Benoni

"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 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.

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.

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 not 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.

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. 

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.

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.

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."

She informed me that she was scheduling an induction at California Hospital, a charity facility in downtown LA where she had privileges, and I would 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."

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.

"What you can't deal with," she answered coldly, "is a dead baby."

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.

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."

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. 

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.

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 really 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.

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.

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!"

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. 

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. 

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.

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?

I kept pushing. "I can see hair!" my husband crowed. Catalina was supportive; Michelle was excited. I started to think-- maybe--

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.

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." 

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." 

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." 

"Of course I will, no one will be able to see it," he said reassuringly. He thought I meant my external scar.

"No, on my uterus... I want a low transverse scar, the same as before..." 

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!"

"I'm going to give you a bolus. You'll be fine."

"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 feel it. I'd read some fellow ICANers stories of surgical awareness, and I was choked with fear, tears running down my face. "Please!"

She snorted in disgust and said scornfully to the RE, "She's demanding general." 

"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--

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.

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." 

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.

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.

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.

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 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 angry. 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. 

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. 

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. 

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. 

Awareness

It'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.

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.

The CDC numbers are out for 2009 (the most recent statistics); the United States currently boasts a 32.9% cesarean rate. 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 not "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 transient tachypnea of the newborn that devolves into neonatal respiratory distress syndrome, 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 placenta accreta or another problematic placental issue that can lead to uterine rupture (yes, even without attempting that controversial VBAC thing), placental abruption. The end result can be utter devastation.

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 every single day. 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 Liz Logelin, which now graces the New York Times bestseller list, thanks to one remarkable father and his determination to turn his personal tragedy into inspiration and support for others.

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 unnecesareans, 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 right now. 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.

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 pump for the SCDs. 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.

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...

Commonplace. Routine. So normal, in fact, that a day without a surgical delivery is remarked upon by nurses, doctors, even housekeepers. How does one maintain awareness, then, in such an environment?

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.

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.

Just about to that point...

... when I think I have to throw in the towel and say, "I'm done."

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 do, 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.

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.

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.

And love. So much love.


~Willow

I Can Dream, Can't I?

Jill over The Unnecesarean posted this a few days back: "Obstetric Violence" Defined as a New Legal Term in Venezuela. It is, in a word, awesome. I would dearly love to see this enacted here in the States. I mean, read this:

The following acts executed by care providers are considered obstetric violence:

    (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 mean, how incredible is that?? Seriously? Could it be any clearer? Medical personnel may not interfere in birth unless they are explicitly requested to do so. Okay, so it doesn't say that precisely, but that's the take-home message: When we want your help, we'll bloody well ask for it!

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 The Truth About Traumatic Births, 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.

Bright 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.

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 not-quite-term 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. Bendithion!

Blogroll

I don't know how may blogs you follow, but these are some recent MUST-READS, in case you missed them. I love, love, love these writers!

Kmom is my heroine and my inspiration-- I want to be her when I grow up! Here she takes on elective inductions, and this one is her latest in a series on healthy birth practices.

And speaking of heroes-- this guy rocks my world! Check out his latest on the Joint Commission Core Measures for Birth, then see what he thinks about birth locations, should he ever have to choose one. Finally, here is his wife's amazing homebirth story (which sort of answers the question above!).

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 both, and I think she is simply incredible.

Jen keeps tabs on all the research and calls physicians to task 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.

Finally, Monica is spreading news and offering support to both English- and Spanish-speaking moms on Poder y Parto (Power and Birth). In this one she eloquently explains why mothers matter as much as babies where birth is concerned.

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?

Blessings of a lovely spring (which always reminds me of birth),

Willow

Cesareans: A Rant for CAM

I have opened the "new post" page half a dozen times, meaning to start something (anything!), 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.

(If I were clever, I would now present some interesting obstetrical analogy here. Rest assured, I have nothing.)

So. It's Cesarean Awareness Month once again! Yes... let's go with that.

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."

Um... CPD? Really? Really?? 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 "cephalopelvic disproportion" without allowing the passenger to give it a go, so to speak?

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.

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."

/jawdrop/

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? Because she wasn't ready to go into labor. Her baby was not ready to be born!

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."

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"???

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 elected it.

Cesareans suck. 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?

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?