out there a blessedly and blissfully happy Mother's Day today. Oh, and one last link: check out what my heroine, Erma Bombeck, had to say about the origin of mothers.

BIB!

Babies have an impetus to be born. They have no concept of time; "due dates" and calendars mean nothing to a developing infant. They come when they're ready, in their own good time. Unforunately, most obstetricians do not respect this intrinsic wisdom, and try to fit babies into their own schedules by encouraging (insisting upon?) inductions for no readily apparent (or blatantly made-up) reasons. Babies resist these interferences; a baby who is not ready to be born will hold out against even the most aggressive induction, and their mothers' bodies will instinctually act to hold their infants in. All the pitocin in the world will fail to evict a baby who is unready to be born; the result is "failure to progress" and an unplanned, or even "emergency," cesarean.

The OBs present these elective inductions as the conscientious, convenient, and compassionate choice. "You look miserable... aren't you tired of lugging that belly around? Your blood pressure is a little elevated, too. Let me induce you-- let's just go ahead and get that baby out of there. I'll pick a day that's good for all of us. We'll just get you taken care of, and you won't have to worry about waiting for labor anymore."

Sounds delightful, yes? Appear at the hospital at the appointed time. Check in with the cheerful, unharried staff. Trade your clothes and dignity (oops, is my bias showing?) for a hospital gown, climb up on the bed and receive your IV and monitor belts. Fluid drips into your veins; you perspire prettily. The Clooney-esque OB arrives, checks you ever so gently, and announces with a flourish that you're ready to push. You strain daintily, and out pops your beautiful baby. No fuss, no muss. All done. Ready for that close-up, Mr DeMille!

If you believe that scenario, there's a bridge in Brooklyn I'd like to discuss with you. It's much more likely that you'll work like a dog all day (they call it "labor" for a reason, especially when it's chemically created and interfered with and mucked up, even with the ubiquitous epidural), the OB will materialize in the last five minutes or so, then suction the baby out with vaccuum, or drag her out with forceps, inflicting a large episiotomy on you in the process. This last indignity will be "necessary" (or unnecessarily necessary, as I usually think of it) because your epidural has been cranked up to the max and you can't feel the lower half of your body well enough to push effectively. Besides, you've been splayed in the frog-like lithotomy position and gravity is, to say the least, unkind to birthing mothers who are stranded on their backs.

If an induced birth is difficult for Mom, it's as hard-- or harder-- for baby. Too often, those conveniently scheduled inductions occur before baby is "cooked"-- in other words, ready to be born. Remember, babies can't read calendars! Sure, "term" is defined as "37-42 weeks," but it's a rare infant who's good to go at the early end of that range. The lungs are the last organs to develop; consequently, many induced babies experience respiratory distress-- hopefully, but not always, transitory. The March of Dimes has been addressing this issue lately, noting the sad and shameful fact that so many NICU patients are near- or later-preterm infants (ie, 35-38 weeks' gestation), and there are special considerations to keep in mind when caring for these babies. Iatrogenic prematurity-- babies born too early for no reason other than because the OB couldn't or wouldn't wait any longer-- is epidemic in this country, and in almost every case it's preventable.

Regardless of reason-- and there are a few legitimate reasons to induce labor-- inductions are geared to the convenience of the physician. The ideal scenario of for a pregnant mother to arrive at 6 am, get hooked up, pitted, and medicated: epidural at 10, complete at 2, pushing and delivered by 3 pm. This gives the OB a morning free for office visits and consultations, then gets him home for dinner at 5. Perfect. Moms, of course, don't always cooperate-- they may not conform to the neat labor curve that the OB expects, and thus may well end up a c-section for "fetal distress," "failure to progress," or the dreaded "CPD" (officially "cephalopelvic disproportion," more often "care provider dysfunction"). For the obstetrician, who is a trained surgeon and relishes the opportunity to wield a scalpel, this is a logical and agreeable conclusion to the day. He's not the one who has to hobble home, guarding an abdominal incision and trying to care for a newborn.

Sometimes moms go faster than the doc expects. The pitocin or cervidil or, heaven forbid, cytotec, work too well. Like yesterday: the nurse who was laboring Jane (names changed to protect the innocent), who had come in at 6:30 a.m. for a pit induction, went to check on her around 9. Jane told her that she felt "something down there." The nurse calmly checked her-- saw a fuzzy little head crowning-- and calmy proceeded to catch the 7 lb 4 oz little girl. We call this a "BIB" delivery-- "baby in bed." It went swimmingly: baby had excellent APGARs, mom's perineum was intact, the placenta delivered spontaneously and intact. Textbook. The physician, who had been paged, arrived shortly thereafter-- and chewed the nurse out for letting his patient BIB!

Now, bear in mind that when the nurse walked in, the baby was crowning. Birth was immiment-- there's no going back at this point. What was she supposed to do? Answer: stop the pit and tell mom, "DON'T PUSH!! Breathe... breathe...relax..."

Seriously. Baby is on the perineum-- hell, through the perineum-- and Jane is not meant to push??!?!??!? She's supposed to just lay there and endure the titanic forces of labor until the OB deigns to appear?

Yes.

That's the OB's feeling on the matter. The nurse should be able to control labor to the nth degree-- regulate it perfectly, so that it's fast, but not too fast. Speed up as needed-- if it gets away from her, she should manage to slow it back down to wait on the physician. And if, gods forbid, a mother actually has the gall to deliver without him, he'll make sure the nurse catches an earful.

Occasionally an OB will punish the patient as well. Not too long ago, we had a mother who BIB'd and was perfectly happy about it. The OB was furious. The nurses all got chewed out, but worse, the patient spent the next two days being harassed and even verbally abused by the physician. The OB insisted that the precipitous delivery must mean that the patient had a retained placenta, therefore she was in imminent danger of bleeding out. Dr M ordered an ultrasound to check for placental fragments, and for an indwelling catheter to be placed. The patient (smart mama) refused: she knew she'd delivered an intact placenta, that she was having scant lochia and no trouble voiding, and that the catheter only increased her risk of urinary tract infection. When informed of the patient's informed refusal, Dr M screamed down the phone at the nurse, "You MAKE her take that catheter!" The nurse reminded the doctor that patients are in fact free to refuse any medication or procedure (at least in theory) and it's illegal to force said medication or procedure on a person who has refused it. Dr M then demanded to be connected to the patient's room, and browbeat the mom, telling her she was "negligent" and clearly cared nothing for her baby, since she was likely to hemorrhage and leave her infant motherless. The patient, bless her, held out-- she never did take the catheter. Dr M retaliated by informing her that, once discharged fron the hospital, she would no longer provide care for her (the mother). No big loss, in my opinion.

I couldn't stop thinking about that particular case for a long time. Why was the physician so hostile? Why do OBs get angry when nurses catch their babies, when women give birth on their own, without the doctor to strut in and look important?

And then I realised why: when a woman BIBs, when babies are born in their own time, without assistance (interference) from the OB, it's glaring proof that the OB is not indispensable to the process. Jane didn't need her doctor. Dr M's smart, courageous patient didn't need her OB either. Obstetricians want control, they want to think they've beat nature into submission, that they can do better than women's own bodies.

The simple truth? They're wrong.

Decompression

I was fortunate to finish up Cesarean Awareness Month (aka April) by attending the ICAN Conference in Atlanta, Georgia. It was, in a word, incredible. The speakers, the topics, the women-- especially the women-- were amazing. I volunteered to help plan the conference this year, and while I don't especially feel that I contributed much of anything, I was privileged to see how much energy and heart the women of ICAN put into the event.

I arrived Thursday afternoon, in time to help with the set-up. I helped put the name badges together-- it was like a virtual reunion, seeing who was attending this year, made even better by the knowledge that every familiar name I came across (Bonnie! Jenny! Erica's coming? Cool!!) would soon grace the neck of an actual flesh-and-blood scar-sister, and I'd be hugging them as soon as I saw them. We organized the gift bags for attendees and speakers (darn, I didn't score one of those adorable ICAN t-shirt-wearing bears!), colated manuals, arranged display tables. Our coordinators were amazing-- it was like watching an entire crew of Martha Stewarts in action!

Chapter leader training began that evening, and as more and more of my sisters arrived, I began to feel more at home, in my element. I am not broken... when my sisters are with me.

We share so much, you see. Most of us have undergone one or more cesareans, sometimes necessary, usually unwanted. We all decry the appalling rise in the c-section rate and the lack of support for birth choices, including VBAC (vaginal birth after cesarean, a safe option for most mothers) and out-of-hospital birth. We come from all backgrounds, differing in religion, philosophy, parenting style, socioeconomic level, education, politics... you name it. We all come together, though, where our babies our concerned. We can all agree that babies deserve the safest birth possible, the best start in life, and more and more evidence supports the fact that birth is safest when it proceeds the way nature intended.

One of the high points of every conference is the informal song session, where many of us gather to express ourselves musically. This year, one of my dear sisters was holding the space for a geographically distant friend whose time of birth was drawing near, and she recorded us singing for Tudu . Nothing I could say captures the spirit of the conference better than this brief moment of communion and conviction.

Birth is as safe as life gets. Birth is life... we only want to live it.

Cesarean Awareness Month: April 2009

Once again, it's April, Cesarean Awareness Month 2009. Every year the CDC announces the latest statistics; every year for the past fifteen at least, the percentage of births via cesarean has gone up.

So, what's the big deal? What difference does it make which way a baby comes out, as long as it does? Vaginal birth, cesarean birth-- it's all the same, isn't it? After all, a healthy baby is all that matters...

More than thirty percent of pregnancies in the United States now end in surgical delivery. Estimates vary, but at least half of these operations-- probably many more than half, in truth-- are of questionable necessity, and a huge number of those are outright unnecessary. When truly indicated cesarean surgery can, of course, be a lifesaving procedure for mothers and infants; however, it is clear that the majority of cesareans today are performed for nonemergent reasons.

One simple fact that cannot be argued is this: a cesarean, no matter how we dress it up and make it palatable for general consumption, is major abdominal surgery, with all its attendant risks. A mother undergoing a cesarean is four times more likely to die as a woman who delivers vaginally. Morbidities are inarguably higher: risk of infection, significant blood loss (sometimes requiring transfusion, which introduces another level of risk in and of itself), damage to bladder and bowel, blood clots, adhesions. Post-op moms face longer recovery times, lingering pain, even long-term or permanent nerve damage. Anesthesia-- even that "harmless" epidural society embraces as the savior of laboring women-- adds another tier of risk, one that is rarely addressed by physicians.

Women are almost never informed about the risks to future pregnancies, but there are many, and they are not benign. Uterine rupture, used so often by physicians to frighten mothers into scheduling repeat sections, is a potential complication-- probably the best publicized, if not the most common. Abnormal placentation, secondary infertility, stillbirth-- all are sharply increased after surgical delivery.

Cesareans, despite what apologists would have us believe, are not without risk to babies, either. Mechanical injury-- scalpel wounds, nerve and soft tissue damage from less-than-gentle extractions-- are more common than one might think. Elective sections, touted as "mother's choice" and "humane" by proponents, are often scheduled for 37-38 weeks' gestation-- technically term, at least by the obstetrician's reckoning, but babies can't read calendars, and surgeons frequently fail to account for the diversity of women's menstrual cycles and ovulation times. The lungs are the last organs to mature; when an infant is forced from her cozy womb at 7:34 a.m. (first scheduled section of the day; after all, the OB wants to be done in the operating room by 11 so he can get back to the office for more lucrative appointments) on a Tuesday, she may simply not be physically ready to part from the umbilical cord and placenta and transition to air breather. Respiratory distress is common-- disturbingly so-- in cesarean-born babies; many suffer transient tachypnea of the newborn, often referred to as "wet lungs." For many babies this translates into several days of labored breathing that resolves with time and may eventually manifest later in life as asthma. For too many others, it means a stay in the neonatal intensive care unit with assisted ventilation, IV lines, antibiotics, ultrasounds and chest x-rays, brain scans, eye exams, and unexpected complications such as NEC (necrotizing enterocolitis)-- a disease that still claims the lives of too many babies every year. This is certainly not a situation most parents envision when consulting their schedules to choose their little ones' birthdays, but it's one that is played out all too often.

The emotional cost of cesareans cannot be underestimated either. Women in late pregnancy are primed by their hormones to react, on a subconscious, emotional, or "gut" level, a certain way to labor, birth, and the early postpartum experience. This is to insure that our primal mammalian selves will receive and nurture the newborn-- simple biology at work. Often, that chemical cascade is interrupted, throwing bonding off track and making it difficult for mothers to transition fully to their new role. Cesarean mothers may be at higher risk for postpartum depression and are less likely to breastfeed their newborns. There are many reasons for this: the post-op mom is tired, hurting, hampered by an abdominal incision. She can't get around easily-- forget jumping up at her baby's first cry. Even a tiny infant starts to weigh a ton when she's resting on a fresh surgical wound. Breastfeeding is awkward and hard to manage when mom can't change positions easily and without significant pain. Let's face it: surgery is a lousy way to begin motherhood!

If asked, the majority of mothers who choose cesarean deliveries will respond that they are most concerned with providing a safe birth for their children. They cannot be faulted for this conviction: the medical establishment and the media are responsible for convincing the public that c-sections are safe and even preferable to vaginal birth. The serious potential for permanent injury-- or even death-- during and after the surgery is rarely mentioned. The cesarean is presented as an easy, convenient, scientific, controlled alternative to the inherently messy, unpredictable way designed by nature.

Convenience is a huge driving factor in the rising cesarean rate. Obstetricians prefer cesareans for many reasons, not the least of which is their ability to exercise some control over nature by making birth conform to the physicians' schedules. It is not cost-effective to attend a woman in labor; birth happens at all times of the day and night, every day of the week, heedless of holidays, vacations, special occasions, even plain exhaustion. Cesareans, on the other hand, can be timed quite specifically without creating conflict for the OB: all he has to do us appear at the appointed hour, scrub in, and be presented with the neatly draped and sterilized belly of the pregnant mother. Forty-five minutes later, the surgeon strips off gown and gloves, pauses to dictate or jot a delivery summary in the patient's chart, and is back on his way to his office, where a waiting room full of paying customers sit patiently for their fifteen-minute time
slots for check-ups or consults.

Parents like the convenience as well. Scheduling surgery means that family can be on hand at the prescribed time, employers can be informed and leave arranged-- down to the minute!-- well in advance. Mothers need not worry about how much longer their pregnancies will last, instead focusing on the matter of preparing for their new arrivals. Dad can be certain his job will accomodate his time off; grandma can be right there to scoop up her precious new grandchild; care can be arranged for siblings without any middle-of-the-night drama or panicked phone calls. All that stress eliminated-- sounds ideal. Why not schedule a cesarean? It just makes sense.

Except...

Regardless of what ACOG, a trade union dedicated to furthering and protecting the interests of its members, and the popular media insist, cesarean surgery is simply not the optimal way for a baby to be born. Vaginal birth is infinitely more complex than purple-pushing an inert lump through one's "bottom" to produce a squalling newborn. It is a complicated, carefully calculated dance, choreographed down to one's very cells, perfected over millenia to provide human infants their very best start in life. No manmade intervention, no matter how well-intentioned (for the mother or the physician), can replicate the delicate and profound forces that combine to bring a child into the world. It is sheer arrogance for surgeons to assert that they can match, much less surpass, a process millions of years in the making.

Fortunately, there are those who recognize this folly, and are fighting to be heard above the rhetoric and misinformation. There is support for mothers trying to recover from cesareans, for mothers wanting to avoid them, for women planning a birth after a cesarean-- whether that's a vaginal birth or a more empowered surgical delivery. I want to add my voice to theirs, to speak my truth: Birth is Life, and we were designed to live it.

If it's Thursday, it must be...

Work.

Well, that's where I am now, as I am most Thursdays. Today hasn't been a bad Thursday, as Thursdays go; still, I'm with Arthur Dent: "This must be Thursday. I never could get the hang of Thursdays."

Thursday tends to be a busy day on the average L&D unit. Lots of scheduled cesareans and inductions: the physicians reason that the vaginal deliveries will go home Friday, or possibly Saturday; they reason that, if the former, they'll see them tomorrow, and if not, well, they can leave a prescription on the chart for pain medication and let whomever is covering for the weekend worry about it. The cesareans will stay the weekend and leave Monday-- maybe Sunday, but again, that's for the on call colleague to decide.

Today the inductions have gone slow-- only one vag birth so far to be admitted to us in mother/baby. Another apparently failed the Friedman Curve an hour ago and was sectioned, so the next shift will have a fresh surgery to contend with. Other days they fly, and babies seem to pop out right, left, and sideways! It's my Friday-- ie, the last day I'm scheduled to work this week-- and I'm grateful it's been a relatively quiet one, for once.

Since it's been a calmer sort of day, I was able to put the finishing touches on an inservice I've got to present on postpartum depression. Here's a quote from the informational letter we'll be giving patients:

Up to 80% of new mothers feel stressed or cry easily after having a baby. This is commonly referred to as "baby blues." These feelings are normal and usually resolve in a few weeks. Postpartum depression is a mood disorder that affects a high percentage of women-- as many as 1 in every 8-- anytime in the first year after their child is born, or after a miscarriage or stillbirth. In the United States, about 400,000 women-- roughly 1 in 650-- may develop postpartum depression each year. A significant number of these will go undiagnosed, and may suffer needlessly...

Postpartum depression is, in my humble opinion, no joke (unlike Tom Cruise, who is!). I essentially lost the first year of my older son's life due to undiagnosed major depression and post-traumatic stress related to a traumatic delivery. The public is woefully undereducated on this topic; even in this day and age, new mothers are handed the unfeeling line, "What's to be depressed about? You just had a beautiful baby!" and worse, ""Get over it!" It's not that simple, as any mother who's tried to cope with the demands of a new infant and the realities of a dark depression can attest. Sure, good nutrition and excellent support will help alleviate the symptoms, but I hate to tell you, they're not a panacea. Sometimes-- much as it may gall me to admit it-- medication is indicated.

I've never had much luck with talk therapy-- I hate going through the ordeal of finding a therapist, meeting him or her, weeping my way through an intake appointment, reciting my woes and stresses and (loooooong) history of depression, and basically reiterating the whole boring saga of how I arrived at this particular point. I feel guilty about inflicting myself on counselors-- no one wants to listen to the baggage I have to offload, even if they are getting paid for it! Medication is safely private-- you can't induce ennui in a capsule of fluoxetine. Of course, your more conscientious physicians will insist that you return periodically to re-up your prescription, although in my experience it's largely a formality. Ideally, one should work with one's care provider vis-a-vis follow-ups, the monitoring of lab values, etc; if your doctor doesn't offer, it's recommended-- if not, indeed, imperative-- that you insist on regular assessments yourself. No matter what they tell you, all medications have side effects; it's best to be aware of them and proactive about addressing them as they arise.

In my experience, whatever the unpleasant symptoms associated with the antidepressants I've personally tried (Prozac, Zoloft, Wellbutrin), they were peanuts compared to the black pit of despair I inhabited after my son's arrival into the world in July 2002. I went to bed every night with the distinct hope that I wouldn't wake up. I cringe to admit that now-- I adored my sweet baby, but I firmly believed I was no good to him whatsoever and he would be immeasurably better off without such a useless mother.

I wouldn't wish that hell on anyone. I stayed there entirely too long, unable to escape the sucking despair. Finally I managed to drag myself to a family practice physician, who prescribed Zoloft, then Prozac. After long weeks, it worked-- I realized I no longer hoped for death. I flirted with guilt for awhile-- why couldn't I be strong enough to get by without the meds?-- but I let that go. The medication allowed me to function again, as a mother and as a human being. I could get up in the morning. I could (and did) breastfeed my child on demand-- and he didn't grow an extra head, or suffer any other setbacks that I've noticed in the intervening years. For me, it was worth it. Do I wish I hadn't had that mess to deal with? Certainly. Am I thrilled that, for me, it appears that antidepressants are an ongoing part of life? Not so much. But my kids have a (mostly) functional mother, and for that reason, I'm okay with it.

MIA!

I set up this blog months ago, determined to join the intellectual elite of the 21st century and add my contribution. I truly intended to get this moving! Instead, life intervened, as life is wont to do, and I procrastinated (as I am wont to do!), and... nothing happened.

It's not for lack of thought. My head whirls every hour of the day with stuff. I think all the time. It's just that very little of it actually makes it out of my brain. Birth, life, death... the Divine or lack thereof... weighty matters (literally and figuratively!), fluffy stuff. Some of it actually seems interesting or important enough to share. Somehow, though, it mainly... stays in my mind.

I mean well; most of us do. The road to hell is paved with good intentions... But too often, little (nothing) comes of it. It would be so much easier if I could upload my thoughts directly to the 'net: things make so much more sense in my head. They lose nearly everything in translation, as it were, to paper or the screen.

However, I'm still determined, and I still mean to carry through. I'm trying to lower my expectations. I don't need vast numbers of readers or followers. I have no one to please but myself. I will try my hardest to abstain from the self-judgment that keeps me paralysed. I will simply write, and hopefully I'll get in touch with that harshest critic: myself.

This is a short post; call it a manifesto. It's spring; it's time to move on. Sondheim said it best: "I chose, and my world is shaken-- so what? The choice may have been mistaken; the choosing was not. You have to move on."

Choose. Stay stuck or stumble forward. Surely the stumbling is better than being stuck?