tag:blogger.com,1999:blog-77432948626946139382024-02-08T06:11:45.230+00:00Willow's RestAn eclectic, rambling journey through the ups and downs of life as a fish out of water-- a birthkeeping, Flamekeeping Goddess worshipper who happens to be an obstetric nurse in the Bible Belt.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-7743294862694613938.post-42095785763723827032012-10-20T21:08:00.000+01:002012-10-20T21:24:39.142+01:00Postpartum Depression ScreeningPostpartum depression has been called "the most common problem associated with childbirth," affecting about 13% of new mothers, or approximately 500,000 women each year (1). Postpartum depression (PPD) can have lasting effects on mothers and babies; untreated (or insufficiently treated), it can lead to bonding difficulties and developmental delays in infants (2). Women who experience PPD report the typical symptoms of situational or chronic depression: sadness; loss of energy; changes in eating habits (significantly decreased or increased apetite); emotional numbness; insomnia; loss of interest in sex; irritability and anger (sometimes intense), as well as mood swings, poor bonding, and strong feelings of shame and guilt associated with cultural disapproval of perceived weakness or selfishness of mothers who feel anything less than total bliss towards their new babies (4). <br />
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At least half of these mothers, and potentially many more, are never diagnosed, and may suffer needlessly-- a true tragedy of modern medicine, considering that screening for the disorder is simple, fast, reliable, and inexpensive. There are several tools available to screen new mothers for PPD; the most common is the tried-and-true Edinburgh Postnatal Depresson Scale (5), which was developed in the UK and has been used for over 20 years to reliably predict patients' risk of developing PPD (6,7). The format is simple: a 10-item self-administered questionnaire, which should be answered by the mother herself, that can be completed in about five minutes and reviewed immediately with care providers. The tool is available at no cost to the administering institution, and can be duplicated with attribution; it is easy to score and results are instantaneous. Each item is scored with 0, 1, 2, or 3 points, and the resulting score is compared to a standardized scale-- the higher the score (30 is the maximum), the more likely the woman is to develop PPD. A score of 12 or higher is considered to be predictive of PPD, while a score of 21-30 is considered high risk and may necessitate immediate consult with the woman's physician (8).<br />
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The EPDS has been validated as effective by many quantitative studies, although sound clinical judgment should always be used in interpreting results (10). Each individual found to be at risk should be evaluated by a medical professional not only shortly after birth, but at the initial postpartum checkup (4-6 weeks), and, ideally, at 3 and 6 months postpartum (11). Some researchers have suggested that screening should be done not only in obstretric offices, but in pediatric clinics as well, to facilitate the identification of as many cases as possible (12). Further, since most mothers who experience PPD also experienced at least one depressive episode prenatally, it has been recommended by some that obstetricians should screen their pregnancy patients at least once per trimester during routine prenatal care (13). While ACOG (the American College of Obstetricans and Gynecologists) cites inadequate evidence to recommend a standard of care, they do recognize the need for screenings, as well as treatment, follow up, and referral as required (14).<br />
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References Cited<br />
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1. <a href="http://www.medicinenet.com/postpartum_depression/article.htm">http://www.medicinenet.com/postpartum_depression/article.htm</a>, retrieved 10/20/2012<br />
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2. Is your new mom depressed? (Did you ask?) Schaar GL - Journal for Nurse Practitioners - November/December 2011; 7(10); 879-880<br />
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3. <a href="http://www.mayoclinic.com/health/postpartum-depression/DS00546/DSECTION=symptoms">http://www.mayoclinic.com/health/postpartum-depression/DS00546/DSECTION=symptoms</a>, retrieved 10/20/2012<br />
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4. <a href="http://www.postpartumprogress.com/6-surprising-symptoms-of-postpartum-depression-and-anxiety">http://www.postpartumprogress.com/6-surprising-symptoms-of-postpartum-depression-and-anxiety</a>, retrieved 10/20/2012<br />
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5. <a href="http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf">http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf</a>, retrieved 10/20/2012<br />
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6. Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item<br />
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Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.<br />
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7. Applying new techniques to an old ally: A qualitative validation study of the Edinburgh Postnatal Depression Scale <br />
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Godderis R - Women Birth - March, 2009; 22(1); 17-23 <br />
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8. Schaar 2011<br />
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9. Godderis 2009<br />
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10. Mothers With Positive or Negative Depression Screens Evaluate a Maternal Resource Guide <br />
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Pascoe JM - Journal of Pediatric Health Care - November/December 2010; 24(6); 378-384 <br />
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11.Screening for postpartum depression. Cole C - Journal for Nurse Practitioners - 01 January 2009; 5(6): 460-461 <br />
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12. Pascoe 2010<br />
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13. Screening for perinatal depression with limited psychiatric resources. Jevitt, C., Zapata, L., Harrington, M., and Berry, E. Journal of the American Psychiatric Nurses Association, Vol. 11, No. 6<br />
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14. Screening for Depression During and After Pregnancy. Committee on Obstretic Practice, American College of Obstetricians and Gynecologists, February 2010. Retrieved from http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/co453.pdf?dmc=1&ts=20121020T1538438353, 10/20/2012 <br />
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<br />Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-10076830242849540462012-05-03T05:03:00.001+01:002012-05-03T05:03:13.781+01:00Willow's UnrestI'm about ready to change the name of this blog: Willow's Unrest. Whatcha think? There's no rest for a birth activist/VBACtivist/lactivist/intactivist. There's no end to the stupidity, the lack of education, the lack of desire to <i>acquire</i> knowledge. I think that last is the worst. It's one thing to be ignorant. It's something altogether different to remain that way on purpose. You can lead a horse to water...<br />
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I know I've burbled on before about feeling burned out, <a href="http://jerwillow.blogspot.com/2010/12/just-about-to-that-point.html">ready to let it all go</a>. I've spilled miles of ink and tapped keys till I developed callouses about why people ought to care about birth-- theirs and all women's. This is nothing new. But I find I've kept it in until I can't contain it anymore-- hence this post. Forgive me, won't you?<br />
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I wrote this several years ago. It's not great, but I still feel this way, so let me get it off my chest-- then I'll get back to my rant. It originated in an offhand comment someone tossed out-- something about "so-and-so could care less about VBAC":<br />
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<span style="font-family: arial;"><i>I suppose I could care less. I could choose to accept the near-30% cesarean rate in the United States. That would mean accepting that wholly one-third of women in this country are unable to deliver the babies their bodies conceived and grew. That would mean buying the whole bill of goods-- doctors know best, birth is the business of surgeons-- read men, because even female OBs are conditioned to be metaphorically masculine in the operating room-- and women are just incidental to the process. Our wombs are dark, dangerous dungeons from which our babies must be cut free. Pregnancy and birth is a primitive, nasty, brutish affair that must be managed and controlled and interfered with every step of the way, from the time the stick comes up blue until the baby is released from its mother's imprisoning flesh.</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I could accept that my cesareans were necessary, lifesaving events that were responsible for giving me healthy, whole children. I could bless the quirk of fate that made my daughter stay footling breech, the neat serendipity that gave wrapped her cord around her neck three times and made external version impossible. Thanks to that, I had a cesarean! Hurray! I was a first-time mother, and I didn't have to bother with messy, unpredictable labor. Rather, the nice medpros in blue scrubs wheeled me into a cold operating room-- one of them punctured my spinal column and anesthestised me, another cut me open and gave me my perfect baby girl. Not only that, but in that one stroke, she guaranteed that I would never have to concern myself with birth again-- in future, I need only open my datebook and choose a day that seems best to me to have my precious babies hand-delivered.</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I didn't need to stress myself nearly to the breaking point, searching high and low for a care provider to see me through my second pregnancy. The year of hell I endured, of postpartum depression and PTSD, of being unable to bond with my son, were all entirely unnecessary. Why did I do that to myself? To him? I could have cared less about VBAC.</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I could spend my days at the hospital where I work complimenting the cesarean moms about the roundness of their children's heads (if they were all round, which they aren't) instead of poring over their charts and trying to figure out where it all went wrong. Why couldn't they deliver? Why were they cut? Why is "failure to progress" a valid diagnosis for a *scheduled* c-section?</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I could throw away the list I keep of VBACs and CBACs at my hospital. I could celebrate the surgeries instead-- Goddess knows the list would be far longer. I could stop agonising about this generation of surgically delivered children. I could accept that it's "just another way to be born" and believe that there are no far-reaching consequences of arriving via "vaginal bypass surgery."</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I could turn my back on the research that refutes the position of the OBs, whose concern lies mainly with their pocketbooks and their malpractice insurance rather than with the patients they purport to care for. I could accept that it's right and good for a new mother to be unable to breastfeed her infant because she's too drugged or in too much pain or her IV line won't reach far enough. I could accept that iatrogenic prematurity is nothing to be worried about, a few days in a NICU is a fine start to life. I could agree that not wanting to "stretch one's bottom" is an acceptable reason to choose major abdominal surgery.</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC. I could take the fading ICAN sticker off my van and stop slipping cards into my patients' education folders. I could insist that homebirth-- not to mention HBAC!-- is dangerous and wrong, and all women can and should simply report to the hospital at 38 weeks on the dot to have their babies removed. I could close my eyes and mind and heart to the pain in the stories I read. I could join the hordes who insist "only a healthy baby matters" and tell my scar-sisters to "get over it." I could ignore my own lingering hurt, pretend my babies and I weren't affected by their "births."</i></span></div>
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<span style="font-family: arial;"><i>I could care less about VBAC.</i></span></div>
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Other than the statistic-- the cesarean rate in the United States is now <a href="http://32.8%25/">32.8%</a>, according to the CDC-- I still feel the same as I did when I wrote that, 3 or 4 years ago. Little has changed; I'm a little further out from my surgical deliveries, but I'm no less outraged. I certainly don't want another one, should I ever be blessed with another pregnancy ! And yet I'm still expected to button my lip, keep it to myself, pretend that it's <i><a href="http://www.whole-woman.com/index.php/a-birth/72-healthy-baby-lie">only a healthy baby that matters</a>. </i>Say nothing that might offend. Or frighten. </div>
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Let me back up; I've wandered off into my rant without giving any context. Sorry about that. </div>
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I'm a nurse. I became a nurse in self-defense, after my CBAC in 2002. My experience was so horrific-- so degrading and inhumane, that I was determined never, ever to be at the mercy of medpros again. For my entire nursing career I have worked in one facility, a mid-sized urban hospital that I must decline to identify. I work primarily in mother-baby, though I sometimes go to NICU or labour & delivery. I spend the vast majority of my time caring for new mothers and infants. Education is such a huge part of my job that last year I became a Certified Childbirth Educator through <a href="http://www.cappa.net/">CAPPA</a>, and I'm one of my facility's instructors for the hospital-approved Prepared Childbirth Class. I teach 4-6 classes annually, to (usually) first-time parents, covering the typical "What to Expect from Your Hospital Delivery" curriculum. On the up side, I get to use the <a href="http://www.injoyvideos.com/product.php?proid=107&page=Understanding_Birth">InJoy Birth/Parenting Education videos</a>, which are well made and comprehensive-- the ones we use were filmed at the same hospital where I delivered my first child, and "my" midwife is featured, which always gives me pause for thought. On the down side, there's little room for, as Opus was wont to do, <i><a href="http://www.carolhurst.com/titles/goodnightopus.html">departing the text</a>. </i>I have 5 hours, total, over 2 weeks, to cover pregnancy, labor, birth, postpartum, and newborn information. I'm not allowed to teach breastfeeding at all-- I'm required to refer my couples to the hospital's Official Breastfeeding class. <a href="http://www.midwiferytoday.com/articles/cytotec.asp">Cytotec</a>? Can't go there. <a href="http://vbacfacts.com/quick-facts/">VBAC</a>? Can't cover it. <a href="http://www.circumcision.org/">Circumcision</a>? Nope. Other than to answer basic questions, I can't say anything "controversial." Nothing that might dissuade a mother from opting out of the culturally and medically sanctioned norm. I'm not technically allowed to provide resources-- the best I can do is say, "I strongly recommend that you look ____ up and educate yourself."</div>
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My opinion doesn't count for anything, as far as the hospital is concerned. Never mind evidence-based. Forget personal experience. Hell, don't even worry about patient advocacy-- which is, as a nurse, my highest concern! Just stick to the party line, and for Goddess's sake, <i>don't make waves!</i></div>
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Deep breath. Okay. I try to toe the line. I answer questions in a manner as vanilla as I can make it. I think I usually manage... or I <i>did</i>. I'm due to start a new class tomorrow night-- and today the nurse-manager of our labour & delivery unit informed me that I need to "be more aware" of what I'm saying. Apparently, she received a comment from a patient who took my class last December, who was (understandably!) upset because I allegedly said that "if you have a c-section, you might as well leave the hospital in a body bag." </div>
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First of all, I assured the manager-- as I am assuring you, now-- that I never, ever, <i>ever</i> said any such thing. I have never uttered the words "c-section" and "body bag" in any kind of proximity to one another. I've wracked my brain, and I can't figure out anything that might have given anyone such a notion. The manager replied that she didn't know where the patient had come up with the idea, maybe I said it, maybe I didn't, but just <i>be careful</i>. I reiterated that I would, and hung up the phone.</div>
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I do teach my classes that cesareans, while sometimes necessary and lifesaving, are not the optimal way to begin motherhood. I have, when asked, elaborated on potential consequences, both in the short term and in future pregnancies. I emphasize that most of the time vaginal birth is preferable, and it's well worth it to try to avoid surgical delivery. When couples ask me about my deliveries, I try to stick to the basics: I had a primary c-section for double-footling breech, a failed induction and repeat c-section, and then a homebirth VBAC. I don't tell my stories. I don't talk about the years of postpartum depression and PTSD. I have spoken of the wound complication I had after my CBAC, because a dad asked if anyone ever had incision problems. Yes, postpartum wound infections occur. I was lucky; I "only" developed a seroma and minor infection; I didn't have a <a href="http://www.livestrong.com/article/197342-cesarean-wound-complications/">full dehiscence</a> that required surgical treatment, debridement, packing and repacking for months, as <a href="http://www.sogc.com/jogc/abstracts/full/200608_CaseReport_1.pdf">some mothers</a> have. </div>
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Essentially, I'm forced to abide by a version of "Don't ask, don't tell." I'm not supposed to offer anything off menu, so to speak. But if asked, I'm not going to lie... and I'm not going to "pretty it up." I will never tell a client "I <i>loved</i> my c-sections!" But I certainly never have, and never will, tell an expectant mother that having a cesarean will kill her. **</div>
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True, my CBAC made me want to die. I can't pretend otherwise. I once sparked a flame war on a prominent pregnancy and birth support forum by stating that I would rather bury a child than endure a forced c-section. Was that overly shocking? Unquestionably, though in my defense I was mired in severe depression at the time, and words cannot describe the anger and bitterness that were my constant companions then. Did I truly feel that way? Yes, I did. Do I now? No... probably not. But if another woman, after a traumatic birth, chose to express herself that way... I would support her. </div>
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I wept because I would never intentionally frighten a pregnant woman. I would never set out to horrify or hurt another mother. But somehow... I did both. I'm angry and remorseful and frustrated. Why go on? Why, if all I do is cause distress? </div>
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Maybe I should just... care less. Stick to the text, never depart. Why, yes, inductions are <i>always</i> medically necessary! Of course epidurals are safe for you and your baby! Your doctor <i>always</i> has your best interest at heart-- he would never section you at 5 pm for "failure to progress," even though the <a href="http://womens-health.jwatch.org/cgi/content/full/2003/219/1">Friedman curve</a> is a myth and you labored nicely to 7 cm in 10 hours, just because he wants to go home and catch the newest <i>CSI</i> episode! Cesareans are <i>always</i> the safest option for "big babies!" No, c-section recovery is no big deal at all!</div>
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I guess we'll see how tomorrow night's class goes. I"ll be good; I won't scare anyone. I won't express any opinion that's even a millimeter out of lock-step with the hospital's standard operating procedure. Maybe I'll even feign ignorance if someone asks about potential complications.</div>
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No, I won't. I couldn't live with myself. I'm a nurse. I'm a mother. I'm a birth activist. There's no rest for the wicked, they say... I suppose I'm living proof.</div>
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** I would never say that... but I might recommend she read the details of the <a href="https://sitemanager.acsysinteractive.com/vSiteManager/Salinas/Public/Upload/Docs/ic_english.pdf">surgical consent form</a>. Unfortunately, <a href="http://www.sciencedaily.com/releases/2008/08/080804100256.htm">cesareans <i>have</i> killed mothers</a>. But no one wants to hear that-- and if I mention it, I'm the bad guy. Goddess help me, maybe it would be better for all concerned if I went back to my archaeological roots and found someplace that would just let me go dig in the dirt.</div>
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<br />Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com11tag:blogger.com,1999:blog-7743294862694613938.post-46436343308447724422012-01-08T23:05:00.000+00:002012-01-08T23:05:30.359+00:00Just an ExampleAs one of my New Year's projects, I've decided to try to informally track the deliveries at my hospital and watch the trends over 2012. This is not a rigorous scientific study, by any means; it's really little more than anecdotal. I plan to record our deliveries daily, and to make note of method of delivery, primary vs repeat cesarean, indication for surgery, etc. This will only include babies who are admitted to the well baby nursery, so there will be a good chunk of missing information right there; we do have a <a href="http://preemies.about.com/od/allaboutthenicu/qt/What-Is-A-Level-III-NICU.htm">Level IIIb NICU</a>, and it will be difficult to obtain delivery notes on those infants admitted directly to them on days I'm not actually here. So, as I say, this is just a sort of exercise-- in observation, data recording, and preliminary analysis.<br />
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I started recording delivery stats on December 19; I have 21 consecutive days of data, as of today. Just for giggles, so to speak, I decided to glance over them-- to see what I had. Here's my data:<br />
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n= total deliveries= 68<br />
v= vaginal deliveries= 39 (57.4% of total births)<br />
x= c-sections= 29 (42.6% of total births)<br />
r= repeat c/s= 11 (16.2% of c/s)<br />
p= primary c/s= 18 (26.4% of c/s)<br />
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The cesareans were done for a small number of predictable reasons. I broke the indications down into four categories:<br />
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1. "failures"-- labeled as such by the OBs, including "FTP (failure to progress)," "FTD (failure to descend)," "failed induction," and the ever-popular, vague, and widely inclusive "NRFHT (non-reassuring fetal heart tones)"<br />
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2. primary elective for breech-- no one here will do vaginal breech deliveries on purpose, so for all intents and purposes, these are physician-elected c/s<br />
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3. primary elective for maternal reasons-- there were three of these, including one mom who was <a href="http://en.wikipedia.org/wiki/Herpes_simplex_virus">HSV+</a> with a current outbreak, one mom who had a history of <a href="http://en.wikipedia.org/wiki/Spina_bifida">spina bifida</a> and attendant multiple back surgeries, and one mom who was urged to elect her c/s for that fabulously accurate diagnosis, "<a href="http://www.aafp.org/afp/2001/0115/p302.html">suspected macrosomia</a>"<br />
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4. other-- only because I wasn't sure where else to put it; I didn't have enough history in the report I got or on the chart; it was presented as a primary nonelective, nonemergent cesarean due to <a href="http://en.wikipedia.org/wiki/Oligohydramnios">oligohydramnios</a> and "placental issues, nonspecific"<br />
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The majority of the primary c-sections fell into the first category: 10/18, or 34.5%. There were 4 breech sections-- three scheduled, one discovered in labor (when mom was ready to push!)-- so 13.8% of the total. The other 4 were also scheduled, for the reasons listed above. That nonelective, nonemergent one resulted in a completely normal newborn with no signs of distress . That allegedly ginormous baby weighed a whopping 8 lbs 4 oz. Oh, and most of those NRFHT sections (ie, for fetal distress) produced babies with <a href="http://en.wikipedia.org/wiki/Apgar_score">APGAR</a> scores of 8/9 and 9/9. Sigh.<br />
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So, in the past three weeks (covering Christmas and New Year's), we had a cesarean rate of almost 43%-- well above the national average. I'll be curious to see if this trend continues. I've long suspected that our facility's c/s rate was that high, but I've never been able to demonstrate it. If I can keep this up, at least I'll be on my way to documenting outcomes for one mid-size hospital in Middle America. That's the plan, anyway.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com1tag:blogger.com,1999:blog-7743294862694613938.post-72815398111068714292011-12-24T03:28:00.000+00:002011-12-24T03:28:11.332+00:00A Bright Blessed Holiday to You All! Bright Yule, Blessed Alban Arthan, Happy Hanukkah, Merry Christmas... Love, light, and joy be yours!<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlAMewPaTPJM7Jbsj7vVbsTdo5WPXVxft1YPDYrmycmjNKU4o1qMaZxD9FIRpAgBX0oAUeFsEvULln6sOL-J2SJjc-vRKN7cI-x_BHbQ2teF8NFTUjnLJ2uveqS_uFC9d3adYFCEGPvnzF/s1600/ChildofPromise.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlAMewPaTPJM7Jbsj7vVbsTdo5WPXVxft1YPDYrmycmjNKU4o1qMaZxD9FIRpAgBX0oAUeFsEvULln6sOL-J2SJjc-vRKN7cI-x_BHbQ2teF8NFTUjnLJ2uveqS_uFC9d3adYFCEGPvnzF/s320/ChildofPromise.jpg" width="228" /></a></div>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-20364894862731367802011-09-09T04:02:00.004+01:002011-09-09T05:11:38.770+01:00Redemption<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"></span><br />
<div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">On the occasion of my sweet son's SIXTH (!!!) birthday, I wanted to post the story of his birth-- and mine. I warn you: it is LONG! Interestingly enough, since it's been 6 years, the dates correspond to this year's calendar. </span><br />
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<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">This is the story of the birth (yes, BIRTH!) of Rowan, my third child, the first baby to whom I gave birth. It's the story of my long-fought-for and dearly wanted VBAC, my UBA2C. In a way, it's my own birth story-- because I felt that I died on the operating table when my second baby was extracted from my body after a failed induction, but I was born as <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> emerged from my strong, resilient uterus.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I'm taking some of this straight from my journal-- I've long since succumbed to some mommy amnesia. Some of my labor and birth are already fuzzy... some parts, like the feel of<span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>'s head as he was crowning, I will <i>never</i> forget. <i><b>Never</b></i>.</span><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><u>Sunday, 4 September 2005</u></span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">My physical state is fine. No sign of impending labor. Let it be. [This Beatles song gave me my pregnancy and birth mantra.]</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Emotionally... sigh. Bored, discouraged, depressed. Wish it'd just get going so I could stop worrying about it. DON'T want to go back to work on Tuesday, but no choice if no labor-- I can't afford to lose paid time off hours. BLECK!!</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><u>Monday, 5 September 2005 -- Labor Day. Ha!</u></span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Physical: fine, a few more ctx [contractions], some fairly intense.</span><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Emotional: hate the world, wish everyone in it would bugger off and leave me alone! </span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><u>Tuesday, 6 Sept 2005</u></span><br />
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</u></span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">41 weeks, on the dot.</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">WHY AM I NOT IN LABOR???!?!?!</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Am I really broken?</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">No. Can't be. Surely not.</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">It'll happen. Won't it?</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Tami G. emailed me and said something profound: in a month, I'll be holding my baby. Hang onto that.</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">ICAN VBAC!!!!!!!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><u>Wednesday, 7 September 2005 ~5 pm</u></span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Stopped to get gas-- reached down to pop the gas tank door-- felt another distinct POP! Water broke-- gushing, but clear. Baby obviously not engaged. Got back in the car and drove home-- lots more fluid with each ctx. Niagara Falls effect stopped when I got home and got upright for awhile-- <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>'s head settled deeper in pelvis?</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Few light ctx, not regular. Trying to stay up, moving, etc, but leaking is a problem. Stood at computer and emailed ICAN, IM'd Lisa-Marie. Hard to concentrate.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">6:30 pm-- kneeling on bed, rocking hips-- feels good. Ctx still seem light.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">7 pm-- up and around a bit, lots of show. Loose stool. Light ctx every 2-3 minutes (trying to avoid the clock). Bored. Lying on side uncomfortable-- up to shower again.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">9 pm-- ctx spaced out. Not timing. Can only focus on one thing at once during ctx. RELAX. More gushing-- not like earlier, though. Sleep soon?</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">10 pm-- KIDS ARE DRIVING ME INSANE!!!!!!!!!!!!!!! Whining, fighting, carrying on-- wish I had someone to take them AWAY! Definite downside to DIY. Ctx more intense. More show. Going to sleep soon-- assuming kids will stay in bed! [NB: Rhiannon, my daughter, was 5 at this time; Gareth, my first son, whose story I posted on his birthday, was 3. They slept through everything.]</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">11 pm-- no sleep for me, can't lie down comfortably. Shower WONDERFUL!</span><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">_____</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">This is where my journal entries end-- I couldn't write anymore. The kids did stay in bed, and I sent their dad, John, to bed too. I told him to get some rest, and I'd call him when I needed him. I figured I had hours ahead of me, and he would need the sleep. Then, labor hit like a freight train!</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I had been in the shower for maybe ten minutes when I got out to tell him that I needed the pool NOW. And I promptly went and got into it!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">The pool was set up in my living room, and was about a quarter filled. John had started working on it as soon as I came home and informed him that my waters had released-- we never did get a hose or an attachment for the faucet, so he was filling it one bucket at a time. Luckily, we have a <i>wonderful</i> hot water heater-- it never failed me. And John, who was a trooper through the whole labor, boiled pot after pot of water (how stereotypical can you get?) to "hot up" my pool even more.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">When the pool was about 2/3 full of blissfully hot water, John set up camp in the living room. He dragged in the mattress from Gareth's (unused) toddler bed, covered it with sheets and a comforter, then got in and tried to go back to sleep, while I labored in the pool.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">It was about midnight-- I'd made John turn the clock away from me, because I didn't want to watch it all night. I knew I had a long slog ahead, and I didn't want to get discouraged. I'd seen that the contractions were coming roughly every 2 minutes, and I didn't want to know anymore.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">The contractions... I'm not sure what to say about them. In the shower, I handled them best by letting the water spray on my back, down low (where I kept my fists jammed most of the night, the result being that my shoulders were killing me the next day) while I rocked my hips back and forth. I was chanting the Goddess Chant through each surge-- two versions, mine and </span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Starhawk's. Sometimes I got them mixed up, but I doubt the Bright Lady cared!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Starhawk: <i>Isis Astarte Diane Hecate Demeter Kali Inanna</i></span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Mine: <i>Isis Athena Rhiannon Cerridwen Brighid Anath Arianrho</i>d</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Soon it changed to "Open" over and over, longer and more drawn out with each surge: "Oooooooopennnn. </span><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Oooooooooooooppppppennnnnnn." Four or five of those got me through a contraction.</span><br />
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</span></div><div></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFtT6F_plddsSENCtFXRnHyEiXVEmjXJ_g3Rjg_khKv67NJ65L0vk5awNJjjqaZxA07J3o4Ptw9CvjbJMLrdmlD3_xfPkpL4OoToqJU6FRu0XVXye6P6MxmCZSxnWFVmD79SYs6nClHchP/s1600/Jer+really+in+labor%2521+crop.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFtT6F_plddsSENCtFXRnHyEiXVEmjXJ_g3Rjg_khKv67NJ65L0vk5awNJjjqaZxA07J3o4Ptw9CvjbJMLrdmlD3_xfPkpL4OoToqJU6FRu0XVXye6P6MxmCZSxnWFVmD79SYs6nClHchP/s1600/Jer+really+in+labor%2521+crop.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">In the pool, early on, I spent time on my knees, still rocking my pelvis. When a contraction came, I had to submerge-- get under it, literally. I went to my hands and knees, then into a push-up position. I hung onto the side of the pool, chanting "open" again and again-- my old trick of counting through each contraction, which I used throughout my labor with Gareth during that idiotic seventeen-hour induction, failed me this time. Nor was I able to escape the sensations and go elsewhere, the way I had last time. This was much faster, much more intense. </span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I found I was better able to handle the contraction on my feet, so I stood up much of the time, knee-deep in warm water, fists thrust into the hollow of my back, toning. "Open" was now just "Ohhhhhh... ohhhhhhh" low and loud-- I couldn't control it, though I didn't want to wake John up. I stood there in the semi-darkness-- the living room lights were out, but the bathroom light shone through-- singing my birth song and trying to work with, rather than against, the expansions of my uterus.</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Does anyone remember the study that said that even a "virtual doula" helps a woman get through labor-- that someone in her head, an imaginary doula to encourage her, is beneficial? Well, I can say that for me, at least, it was true. The real-life doula I had during my attempt at hospital VBAC was kind but ineffectual. The one in my head this time-- Kmom!-- was brilliant! She said everything I needed to hear: you're doing great. Keep breathing. don't forget to pee. You're doing this, you really are!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">And so I labored. As before, I had no concept of time. John tells me it was about 1 am when my vocalizing changed and he woke up fully (he'd only been dozing anyway). About 1:30 he remarked casually, "They're less than a minute apart now. You ARE progressing. They're lasting about 20 seconds."</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Twenty seconds--?? I was crushed. I kept thinking, "longer, stronger, closer together." If these were only 20 seconds-- !!!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"I don't want to know that," I groaned. "Don't tell me that."</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">After a few minutes, Kmom told me to go to the bathroom again, so I did. I emptied my bladder-- John had placed a large mug of water and a huge plastic cup of crushed ice on a milk crate beside the pool, and I had been drinking and crunching plenty-- then got back into the shower. It wasn't as comforting as it had been, so I went back to my pool and asked John to add some more water. He tried to hold me, offering to do a supported squat, but I couldn't bear to be touched during a contraction. So he bailed some water out of the pool and replaced it with hot.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">He was so supportive, even though he felt he didn't do enough, that he was "too hands-off." But that's exactly what I needed. He held the space and he kept my water hot. He sat quietly and watched me, but didn't interfere; he helped me focus when I really needed it. He was perfect, and for that, I will always be grateful.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">A small piece of my mind wondered where I was, dilation-wise. I didn't want to psych myself into thinking it would be done soon, even though it felt VERY fast and intense to me. I was trying to prepare myself, physically and mentally, for another whole day of this-- longer, if necessary! Think of Eugenie, I told myself-- Eugenie, brave woman, who labored for 80-plus hours to birth her son. Yes, I argued with myself, but think...</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">There were clues, and I couldn't help but notice them: the way I was toning through contractions, the lowing, birthsong quality to them. Shorter, more intense contractions could mean I was in or near transition. I was starting to feel nauseated at the end of each surge. I never did throw up, but I told John repeatedly that I felt I might. I started dozing or "zoning out" between contractions, drifting into a strange, incoherent laborland. I could only endure contractions by standing and rocking my hips, then getting underwater and floating once I'd passed the peak.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I realized I was feeling very foggy. Random thoughts crossed my mind-- bizarre, dreamlike notions that seemed to make sense at the time, even though a part of me knew they didn't. The only one I remember was odd-- and please, don't anyone take this as offensive, it's just what wandered through my head: "I wonder why it is that white women named Irene often shorten their name to Reni, while non-white women just use 'Irene'?" [I have no idea if this is true, but I doubt it. Weird labor thoughts!] "And why is it 'Ear-ray-na" in England, but 'Eye-reen' here?" Transition, anyone? ;)</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Then, abruptly, the fog lifted. Suddenly I was thinking clearly again-- the world came back into focus. And to my astonishment and chagrin, I realized that I was pushing at the end of each contraction!</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">This can't be right, I thought wildly. Something's wrong-- it's too soon--</span></div><div><br />
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</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">But it didn't feel wrong; it felt right. Not good, but RIGHT. So I pushed.</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I remember thinking, I want this over! I want it over and done. How much can a person be expected to take? This is silly! I did not have to do this!</span><br />
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</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I don't think I said any of this aloud (and Kmom chastised me, albeit gently, in my head!). I know I did whine, "I can't do this!" once or twice, and John came and looked me straight in the eyes, saying, "Yes, you can, you are, you're doing great." I reminded myself that I'd known what I was getting into, I'd made my choices and I had to accept them, and whinging about it wasn't going to help anything. I may as well be there, since I had to be-- it was like that old kids' game, "Going on a Bear Hunt" : "Can't go over it. Can't go under it. Have to go THROUGH it." At times I hated it-- my friend Gretchen is right, pushing SUCKS-- but I kept going through.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">The urge to push was subtle. It wasn't "I GOTTA PUSH," the way it was when I was laboring with Gareth. It was like something had taken over my body and was pushing whether I liked it or not! I began to roar with each push, getting louder and stronger.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"You're progressing," John said with satisfaction.</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"I think I'm pushing," I told him.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Don't wear yourself out. Take it easy."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Easy to say, but the effort was impossible to resist. I was worried-- it still seemed too early (as far as I can make out, it was only about 2 am) to be pushing. I hadn't been laboring long enough. I was afraid that I was only 5 cm with a badly malpositioned baby, that I was making it worse with every surge, swelling my cervix and sealing my doom. I didn't know what to do, and I said so. Then, in a fit of desperation and doubt, I asked John to check me-- the first vaginal exam I'd had since I was 9 weeks along and worried about a possible miscarriage.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">He went and scrubbed up-- offered to use bleach (!!!) but I convinced him that soap and water was sufficient, as long as he scrubbed for at least 20 seconds. (I think he did 2 solid minutes. ;) He came back, and we waited through another contraction. Then I tried to lay back and let him fumble around for a moment or two, as long as I could endure. He reported, "No, nothing."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I wanted to cry. In fact, I think I did cry, a little it. How much more could I bear? What should I do?</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Another surge, like a terrier shaking a rat. Lots of show, some gushing fluid, intense pressure in my rectum. Something was moving through me-- there was no escaping it. "It feels like it's <i>right</i> there," I kept saying. "It" was hard to describe, but it felt foreign-- not me. It seemed to move opposite to me-- if I swung my hips left, it rotated right, or else I rotated around it while it stayed still. It didn't hurt, but it was very, very uncomfortable. There was no getting away from it. It was... inexorable.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I pushed and roared and pushed, giving up my brain's worries to let my body, my primitive self, take over. "I surrender," I told the Universe. "Whatever happens..."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">It went on, and on, and on. I had no clue what time it was, or how long I'd been there. I pushed standing up in my pool until my knees shook and threatened to buckle, then I went back to kneeling. I tried to push while lying on my side-- first right, then left-- but while floating on my side and back between contractions felt good, pushing in those position did NOT!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Standing was best-- kneeling was tolerable, but only just. Sitting, lying, even floating in the push-up pose I'd used earlier-- these were all completely untenable.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Bathroom," Kmom commanded in my head, and I managed to drag myself out. I sat on the toilet and pushed there through a few surges-- that felt pretty good, but not as effective as I'd hoped, so I went back to the pool. Surge-- push-- howl like a wolf. Repeat.</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">After awhile, John, who was getting more excited and nervous, asked me, "Should I check you again?"</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"If you want..."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">More groping, then, "It feels like it's getting harder."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"The head?"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"I don't know... but I can tell you, you're <i>really</i> open."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Push. Roar! Breathe. Again. And again. Have I ever worked so hard in my life?</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Push. Push with all my might-- I was worried that I was doing the "purple pushing" encouraged in hospitals. Shouldn't I be trying to breathe the baby out instead?</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Screw it! I thought grimly. I don't care if I tear six ways from Sunday. I want this kid OUT!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Push. ROAR! Breathe.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Over and over, more than body and soul can bear. I can't do it. I can't. Not anymore. I can't.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Yes, you can," John insisted. "You've come this far. You're not giving up now. You've told me a hundred thousand times you can do it, and I believe you. You CAN."</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I reached down, trying to see if I could feel-- something, anything. "If it helps," John was saying, "your belly [meaning the bump that was <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>] is lower." With my last push, I had felt a stinging sensation, and the phrase "ring of fire" had danced through my mind, but I had quickly dismissed it. Still-- maybe my perineum was at least bulging a bit--</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">And there "it" was, just under my fingers, barely inside me: a squishy soft mound, damp and warm. I froze. O my dear good Goddess--</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"There's a head there," I said, shocked.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">John lit up. "Yay! You're almost there!"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Another push-- the head slipped back, but only a little, and there was a definite burn now. I didn't care-- it wasn't bad, and anyway, there was a head there! Set me on fire, I don't mind, I'm <b><i>BIRTHING!</i></b></span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">The surge ended. "Want to feel?" I asked John, and he reached into the water-- I must have been kneeling at this point. I can't describe the expression on his face. "Yeah," he whispered. "Yeah..."</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">PUSH! I bore down hard, remembering the old saw, "Giving birth is like passing a watermelon through a hole the size of a lemon." I pressed my fingers hard into the skin around my vagina, trying to stretch the tissues. That one stung-- but in the next moment, I had a small (!) firm head in my hand! John was holding it too-- <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan </span>was out to his ears, maybe, and I was screaming. It HURT-- the only part of the whole labor I could truthfully call, well, excruciating.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"What now?" John wanted to know. He was stunned.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Wait," I gasped, "for the next contraction..."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Come on..."</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">It felt like forever. I tried to push without the contraction, but the baby didn't budge. For the first time all night I was praying-- pleading-- BEGGING for another contraction!</span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Finally it came-- and I PUSHED--</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">The head came out; the shoulders and body quickly followed. (So much for my fears about shoulder dystocia!) Before my brain could register was had happened, I was holding a slippery new baby in my arms!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I sat back-- the pool, which up till now had stayed remarkably clear, was now murky with fluid, blood, mucus, and fecal material-- but mine; there was no meconium. I didn't care what I was sitting in. I had done it! I BIRTHED MY BABY!!!!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><b><i>I VBAC'd!!!!!!!!!!!!!!!!!!!!!!!!<wbr></wbr>!!!!!!!</i></b></span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><b><i><br />
</i></b></span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Hello," I crooned to my new little bug. "Oh, hello!"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">He was perfect-- well, I didn't know he was a "he" yet-- snuggled up to my shoulder. He was dusky, but his face and chest were pink. He hadn't made a sound. I rubbed him, talked to him-- he opened his eyes and looked at me, but he still didn't make a peep.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCheQ-Ow-acEWexu6ytgxz6HVbvf_EvBomSdg7wOncPYA1qlPmpZYaeajMvtF6qeET_P8vP4Q3LYf3j6Y5rzlHnkghhcfFmapdb5-pkHPzqesHgAE_XchTzTt3yj9JyJfQ0IHIq5Ft2gJC/s1600/Rowan%2527s+birth+crop.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCheQ-Ow-acEWexu6ytgxz6HVbvf_EvBomSdg7wOncPYA1qlPmpZYaeajMvtF6qeET_P8vP4Q3LYf3j6Y5rzlHnkghhcfFmapdb5-pkHPzqesHgAE_XchTzTt3yj9JyJfQ0IHIq5Ft2gJC/s1600/Rowan%2527s+birth+crop.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Hi, sweetie," I said. "Oh, you're so beautiful. Look at you-- oh, hello, <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>!" </span></div><div><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">He finally whimpered a little when I gave into John's increasingly anxious requests and turned him over to check the sex. I laughed in surprise: "Oh my God, it's <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan </span>Riley!"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> would have been <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> whether he was a boy or a girl, but with different middle names depending on gender. We had been expecting a girl all along, but <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> fooled us. We laughed and <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> finally cried, and I held him close while John got a towel to cover us.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I couldn't stop thinking, I did it! I DID it!! <i>I DID IT!!!!!</i></span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><i><br />
</i></span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"What time...?" I managed.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"Congratulations!!!" John shouted. "You did it-- 4:33 am!"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">4:33 am?? That's ALL??! I was in complete shock-- my water broke at 5 pm, I'd only really labored since 11 pm. Five and half hours, and most of it pushing...? Early in the evening I had joked, "Wouldn't it be great if the kids could wake up and find their new sibling? And I could call my mom and tell her to stop by on her way to work?" I never thought it would happen...</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">John helped me out of the pool and we headed for the bedroom, marveling over our new baby boy. I found a tape measure and tried to get some stats-- I came up with 14 1/2" head circumference (molded) and 21 1/2" body length, but <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> wasn't very cooperative, so they were largely gross estimates. He seemed smaller than his siblings-- smaller than Gareth, certainly, who had been 10 lbs 5 oz; maybe littler than Rhiannon, who'd weighed a pound less. But who cared? I had birthed him!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I put him to the breast, and he latched on and nursed for quite some time-- twenty, thirty minutes? Can't recall. I was still have irregular, intense contractions, and around 5:15, they started gearing back up, getting stronger and closer together. I told John to get the big plastic bowl I'd bought, and I got up to deliver the placenta. Push-- but only a small, palm-size piece came out. A clot? No, definitely part of the placenta. It was followed by another, larger chunk, and in a few minutes, the largest piece-- but still only a quarter to a third of the whole. This one included the cord, which was perfectly, beautifully attached, just as it should have been-- a proper, three-vessel cord with textbook insertion.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I knew that a placenta that delivers in pieces is a bad thing, and if I had been thinking straighter I would have called for transport then. But I was high on my birth, I was exhausted, and I just wanted it to be over so I could bask in the afterglow and snuggle with my little guy. In retrospect, of course, it was a bad call.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">John went and called my mom and said, as I'd instructed, "Stop by the house on your way to work-- there's someone you'll want to meet." Then he came back and took the baby, and I got up and took a shower! Such a small thing, but when one's previous "birth" experiences entailed major surgery and a long period of convalescence, the ability to step into one's own shower, unassisted, is nothing short of a miracle-- and underscores yet again (as if I needed reminding!) the vast difference between a vaginal birth and cesarean surgery. The latter is most definitely NOT "just another way to have a baby"!!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">At 6:30 we woke the kids up to get ready for school. John told Rhiannon, "Come in here and see-- baby <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> came." Rhi tore into my room, saw <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>, and stopped short, staring in awe. Then she cooed, "Oh, he's soooo cute!" Gareth came just after, amazed to find that "the baby came out of Mama's tummy!" They were just precious, both of them.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">My mom and sister arrived at 7:15 with a baker's dozen of Krispy Kreme doughnuts. They stayed with me and admired the baby while John took Rhi to school. My sister was especially amazed-- she had fully expected me to have to be taken to the hospital in a flight-for-life helicopter for emergency surgery. She'd had nightmares that <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> and I would die-- the main reason I hadn't told her or my mom that I'd been in labor.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">"I can't believe it," my sister kept saying. "You look great. I remember after Gareth was born-- even after Rhi. You looked so sick-- grey and little and sick. Now you're just... glowing!"</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">If pride and excitement were visible, I'd be lighting up the entire city. I've never felt so alive, so empowered, in my life. I could move mountains!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">My mom went on to work, and my sister took Gareth. John and I rested, then got up and took <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> to our pediatrician, when he was 6 hours old. The office staff was aghast and amazed when we told them about our unassisted homebirth. But the doctor pronounced <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> "perfect!" and gave us the official stats: 21 1/2" long, 14 1/2" head, 10 lbs 8 oz!!!! Bigger-- just a little, but he had had a wet and dirty diaper since his birth-- than Gareth!!!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">I was stunned-- I'd really thought <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> was smaller, since I didn't get as big as I had with his brother, and he just seemed little. I'll admit I was slightly disappointed, thinking, Well, maybe I couldn't deliver a ten-pounder, but at least I can deliver an eight-pounder.... But the scale confirmed it: TEN-POINT-FIVE POUNDS, definitely a "big baby" by modern medical standards. That ten-pound stigma had caused my medwife to dump me last time-- she was terrified of Gareth's size. But I birthed the same size baby on my own with no problems-- no sticky shoulders, not a tear, not a skidmark, nothing! HA!!!!!!!!!! Take <i>THAT</i>, sOBs and Evil Medwives of the world!!!</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">Birth happens. I know it does. It happened right there in a blow-up pool in my living room. Birth happens as God/dess intended, without drugs or knives or sterile fields. Birth happens.</span><br />
<span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div></div><div><span class="Apple-style-span" style="background-color: #eeeeee; font-family: Arial, Helvetica, sans-serif;">It wasn't perfect-- I still had the retained placenta to deal with. (I'll write a separate epilogue for that-- I've gone on long enough!) But in the end, it was all so beautifully simple. I went into labor. I dilated to complete, without anyone having to reach gloved fingers into my body to verify it. When it was time to push, my body did what it was supposed to (although I'm a little bitter that I didn't get my "rest and be thankful" moment!). I acted instinctively to assume the positions that were best to facilitate <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span>'s descent. I supported my own perineum, and I did not tear. <span class="il" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial;">Rowan</span> was born-- and so was I.</span><br />
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</span></div>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com3tag:blogger.com,1999:blog-7743294862694613938.post-64098774157985000842011-08-30T12:27:00.002+01:002011-08-30T12:31:54.069+01:00Capitalizing on Loss and RiskMy dear friend Shannon at BirthAction wrote this post that everyone should read. Go on, read it. I'll wait.<br />
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<a href="http://birthaction.org/2011/08/28/capitalizing-on-loss-and-risk/#.TlzI0v-ovo8.blogger">Capitalizing on Loss and Risk</a><br />
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It brings up so many good points... the main one being that, for women birthing in hospitals, the playing field is never level. True informed consent does not exist in our current system; without it, women "choose" interventions and procedures that damage them and their babies-- and sometimes kill. How can we increase awareness? How can we make women understand that they have choices? That labor starts and progresses without dangerous drugs-- that babies can be born without drips and wires and gleaming metal instruments? How can we convince women that they are strong and capable, and they do not have to lie down for the knife? Most of all, that birth is safe... interference is risky?Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-57136721576543430892011-07-20T03:49:00.006+01:002011-09-09T05:13:58.045+01:00Benoni<div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><i>"And it came to pass, when she was in hard labor, that the midwife said unto her, Fear not, thou shalt have this son also. And it came to pass, as her soul was in departing (for she died), that she called his name Benoni: but his father called him Benjamin."-- Genesis 35:17-18</i></div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I have three children, but in my mind, I've only given birth once. While I'm forever grateful for that birth, I still haven't come to terms with the delivery that preceded it. Today is the ninth anniversary of an ill-advised induction and rather sad VBAC attempt-- I look back with some bitterness and much pity on that woman, who thought she was prepared and so clearly wasn't. Gareth, my first son, will be nine tomorrow, and I will celebrate him, all the wonderful things he's brought to my life. Today is my griefday, the day I try to find some peace for myself.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">Like every attempted VBAC, this story begins with a cesarean. In 1999 my dd arrived via a prudent, respectful, and not altogether horrible (though not conclusively necessary) c/s in Boulder, Colorado. She was a double footling breech with a triple nuchal cord-- I'm not convinced she was unbirthable, but in my ignorance and lack of initiative, I opted for a planned surgical delivery. My midwives and OB were very supportive; their assumption was that I would VBAC next time. The recovery wasn't bad, and I was comforted by the fact that she chose her own birthday-- I went into spontaneous labor with a dramatic water-breaking event worthy of a sitcom-- but I never once considered having a repeat section. My daughter's delivery was fairly atraumatic, but it wasn't, in my opinion, the way babies ought to come into the world. I began researching VBAC as soon as I got home from the hospital.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I might've been all right if I had stayed in Boulder, but by the time I found myself pregnant again, I was in Los Angeles-- definitely <i>not</i> a positive move in terms of birth options. The clinic that confirmed my pregnancy for me asked if I wanted a referral to an OB "for prenatal care or for termination?" Every OB practice I called wanted to schedule a repeat section without even taking a history. I got plenty of gasps and horror stories when I asked about VBAC: "Oh, no, we don't do that anymore! I have a friend who's a nurse, and her sister wanted a VBAC, and she went to 36 1/2 weeks without going into labor and when she did her uterus split open and she DIED and so did her baby..." It was hideous. Fortunately, I had found ICAN by then, and I knew a dead baby card when I heard one. I hired and fired two OBs, an APN, and two midwives, driving up and down the Los Angeles freeways-- Ventura to San Diego County, Simi Valley to Riverside. I got more and more frustrated; my marriage, which wasn't what one could call rock-solid to begin with, became more and more strained. Finally, at 30 weeks, I found a "famous" Hollywood birth center that would take me on and allow me to have a VBAC out of hospital. The midwife I met with, Elizabeth, was a little older than me and about 24 weeks into her own pregnancy. She was just what I was looking for: passionate about birth, excited about VBAC, supportive of me and my dreams for this birth. I only had 10 weeks (plus or minus-- dd came at 39 weeks, but I was prepared to go 42 or more), but I felt I had finally found a caregiver I could work with.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">That may have turned out to be true-- I have no way to know. Three weeks later, Elizabeth broke her foot and went on medical/maternity leave. My care fell to the founder of the birth center, Nancy-- midwife to the stars, self-proclaimed pioneer of waterbirth. From my first meeting with her, I knew the game had changed-- she was much more medicalized than her colleague, much less enthusiastic about my chances of a successful VBAC. I kept going to her center, though, because I had no one else to turn to. As far as I knew, Nancy was my very last chance. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I hired a doula around the same time. She was finishing her certification; she needed two more births, and she gave me a great deal, financially speaking. Unfortunately, I found that I got what I paid for: Michelle was sweet, but inexperienced; she was no more prepared to deal with single-minded medpros than I was. When push came to shove (literally), she did not have it in her to support a VBAC in the face of resistance from hospital staff.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">From our first meeting, Nancy was worrying about my baby's size. She commented on my two-year-old daughter's "chipmunk cheeks" and wondered if "she was always a Sumo baby." At her mandatory childbirth prep class she told fearmongering stories about "giant babies" and bad outcomes-- shoulder dystocias, nerve damage, a death. If I'd been in my right mind, I would've run like hell-- but I couldn't do it. Instead I swallowed it all and did what she told me, slashing my carbs, trying to stick to her recommended (and quite restrictive) diet so I wouldn't grow too big a baby. I kept a detailed food journal; my net gain for the pregnancy was 11 lbs. She accused me of lying, of not writing down every morsel I ate, of bingeing on ice cream and popcorn. She kept harping on how big this baby was going to be, "at least 10 lbs, you better hope you go into labor sooner than later!" She wanted me to have an ultrasound to get an estimate of size; I refused, knowing how inaccurate late-term scans tend to be. I concentrated on trying to go into labor, as she suggested: I ate the hottest, most cilantro-filled Mexican food I could find, I walked around the Burbank IKEA until I thought my feet would fall off, I bought the homeopathics she recommended and dutifully swallowed them every 2-3 hours, around the clock. I prodromaled from 37 weeks on, but I did not go into labor. I was losing all hope for my birth.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">At 40 weeks on the dot I went to see Nancy. She checked my cervix, pronounced me "soft, squishy, almost completely effaced, maybe a fingertip dilated." Then, before I could get off the table, she brought in a sonographer and subjected me to an ultrasound I did not want and to which I had not consented. The results were predictable: "This baby is already 10 lbs. If you don't go into labor by 40 weeks, 6 days, I'm done-- I have to risk you out. I have no choice-- I can do a VBAC or I can do a big baby, but not both."</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">She informed me that she was scheduling an induction at California Hospital, a charity facility in downtown LA where she had privileges, and I <i>would</i> show up. If I went into labor before then, great. But she expected that I would end up with another cesarean. "If I'd known how big your daughter was [9 lbs 5 oz, 22 1/2"], I would never have taken you on."</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I begged for an extension. It was July 12; 41 weeks would be July 19. I was moving to Arkansas July 29, driving across the country-- I told her I could not deal with a c-section.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"What you can't deal with," she answered coldly, "is a dead baby."</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I went sobbing to my doula and to the wisewomen of the ICAN list. Michelle had no suggestions, beyond offering tools and tricks to deal with the induction. My ICAN friends were succinct: Get. Out. Don't go. Have a sick child, a lost cat, a flat tire. DON'T AGREE TO THE INDUCTION. Sensible advice... but I didn't listen. I asked Michelle what would happen if I waited to go into labor and showed up at another hospital-- she conceded that it was an option, but she could not in good conscience go with me, for fear of being charged with practicing medicine without a licence. I continued to prodromal, but I couldn't go into labor. I wrote a heartfelt eviction letter to my baby, pleading with him/her to come out. My sister took my daughter for a day so her father and I could engage in awkward, joyless intercourse, just for the prostaglandins. I kept taking those tiny white pills; I gulped down an entire bottle of castor oil in root beer. Nothing. And then it was Thursday night, and dh was on the phone with Michelle, arranging a time and place to meet.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">At 5 am we met Michelle in the parking deck. The first thing Michelle did was apologize for not having a birth ball-- "I don't think there will be room"-- or a CD player-- "My toddler broke it." We walked into the hospital and were escorted to L&D by a security guard. Nancy arrived at 6:30, half an hour later than she'd planned. She barely looked at me as she rushed us into a small, shabby room. She handed me a faded hospital gown and pointed me to the bathroom. "Let's get this show on the road."</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">She had promised me I could wear my own clothes. She had assured me that I would have mobility, autonomy. "You just need a whiff of pitocin and you'll just spit that baby out." Instead, she shoved the gown into my hands and told me "get a move on." I took off my red maternity shirt-- blood-bright, it sang birthing power to me-- and pulled the thin, scratchy gown on instead. In that moment I gave away the last of my power, my self-determination. I buckled, caved. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I climbed awkwardly onto the bed, met the offgoing nurse, Catalina, who had had two VBA2Cs and saw no reason why I shouldn't succeed too, and then the day nurse (Julie? Jeannie?), who had had a waterbirth with Nancy at her birth center a year before. I got an IV, external monitor and tocometer, blood pressure cuff. They started the pit at 7 am sharp... and Nancy disappeared. I only saw her once more-- rather, I heard her-- hours later.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">Labor hit hard; my concept of time disappeared. From time to time people came in-- a resident, I think, did a vag exam and said I was closed, thick, posterior. Nancy had lied; my cervix was not ready. I'd been told I could get off the monitors and go to the bathroom; when I tried, I was informed that was not possible and handed a bedpan. I could not void; the indignity and awkwardness made it impossible. I requested a Foley catheter, adding another tether to the bed. They kept increasing the pitocin, and soon added a pulse ox monitor to my lines. I think I was only about 2 cm when they broke my water, insisting that it was necessary in order to place an internal monitor, since the EFM wasn't picking up well. The ham-handed resident did it, and got the internal fetal probe hung in my cervix. That must have <i>really</i> messed up the fetal heartrate tracing, because two or three nurses came running in and huddled around the machine. The resident was called back, and fixed the problem by screwing a new electrode into my baby's scalp.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">The day wore on. I tailor-sat on the end of the bed and counted myself through contractions. Michelle and my husband hovered in the background, uncertain what to do. I didn't want to be touched, effleuraged, or even talked to. I pretty much ignored everything that went on around me-- until I heard Nancy in my ear, telling me it was 5 pm, I was about 5 cm, and she wasn't going to be able to make it to this birth, "but good luck." Then she had the nurse put me on my left side-- a move I resisted. I didn't want to lie down. I wasn't given an option.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">At 7 pm Catalina came back. She brought a doctor with her, a man with a thick accent and an unpronounceable name embroidered on his lab coat, above the words "Reproductive Endocrinologist." He was on call for the evening, and wanted to know a) why I didn't have an epidural and b) why I was still being permitted to labor. Catalina gave him report and told him I'd been progressing slowly but without difficulty. He recommended an immediate c/s. She told him no, I was working for a VBAC. He wanted to know, "Is her pelvis adequate?" At that point I sat up and yelled, "It most certainly is!"</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">As far as I can recall, he never spoke directly to me. He told Catalina, my husband, and Michelle that I was still only 5-6 cm, and he would give me 2 hours to make significant progress. Also, he insisted that I accept an epidural immediately, or he would roll me to the OR and deliver me at once. Then he swept out. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I was crushed. I had achieved a sort of "groove" with my labor, and even though the pitocin contractions were hard, unremitting, relentless-- I was coping. As soon as that doctor walked in, the atmosphere was poisoned, ruined. Michelle encouraged me to go ahead and get the epidural-- "Maybe it'll help you relax and dilate." So I agreed, and the next thing I knew, an officious and unsmiling CRNA (certified registered nurse anesthetist) arrived. She cleared the room, forcing my panicked spouse and doula to leave. She was as compassionate as an iceberg as she drove that trocar into my back three times-- three attempts to place the epidural, three misses. I'd had enough; I told her the third attempt had worked, although I still had full sensation down my right side. She taped down the catheter and left at last, allowing my support team to return. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">The RE came back around 9 pm. I was "maybe 6-7," but it was progress, and he let me continue. I labored through transition-- I left reality behind at that point; I vaguely recall reciting a cake recipe. Then, suddenly, the fog lifted-- the world came back into hard focus. Catalina checked and pronounced me complete. I'd done it, I'd labored to 10 cm. It was about 11 pm.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I started pushing immediately-- coached pushing, on my side, which was uncomfortable and felt unproductive to me. But I kept going, pushing with all strength, while a tech came in and set up the delivery table. Row after row of shiny instruments, green surgical towels, a bucket-- Was this really going to happen?</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I kept pushing. "I can see hair!" my husband crowed. Catalina was supportive; Michelle was excited. I started to think-- maybe--</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">After an hour or so I was still trying to birth my baby. Catalina was watching the monitor intently. She grabbed an oxygen mask and slapped it on me, telling me to "breathe for the baby." She reached up inside me, stimulating the baby's scalp as the strip showed a significant decel. "Push now," she told me, as if I hadn't been straining for what felt like forever.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">Suddenly she was screaming out into the hallway, and in a few seconds the room was buzzing with activity. The doctor appeared and studied the strip. "You must push now. This baby needs to come out." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">Catalina and another nurse got me up into that wonderful frog position, and I pushed with everything I had. They could see a silver dollar's worth of scalp, but it didn't descend. The doctor called for a crash section. Michelle leaned in and whispered, "It's time to do what the doctor says." Then the bed was rolling, I was moving down the hall, into bright lights and noise, into a cold white OR. The nurses helped me scoot over to the operating table. The doctor leaned over me. "Your baby's heart rate dropped for several minutes," he said. "It has recovered now, and there is no distress. But I cannot let you push again. We need to do a c-section now." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I was crying now as the staff fell into the practiced choreography of surgical prep. "Will you use the same scar?" I asked the RE. "I want you to use the same scar." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"Of course I will, no one will be able to see it," he said reassuringly. He thought I meant my external scar.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"No, on my uterus... I want a low transverse scar, the same as before..." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">He muttered something and turned away. The CRNA came to dose the epidural, and I realized I could feel what they were doing as they washed and draped my belly. "I want general," I blurted, and she glowered at me. "Please!"</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"I'm going to give you a bolus. You'll be fine."</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"But-- I can-- " I couldn't get the words out. I was suddenly terrified that not only was I going to end up having a cesarean, but I would <i>feel </i>it. I'd read some fellow ICANers stories of surgical awareness, and I was choked with fear, tears running down my face. "<i>Please!"</i></div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><i><br />
</i></div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">She snorted in disgust and said scornfully to the RE, "She's demanding general." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">"Dose the epidural." And he kept on with his prep. I could feel pressure on my belly-- I didn't know what they were doing--</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">Then I heard, "Oh, shit." The CRNA held up the epidural catheter, which had apparently fallen out when they transferred me to the table. The RE said, "Put her out." A black mask came down, and everything went dark. The last thought in my head was, Oh, good, I can go now. The baby will be fine, his dad can take care of him. I honestly expected-- and wanted-- to die.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I woke up as they were wheeling me into recovery. I could hear voices, but they all seemed to be coming from the end of a long tunnel. I saw my husband in scrubs, holding a small blanket-wrapped bundle; someone said, "You had a boy." I thought groggily, Someone had a boy... that's nice... I felt something hot run down my inner thigh; I mumbled, "There's more amniotic fluid." Michelle appeared and said soothingly, "That's not amniotic fluid now, sweetie. That's blood." </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I'm told I breastfed my new son in recovery, but I don't remember it. He was big, indeed-- 10 lbs, 5 oz. I have no memory of him in the hospital at all, though I know he was there, that I held him and nursed him. We only put him in the crib when I pushed it out into the hall and forced myself to walk in the corridors. My first clear recollection of Gareth Benjamin is when I was finally discharged from the hospital on Tuesday afternoon-- he was extracted at 1:11 am on Saturday, July 20, 2002-- and his dad hadn't installed the carseat. I struggled up out of the wheelchair and put it in the car myself, then put Gareth into it. I climbed in beside him and left the nightmare behind-- I hoped.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">During my stay on the postpartum unit, I was denied pain medication after the first day. Since I didn't have an epidural, there was no option for PCA pain control. For some reason, no one would prescribe pills. I was given IM shots of morphine, which did little for the pain and made me itch abominably but allowed me to leave reality behind temporarily. I had three of those, but when I begged for a fourth, I was told, "Nobody ordered any more meds for you, that order expired." They gave me 600 mg of ibuprofen-- equivalent to 3 Advil, which is what I normally took for a headache. No one helped me clean up-- I remember having to get up about 8 hours after surgery and try to pee, since they had taken the Foley out in recovery as well. Someone helped me shuffle to a shower chair, then left me on my own. If my linens were changed, it was done while I was drifting in a morphine fog. They would not let me eat-- no one advanced my diet from clear liquid to regular until lunchtime on Tuesday, just before I left. Mostly I was ignored, left alone with my baby son, since my husband had to care for our two-year-old. The brightest spot in my stay was one evening when my sister sneaked me in a milkshake.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I went home on Tuesday, July 23. Immediately I had to deal with packing up and getting ready to move across country, since we were leaving on July 29. On Friday, I got into the shower and pulled off the peripad I'd been using to shield my incision. I screamed-- the pad was soaked with blood. My incision was open on the right side-- maybe an inch, and draining what looked like watery blood. I made my husband take me to the nearest ER, where I was told that such mild dehiscence was a "normal but uncommon result of abdominal surgery." There was some talk of opening the wound and packing it, but the Er doc finally decided to leave it alone. He told me to keep a pad on it, monitor the drainage, and come back if it started to look like pus. He prescribed a 10-day course of Keflex and sent me home. On Monday we left Los Angeles and headed east on I-40. My incision stayed open and leaked serosanguinous fluid for 6 weeks.</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I barely remember my son's first year. I lived-- survived-- in darkness, only getting out of bed to care for my babies. I had nightmares, cold sweats, flashbacks to the OR. Most days I wished I had died on that operating table. I poured out my grief and rage on the ICAN list, and the wonderful wisewomen there supported me as best they could. It took years before I could talk about Gareth's "birth" without weeping, and I still can't talk long without tearing up<i>. </i>I hated all doctors, all midwives, all doulas. They had betrayed me, stolen my baby's birth. I was broken and defeated. I was bitter. And then I was <i>angry. </i>I burned in that crucible, channeled my fury into nursing school-- I refused to ever be at the mercy of medpros again. I became an RN and took a job in postpartum, so I could give mothers the care I did not receive. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I conceived again just before my last semester of nursing school; I sat my boards hugely pregnant. I had an empowering unassisted pregnancy and birth, and three years and six weeks after Gareth was surgically removed from my uterus, I gave birth to his baby brother-- in my living room, on my own terms, into my own hands. He was slightly bigger than Gareth, who was vertex but had his head cocked-- an asynclitic presentation. Rowan was positioned beautifully, in part because I had learned how much more important position is than size-- something Nancy never mentioned or, I suspect, even considered. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">So... that's my story. The CBAC from hell made my career and my triumphant UBA2C possible. And of course I got the gift of my first son, my Gareth-- my gentle, angry boy. I guess I should feel some measure of peace over it now... maybe one day I will. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
</div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;">I gave him the middle name Benjamin for my grandfather. But it was fitting in another way as well. In the book of Gensis, Rachel dies giving birth to a son she names Benoni-- "son of my sorrow." His father, Jacob, renamed him Benjamin, "son of the right hand." In a very real sense-- to me, at least-- I died on that table. The woman I was, who trusted professional caregivers to do what they promised, went to sleep and never woke up. Instead there was-- me, angry and bitter and devastated-- and determined. </div><div style="border-collapse: collapse; color: #333333; font-family: arial, sans-serif; font-size: 13px;"><br />
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</div>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com6tag:blogger.com,1999:blog-7743294862694613938.post-7210767578462538172011-04-27T04:25:00.000+01:002011-04-27T04:25:49.220+01:00AwarenessIt's April again... it seems to come faster and faster every year. And I'm back-- I know, I said I was done, but... well, in birth advocacy, it seems there's no "done" until every baby and every mother has the best birth possible under their respective circumstances. Of course this year was special: it was an ICAN conference year, and the conference was wonderful, as always. It went too fast (as usual) and I didn't get nearly as much accomplished as I'd hoped, but I wouldn't trade that four days for anything. We are truly "gentle angry women," and I am honoured and proud to join my sisters in what has become a sacred pilgrimage every two years.<br />
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Now... Awareness. It seems like a simple concept: being in the moment, experiencing life as it comes. In practice, awareness is exquisitely difficult, at least for me-- in terms of the cesarean epidemic, it's excruciating. Let me illustrate.<br />
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<a href="http://ican-online.org/news/cesarean-rate-jumps-again-record-high">The CDC numbers are out for 2009</a> (the most recent statistics); the United States currently boasts a <b>32.9% cesarean rate.</b> That number has risen every year for the last thirteen-- and it's more than double the highest rate recommended by the World Health Organization. Effectively one-third of all women giving birth in this country are having their babies surgically removed, exposing them and their infants to risks that include haemorrhage, infection, injury to bowel and bladder, respiratory difficulty, and, yes, death... now, or in later pregnancies. C-sections are no laughing matter; they are most assuredly <i>not</i> "just another way to have a baby. That said, many of these surgeries are undoubtedly necessary, and certainly when they are everyone involved is glad that there are skilled surgeons available to intervene. But in the majority of cases, surgical delivery is not warranted, and too often, mother or baby suffers because of it. Baby has <a href="http://www.nlm.nih.gov/medlineplus/ency/article/007233.htm">transient tachypnea of the newborn</a> that devolves into <a href="http://www.nlm.nih.gov/medlineplus/ency/article/001563.htm">neonatal respiratory distress syndrome</a>, leading to a stressful (and costly) stay in the NICU. Mom develops a wound infection and has to be re-hospitalized. Breastfeeding relationships are compromised. In a future pregnancy, mom is diagnosed with <a href="http://www.americanpregnancy.org/pregnancycomplications/placentaaccreta.html">placenta accreta</a> or another problematic placental issue that can lead to <a href="http://emedicine.medscape.com/article/275854-overview">uterine rupture</a> (yes, even without attempting that controversial VBAC thing), <a href="http://www.nlm.nih.gov/medlineplus/ency/article/000901.htm">placental abruption</a>. The end result can be utter devastation.<br />
<br />
And this has what, exactly, to do with awareness? Well, I'm getting to that. Firstly, being aware means understanding that all of the above goes on <i>every single day</i>. True, most cesareans come off without a hitch-- "mother and baby are doing well," as many an excited new father has announced proudly to his friends and family. But... not always. And we should never lose sight of the fact that terrible things happen: while one mother is recovering without incident and enjoying her new baby, another is... not. I refer you, for example, to the heartbreaking story of <a href="http://www.mattlogelin.com/archives/2008/04/13/what-happened/">Liz Logelin</a>, which now graces the New York Times bestseller list, thanks to one remarkable father and his determination to turn his personal tragedy into<a href="http://www.twokissesformaddy.com/about/"> inspiration and support for others</a>.<br />
<br />
I work in maternal-infant health. It's a rare day on my unit that we don't get a c-section up from L&D. Some are scheduled, elective surgeries that are usually (but not always) repeats. Others are non-elective-- rarely true emergencies, most are what I would term <a href="http://www.theunnecesarean.com/the-unnecesarean/">unnecesareans</a>, which Jill discusses much better than I can. Usually these are the "failed inductions"-- moms are brought in and given drugs (pitocin, cytotec) to force them into labor. Too frequently, they don't work-- well, of course not, since any sensible pregnant body will fight against such a thing to protect itself and its offspring-- and then it's off to the OR. "Time to get this baby out," the OB will say, when in reality he's probably thinking, I really don't want to be up all night, clinic will be a bear tomorrow, and I'm tired of listening to the wife nag when I'm late again for dinner, so let's get this over with <i>right now</i>. Mom is exhausted, confused, frightened; she readily agrees when the experts tell her that her baby is in distress and if they wait much longer he could die. When it's all over, the OB comes out covered in glory-- he saved the baby, after all!-- and mom is just grateful that all's well that ends well.<br />
<br />
I see this scenario over and over. So often, in fact, that I and all my coworkers consider it routine. Another c/s coming to room 3. Get an IV pole and a <a href="http://www.msdonline.com/biomed/meh/SCD.HTM">pump for the SCD</a>s. CBC for in the morning. Clear liquids now, regular diet in the morning. Foley catheter out and dressing off in 24 hours. Epidural stays in till post-op day 2; expect discharge on POD 3. No big deal; it's just another delivery.<br />
<br />
But it's not. And that is so hard to keep sight of, day in and day out. I don't know what my hospital's cesarean rate is (they are not required to release those numbers to the public, just to the health department, and the stats are lumped in with those from the county's other hospitals), but based on what I see, I would expect it to be higher than the national average-- probably at least 35%, maybe closer to 40%. On some days it's much higher-- there was a string of Fridays back in January and February where we were doing 5 or 6 sections each day, which was 75-100% of the total deliveries on those days. Coincidentally (!), our NICU admissions soared during that period as well...<br />
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Commonplace. Routine. So normal, in fact, that a day <i>without</i> a surgical delivery is remarked upon by nurses, doctors, even housekeepers. How does one maintain awareness, then, in such an environment?<br />
<br />
I tell myself every work day that, even though for me it's just another day at the grindstone, for my patients, it's the beginning of the rest of their lives. They will remember what I will not. It helps... but not enough.<br />
<br />
So. It's April again. Almost May, now. I renew my promise, every year, to cultivate awareness in my life, to be fully present for these new mothers and families, for the babies who are welcomed earthside in what believe to be less than optimal circumstances. I bear witness. It's all I can offer.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com2tag:blogger.com,1999:blog-7743294862694613938.post-83683908773690124462010-12-22T03:06:00.000+00:002010-12-22T03:06:56.669+00:00Just about to that point...... when I think I have to throw in the towel and say, "I'm done."<br />
<br />
The caesarean rate keeps climbing, even when the birth rate in the United States actually goes down. Intervention rates continue to skyrocket. No one actually seems to care, except the minority of us who <i>do</i>, and we keep talking in circles. There is a bare handful of individuals who are walking the walk, so to speak, but I don't seem to be one of them.<br />
<br />
So, I'm done. For now, anyway. Ironic that it's on Solstice Day. The Wheel keeps turning, but I seem to stay firmly in place... doing no one any good at all.<br />
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Brightest Blessings to you all, with all my heart. Peace of oak and ash and thorn, of root and crown, of leaf and bough, of earth and sky. Of wind and water... of well and womb.<br />
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And love. So much love.<br />
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<br />
~WillowWillowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com4tag:blogger.com,1999:blog-7743294862694613938.post-21244607904517718722010-11-11T18:35:00.000+00:002010-11-11T18:35:10.992+00:00I Can Dream, Can't I?Jill over The Unnecesarean posted this a few days back: <a href="http://www.theunnecesarean.com/blog/2010/11/7/obstetric-violence-introduced-as-a-new-legal-term-in-venezue.html">"Obstetric Violence" Defined as a New Legal Term in Venezuela</a>. It is, in a word, <i>awesome</i>. I would dearly love to see this enacted here in the States. I mean, read this:<br />
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<blockquote><i>The following acts executed by care providers are considered obstetric violence:</i> </blockquote><blockquote><i> (1) Untimely and ineffective attention of obstetric emergencies; (2) Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available; (3) Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breast-feeding immediately after birth; (4) Altering the natural process of low-risk delivery by using acceleration techniques, without obtaining voluntary, expressed and informed consent of the woman; (5) Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman.</i></blockquote><br />
I mean, how incredible is that?? Seriously? Could it be any clearer? <i>Medical personnel may not interfere in birth unless they are explicitly requested to do so.</i> Okay, so it doesn't say that precisely, but that's the take-home message: <i>When we want your help, we'll bloody well ask for it!</i><br />
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I'm not an idiot; I know perfectly well this would never, ever fly here in the US. (And truthfully, I doubt it's well-enforced in Venezuela-- but yay them for even codifying it!) It's all about liability and CYA and the almighty dollar. Maternal and child health come in way behind in terms of importance and influence-- still later comes any value placed on the childbirth experience, for mom or baby. Those of us who do value the experience-- who see it as a rite of passage, as seminal event in a woman's life, something to be honoured and empowered-- are accused of selfishness or derided as "hippies." Which brings me to another pertinent (and fabulous) blog post of recent vintage, here at <a href="http://birthtraumatruths.wordpress.com/2010/11/06/women-suffering-from-birth-trauma-are-not-just-being-selfish/">The Truth About Traumatic Births</a>, which succinctly and politely explains how every mother is entitled to frame her birth experience any way she pleases. One woman may view her cesarean as a life-saving God-send; another may see it (as, I confess, I do) as nothing short of brutalisation and near-death. Those of us who fall in the latter category are not horrible selfish people and evil mothers who placed our birth experiences over our children's wellbeing... but I digress.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-67444843329915233302010-09-30T03:02:00.000+01:002010-09-30T03:02:02.646+01:00Bright Blessed Autumn!Fall is my absolute favourite time of year-- the crisp air, the falling leaves, the way the light seems to slant at an angle. It's also an incredibly busy time for us in the birth world-- babies, babies everywhere! We joke at work that we're reaping the consequences of all those holiday parties nine months ago.<br />
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Unfortunately, more babies means more atrocities, at least where I work. More cesareans... more mothers subjected to unnecessary surgeries, more infants struggling with the effects of being <a href="http://www.marchofdimes.com/files/MP_Late_Preterm_Birth-Every_Week_Matters_3-24-06.pdf">not-quite-term</a> due to elective inductions and c-sections. It's frustrating and demoralizing, and I've decided to do something about it-- but more on that later. For now I just want to wish you all joy of the season, what I think is "the most wonderful time of the year," and offer heartfelt blessings of wind and branch, storm and sea, earth and sky. <i>Bendithion</i>!Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-66844594074088936572010-04-26T17:01:00.002+01:002010-04-26T17:49:54.427+01:00BlogrollI don't know how may blogs you follow, but these are some recent MUST-READS, in case you missed them. I love, love, <em>love</em> these writers!<br /><br />Kmom is my heroine and my inspiration-- I want to be her when I grow up! <a href="http://wellroundedmama.blogspot.com/2010/04/elective-inductions-and-elective.html">Here</a> she takes on elective inductions, and <a href="http://wellroundedmama.blogspot.com/2010/04/healthy-birth-practices-get-upright-and.html">this one</a> is her latest in a series on healthy birth practices. <br /><br />And speaking of heroes-- this guy rocks my world! Check out his latest on <a href="http://mannursediaries.blogspot.com/2010/04/joint-commission-fewer-inductions-fewer.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TheMan-NurseDiaries+%28The+Man-Nurse+Diaries%29">the Joint Commission Core Measures for Birth</a>, then see what he thinks about <a href="http://mannursediaries.blogspot.com/2010/04/panicky-births-why-i-wouldnt-give-birth.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TheMan-NurseDiaries+%28The+Man-Nurse+Diaries%29">birth locations</a>, should he ever have to choose one. Finally, <a href="http://mannursediaries.blogspot.com/2009/07/how-my-wife-had-11-pound-baby-at-home.html">here</a> is his wife's amazing homebirth story (which sort of answers the question above!).<br /><br />It's hard to be a birthkeeper in a culture that doesn't value birth-- and it's even harder to feel compassion for those who can't admit that their births have caused them hurt. My friend the VBACWarrior manages <a href="http://nowombpods.blogspot.com/2010/04/my-response-or-why-i-choose-vaginal.html">both</a>, and I think she is simply incredible.<br /><br />Jen keeps tabs on all the research and calls <a href="http://vbacfacts.com/2010/04/11/portraying-obs-as-the-bad-guys/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+VbacFacts+%28VBAC+Facts%29">physicians to task</a> when they deserve it. Her evidence is unassailable, and she disseminates it to the public at large. Her website is the best around when it comes to pulling together all the pertinent news about birth.<br /><br />Finally, Monica is spreading news and offering support to both English- and Spanish-speaking moms on Poder y Parto (Power and Birth). In <a href="http://poderyparto.wordpress.com/2010/03/30/can-we-move-beyond-tolerance-how-about-honoring-mothers-rights-to-a-fair-chance-at-birth/">this one</a> she eloquently explains why mothers matter as much as babies where birth is concerned.<br /><br />Who am I missing? I'm sure there are quite a few-- let me know if you see any blogs I need to be following, 'kay? <br /><br />Blessings of a lovely spring (which always reminds me of birth),<br /><br />WillowWillowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com4tag:blogger.com,1999:blog-7743294862694613938.post-81759489153620280442010-04-04T18:49:00.009+01:002010-04-04T23:15:03.933+01:00Cesareans: A Rant for CAM<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh3lKiNBSpGAMlVrLaWrRckALflMZm6zABGGpIp29bQX80lOnHmRZ1BnpZow3d7vxb2e2AAqpcRp53iD8xxV7unsrHokSWk0j1iO4sRp-GywQ7-uGH-Hv0DND_VGZ1fQ8wCNHeJk3qpPXR/s1600-h/CAM+ribbon.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 311px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh3lKiNBSpGAMlVrLaWrRckALflMZm6zABGGpIp29bQX80lOnHmRZ1BnpZow3d7vxb2e2AAqpcRp53iD8xxV7unsrHokSWk0j1iO4sRp-GywQ7-uGH-Hv0DND_VGZ1fQ8wCNHeJk3qpPXR/s320/CAM+ribbon.jpg" alt="" id="BLOGGER_PHOTO_ID_5325884383819336674" border="0" /></a><br /><br /><br />I have opened the "new post" page half a dozen times, meaning to start something (<em>anything!</em>), but I keep getting distracted and forget what I was thinking about or where I was going with it. Nothing seems to stick... I know I have stories to tell, opinions to elaborate upon, but when I actually sit down to write, my mind goes blank. It's like Blockbuster Syndrome: a well-documented (by me, at least) disorder in which one wants to rent a movie, one has a mental list of several films one would like to see, and then when one enters the video store, it's "Movie? I wanted a... what? Video? What's that? Um..." Very, very frustrating.<br /><br />(If I were clever, I would now present some interesting obstetrical analogy here. Rest assured, I have nothing.)<br /><br />So. It's Cesarean Awareness Month once again! Yes... let's go with that.<br /><br />I kicked off CAM with an elective primary section. Well, not me, personally, of course. My patient, a 24-year-old primigravida, delivered her son by cesarean on Friday... for absolutely no reason at all. There were no indications-- nothing in her history to necessitate major abdominal surgery. The OB's dictation states "The patient, over the course of this pregnancy, has requested a cesarean." There is no indication that he counseled her about her apparent fear of labor and delivery, or tried to dissuade her in any way from taking what is unquestionably a more dangerous route for herself and her child. He finishes, rather weakly, "She does show some signs of CPD."<br /><br />Um... CPD? Really? <em>Really??</em> Forgive me; I know "CPD" is a convenient label, the diagnosis of choice for physicians wanting to justify their surgical terminations of their patients' pregnancies. But shouldn't one give a baby a chance to negotiate the pelvis before pronouncing it "disproportionate"? How, exactly, does one diagnose <a href="http://www.americanpregnancy.org/labornbirth/cephalopelvicdisproportion.html">"cephalopelvic disproportion"</a> without allowing the passenger to give it a go, so to speak? <br /><br />This gargantuan baby, by the by-- so monstrous as to be unable to fit through his mother's pelvis, according to the OB-- weighed in at a whopping 7 lbs, 11 oz. And the mother came from recovery complaining of intractable pain-- pain that took several doses of morphine to manage,leaving mom too groggy to breastfeed initially-- so baby is now on formula. Chalk up one more success for the American way of birth. <br /><br />Here's another one: a 17-year-old sectioned on Friday-- a few hours after my patient-- is walking the halls. When asked, "Why did you have your cesarean?" she replied, "Because I was 38 weeks and my baby wasn't in the birth canal." <br /><br />/jawdrop/<br /><br />Honestly, what is wrong with these obstetricians? Why is that acceptable-- to cut open a teenager and give her such a ridiculous reason for it? In reality, this girl was a failed induction: after 12 hours of pitocin (cranked up to the max, no doubt), she did not dilate past 3 cm. Why? <em>Because she wasn't ready to go into labor. Her baby was not ready to be born!</em> <br /><br />Does she know that? Of course not. She trusts her doctor. He said so; it must be true. I happen to know-- because a friend of mine was at the nurses' station and heard the conversation-- that the three cesareans that were performed back-to-back-to-back last Friday (that's not including the scheduled elective primary I alluded to above) were done for no more pressing reason that the respective OBs (including the 17-year-old's doctor) wanted to be done with their patients. In the words of my friend, another obstetric nurse, "They didn't want to mess with them all weekend."<br /><br />That's right. Three babies were surgically removed from their mothers because three OBs didn't want their weekend plans interfered with. Tell me, please, whatever happened to "First, do no harm"???<br /><br />The mom who elected her cesarean is hurting. She asked me earlier, with tears in her eyes, "How long is it going to hurt like this?" I could only tell her that I didn't know, it varied from woman to woman, but that it would get better... slowly but surely. And in my heart-- I shouldn't admit this, but I'm human-- I couldn't feel totally sorry for her... because she chose this, you see. She <em>elected</em> it. <br /><br />Cesareans <em>suck</em>. Recovery hurts, even without the added challenges of caring for a newborn. Didn't she think to ask? Did she think that by circumventing labor, she would avoid pain? Why didn't her doctor tell her what she was in for?<br /><br />Judging by the patients recovering from cesareans today on this floor, doctors play all their cards close to the vest. They don't see fit to share much information with anyone. Can I blame a primip for fearing labor-- something she's probably seen only in idiotic Hollywood depictions-- when it's the OB, the so-called expert in birth, who perpetuated the fear and granted her wish for an unnecessarean?Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-80550306845676257502010-03-07T23:57:00.008+00:002010-04-04T16:31:34.433+01:00How to Have a Hospital VBAMCIt's difficult-- nearly impossible, in some parts of the country-- to find an obstetrician who will agree to "let" a mother attempt to use her vagina for its biologically mandated purpose once she has had a cesarean. As access to hospital VBAC gets more and more rare, many moms opt to stay home, choosing to labor and birth with a midwife or on their own. Others, though, still want to have their babies in the hospital, but refuse to submit to a repeat cesarean. These mothers may plan to stay home as long as possible in labor, waiting until the last moment to notify their OB and go to Labor & Delivery. Sometimes this works-- "showing up pushing" can mean that even a VBAC-wary doctor won't have time to object, when they walk into the room and the baby is already crowning. Other times, though, the ploy fails: there are many horrible stories (see Jennifer Block's <a href="http://www.jenniferblock.com/"><span style="font-style:italic;">Pushed</span></a> for details) of mothers arriving in the emergency room in hard labor, and being forced instead to undergo a stat section. One dear friend experienced just that: as she neared the end of a perfectly normal labor, she was wheeled into the OR, screaming, "I do not consent!" No one listened; she was cut against her wishes. Another brave mom I know had her crowning baby <span style="font-style:italic;">shoved</span> back up the birth canal and then removed surgically-- again, without my friend's consent. <br /><br />If having a hospital VBAC is difficult, finding someone to attend a VBAMC (vaginal birth after multiple cesareans) is that much harder. Even though <a href="http://www.acog.org/">ACOG</a> itself admits that <a href="http://www.childbirth.org/section/VBAC1.html">two c-sections</a> are not an absolute contraindication to VBAC, it's a rare OB who will agree to attend a trial of labor for a VBA2C, and only then if the mother has had a previous vaginal birth (not necessarily a VBAC). Higher-order VBACs(those occurring after three, four, and even more cesareans, as documented <a href="http://www.plus-size-pregnancy.org/CSANDVBAC/VBA2Cstories.htm">here</a>) by Kmom in hospitals are nearly unheard of; the majority of OBs, and even many midwives, consider the risks unacceptable. In fact, there are <a href="http://www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm">few studies</a> that look at VBAMC, and <a href="http://www.medicalnewstoday.com/articles/178088.php">a recent study</a> even suggests that VBA3C moms face risks comparable to any other VBAC mother. Of those <a href="http://www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-risks-of-vbac-and-cesarean-deliveries">risks</a>, the most loudly trumpeted is <a href="http://en.wikipedia.org/wiki/Uterine_rupture">uterine rupture</a>-- something a mom who wants to labor after multiple cesareans is likely to be told is nearly inevitable in her case, even though this assertion is not supported by the evidence. Faced with this fearmongering tactic (referred to by birth advocates as the "dead baby card"), most would-be VBAMC mamas back down, defer to the "expert" obstetrician, and schedule a repeat cesarean-- which will be coded as "elective"-- and honestly, who can blame them? Aren't doctors supposed to know best-- aren't they there to protect our interests as patients, to keep us safe? To <span style="font-style:italic;">do no harm?</span><br /><br />It is well to keep in mind that physicians are human, and humans, no matter their ideals or sense of altruism, are ultimately most concerned with their own best interests-- precisely why every pregnant woman, regardless of circumstance or desired birthplace, must educate herself and become her own number-one advocate. ACOG is, first and foremost, a trade union, and it does what such organizations do best: it protects its members. Obstetricians, because they deal intimately with such a life-changing (life-beginning!) process, are targets of litigation- because in our society, if something goes wrong with a delivery, if a family is presented with a so-called "bad baby," they naturally look for someone to blame. It's common wisdom among OBs that "the only c-section you get sued for is the one you don't do"-- in other words, if a baby sustains injury or lasting damage during a vaginal birth, the first question a lawyer seeking reparations will ask the OB is, "Why didn't you do a c-section?" (Or, in this day and age, even "Why didn't you do a c-section sooner?")<br /><br />Fear of litigation drives medical care in this country, especially where mothers and babies are concerned. Obstetricians pay some of the highest malpractice insurance premiums in the business. So perhaps it's understandable that they panic in the fact of what they see-- what they are conditioned to see-- as unacceptable risk, such as VBAMC.<br /><br />Dr Wells (note: all names and a few details have been changed, in compliance with HIPAA laws) must have experienced a chill when he got the call from the medical exchange Wednesday night: his 25-year-old patient, Anne, was in labor. Anne has three older children: five, three, and eighteen months. Anne has had three c-sections.<br /><br />At just 37 weeks' gestation, Anne hadn't expected to go into labor. Her (arbitrarily and probably unwisely) scheduled fourth c-section was still a week away. When she realized that she was having regular contractions only a minute or so apart, it dawned on her that she might behaving this baby sooner than later. She went to the nearest emergency room-- at a small local hospital with no L&D and no maternity services. She was triaged, and the ER nurse quickly determined that she was definitely in labor: Anne was completely dilated, with a bulging amniotic sac. Dr Wells was paged and implored to come, <span style="font-style:italic;">stat!</span><br /><br />Dr Wells hit the road running. As soon as he arrived at the emergency department and checked Anne, he called for her to be taken to the nearest OR at once. The staff balked; they did not have the necessary equipment on hand for a cesarean, much less to care for a <a href="http://www.clinicaladvisor.com/guidelines-for-the-late-preterm-infant/article/162688/">late preterm infant</a>. Dr Wells-- who, it must be said, is well known for his colorful vocabulary-- cursed and called the nearest large hospital with a <a href="http://allnurses.com/nicu-nursing-forum/what-level-nicu-156806.html">level III neonatal intensive care unit</a>, demanding that they send a team at once. The NICU staff demurred, stating-- quite reasonably-- that they would be unable to provide a comprehensive neonatal resuscitation team, with all the requisite personnel and equipment, in time. The physician argued, insisting that a nurse and respiratory therapist <span style="font-style:italic;">must</span> jump into an ambulance at once and drive at full speed to attend a stat section fifteen miles away. Again, the NICU declined, at which point the nurse manager was treated to an unexpurgated rant by the OB.<br /><br />And Anne? She was still in labor, and within twenty minutes of the irate doctor's arrival, she delivered a healthy seven-pound baby girl-- vaginally, without complications of any kind, right there in the ER. Mother and daughter were transported to the larger hospital, to our mother-baby floor, where I was privileged to care for them until they went home yesterday. When I asked her how her recovery was going, she laughed and said, "It's a world away from a c-section!"<br /><br />When her OB rounded, he spent less than a minute in his patient's room-- and nearly half an hour with her chart. Dr Wells's main concern, it seemed to me, was to fully document the incident-- concerned, as always, that a lawsuit of some kind might be in the offing. He wasn't interested in the implications: Anne had escaped major surgery-- a surgery he had mandated-- and had instead had an uncomplicated VBAC. She and her baby were happy and healthy-- isn't that all that matters?<br /><br />Not to this obstetrician. He had lost control of the situation. Instead of a calm, routine cesarean, he was forced to race across town in a mad dash to catch a baby in a hurry. Apparently, non-bankers'-hours obstetrics are not his cup of tea. Will he encourage VBACs for future patients? I doubt it. Will he permit Anne to labor again, if she becomes pregnant in another year or so? Unlikely... he will probably scare her to death with what-if tales of horror, and insist that she submit to a cesarean at 36 weeks. What's one more preemie, if he can continue to circumvent birth?<br /><br />I'm at a bit of loss, myself, as far as how to feel about this story. I'm thrilled for Anne, who had a quiet everyday miracle of her own in a rural emergency department. But I'm honestly not sure she understands what she accomplished-- or how she did it. I don't know for certain that she's ever even heard the term VBAC-- I'm positive, given that Dr Wells has delivered all her children, that she has never been offered the opportunity to even go into labor, much less have a vaginal birth. If she gets pregnant again, will she go back to Dr Wells, knowing what she does now? Will she demand a VBAC, or will she schedule another section?Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-76960760238264729732010-02-26T02:09:00.009+00:002010-02-27T22:45:50.723+00:00VBAC ViabilityOther, better commentators (<a href="http://www.hencigoer.com/articles/vbac/">Henci Goer</a>, <a href="http://www.midwiferytoday.com/articles/acog.asp">Marsden Wagner</a>, <a href="http://www.sarahjbuckley.com/">Sarah Buckley</a>, <a href="http://www.plus-size-pregnancy.org/CSANDVBAC/csvbacindex.html">Kmom</a>, <a href="http://rixarixa.blogspot.com/">Rixa</a>, <a href="http://theexcellentadventure.com/elementalmom/">Laureen Hudson</a>, <a href="http://vbacfacts.com/">Jen of vbac.com</a>, and many more) have written extensively about <a href="http://www.childbirth.org/section/VBACFAQ.html">VBAC</a> and why it's preferable to repeat cesareans for most mothers. Anyone who has done even the most casual reading on the subject knows that surgical deliveries carry with them a significantly increased risk of injury, infection, hemorrhage, and other complications for mothers and babies. Cesareans require longer hospital stays, more pain, more drugs, more risk of respiratory problems. NICU stays are more common; so are post-op transfusions, deep vein thromboses, and hysterectomies. Recovery is substantially longer-- those first few weeks of motherhood are challenging enough without adding the debilitation of major abdominal surgery to the mix! Babies are less likely to continue breastfeeding-- mothers who are exhausted and in pain, who can't lift their infants or even sit up straight, often give up and bottle feed. Consequently, cesarean-delivered babies are more likely to experience <a href="http://kidshealth.org/parent/pregnancy_newborn/common/jaundice.html">jaundice</a> shortly after birth, and asthma, allergies, and obesity later in life. And while the initial cut is bad enough, each subsequent cesarean raises the risk of long-term complications for mama: placentation problems (<a href="https://health.google.com/health/ref/Placenta+previa">placenta previa</a>, <a href="https://health.google.com/health/ref/Placenta+abruptio">abruptio placentae</a>), <a href="http://www.fertilityfactor.com/infertility_secondary_infertility.html/">secondary infertility</a>, miscarriage, and <a href="https://health.google.com/health/ref/Ectopic+pregnancy">ectopic pregnancy</a>. Any of these are potentially devastating issues-- and yet mothers are told, time and again, "It's just a c-section."<br /><br />"Just" a c-section? I've heard this phrase over and over, both as a mother and as a nurse. When completing a history and physical for a new family doctor, I checked the box that said "Prior surgeries" and wrote in "cesarean times two." The medical assistant who reviewed my chart commented, "So you've had surgery? Oh, no, I see-- you've just had c-sections." I had to bite my tongue to keep from screaming, "What part of major abdominal surgery aren't you getting? Have you been splayed open like a fish, your guts exposed to all and sundry, your abdominal muscles split and left to reapproximate in whatever slapdash fashion they choose? Have you dragged yourself up and down a flight of stairs, clutching the banister with one hand and your belly with the other, convinced that you're going to open up and spill your internal organs on your shoes? Sure-- <em>just</em> c-sections!"<br /><br />Hollywood and the media are responsible in large part for the public perceptions of birth and cesareans. Everyone has seen the <a href="http://www.youtube.com/watch?v=h9IwfCIuPzw">TV version</a> of labor and delivery: mom rolling around in a hospital bed, screaming, cursing her husband's name, swearing "He'll never touch me again!" Comic sidekicks rush in and out while mom groans and shrieks and generally does her best Exorcist impersonation before delivering a bright-eyed three-month-old to the general adoration of all in attendance. Celebrity moms-- Victoria Beckham, Britney Spears, Madonna-- all those "too posh to push" mums, who get tummy tucks at delivery, who have personal trainers to get them back in shape fast and personal chefs to feed them and nannies to take care of their newborns and older children-- they make cesareans look like the easy, chic way to have babies. None of the fuss and muss of labor-- just show up at the hospital on the appointed day, coiffed and made up and manicured, pop into the operating room and get that oh-so-lovely epidural, and wait for your surgeon to hand you your clean, scrubbed, blanket-wrapped newborn.<br /><br />Unfortunately, we don't get to see the all-too-common aftermath: a mom too drugged to hold her new infant; when the epidural comes out, in too much pain to put him to breast. The indignity of having a Foley catheter removed, only to have it reinserted when she can't urinate on her own. The agony of hobbling to the bathroom like an octogenarian, terrified of falling or opening her incision. The frustration of having to tell her toddler that she can't pick him up because of the ouchie on her tummy. The days and weeks of lingering pain, muscle weakness, helplessness.<br /><br />In the years since my two cesareans (ten years ago and seven and a half, respectively), I've gained a bit of perspective. I don't rant much anymore; I don't brood often, or for long when I do. I take care of new mothers who actively choose their c-sections, and seem reasonably satisfied with the results; mostly I'm able to keep my feelings to myself. I slip <a href="http://www.cafepress.com/vbacfacts.275523824">referral cards</a> into teaching packets with links to <a href="http://ican-online.org">ICAN</a> and vbacfacts.com. When families ask "is this much pain normal?" or "what can she expect when she goes home?" I tell them the unvarnished facts: Cesareans hurt, surgery is painful, recovery takes time. Occasionally I'm asked if a mother might ever reasonably expect to birth a subsequent child vaginally; on those rare occasions I offer my (heavily edited) <a href="http://jerwillow.webs.com/birthkeeping.htm">stories</a> and the assurance that VBAC is possible and definitely worthwhile, but it takes work. The sad fact is that most of the women I meet aren't willing to do the work-- their doctors tell them no, it's too much hassle, it's dangerous, etc., and they accept that answer as gospel. Society supports the status quo; those of us who are willing to educate ourselves, take responsiblity for our health and our births, are regarded as hippies, zealots, weirdos. Good girls don't buck the system. Good girls do what they're told, lie down and allow themselves to be sliced open for their obstetricians' convenience. Good girls put themselves and their babies at risk by choosing repeat cesareans-- or, probably more accurate, allowing repeat cesareans to be chosen for them. True informed consent is rare: as one OB famously stated, "If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get up and go out and have their baby under a tree..." (Neel, J. Medicolegal pressure, MDs' lack of patience-- cited in cesarean 'epidemic.' Ob.Gyn.)<br /><br />Cesareans are forever. No matter how good one's experience, the effects remain. Scars heal, fade, but mothers ever after will experience statistically higher morbidity and mortality. I had a life-altering vaginal birth after two cesareans, but my triumph was marred by a <a href="http://www.healthline.com/yodocontent/pregnancy/complications-retained-placenta.html">retained placenta</a>. Was it caused by my cesareans? I don't know for certain, but I strongly suspect so. I managed to push a baby out of my vagina, but I still had to turn to medpros for a <a href="http://www.mayoclinic.com/health/dilation-and-curettage/MY00345">D&C</a>-- another uterine surgery, which in itself increases my risk of complications should I ever plan another birth-- all thanks to an OB who wanted to get home sooner than later. <br /><br />I will never go into labor without that CNN-style ticker tape in my head, reminding me of the <a href="http://www.drspock.com/article/0,1510,5926,00.html">warning signs of uterine rupture</a>; I will never welcome a baby in blissful ignorance, as so many of my patients seem to do. I envy them sometimes, the mothers who have never had a reason to question their doctors, who go to the hospital with the first twinge of labor, accept all the interventions, and still pop out their babies with very little trouble and no apparent lasting effect. Still... there is something to be said about the journey. And there's no question that my journey has been valuable-- priceless, even. That's the intangible reward of pursuing VBAC: the self-searching, the questioning, the obtaining of knowledge. I learned more about myself in the years that I struggled against depression and <a href="http://www.angelfire.com/moon2/jkluchar1995/">PTSD</a> than I ever would have if I'd been one of the "lucky ones," the women who make it through the birth mill unharmed. I survived the inferno and emerged from the crucible, tempered and, I think, strengthened. Certainly I would not be the person I am without my fight to VBAC-- and after a good many years, I'm finally able to say that, yes, I like that person. That's worth almost as much as my children.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com2tag:blogger.com,1999:blog-7743294862694613938.post-45985668328777025022009-07-16T16:34:00.002+01:002009-07-16T16:38:28.309+01:00Another quick I'm-not-dead post... and a truly excellent link: <a href="http://keyboardrevolutionary.blogspot.com/2009/07/just-when-id-thought-id-heard-it-all.html">Pit to Distress</a> 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 <em>babies</em>... <br /><br />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. <em>Women of Earth, take back birth!!</em>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com3tag:blogger.com,1999:blog-7743294862694613938.post-33286465174375625732009-06-06T17:04:00.013+01:002009-07-17T13:26:25.685+01:00Barbarism, 2009Let'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. <br /> <br />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."<br /> <br />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.<br /> <br />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. <br /> <br />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. <br /> <br />You close your eyes, sick to your stomach. All you can do is pray for sleep and time to ease your pain.<br /> <br />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?<br /> <br />I am sick to death of <a href="http://www.askdrsears.com/html/10/t101500.asp">circumcisions</a>. There, I said it. <br /> <br />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!!<br /> <br />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??!?!?!<br /> <br />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 <a href="http://www.uptodateinc.com/online/content/images/obst_pix/Gomco_clamp_with_safety_pin.jpg">device that looks like it was developed by sadistic Inquisitors during the Dark Ages</a> and hacking away one-third to one-half of the skin of his most sensitive organ. Don't believe this is what happens? <a href="http://www.bmcb4.org/Pediatrics/Circumcision.ppt">Don't take my word for it.</a><br /> <br />And for what? There is no medical indication for routine infant circumcision: so says the <a href="http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html">American Academy of Family Physicians</a>, so says the <a href="http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686"> American Academy of Pediatrics</a>, 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.) <br /><br />With the overwhelming <a href="http://www.doctorsopposingcircumcision.org/DOC/circumcision_quiz.htm">evidence</a> falling squarely on the side of <em>not</em> 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 <a href="http://www.doctorsopposingcircumcision.org/video/prepuce.html">this video</a>, produced in informative (and graphic, so be warned) detail, the appalling statistics would change.<br /><br />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 <a href="http://www.naturalbirthandbabycare.com/elimination-communication.html">those who don't</a>, but the sad fact is that circumcision is not the benign procedure it's painted to be. Mishaps happen; there are <a href="http://www.cirp.org/library/complications/">risks</a>. 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!!"Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com2tag:blogger.com,1999:blog-7743294862694613938.post-84724888777299296832009-06-05T16:00:00.002+01:002009-06-08T17:57:03.322+01:00Blogging by ProxyI'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. <br /><br /><a href="http://wellroundedmama.blogspot.com/2009/03/history-of-vbacs-and-cesareans-in-usa.html">Check it out!</a>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com1tag:blogger.com,1999:blog-7743294862694613938.post-29922533126911233642009-05-26T22:48:00.003+01:002009-05-26T22:52:11.795+01:00Brilliance That Cannot Be Improved UponCheck it out <a href="http://gisellestotalwasteofbandwidth.blogspot.com/2009/05/different-kind-of-consent-form.html">here</a>. 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.<br /><br />Giselle, I applaud you. Brilliant!!!Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-71904843025510117002009-05-10T19:12:00.003+01:002009-05-10T20:59:18.062+01:00Mother's Day ThoughtsI was wondering what on earth to write about this week... my <a href="http://store.higherheart.com/product.php/1702/0">muse</a> 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. ;)<br /><br />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. <br /><br />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... <br /><br />What's really odd, given the recent storms, <a href="http://en.wikipedia.org/wiki/Lunar_effect">the full moon</a> , 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 <a href="http://parenting.ivillage.com/pregnancy/plabor/0,,6xr4,00.html">Cytotec induction</a>. It's almost... <em>spooky</em>. 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.<br /><br />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 <a href="http://en.wikipedia.org/wiki/Journeyman">journeyman</a>, if not a <a href="http://en.wikipedia.org/wiki/Master_craftsman">master</a>-- 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!)<br /><br />I think I'll just close with today's <a href="http://www.gocomics.com/stonesoup/"><em>Stone Soup</em></a>, by <a href="http://www.stonesoupcartoons.com/about-jan.html">Jan Eliot</a>:<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr8rSfJmyvoaWyrFapm-r8WMPs2GiKF-Izxd4-2ZEtceZxb9CgFbLeABf-vzxIXgkYrzVcOWurX_mb83sobCdUFrNuyvUJN5miViJZowF1nX4fAXFHvX3EI4zbAD88fMMotgBWb5aSjE-R/s1600-h/stonesoup.gif"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 158px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr8rSfJmyvoaWyrFapm-r8WMPs2GiKF-Izxd4-2ZEtceZxb9CgFbLeABf-vzxIXgkYrzVcOWurX_mb83sobCdUFrNuyvUJN5miViJZowF1nX4fAXFHvX3EI4zbAD88fMMotgBWb5aSjE-R/s320/stonesoup.gif" border="0" alt=""id="BLOGGER_PHOTO_ID_5334285307048407090" /></a><br /><br />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, <a href="http://www.ermamuseum.org/home.asp">Erma Bombeck</a>, had to say about the <a href="http://humor.about.com/gi/dynamic/offsite.htm?site=http://www.geocities.com/HotSprings/Spa/9599/mothers.html">origin of mothers. <br /></a>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-5580597277164727452009-05-04T18:24:00.008+01:002009-05-05T22:49:04.311+01:00BIB!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 <a href="http://pregnancy.about.com/od/induction/f/pitocin.htm">pitocin</a> 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.<br /><br />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."<br /><br />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!<br /><br />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<a href="http://en.wikipedia.org/wiki/Ventouse"> vaccuum</a>, or drag her out with <a href="http://www.healthline.com/yodocontent/pregnancy/forceps-assisted-delivery.html">forceps</a>, inflicting a large <a href="http://www.birthpsychology.com/messages/episiotomy/episiotomy.html">episiotomy</a> 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 <a href="http://www.birthingnaturally.net/barp/lithotomy.html">lithotomy position</a> and gravity is, to say the least, unkind to birthing mothers who are stranded on their backs.<br /><br />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 <a href="http://www.marchofdimes.com/pnhec/240_48590.asp">March of Dimes</a> 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.<br /><br />Regardless of reason-- and there are <a href="http://www.givingbirthnaturally.com/reasons-to-induce-labor.html">a few legitimate reasons</a> 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.<br /><br />Sometimes moms go faster than the doc expects. The pitocin or <a href="http://www.birthingnaturally.net/birthplan/intervention/induction/cervidil.html">cervidil</a> or, heaven forbid, <a href="http://www.midwiferytoday.com/articles/cytotec.asp">cytotec</a>, work <em>too</em> 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 <a href="http://www.childbirth.org/articles/apgar.html">APGARs</a>, 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!<br /><br />Now, bear in mind that when the nurse walked in, the baby was <a href="http://www.birth.com.au/2nd-stage-of-labour/Crowning-phase.aspx">crowning</a>. 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..."<br /><br />Seriously. Baby is on the perineum-- hell, <em>through</em> the perineum-- and Jane is <em><strong>not meant to push??!?!??!?</em></strong> She's supposed to just lay there and endure the titanic forces of labor until the OB deigns to appear? <br /><br />Yes.<br /><br />That's the OB's feeling on the matter. The nurse should be able to control labor to the <em>n</em>th 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.<br /><br />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 <a href="http://www.healthline.com/yodocontent/pregnancy/complications-retained-placenta.html">retained placenta</a>, therefore she was in imminent danger of bleeding out. Dr M ordered an ultrasound to check for placental fragments, and for an <a href="http://en.wikipedia.org/wiki/Foley_catheter">indwelling catheter </a>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.<br /><br />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?<br /><br />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 <em>the OB is not indispensable to the process.</em> 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. <br /><br />The simple truth? <strong>They're wrong.</strong>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com7tag:blogger.com,1999:blog-7743294862694613938.post-43554371013627863212009-05-02T19:17:00.007+01:002009-05-05T00:51:57.364+01:00DecompressionI was fortunate to finish up <a href="http://www.birthactivist.com/2009/04/734/">Cesarean Awareness Month</a> (aka April) by attending the <a href="http://ican-online.org/">ICAN Conference</a> in Atlanta, Georgia. It was, in a word, <em>incredible</em>. 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.<br /><br />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 (<em>Bonnie! Jenny! Erica's coming? Cool!!</em>) 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!<br /><br />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. <em>I am not broken... when my sisters are with me.</em><br /><br />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 <a href="http://vbacfacts.com/">VBAC</a> (vaginal birth after cesarean, a safe option for most mothers) and <a href="http://www.gentlebirth.org/ronnie/homejjg.html">out-of-hospital birth</a>. 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.<br /><br />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 <a href="http://www.youtube.com/watch?v=MdV6pCtnoD0">for Tudu</a> . Nothing I could say captures the spirit of the conference better than this brief moment of communion and conviction.<br /><br />Birth is as safe as life gets. Birth <strong><em>is</em></strong> life... we only want to live it.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-204959983261836302009-04-18T04:36:00.001+01:002009-04-19T02:56:20.681+01:00Cesarean Awareness Month: April 2009<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh3lKiNBSpGAMlVrLaWrRckALflMZm6zABGGpIp29bQX80lOnHmRZ1BnpZow3d7vxb2e2AAqpcRp53iD8xxV7unsrHokSWk0j1iO4sRp-GywQ7-uGH-Hv0DND_VGZ1fQ8wCNHeJk3qpPXR/s1600-h/CAM+ribbon.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 311px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh3lKiNBSpGAMlVrLaWrRckALflMZm6zABGGpIp29bQX80lOnHmRZ1BnpZow3d7vxb2e2AAqpcRp53iD8xxV7unsrHokSWk0j1iO4sRp-GywQ7-uGH-Hv0DND_VGZ1fQ8wCNHeJk3qpPXR/s320/CAM+ribbon.jpg" alt="" id="BLOGGER_PHOTO_ID_5325884383819336674" border="0" /></a><br />Once again, it's April, Cesarean Awareness Month 2009. Every year the <a href="http://www.cdc.gov/nchs/births.htm">CDC</a> announces the latest <a href="http://www.childbirthconnection.org/article.asp?ck=10554&ClickedLink=274&area=27">statistics</a>; every year for the past fifteen at least, the percentage of births via cesarean has gone up.<br /><br />So, what's the big deal? What difference does it make which way a baby comes out, as long as it <span style="font-style: italic;">does</span>? Vaginal birth, cesarean birth-- it's all the same, isn't it? After all, a healthy baby is all that matters...<br /><br />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 <span style="font-style: italic;">unnecessary</span>. 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.<br /><br />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 <a href="http://www.childbirth.org/section/risks.html">all its attendant risks</a>. 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. <a href="http://www.capanes.com/services_cr.html">Anesthesia</a>-- even that "harmless" epidural society embraces as the savior of laboring women-- adds another tier of risk, one that is rarely addressed by physicians.<br /><br />Women are almost never informed about the risks to <a href="http://www.pregnancy-info.net/csections_future.html"><span style="font-style: italic;">future</span></a> 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.<br /><br />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 <a href="http://kidshealth.org/parent/medical/lungs/ttn.html">transient tachypnea of the newborn</a>, 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 <a href="http://kidshealth.org/parent/medical/digestive/nec.html">NEC</a> (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.<br /><br />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, <a href="http://www.newscientist.com/article/dn14662-csections-may-weaken-bonding-with-baby.html?DCMP=ILC-hmts&nsref=news3_head_dn14662">that chemical cascade is interrupted</a>, 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 <a href="http://pregnancy.emedtv.com/cesarean-section/postpartum-depression-after-c-section.html">postpartum depression</a> and are <a href="http://www.plus-size-pregnancy.org/CSANDVBAC/bfaftercesarean.htm">less likely to breastfeed</a> 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!<br /><br />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, <span style="font-style: italic;">controlled</span> alternative to the inherently messy, unpredictable way designed by nature.<br /><br />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<br />slots for check-ups or consults.<br /><br />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 <span style="font-style: italic;">not</span> schedule a cesarean? It just makes sense.<br /><br /><span style="font-style: italic;">Except...</span><br /><br />Regardless of what <a href="http://www.acog.org/">ACOG</a>, 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 <a href="http://www.collegeofmidwives.org/ObGynNews%2001a/OBN%20no%20purple%20pushing%20Mar03.html">purple-pushing</a> 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.<br /><br />Fortunately, <a href="http://www.childbirthconnection.org/article.asp?ck=10166">there are those who recognize this folly</a>, and are fighting to be heard above the rhetoric and misinformation. There is <a href="http://ican-online.org/">support</a> for mothers trying to recover from cesareans, for mothers wanting to avoid them, <a href="http://www.birthaftercesarean.com/">for women planning a birth after a cesarean</a>-- 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.Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com2tag:blogger.com,1999:blog-7743294862694613938.post-43146132586611241332009-04-16T23:24:00.002+01:002009-05-05T23:25:30.638+01:00If it's Thursday, it must be...<div>Work. </div><div></div><br /><div>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: <em>"This must be Thursday. I never could get the hang of Thursdays."</em> </div><br /><div></div>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.<br /><br /><div></div><div>Today the inductions have gone slow-- only one vag birth so far to be admitted to us in mother/baby. Another apparently failed the <a href="http://www.medscape.com/viewarticle/450311">Friedman Curve</a> 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. </div><br /><div></div><div>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:</div><br /><div style="text-align: left;"><em> Up to 80% of new mothers feel stressed or cry easily after having a baby. This is commonly </em><em style="font-style: italic;">referred to as "baby blues." These feelings are normal and usually resolve in a few weeks. </em><span style="font-style: italic;">Postpartum depression is a mood disorder that affects a high percentage of women-- as </span><em style="font-style: italic;"></em><span style="font-style: italic;">many as 1 in every 8-- anytime in the first year after their child is born, or after a miscarriage</span><em style="font-style: italic;"> or stillbirth. </em><span style="font-style: italic;">In the United States, about 400,000 women-- roughly 1 in 650-- may develop</span><em style="font-style: italic;"></em><span style="font-style: italic;"> postpartum depression each year. A significant number of these will go undiagnosed, and </span><em style="font-style: italic;"></em><em style="font-style: italic;">may suffer needlessly</em><span style="font-style: italic;">...</span><br /></div><br /><div>Postpartum depression is, in my humble opinion, no joke (unlike Tom Cruise, who <em>is!).</em> 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. </div><div> </div><br /><div>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 <em>vis-a-vis</em> 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, <em>all </em>medications have side effects; it's best to be aware of them and proactive about addressing them as they arise.</div><div> </div><br /><div>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.<br /><br />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.<br /></div>Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0tag:blogger.com,1999:blog-7743294862694613938.post-45225195956020287012009-04-13T21:51:00.001+01:002009-04-13T22:21:31.749+01:00MIA!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 <em>get this moving</em>! Instead, life intervened, as life is wont to do, and I procrastinated (as I am wont to do!), and... nothing happened.<br /><br />It's not for lack of thought. My head whirls every hour of the day with s<em>tuff</em>. 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.<br /><br />I mean well; most of us do. <em>The road to hell is paved with good intentions</em>... 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.<br /><br />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.<br /><br />This is a short post; call it a manifesto. It's spring; it's time to move on. Sondheim said it best: <em>"I chose, and my world is shaken-- so what? The choice may have been mistaken; the choosing was not. You have to move on."</em><br /><br />Choose. Stay stuck or stumble forward. Surely the stumbling is better than being stuck?Willowhttp://www.blogger.com/profile/01069471819840078854noreply@blogger.com0