April 23, Big hurdles / Baby Steps

I certainly got derailed from my quest, but I am not giving up. I'll have to revise the mission. Instead of a post per day for every day of Cesarean Awareness Month, I will strive to post a month's worth of useful information. However, it might take me twice or three times that time to do it. This week I have been caught up in the Earth Day furor. It's really catching on and becoming part of the culture.

At the moment I am trying to fight off guilt about the 40 years of plastic I've used and discarded. As a child, I clearly remember eating fast food and my Dad manually rolling down the windows for us to throw it right out onto the road. Classy, huh? Thank goodness for progress, if only inch by inch. I recoil at even a flying cigarette butt flying out a car window these days. At the moment I am googling ways to reduce use of plastic packaging and wishing the grocery stores would enable this. The most striking statement I heard in an Earth Day TV program yesterday was the following. In the ocean between CONUS and Hawaii, in an area of strong swirling currents where boats rarely go, there is a mass of plastic garbage rotating. The size of this mass is twice the size of Texas! Sea birds are dying, and their bellies are found stuffed with it. The scientist called it a "plastic soup" and there is more plastic than plankton per cup of water. It affect every species from the tiniest to the largest, including us. Our behaviors have to change.

When faced with overwhelming wrong and enormous mistakes, we can only change it one step at a time.

I will continue my blog one step at a time, as I can with a young child in my arms, and not beat myself up for not getting it perfect the first time.

I will make incremental changes in my behaviors to reduce waste my family's life. I will be open to new products and supportive of manufacturers and stores who are trying to move toward a better model.

I will improve how I take care of my house and organize my life, learning good skills and positive attitudes one step at a time (yes, I'm a FlyLady subscriber www.flylady.net).

We will question the warped priorities of our healthcare system and clearly but respectfully demand changes that result in healthier babies and mothers at childbirth, though we might feel so small next to the enormity of that system.

To link the two issues together - how much plastic waste do you think comes out of a single hospital birth compared to a single home birth? Think of every needle in a plastic case, in a plastic sleeve, in a box. All the disposable bedding. The pharma bottles, masks, disposable but non-degradable surgical gowns. All the chemicals. It's interesting how everything comes together. In your own home, with your own familiar germs, the need for plastic disposables or sterilized products is very small or reserved for unusual circumstances.

Recycling: Plants Recovery: Just What the Doctor Ordered (From "WasteAge")


Shari

Birth Story 1: How I became a Monster

It started innocently enough. At 34 I became pregnant after a few runs of Clomid, glucophage, weight loss and such. Spent month 3 at a fiddle camp at the University of Limerick, Ireland where I hated all the food except the fruit and fries. I think this led to my one pregnancy complication - six months of horrendously painful and relentless gallstone attacks. To be honest, after knowing I could endure that pain, I was not at all worried about the pain of giving birth and so far that's on the mark. I lived on power bars and cola Icees. Maybe that explains my son's sweet tooth?

Here's the way I wrote Ezra's birth story before I had gone monster-patient. It had still not dawned on me that it could have been handled differently. Comments in gray added later. Such a typical story...

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I went in for my Non-Stress test at the 42 week appointment. My docs were itching for me to accept induction. I was less than a fingertip dilated and 75% effaced. No labor signs or signals at all. We went for an ultrasound to check the amniotic fluid, and doc said if there is plenty we can wait a few more days. However, there was very little amniotic fluid left, so we agreed to be induced.

At 4pm Friday I took Cervadil and was admitted and monitored, and by 10pm was starting to feel labor pains and beginning to dilate. I wanted it to be as natural as possible and avoid excessive drugs that would lead to c-section or slow labor.

The Cervadil did a great job by itself. I went through the entire process of labor pretty smoothly and was keeping my cool but was entertaining the possibility of taking Stadol for pain by 6pm Saturday, around 7cm. However, the baby's heartbeat was having some dips and irregularities. The doctor said I could, but he wouldn't recommend it at the time, so I said forget it. (About 26 hrs into labor now - tick tick!)

I got to 10cm with no drugs. It was time to push. Baby's heartbeat was pretty high and doc was a little worried. The pushing felt great next to the labor phase! It was ALMOST fun. I pushed for 2 hours but could not get the baby past the pubic bone. His head was rotated. Doctor put his hands in to try to spin him, and that made me scream like a demon - that was the worst part of the process! But Ezra spun right back. I tried several positions (on my back) but couldn't get him out. The doctor recommended C-section after 2 hours of pushing (about 30 hrs labor - tick tick!), and due to the heart rate issue I reluctantly agreed. (Doc even talked to my parents and told them "we need to convince Shari to have a cesarean now. Note the effective use of emotional manipulation and power differential.)

I felt horrible having gone through all that just to be cut open. There was a flurry of activity while I was whisked to OR and prepped - I felt like a piece of meat, so out of control and still having painful contractions on that flat cold table. As soon as they put in the spinal, my mood shifted for the better. Miraculously, within 10 more minutes I heard the screams of my newborn and learned it was a boy! They sucked out the mucous, cleaned him up, and let me see him. Seth video taped his first moment after (not during) birth. At that moment, it all seemed worth while and I knew I had done the very best I could. When the doctor opened me, Ezra was sitting right there at the surface and really had not descended much at all, so I believe it was the right decision to undergo C-section. (I've heard it's common to hear a reassuring reason that you "did the right thing". Guess that avoids a lot of pesky post partum questioning?)

We are home now and I am healing quickly. I love my boy more than anything. He is a beautiful little innocent with dark eyes and lots of wavy dark brown hair. (Had my gallbladder removed six weeks later - double abdominal whammy!)

Now we are planning the bris for this Sunday.

We are exhausted but in heaven. More later! Thank you all so much for your support!!!!!
(P.S. I failed to produce adequate milk. Reason unexplained.)

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Yes, I am thankful for this healthy baby boy - extremely unendingly thankful. But not to the docs. Soon after this experience, I began doing my research into c-section, VBAC, etc. I will never know if the section was absolutely necessary, but allow me to do some Monday morning quarterbacking about how I would handle it differently.

* I would realize that the doctors had a vested interest in delivering me by 42 weeks.

* I would ask "how low" and "how dangerous is that" and "what are the parameters" regarding the amniotic fluid level.

* I would not have agreed to immediately going to the hospital. We would have gone home to sleep on it and do our own research.

* I would have reminded myself that many babies just need a few more days.

* Once in the hospital, I would have resisted breaking the waters as that starts the c-section clock. I would have insisted trying other birthing positions such as squatting and all fours to help the baby descend. I also would have eaten instead of gotten terribly weak by the end of a long labor.

* I would have worked harder to figure out if the baby's heartbeat issues were truly an immediate emergency or within normal variabilities. But by then I was pretty wiped out.

My gut feeling is that Ezra was just not ready to be born, and that he would have come within a few more days of waiting.

Since then, I've become a "monster patient" - questioning everything and resisting when needed, but always respectfully.

Shari

Short Break

Taking a break for Passover. Will try to make up for it when back to normal and the matzah is out of my system.

Shari

April 7, Rainbow of Choices

This post is largely based on a brief article "Spectrum of Caregiver Choices" by Barbara Stratton of Baltimore ICAN. She believes it's important to understand your choices to promote the healthiest birth. Not every choice is appropriate for everyone, but in a relatively uncomplicated pregnancy they can all be seriously considered, and even compatible with certain complications. Homebirth might sound really "out there" if you've never really looked into it, but women all over the U.S. are turning to it in increasing numbers for very practical reasons. It's not an alternative lifestyle thing anymore.

A-----B-----C-----D-----E

A: homebirth with midwife
B: independent, freestanding birth center staffed
by midwives (not a hospital wing that calls itself a "birthing center")
C: independent midwife with a hospital birth
D: midwife as part of an OB practice
E: OB

Quoted material from Barbara's article, the rest mine.

"Generally, the farther left you stay on the spectrum, the fewer interventions (including cesarean) you will have with your birth. For example, a homebirth midwife may transfer 5% of her clients to the hospital for cesarean surgery while there are reports of obstetricians with 50% cesarean rates."

"It is important to understand the different types of care you get according to what type of provider you select. A laboring woman who has hired an OB for her care and whose baby is malpositioned (sunny side up for example) and having a stalled labor as a result will typically receive Pitocin to strengthen contractions. The Pitocin causes unusually strong labor pain and often results in the mother getting an epidural for pain relief and then being confined to bed." This may render her "unable to move in ways that help the baby navigate her pelvis." After a trial of this sort, it's not unusual to then move on to a cesarean.

"A hospital based midwife may suggest position changes to help the baby correct his presentation before resorting to Pitocin augmentation. A homebirth midwife may first counsel her pregnant clients on ways to avoid having a malpresentation to begin with (some hospital based midwives do this as well) and then in labor may suggest labor positions to help the baby rotate" as well as employing a number of other remedies and techniques to move past the barrier of difficult positioning. The mother attended by a midwife is also virtually guaranteed to be given the luxury of time to figure out what works for her.

"If you select a caregiver farther to the right of the spectrum then it is especially important to hire a doula who is well versed in helping babies be born and ensure that your doctor or midwife will allow you to use any of the remedies that may become necessary." I.e. they can help you negotiate the stress and urgency imposed by a hospital environment to achieve a more gentle and healthful birth.

Please note that unassisted childbirth is not on the spectrum. Barbara did not include it (I didn't ask why) and I would not include it. It is my personal conviction that planning an unassisted birth is unnecessarily risky. Many events occur in a birth that can be handled easily by a midwife but that could go wrong without a little proper attention or birth "first aid". Of course, babies are born at home and in taxis and such by accident and most do fine, but I'm not going to recommend it here.

This article is one person's survey of her local birth choices in Madison, Wisconsin. Find out what the choices are in your area.
http://www.thedailypage.com/isthmus/article.php?article=5245

Shari

April 6, A helping hand

If you feel it would be helpful to have someone nearby who can help advocate for you and nurture you through stressful moments, consider hiring a doula. A doula does not take the place of your husband or other close companion, but provides her own special services. She can help you avoid some pitfalls and interventions by suggesting alternatives, and providing physical and emotional comfort.

A doula is someone you can engage well before the birth or just at the end. You should allow time to get to know each other. The doula is ideally someone you trust, someone reliable, knowledgable, and someone who will be proactive but unobtrusive. Best to check references with her prior clients, and don't be afraid to switch doulas late in the game if you aren't comfortable.

Learn more here:
Doula Organization

April 5, It's in the Numbers

If you like stats, I've got a nice chapter for you to browse from another Henci Goer book entitled "Obstetric Myths Versus Research Realities." The beginning of the book is a primer on how to read medical research, but if you're not up for that, skip to page 21 to the chapter 3 "The Cesarean Rate."

You can read a few interesting chapters online without buying the book, and if that sparks your appetite, try the library.

You will see some of these topics:
- "C-Sections are not responsible for improved perinatal outcomes." That is, while c-section rates have skyrocketed, the rate of infant survival hasn't changed much.
- "Non-medical factors influencing cesarean rates."
- "The women having c-sections are the women least likely to need them."

You might say this all sounds very biased. However, the author backs up every point with articles and research published in respected journals, and provides an indication of the quality of research for each reference. It's up to the reader to evaluate their trust in the information and always look at both sides of the coin.

Shari

April 4, Playing with the Big Dogs

When you enter the birthing system by visiting your OB, midwife, or going to the hospital, you are joining the play of a complex game and probably don't even realize it as a first-timer.

An expectant couple ranks as novice playing a round of "manage the birth" with seasoned experts. (I hate to say "against" as that is non-productive.) The pros have the medical knowledge and hands-on experience, of course, and that is what we depend upon. However, there is a lot more to the game than meets the eye.

In fact, the players actually have different goals.

Parents' Goal:
Maximize points by producing a healthy baby and mother.

Practitioner's Goal:
Maximize points by
* Ending with a healthy baby, and bonus points for a healthy mother too
* Avoiding lawsuits
* Keeping malpractice insurance
* Keeping medical licenses
* Working within practice and hospital policies
* Following medical insurance company regulations
* Maximizing profits
* Dealing with a hectic schedule of many patients
* Protecting personal time
* more...can anyone name some more?

I can't even begin to guess at all the rules OBs are under to satisfy parties other than parents and baby, but you can feel them at work if you are aware enough.

Let me make it clear that I am not trying to paint a devilish mustache on every OB who plays this game. They are required to do it. I am sympathetic to some extent that OBs often have to make decisions that go against their medical expertise in order to please all of these parties in a severely flawed system. More on this on another day. However remember - you are playing to achieve your goal, not to help the OB. His or her external constraints are frankly not your problem unless you fail to realize how they affect you.

In order to manage your birth, doctors use many techniques. Consider what techniques they might employ to max out points shown above (e.g. keep labor short, follow a birthing protocol, offer pain meds, overly conservative advice, schedule inductions, etc.) To manage you, they need to manipulate you. Selective factual information might be offered to influence you to take a test, have a scan, accept a drug or procedure, be induced. Resistance, delay, or questions require emotional manipulation which is very hard for parents to counter. The bag of tricks includes silence, closed gestures, frowning, worrisome stories, horror stories. My OBs were never shy to pull out "you might want to do this or your baby could die". This one efficiently disarms parents' critical thinking skills whether at an office visit or worse while you are tethered to monitors and IVs in the hospital after a few hours of labor. One of them said this to me at an office visit in front of my four year old daughter who eagerly awaited the birth of her little sibling. I was livid but decided not to choose that battle at that moment.

There is an enormous doctor-patient power differential and OBs deftly use it to get whatever result they want. They are very good at the game. And please remember, they want a healthy outcome for you and baby, but they don't get enough points by satisfying only you. They must satisfy all the other stakeholders who control their livelihoods. Your goal is much simpler - you get maximum points for healthy baby and Mom, and you might need to play hardball to make it happen. It's stressful, but worth it.

You cannot become an expert in any of these areas before your baby's birth. But you can become aware that you are indeed in a game, and you must be ready to play it or simply be a pawn. Research, questioning, thinking, and heart to hearts with your mate about your comfort level and values will help you navigate this system with better results.

Here's a highly respected book you can get online or in your library. There is a section on power differential.
The Thinking Woman's Guide to a Better Birth, Henci Goer

Have a good game,
Shari

April 3, It's the Pits

So far I've really been running off at the fingertips. I'll try to start pacing myself today.

Here is a wonderful article about (read against) overuse of Pitocin for inductions. There are a few surprises in here, and lots of information that's hard to come by elsewhere in layman's terms. It goes far beyond hard contractions and possible rupture.

Before you hear "Let's induce you with Pitocin and get this ball rolling", read this and think thrice.

Let the Baby Decide, A Case Against Inducing Labor (2001)

Again, I am not trying to scare you if you need an induction - we are just learning together while we have the luxury of time before the due date.

Enjoy! I'd like to hear your objective feedback.

April 2, Think 42

What's the rush to give birth on your due date? The due date is an average. While some women labor at 39 weeks, many more go all the way to 41 or 42 weeks. It gets a bit hard to sleep at night. You may have aches and pains as you go on. However, if you can keep your spirits up and think of 42 as the finish line instead of 40, it can really reset your attitude in the last lap.

Induction before 42 weeks is rarely a necessity, however it is very popular with physicians. You will hear about placental aging, which happens at different rates in each woman. Most of the reading indicates that the placenta typically ages just a bit more at 41 weeks, and more significantly AFTER 42 weeks. The increase is small, while risks associated with induction (which often leads to c-section) are much higher.

You might be warned about a big baby/macrosomia. It's unlikely to be bigger than you can handle. Cut out the sweets if you are worried - stick to whole wheat bread and fruit. It's better for you both anyway!

You might be warned of low amniotic fluid/oligohydramnios. Be suspicious of this if they try to whisk you away directly to the hospital. Where's the fire? Get a detailed test. Ask HOW LOW? Ask what the parameters are for your week of pregnancy, and see how close you are to them. Realize the test is imperfect. If it is very low, an induction might be a reasonable response. Take the info home and think about it overnight and do your research. Sometimes the baby really needs that extra few days safe inside you before sending out its labor signals.

Think 42! It will keep you sane the last few days when you really just want that baby in your arms and when the "where is the baby" phone calls are non-stop. Make sure your OB or midwife knows that you are comfortable with 42. Let them know that unless it is an obvious medical emergency, inductions discussions should not even begin until 41 or later. Most experienced OBs know this is safe, but are under external pressure to act otherwise. Don't let malpractice corporations run your birth - go with the facts and intuitions of YOUR pregnancy.

Articles:
Is 42 too long?
Induce? Give me a good reason.

April 1, Don't Like Them Odds

No fooling! The most important time to learn about c-section is BEFORE your first baby! The World Health Organization calls for a max c-section rate of 15% in any nation in the world. Anything above that "seems to result in more harm than good," according to the British medical journal Lancet 2006. Did you know that about 32% of all U.S. births are now c-section? Does this sound necessary? Of course not! Think about it - really sit down and consider why, and whether you are willing to be uninformed at birthing time. In 1965, c-sections were only about 5% and infant and mother mortality were similar to today's rates. Who does "defensive medicine" really help? Hmmmm.....

Childbirth Connection
Childbirth Connection Link
Cesarean section and everything you need to know about cesarean birth.

Cesarean Awareness Month - My Challenge

April is Cesarean Awareness Month.

Learn about C before you step foot in a hospital!

This is a very important issue to me, so my goal is to post one idea about C-Section every day this month. Please send this link to every child-bearing person you know, including the Daddy!

For those of you who don't know me, our first son was born via c-section in 2003 after an induction at 42 weeks and long labor. Reason was failure to progress. If I had waited a few days longer, tried other positions, walked, and let nature help instead of doctors I don't think I would have had that unfortunate first cut. The surgery was not traumatic, but it set me up for increased risk with future births, and carried its own risks. I was very naive then but began to educate myself.

In 2004 I was induced via pitocin at 41w3d and gave birth to our daughter at 9lbs 2oz. I had to engage in an unpleasant and discouraging political battle with my OBs as the establishment was strongly against VBAC. I am well aware that pitocin induction carries certain risks, and is worth avoiding if you can, but I still felt it was better than a 2nd c-section. Read up on the relative safety of VBAC.

In the 34th week of my 3rd pregnancy, my doctors proclaimed "absolutely no VBAC induction" and "natural labor by 40w3d or automatic C-section". They were also generally discouraging about VBAC overall and loved to regale me with horror stories. Given my history of long pregnancies, I felt cornered by the new rules (now becoming more common across the country) and began looking for alternatives, going into major research mode. VBAC bans nationwide are reaching hysterical levels, and are based on insurance and malpractice issues instead of on the health of mother and baby. By the way the "ban" is a bluff - you can do what you want if you push back hard enough - patient's rights. I gave birth to our third child, a son 7lb15oz, at home in the hands of my husband, sister and experienced midwives. It was as perfect as childbirth can be (yes it hurt a little!)

My best advice is to put down What to Expect When You're Expecting, and spend much of your pregnancy gaining knowledge about nutrition, birth, minimizing interventions, and avoiding c-sections. Women were created to birth successfully, and in most cases that is the healthiest way to go. Avoid that first cut for the best long term reproductive health! C-section is a true life-saver in a true emergency, but these are not so common. Have faith in your body's ability to birth a child. Get your husband or SO involved in the learning process! Find your inner cavewoman!

I am not a medical professional or birth professional, just an experienced and self-educated Mom. That is why I am providing links so you can learn it from the pros.

International Cesarean Awareness Network
ICAN Online Link
The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth.