More Business of Being Born VBAC Segment

I was so excited to watch this. I thought that I would enjoy lending it to clients of mine, and had even prematurely asked if my Professor friend over at the college would help me set up another campus screening with a followup Q&A about VBAC.

Boy was I wrong. So, so wrong.

The VBAC segment was not only mostly one-sided, the risks were over inflated and misrepresented. The title of the segment is a load of crap, because it really DOESN'T talk much about what a woman's options are. It shows the incredible amount of unbalanced information that is out there, especially from OBs.  A sound resembling a dying cat escaped my throat every time I heard the words, "attempt a VBAC", "try to have a VBAC", and "trial of labor". Yes, this is OB lingo. And while I will agree that in the hospital it really IS "attempting" a VBAC, because hospital VBAC "attempts" are rarely successful...and even less so if we look at the big picture and include women that start out interested in having a VBAC, and then are dissuaded by the OB...it is hurtful language. I believe in the power of words. What if we told each mom who wanted a natural birth that she was, "attempting a natural birth", or that she could, "try for a natural birth"? What does this imply? This, to me (and many other women) implies great room for FAILURE. Never mind that most natural birth "attempts" are hindered by the hospital staff, or by lack of support, or by lack of knowledge.

What if I told my clients that I would be happy to help them "attempt" a home birth? Holy cow, that would be scary! That would leave their minds open to the idea that they are likely to end up in the hospital, and not with the home birth that they planned for.

One thing that they did portray accurately - though I'm sure wasn't the intention - is the fact that the Obstetric system is NOT set up to support VBACs. The doctors interviewed spoke openly about issues with hospital protocol, and mainly, liability insurance. And that's what it comes down to. Not risk. Not a woman's ability to have a VBAC. Politics.

One of the most common things I have heard from women and OBs is that a VBAC isn't allowed at a certain hospital because they are not equipped to handle emergency surgery. Let's think about this for a moment. A uterine rupture is HARDLY the only emergency that can come up during childbirth, necessitating immediate surgical delivery. Cord prolapse, placental abruption (both of which occur more often with intervention, for the record) both would fall in this category. If a hospital isn't equipped to handle a VBAC, it isn't equipped to handle ANY birth. Period.

I screamed outright at the screen when a woman was interviewed who had found a supportive OB, and planned for a VBAC. She labored at home before going in. Once in the hospital, her OB discussed the need for her to progress consistently and timely (?!?!?!?!) in order for her to have her VBAC. He discussed breaking her water to speed things up if need be. (!?!?!?!?!?!?!)  She was a good girl and progressed from 7cm to 8cm in an hour. Then an on-call OB came in 2 hours later and checked her AGAIN, and found her to "still" be at 8cm. Started talking cesarean immediately. She mentioned breaking her water (!!!!!!) and asking for her OB to be called in. The doctor was upset that she was refusing medical advice. Her baby was fine. She was fine. But she had not progressed in 2 hours - or so the new OB said. Her OB was called back in, and in this Mama's words was, "So gracious to allow me more time". OMG! So gracious to ALLOW you and your perfectly healthy baby more time in labor?!?! Let's give her OB of the year award, shall we? The OB said she MUST progress to 10cm quickly, and baby must be descending.

She got to 10cm. But baby was not descending. What did she do?

She said that she had already put her OB in a difficult situation, and she knew it wouldn't BE FAIR to her OB to expect more. She agreed to a cesarean.

SHE AGREED TO A CESAREAN AT 10CM, BOTH HER AND BABY WERE FINE. ALL SO THAT HER OB WASN'T MADE TO BE UNCOMFORTABLE?!?!?!?!?!?!?!?!?

This is what happens to a HUGE chunk of women who think they are going to have a hospital VBAC. They get HUGELY manipulated into thinking that they should be FAIR to the person they *hired*. At the expense of their body, and their baby. They agree to surgery that is NOT medically warranted...because they love their doctor.

One OB who was interviewed said that the risks of VBAC may *seem* low, but that those low risks can come with catastrophic results. Hmmm...so can induction of labor. How many women has he ordered induction for, in his years as a doctor? How many amniocentesis has he performed? An amnio comes with a higher risk of death to the baby than a VBAC does. (1 in 200-400 vs 1 in 2000)Yet, many women wouldn't blink an eye at having an amnio done if their doctor said it was best.

I recently read a study that said that women are more likely to go along with whatever their doctor says is the right course of action, regarding a VBAC or a ERCS. Regardless of empirical research that shows that a cesarean comes with a 2-4x greater risk of death for both mom and baby, if a doctor says it's best to do - most moms will go with it.

The study was a survey provided to women upon admission for their elective repeat cesarean section (ERCS) or trial of labor after cesarean section (TOLAC).  I am really shocked at the level of knowledge most of the women had. 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture.  54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture.

So then I question - are WOMEN really making the choice if they are presented with inaccurate information? If they are willing to agree to major abdominal surgery on the suggestion of their OB? This is NOT informed consent. This is manipulation in the most base of forms. Women need to do their research. I've said it before - women research the type of car seat to buy, crib, diaper bag, more than they research their options in birth and weigh the risks/benefits of each. In our culture, however, we are pretty much brainwashed to view our doctor as our authority figure and not question. I have seen this with friends. Their OB lied to them or misrepresented risk, and they ended up with a cesarean. They go BACK to the same OB and talk to him/her about a VBAC. One of two things occurs most often:

1) OB says, "Well, you could TRY, but with your history of __________, the chance of needing an emergency cesarean - which is more dangerous for baby - is high. It's up to you though."  (yeah RIGHT)

2) OB says, "Sure, you can TRY for a VBAC. It doesn't LOOK like your issue should repeat." and then finds a reason at the end of pregnancy as to why a VBAC isn't going to happen. OB seems supportive, and then lovingly (HA!) finds a gentle way of telling mom that it doesn't look like a good idea after all.

Do you think she's going to switch care providers? For most women, no. It's this sick dependency thing we have going on, along with a very twisted romancing of complications and emergencies in birth and "needing" to be saved. Apparently this ranks higher than empowerment and an innate knowing that we are MADE to birth.

Anyway, back to the film. A doctor who was interviewed was asked to touch on the subject of HBAC - Home Birth After Cesarean. He inflated the risks. He talked about needing an OR available immediately - which is NOT GUARANTEED in the hospital!!! Nor is it evidence based. Studies show that you have 20-30 minutes to get to baby after a uterine rupture is suspected. Guess what? They can't have the OR prepped and ready in less than that in the hospital. But then he followed with, "Of course, a woman has to make this decision for herself."  HA! How many women do you think would choose this, or even do her own research if she was told that her baby is likely to die if she ruptures at home? (Let's go back to the fact that uterine rupture occurs in only 0.3-0.7% of VBACs, and those include the most common, asymptomatic uterine dehisciences, and that the risk of catastrophic rupture is a fraction of the 0.3-0.7%!)

Even Dr. Moritz admitted that in the hospital a VBAC has to go PERFECTLY. He called it a "Cinderella Birth." Which is realistic, how?? He also admitted that if there are ANY fluctuations in baby's heartrate, that it would be an immediate cesarean, without waiting any time at all to see if things were fine. Never mind that external consistent monitoring is highly inaccurate.

If I had been a mom watching the film for information on VBAC, I wouldn't be compelled to do my own research. I would walk away from the film with the idea that I should talk to my OB, and should act on his/her recommendation. I wouldn't look into my options, I would acquiesce to my doctor's advice and not think twice about it.

Ricky Lake and Abby Epstein had the opportunity to REALLY explore the problem with our current cesarean rates, and the extremely low rate of VBAC in our country - and they failed miserably. The only SLIGHTLY redeeming factor of this film is the birth story at the very end. Mom refused to bow to scare-based protocols of her local hospital, and planned a HBAC instead. Even in the face of the OB who refused her a "TOL" (trial of labor) calling her at 34 weeks to say that he would ALLOW her to TRY after all, she continued with her plan. It showed the very emotionally damaging effect that cervical exams can have, especially in a VBAC, when she was checked to be "only" 1cm, and wanted to give up and go in for a cesarean. Instead, her husband rallied by her side and helped her pick back up her resolve. She had a beautiful HBAC in the water - where she caught her baby herself.

But really, More Business of Being Born?? ONE positive, empowering story in all of an hour?? ONE? And the ONE woman you had talking about the risks of repeat cesareans - which are MANY - was not a "professional", but a mom. How does that look to people? The "professionals" are reiterating the risks and limitations of hospital VBAC, and a non-formally educated woman is citing the risks of surgery. Totally biased in presentation of risk/benefit. The risks of repeat cesareans were skimmed over, and the HUGE problem of care provider manipulation, hospital protocol, and misrepresentation of VBAC risks were barely touched on in the right way.

A study done on the morbidity rates of repeat cesareans:

METHODS:
Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).
RESULTS:
There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION:
Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

And these are JUST the risks associated with repeat cesarean for MOM. This also doesn't take into account the rates of infection, the increased risk of DEATH, nor does it take into account the difficulty of healing from major abdominal surgery while having multiple children (and a newborn) to care for.

Once a woman has had a successful VBAC, her risks actually DECREASE for future pregnancies.

RESULTS:
Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION:
Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.

The problem is that when women are given the MISREPRESENTED information about VBAC, very few who are initially interested end up having one. So they end up in the category above - at higher risk for serious complications with each subsequent pregnancy. We have a HUGE issue on our hands here, and most days I feel hopeless for change. With women refusing to do research on their own, because it might mean choosing a different OB (or - :gasp: - a Midwife, increasing her chance of a successful VBAC!), or standing firm and choosing a VBAC against the advice of her care provider....we are going to continue to see a very high rate of uninformed women choosing repeat cesarean. We will also see higher rates of complications in pregnancy, and eventually, higher infant mortality.

And the root of the problem lies in the lack of ethics and evidence based protocols in Obstetrics, where it is commonplace to manipulate, scare, and even bully a woman into intervention that increases her risk of that primary cesarean. Women NEED to become better informed of what empirical evidence says about the common issues that arise in pregnancy, labor, and birth. Until women make a stand and demand better care, these risks will only continue to increase.

Brilliant Repeat Cesarean Patient Plan

Step 1:

Convince first time moms that pregnancy and childbirth is so dangerous and so scary that they need to hire a trained surgeon (OB) to care for them. Even though pregnancy and childbirth are physiologic events. After all, things can go wrong at ANY MINUTE, right?

Step 2:

Convince women that heavy monitoring and/or induction and/or epidural and/or cesarean is going to be necessary. Small pelvis. Past due date. Low fluid. Big baby. Small baby. One or two higher blood pressure readings. Water broke without labor.

Step 3:

If women refuse labor induction, find a reason to scare the shit out of them. Most often? "YOUR BABY WILL DIE IF YOU DON'T ACQUIESCE!" Your baby will be too big, and will get stuck in the birth canal. Your baby is in distress because we found meconium on the bio-physical profile at 41 weeks. Your baby has little to no fluid left, and can die. Your pelvis is just too narrow...we'll LET YOU TRY, but you will probably need a cesarean. If you attempt a vaginal birth with a breech baby, you will kill/harm/damage him. If you attempt a vaginal birth with twins, you will kill/harm/damage them.

Step 4:

Begin induction on a woman whose Bishops Score is unfavorable. Crank up the pitocin, even though the woman's cervix is not low, soft, or dilated. (Or barely so) Recommend an epidural so that the pain of the unnaturally strong (and unnaturally occurring) contractions can be taken away. Break her water artificially. Do internal exams every 2-4 hours.

Step 5:

As soon as the baby goes into distress as planned as you knew he would unexpectedly/mom gets a fever/placenta abrupts, explain to woman that she needs an emergency cesarean NOW, otherwise baby will die/be harmed. You DO WANT WHAT'S BEST FOR BABY, DON'T YOU?

Step 6:

Do not share with woman that according to evidence based research, it was a failed induction because her baby was not ready to be born. Or that inducing for "suspected macrosomia" is going against evidence based protocols. Or that inducing at 12/18/24 hours after water breaks is not evidence based. Or that inducing with a low Bishops Score is formula for cesarean. Or that inducing for low/no fluid is not evidence based.

Step 7:

Convince the woman that it was her body's fault, or baby's fault, that she had a cesarean. Your pelvis wasn't large enough. Your labor wasn't fast enough. Your body didn't create enough fluid at the end. Your baby didn't tolerate labor well. Your baby was too big. Your baby didn't come out when he was supposed to. Your baby wasn't in the right position.

End result?

Scenario 1:

A woman who is now even more scare of pregnancy, labor, and birth. A woman who believes that her body is broken, and that her body put her baby in danger. A woman who will be far too terrified to plan for a normal birth with the next baby. Who will plan her repeat cesarean for 39 weeks, since her body is too dangerous to try again.

Scenario 2:

A woman who will ask her "wonderful, natural friendly" OB (surgeon) if she can "try" for a VBAC, and will not do so because her OB (surgeon) reminds her that her body didn't do well the first time around, and it's safer to have repeat surgery.

Scenario 3:

A woman who will plan a VBAC, but will once again hire a trained surgeon (even though she's trying to AVOID surgery) and most likely will allow interventions in a normal pregnancy and/or labor (VBAC is still normal!) for the same reasons listed above.


Obstetrics, even though 2/3 of their protocols are NOT based on scientific evidence (according to the latest research), continues to claim 99% of women as "patients". Some people wonder why our cesarean rate is so high nationally, and our infant mortality rates are inexcusable. It's really pretty simple. Take healthy, low risk women with healthy, low-risk babies and convince them that they need Obstetric (surgical) care. Add this to the above formula, and you have almost guaranteed repeat cesarean clients. Higher revenue for doctors, insurance companies, and hospitals. (Let's not forget that with cesareans comes a higher rate of NICU admission - even more revenue)

Women - start thinking wisely. Research your options more carefully than you research the car seat, crib, diaper bag, or latest accessories. Childbirth is nothing to fear. Really.

Vaginal Birth a Safe Option After *Multiple* Cesareans

When you understand the actual statistical risks associated with a VBAMC (vaginal birth after multiple cesareans), you understand that the risk is really very small in terms of uterine rupture. Because of my personal history with VBAC'ing, it frustrates me when care providers of all types are afraid of rupture. They obviously haven't done the research, because if they had they would understand that the risk is just as low as other birth emergencies (such as cord prolapse). There are emergencies that can come up in *any* labor and birth, which is why it is important for care providers of all types to be prepared. But to be scared of VBAMC? It's just not evidence based fear.

Dr. Mark Landon has done multiple studies on vaginal birth after multiple cesareans, showing a risk of 0.9% for rupture in women who have had multiple prior cesarean sections.

You can read the bulletin here , and here is a quote from it:

Landon found that the risk of uterine rupture was 0.9 percent in cases of women with a history of multiple prior cesarean deliveries undergoing a trial of labor, compared with 0.7 percent in the cases of patients who had experienced only one previous cesarean delivery. These data challenge the notion that women with more than one prior cesarean are at dramatically increased risk for uterine rupture with a VBAC attempt.

“We looked at the outcomes associated with uterine rupture, including catastrophic outcomes such as stillbirth, or hypoxic brain injury to the baby,” says Landon. “And the good news is that the vast majority of uterine ruptures fortunately are associated with healthy infants. The absolute risk of catastrophic rupture with poor outcome is, in fact, quite small.”

So ladies - take heart! Not only is a vaginal birth POSSIBLE after multiple cesareans, it is also considered safe. Don't take no for an answer. If you are told no, if you are told that you don't care about your baby's life, if you are told that you will kill your baby ... find another care provider.

And here is a YouTube slide show of VBAMC to enjoy. :)

My Baby's Birthday, and My HBAC Anniversary

Four years ago today, I gave birth to my youngest child Megan. It was a triumph on multiple levels, as I had a cesarean with my second child, and was told that I would surely kill Megan or die myself if I "attempted" a VBAC. You see, I am prone to having larger babies ( those of you who have met my husband understand, lol ), I was closed with a single layer of suturing instead of double after the cesarean, *and* I got pregnant with her less than a year after my cesarean. I was told that all of these lined up would mean certain uterine rupture. The OBs who had agreed to "let me try", all gave me a gestation limit of 40 weeks. They all said that it would be an automatic repeat cesarean if I got to that point with no signs of labor in sight. And if she was looking to be "too big", it would be an automatic repeat cesarean. Basically, if I looked at them funny it would be an automatic repeat cesarean. It took some women from ICAN ( International Cesarean Awareness Network ) to challenge by beliefs about childbirth, for me to even look in a different direction.

Like most people, I believed that doctors know best. After all, they go to medical school for years and years, and HAVE to know all there is to know. It took me a while to learn that Obstetricians are NOT trained in natural birth. Most go through their entire residency without seeing a single truly natural birth, with the exception of the mom who walks in ready to push ... and even then everyone freaks out. Obstetricians subscribe to the belief that childbirth is a pathology, not physiology. Now, there are certainly exceptions to the rule ... just as not everyone home birth Midwife is trusting of the birth process, or best for mom and baby. But it took me from the beginning of my pregnancy, until 33 weeks, of research to come to this epiphany.

If there is one thing that I can tell women who have had a cesarean, and were told that either their body failed them ( pelvis is too small, labor was too long, cervix didn't open enough, body got too tired ), or their baby failed them ( baby too big, baby didn't come soon enough ) ... is to research their butt off. Because it is so much easier for a care provider to tell a woman that her body didn't work right, rather than to admit that baby and body just weren't ready, or that he/she ( the care provider ) unnecessarily intervened in the process, causing it to spiral into the operating room.

At 33 weeks I started calling Midwives. I was turned down by many. I was starting to lose hope of giving my daughter a better birth, because I knew it wasn't going to happen in the hospital. I was down to one last name ... and thankfully, God had us matched perfectly. Brenda is an amazing Midwife who serves women who need it the most, especially when many others would turn them away. Without her, not only would I not have given Megan a better birth, but I also wouldn't be the Midwife I am today.

I will premise my birth story by saying that four years ago, I wasn't where I am now in my beliefs about birth. There are certainly a few things that I would do differently. I do NOT advocate castor oil inductions by any means. Nor do I advocate artificial rupture of membranes. At the time, having my midwife break my water was a blessing. I was starting to pass out. But in my own practice, I have not yet found a valid reason to break the bag of waters ... leaving things to occur naturally in their own timing.

Now, without further ado, Megan's birth story. My triumphant ( and HARD! ) HBAC.

Megan Ohana Fiscer
November 16, 2005
10 lbs 10 ozs, 23" long



I had been doing the yucky prodromal labor think for what felt like forever. I had almost 6 weeks of contractions that would get so regular and start getting more intense, that I was sure it was "it" a few times. Even had my poor midwife drive out here in the middle of the night which ended up being for nothing. I had regular contractions all through the night on the 10th and called Brenda at about 4am. She came and when she checked me at 8:30 or so, I was a mere 2cm and not effaced much. Megan was also floating high still. I was crushed. Jeramy had the day off and since his grandmother had come up to help with the kids, we decided to go walking that evening to see if it would help anything. I had horrible pressure on my cervix and ended up passing some bloody show. Nothing more though.

The pressure on my cervix changed to a stabbing pain anytime I was doing anything other than sitting, so on Monday the 14th we decided to go walk around a shopping center that is a mile around. The pain was awful, but I wasn't having any contractions at all. I asked Jeramy to stay home on Tuesday because of the pain, and to help around the house. That evening I decided to call Brenda to see if we could try castor oil in the morning. ( Added note: At the point of Megan’s birth, I wasn’t at the point where I really believed that birth was best left alone … I still had a LOT to learn! ) The pain was really awful, and I was having an incredibly hard time getting around after my kids and doing much of anything. I was also a week past my due date and more than a little miserable ( I know, bad reason to try castor oil...but I felt I couldn't take it anymore ).

Right after I got the go ahead from her for the cocktail in the morning, I used the restroom and had at least 3 tissues full of mucous. I called her back to give her the heads up, as I went into labor the same night I passed mucous like that with Noah. I decided to go to Walmart to get some laundry detergent and some needed things and then came home and took a shower. I had been having very small contractions on and off all day, but not much of anything. After the shower, I began having really strong contractions all of a sudden. I went in to lay down to see if they were staying...and they only got stronger. Stronger to the point where when Jeramy checked on me I was in tears. I said it was time to call Brenda. He wanted me to make sure it was really time so she didn't come out again for nothing. I assured him it was! Jeramy filled up the tub, which I went back and forth from because I kept getting too warm. She got here at about 1 or so...and by that time I had already told Jeramy I wasn't sure I could do it. The contractions were very intense and I couldn't imagine it just getting worse. I was also afraid of how far I had progressed...not wanting to hear 3cm or so. When Brenda checked me I was happy to find myself at 5, and she could actually stretch me to 6cm. I tried getting back into the tub, but only ended up getting too hot again. I decided to go lie down in bed to try to cope with everything. I did okay for a while, until things got REALLY intense, at which point I would lose it when a contraction peaked and start shaking my head hard saying I couldn't do it. Brenda was amazing in helping me relax through some of them, reminding me to relax my entire body and even asked if she could pray over me...which I welcomed gladly. Back labor was awful, and my poor husband tried applying counter pressure when I almost felt like I jumped out of my skin...it didn't feel good at all, it only intensified things. I got up and labored on the toilet for a bit which felt good for a while, but then let out a grunt when it felt good to bear down. This alarmed Brenda, and she and Jeramy got the bed prepared. They got the shower liner under the sheet and the chux pads out on the bed. She decided to check me again to see if I was complete, but I was only at 7-8cm. The pressure was awful and I felt like I was having one big contraction and was starting to feel like I was going to pass out, instead of breaks in between. After lots of discussion, we decided to go ahead and break my water, and that helped TREMENDOUSLY. I was able to relax and sleep in between contractions somehow. By this point I had gotten REALLY vocal and was having a hard time relaxing during contractions at all. I started feeling pushy again, and when checked I was complete with just a little lip. Brenda said if I was feeling the urge to push, she could help move the lip out of the way. I began pushing and that became an exhausting experience. When I would push, burning pain would radiate through my hips. It felt amazing once I was really pushing effectively, but at the beginning of each push it hurt horribly. I was really becoming exhausted, and Brenda had me change to a side-lying position to push which seemed to be helping, but still not as effective. She suggested the toilet again, but I didn't think I could get up to it. So I rolled over and got on hands and knees and tried that way. Now I was REALLY screaming that I couldn't do it...I was too tired. Jeramy and Brenda kept reassuring me that I could, but I really needed to push. I was the only one that could get her out, and I needed to do it now. I ended up pushing more in a sitting/squatting position and even bit poor Jeramy's hand during one big push. Megan started crowning and I had never felt a burning sensation like that in my life. I was sure everything was going to split wide open. I remember the feeling of Brenda stretching me to keep me from tearing, hurting pretty badly as well. But getting her head out was the hardest. Brenda kept telling me I needed to push through the burning and get her out now, as she had been in that spot for a while and her head was kind of stuck behind my pubic bone. Megan was also going back up in between pushes because I couldn't hold it. So I pushed through the burning and felt her head come out, and then very quickly the rest of her slid right out. It was an amazing feeling.

I relaxed my entire body, still in that squatting position, onto the pillows in front of me. My hair was soaked with sweat and I was exhausted beyond belief, and also incredibly relieved that she was out. I smiled up at my husband and told him that I could feel her kicking against my thighs. They had me roll over, and Jeramy got to hand her to me, but had to be careful since the cord was short. She was beautiful. The first thing I noticed was how long her fingers were. She was so calm and alert. Jeramy was beaming and told me I did it and how proud he was of me. We waited for the cord to stop pulsating and then Brenda clamped and Jeramy cut. I spent some time admiring her, and then Jeramy took Megan out to the livingroom to meet her brother and sister and great grandma so that I could deliver the placenta. It wasn't hard at all, I just pushed and it came out easily. That also felt really good to get out. I was still burning quite a bit, but was laying back and relaxing knowing that the hard work was done.

Jeramy came back in with Megan, and I latched her on to nurse. She latched on immediately and did so very well. I asked if we could weigh her and get measurements...I was so anxious to see! When Megan was born, Brenda said she thought she was a good 8 1/2-9 lbs. Well, Jeramy was the one to weigh her, and he got wide eyed and asked Brenda if what he was seeing was correct. She looked at the scale and got the same look on her face! He then announced 10 lbs 10 ounces and I couldn't believe it. Furthermore, I couldn't believe when Brenda measured her and she was 23 inches long. I knew my belly had been huge, but never imagined she'd come near to 11 pounds. Jeramy went out and announced it to his grandma, who couldn't believe it either.

Brenda checked me for tears, and said it looked like I had one up towards my labia, and then one on my perenium and she could sew me up after I got cleaned up and showered. I tried twice to get up and shower, but while sitting on the toilet I almost passed out after the burning from peeing. So I was sent back to bed until I could get some fluids in and some toast. When I did take a quick shower and get back into bed a few hours after Megan was born, Brenda checked me to find that by me laying with legs together for so long, I was already starting to heal naturally. She had to really look for the tear she found before on my perenium, and she said there were only a few slits up towards my labia from the skin stretching, and those would heal on their own. As for the perenium, she numbed me, which didn't take too well...and I cried through the single stitch she put in. She said one would be enough along with me keeping my legs closed for a while. I was relieved not to have to endure another stitch. She gave me my instructions and a big hug and kiss and left us to our new family.

Recovery has been amazingly fast in comparison to both my previous vaginal birth, and the cesarean. It's amazing how things work perfectly when done naturally. My system didn't have to get over any drugs being pumped into me, or soreness from an episiotomy and stitches. Compared to a lot of homebirth stories I have read, I didn't feel mine went as smoothly, and I definitely didn't cry out that I would do it again after all was said and done...but it WAS beautiful. It was beautiful that my baby was handled gently at birth, not rubbed down and tagged with plastic and handed from one unfamiliar hand to another. She was treated peacefully and gently, and for that alone I would go through the pain all over again.

Neonatal Outcomes Better With VBAC

This is from the June issue of *Obstetrics and Gynecology*!! All of the things WE'VE KNOWN, yet they have been against admitting. Maybe the evidence of harm in ERCS is increasing?

Women need to be educated. That's the first step. They need to stop being so darn scared of the pain of labor, and educate themselves of the dangers of things like inductions, augmentation, epidurals, labor narcotics, artificial rupture of membranes, and delivering in the hospital period.

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Neonatal Outcomes May Be Better With Vaginal Birth After Cesarean Delivery

Laurie Barclay, MD


June 3, 2009 — Neonates born after elective subsequent cesarean delivery have significantly higher rates of respiratory morbidity and neonatal intensive care unit (NICU) admission and longer length of hospital stay vs those with vaginal birth after cesarean (VBAC), according to the results of a retrospective cohort study reported in the June issue of *Obstetrics & Gynecology*.

"Controversy remains on whether a trial of labor or an elective repeat cesarean delivery is preferable for a woman with a history of cesarean delivery," write Beena D. Kamath, MD, MPH, from the University of Colorado
School of Medicine in Denver, and colleagues.

Wait? What?!?!?! Didn't the study prove that outcomes were better with VBAC?

"Historically, concerns regarding the increased risk of uterine rupture and perinatal asphyxia in trial of labor after cesarean compared with planned repeat cesarean have swayed obstetricians away from recommending a trial of labor after cesarean delivery; however, the absolute risk of perinatal asphyxia remains small."

Um - the risk of Uterine Rupture is approximately 0.3-0.7%. And that's not the risk of death with UR. The actual risk of death of baby after a Uterine Rupture is a FRACTION of this less than 1% risk. And the OBs are swayed against recommending it - why?? And historically? Really? Is that why the VBAC rates were HIGHER 10 years ago, and the cesarean rate lower?

The goals of this study were to compare the outcomes of neonates born by elective subsequent cesarean delivery vs VBAC in women with 1 previous cesarean delivery and to compare the cost differences between these
procedures. The study cohort consisted of 672 women with 1 previous cesarean
delivery and a singleton pregnancy at or after 37 weeks of gestation. Participants were categorized based on their intention to have an elective subsequent cesarean delivery or a VBAC, whether successful or failed. The main endpoints of the study were NICU admission and measures of respiratory morbidity.

Compared with the VBAC group, neonates born by cesarean delivery had higher
NICU admission rates (9.3% vs 4.9%; *P* = .025).

:Nods: I lived through the absolute HELL of this.


Rates of oxygen supplementation were also higher in the subsequent cesarean group for delivery room resuscitation (41.5% vs 23.2%; *P *< .01)

:Nods Again: Noah was on CPAP the first 2 days, intubated the following 2 days, and then on a nasal cannula for the remainder of his 9 day stay.

and after NICU admission (5.8% vs 2.4%; *P* < .028).

DOUBLE the risk of NICU stay - did you catch that?!?!

The rates of delivery room resuscitation with oxygen were lowest in neonates born by VBAC and highest in neonates delivered after failed VBAC.

Yep. I can see that. "Failed" VBAC = Another Cesarean Section. Cesareans are harmful for baby. Got it.

Although the costs of elective subsequent cesarean delivery were significantly higher vs VBAC,

And women really believe that their surgeon - Ooops! I mean OB - don't get paid more for elective surgeries? They can schedule it around their personal schedule, and they're in and out in about a total of 2 hours. Hmmmm ...


the highest costs for the total birth experience were for failed VBAC, considering both delivery and NICU use.

I would LOVE to see hospital VBAC success % vs Home VBAC success %. Those of us who know, know that VBACs are more likely to be successful at home, due to a NUMBER of different factors.

"In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay," the study authors write.

And yet, women are still told that VBAC is too dangerous. Really?!

Limitations of this study include relatively short postpartum follow-up of the mothers to determine the additional costs of postsurgical complications and insufficient data to allow estimation of costs other than those for hospital care.


Even if you don't know a whole lot about Cesareans vs. Vaginal Birth, it is a pretty logical conclusion to believe that complications are higher after surgery, correct? This study didn't account for those women who had to go back into surgery because of an infected uterus or incision. It didn't account for those who were sent home with Home Health Care Nurses, because they had to pack their incision for several weeks.

"Given the increasing rates of primary cesarean delivery and the concomitant decrease in VBACs, once a woman has had a primary cesarean delivery, we must consider the risks that this places on her subsequent deliveries and subsequent neonates," the study authors conclude.


Hmm. Okay study authors, are you suggesting that cesarean sections not be recommended for the slightest thing, as they are now? That would require OBs not intervening in normal labor as much as they do. That would mean not breaking a woman's water, not restricting women to the bed, and not recommending inductions or augmentation. Start THERE!


"Indeed, this argues for greater selectivity in performing a cesarean delivery in the first place, and certainly a greater need for counseling before a primary elective cesarean delivery.

The ways that "elective cesarean delivery" are used though, is what needs to be examined as well. My cesarean was labeled "elective" in my surgical notes. Did I ultimately consent? Sure, after having the crap scared out of me by my OB. Do they account for coercion? Abuse of perceived authority?


As investigators continue to search for ways to make cesarean delivery safer,

Wait - WHAT?!?! There *AREN'T* any ways to make cesareans safer. It's MAJOR ABDOMINAL SURGERY! You are literally removing a baby from a woman's body - most of the time before the baby is ready to be born. And has anyone missed how rough a cesarean can be for a baby?

we may be better served by exploring other means for reducing overall cesarean delivery rates and recognizing our own preoccupation with the individual that will be our patient, whether it be mother or neonate."

Not very intelligent or witty, I know - but my only response to this is DUH!

*The study authors have disclosed no relevant financial relationships.*

*Obstet Gynecol*. 2009;113:1231-1238.

Free in Southern Utah - Midwife Open House and Business of Being Born Screening

Meet the Midwife Open House and Film Screening!

Bring your girlfriends, neighbors, pregnant ( or hoping to be ) friends! Hope to see you there!

Christine Fiscer - Traditional Midwife
www.joyfulbirthservices.com
(Please excuse the kinks - still working some out )

I am a new Midwife to Utah, originally from California. I will be hosting an open house on Saturday, August 8th at 6pm. Business of Being Born showing at 7:30pm.


*Watch Ricki Lake's birth documentary - The Business of Being Born
*Free initial consultations
*Q&A about Home Birth, Waterbirth, VBAC, Twins
*Raffle for a handmade Mei Tai Baby Carrier

I am located in Hurricane, just 2 1/2 miles from I15 on State Route 9. Email JoyfulBirthServices@gmail.com, or call 435-216-5411 for additional information and directions. **Please RSVP if you plan on attending.**

Cesarean Awareness

There are people who might look at this title, and think "What is there to be aware of?". So often now people view cesareans as just another way to have a baby. Rarely are the true risks of a cesarean told to expecting couples, and those are usually the immediate risks that are mentioned ( most often in passing ), nevermind the long-term risks that a cesarean can create.

I am involved in a new organization called BirthAction. The site is still in progress, but we very much hope for it to be a hub for pregnant women to come and receive well-rounded information on everything pregnancy. Kind of like What To Expect When You're Expecting, just with accurate information. ;) We'd like it to be a place where women can come and find information about routine pregnancy screenings ( like ultrasound, afp testing, gestational diabetes testing, Rh sensitization, gbs, etc ) and make informed decisions about their prenatal care. It also offers tips on how to avoid a primary cesarean, tips on how to optimize the chance of a successful VBAC, information on home birthing, unassisted birthing, water birth...and everything in between.

In our goal to create awareness about the risks of cesarean sections, I designed the poster that I am putting on this page. Women need to think long and hard before agreeing to a cesarean for reasons that are not life threatening, and to elective ( or coerced ) repeat cesareans.

I am five years out from my one and only cesarean, and I have what will probably be life-long side effects. For the first time in my menstrual history, I have irregular periods, endometriosis, and PCOS. This did not occur until *after* my cesarean. I have had hormonal problems, weight gain, and much pain as a result. It breaks my heart when I hear of women resigning to a cesarean for a "large" baby, for a breech baby, or for twins. It breaks my heart and makes me want to throttle doctors when I hear of elective inductions, inductions for "large baby", inductions because mom hits 40/41/42 weeks. It makes my stomach drop when I hear women count down to their due dates, because they obviously are unaware that a due date is simply an estimation, NOT a guaranteed date of arrival. It makes me cringe when women call themselves "overdue" when they are a few days past 40 weeks. They do not know that they are not a bit "overdue" until after 42 weeks. Technically, according to medical literature, not even until after 43 weeks. It's 42 *completed* weeks.

So many cesareans can be avoided. If women would come back to the knowledge that their bodies are strong. That they are capable. That pregnancy is not a condition or disease or pathology. That they do not need drugs to begin, or to get through their labor. That their baby is healthier when they allow labor to begin, and to occur naturally. I wish that women would stop believing that there is something wrong with their body, or that they are not strong enough to endure labor without the blasted epidural.

Women need to wake up and realize what is being done to their babies.

When a Woman's Body Fails Her

Within the past month, I have heard more than a handful of stories where planned vaginal births ended up in "emergency" cesareans, and mom was given a diagnosis of either FTP or CPD. More horrifying, I keep hearing of *ELECTIVE* cesarean surgery, to avoid the pain or possible injury of a vaginal birth, because a woman is led to believe that a VBAC is just too risky, or because she "cannot" find a care provider to support her in one. I continue to be utterly baffled by the mentality in our society, surrounding cesarean sections, ie, major abdominal surgery. The risks are pasted all over the internet, warning women about choosing such a dangerous mode of delivery, and yet...we have the highest cesarean rate that we've ever had as a country. There's absolutely no excuse for a 31.1% ( and that was 2006, we don't know 2007's rates yet! ) cesarean rate. The WHO has recommended a national cesarean rate of NO MORE than 10-15%, which means that roughly 1/2-2/3 of *all* cesareans done are unnecessary!

I'll say it again. Roughly 1/2 - 2/3 of ALL cesareans done right now are unnecessary.

Does that not bother anyone? Ah, but I get the myriad stories of "My body wouldn't dilate", "My baby was too big", "My pelvis was too small", "I have already had a cesarean, and my OB ( SURGEON! ) wouldn't 'do' a VBAC".

I did a recent poll on a mommy-site, to see what reason women were given for their "emergency" c-section. 85% of them said that it was an induction ended in either FTP ( Failure to Progress ), or CPD ( CephaloPelvic Disproportion...pelvis too small, baby too big ). And they believed their diagnosis, because why would their doctor lie to them? They tried *everything*, and their baby just could not come out naturally.

Why is it that women are so ready to believe that their body failed them, rather than the SURGEON that they hired, screwed them over? Maybe not intentionally, no. I'm not saying that all Obstetricians are evil, and I'm also not saying that ONLY Obstetricians are the cause for unnecessary cesareans. Midwives can be just as bad, if not more damaging, IMO. But, let's face it. Women are hiring trained surgeons, but begging to avoid surgery. Why?

Let's go over a VERY common scenario:

First time mom, hires an OB because that's "just what's done". Plans a hospital birth. Really wants a natural birth, or as natural as she can "handle". Excitedly prints up her birth plan, that includes "No cesarean unless absolutely necessary", and has her doctor sign it, who is happy to do so, and says to patient "I ONLY do cesareans when necessary!". Patient gets to her due date. Doctor begins to check her cervix, that is yet "not doing anything". Cervix is high, thick, and closed. Doctor begins planting seeds about induction being necessary if patient is still pregnant by 41 weeks, because her body may need a jump start. And, baby might be a bit bigger since the baby has not dropped.

Mom may not necessarily want to be induced, but trusts that her doctor knows more about childbirth than she does, because she's never given birth before, and he's seen thousands of deliveries.

Does this sound familiar yet?

Patient gets to 41 weeks, cervix is still high, thick, and closed. Baby has not dropped. Doctor fails to inform patient of her Bishop's Score ( chart that can predict the likely success of an induction ), and says to head over to the hospital for an induction the next morning. Doctor also fails to tell patient that the labor hormones are more potent at night ( which is why women usually begin laboring at night ), because it's more convenient to schedule an induction during business hours.

Patient is excited, and nervous, and doesn't do any research, because she believes that she will go in, have baby, and leave hospital happy. She arrives at the hospital between 6 and 7 am, signs paperwork, is monitored, blood drawn, and cervadil is usually administered. For doctors who don't care about the risk of DEATH, cytotec might be administered instead. Patient must lie in bed for roughly an hour, and then is *allowed* to walk the halls if she wishes. But, needs to sport her IV pole and sexy hospital gown as well. Patient is checked a few hours later, and the cervadil has softened the cervix a bit, but hasn't done much dilation wise, so she is informed that the Pitocin is being ordered, and will be started shortly. With the pitocin comes constant monitoring, because of the risk of overstimulation to the uterus, though she isn't told this risk.

Sometimes, the doctor will also suggest breaking the bag of waters, to get things moving more. Patient is not told the risk of causing, or cementing, a malposition along with this procedure, nor of the risk of distress to baby by causing head to hit pelvis unnaturally. ( Meaning before it would have broken on its own ) So now, patient is in bed ( or in a chair if she's *allowed* to be out of bed ), dealing with the unnatural contractions that pitocin brings, and will shortly ask for the epidural that she didn't really want to resort to, just a few weeks ago.

She is given her epidural, and left to lie/sit in bed, while not being able to feel much from the hips down. She is likely not told of the risks ( both short and long term ) of the epidural anesthesia, to both her and baby. However, she signs a blanket consent form, without reading, and happily gets a very long needle inserted into her dural space. She is checked a few more times, and is told that she is making progress, but slowly. So, the doctor is ordering that the unit of pitocin is turned up a bit. Sometimes they will then insert an internal monitor for both contractions, and for the baby's heartrate. The one for baby is a monitor that *screws into the baby's scalp*. Patient is not told of the risk of infection to baby in doing so.

When she is checked again and found at the same dilation as the last two checks, the Obstetrician comes in and talks to her about CephaloPelvic Disproportion, or CPD. He explains to her that her pelvis is not large enough to allow the baby to drop, nevermind be born through it. He tells her how good of a job she has done in labor, and that she gave it her absolute best. He explains that if they continue, there is a risk of injury to the baby, since her pelvis is too small to allow him/her to pass through. He tells the patient and her partner, that he can do a cesarean section, and they can see their baby within 30 minutes. He has a team waiting in the OR.

Or, alternate outcome....patient is finally found to be 10cm, preparations for the birth begin. The bed is broken down, the stirrups are pulled out, and the doctor dons the facemask, surgical gown, gloves, and turns on a very bright light. Mom is told when to push, where and how to push, and for how long. The baby's descent is seen, but baby continues to go back up after mom pushes. After a few of these, the doctor explains that he is going to help mom out, by using a set of forceps, or a vacuum extractor. The "aid" is placed, and doctor pulls on baby, to try and assist in the delivery. After a few tries, the doctor tells the patient that her pelvis is not large enough to allow the baby to pass, and that is why the baby never descended, and that is why the baby was not able to be born, despite the aid of forceps or vacuum. Patient is rushed off to an "emergency" cesarean.


I'm sure anyone reading this has heard a story ( or several! ) that runs along these exact lines. Is it that there are now so MANY women who cannot deliver their own baby, or have screwed up bodies that fail them in the one thing that they were LITERALLY designed for? Or is it that Doctors and Midwives are failing women in not informing them of the risks of the things that they walk into willingly, and equally, the fault of the women for not doing research for the most important thing they will ever do?

It makes me so incredibly sad, and so incredibly angry that women would rather believe that their body is broken, rather than understand that they weren't given a fair shot, and that their choices ( in care provider, place of birth, interventions ) failed them instead. I will agree though that it is MUCH harder to take responsibility. I didn't want to believe that I could have avoided my cesarean, or that I could have avoided my son being in the NICU. That was one of the hardest things that I have ever done. To realize that my choices led to what happened to my body and my son, was heartbreaking.

I don't wish heartbreak on every woman out there who had an obviously unnecessary cesarean, but I do wish that women would become educated. I would rather heartbreak, than elective repeat cesareans. I would rather heartbreak than the belief that a woman's body just didn't work for them, and failed them in becoming a mother.

So above, what went wrong, and why?

* First time moms with a low Bishop Score, is up to 80% more likely to have a cesarean section due to the body not being ready for birth.

* Pitocin is known for causing distress in a baby, as it causes unnaturally strong contractions. If a baby wasn't ready to be born to begin with, the baby was not ready for *any* labor, nevermind unnaturally strong labor.

* Artificially Rupture Of Membranes ( AROM ) is known to sometimes cause a malposition in baby ( if baby is not low in pelvis ), or cement a bad position such as posterior, asynclitic, transverse. It can also cause distress, as the baby's head could have gone from outside the pelvis, to rammed *onto* the pelvis, with no cushion.

* Drugs or Epidural anesthesia are known for slowing or stalling labor progression. The medication also passes through the placenta, and into the baby's blood stream. This can lead to breathing depression, lethargy, problems nursing, and lower apgar scores in baby. Epidural anesthesia can also lead to a spike or drop in blood pressure for mom, fever ( which will be treated as possible infection ), headache ( that can last for weeks ), infection at the injection site ( that can lead to Staph ), nerve damage to the back, and in extreme cases...paralysis.

Epidurals also inhibit the pushing phase. Not only is mom unable to get up into varying positions to facilitate a larger pelvic opening ( lithotomy position causes the pelvis to be up to 20% smaller than in other positions for birth ), has a high risk of instrumental delivery, and perineal injury. Controversially, epidurals increase the risk for cesarean delivery because of these factors. When a woman has an epidural, she cannot efficiently feel when/where/how to push. She loses the ability to push effectively, therefore leading to the risk of higher rates of instrumental delivery.

* Vacuum delivery comes with a list of its own risks to baby. The most common is a hematoma, or a pocket of blood underneath fibrous covering of the skull bone. This can result in a "lump" the size of the vacuum cap. Also common are "superficial" markings to the scalp, or splits in the skin. Less commonly, these can be open to infection. Less common risks include neonatal jaundice, intracranial hemorrhage, and retinal hemorrhage.


But the most damaging risks, in my opinion, are the risks that come with a woman believing that she did everything she could, and that her body just didn't work right. Women anymore have so little belief in their body's ability, and don't look at the risks that come with each of the interventions that are allowed into a normal labor.

My desperate goal is to get women to make more careful choices in care provider, place of birth ( What is your doctor's cesarean rate? What is the hospital's cesarean rate? What is your doctor's track record with NATURAL - not just vaginal - births? What is your doctor's instrumental delivery rate? What's your doctor's episiotomy rate? ) Women need to make truly INFORMED decisions. Not just take the word of their care provider ( whether this be OB, Hospital Midwife, Birth Center Midwife, Home Birth Midwife ), friends, family members, and online pregnancy sites. Women need to understand the possible consequences of their decisions.

So many women believe that inductions are harmless, and therefore don't research the MANY possible risks. Many women believe that epidurals are harmless, and therefore don't research. Many women sign up for repeat cesarean sections, believing that it's safer than a VBAC ( Vaginal Birth After Cesarean ), without actually doing the research.

Women, we're smarter than this. And yet, we allow our instincts to be overridden by a care provider with a medical degree, or a mom who has had more children than we have. We allow our empowerment to be taken away by believing that the hospital is the safest place for ANY birth, and hand over our autonomy as soon as we check in.

I feel helpless so often, because it's constantly pointed out that I have no medical degree. It's true, I don't. But I have devoted the past 4 years to study pregnancy, childbirth, and ALL that goes along with it. Four years to this alone. Every aspect that comes with each. I have attended women in birth who had previously been duped into believing that their body didn't work, and watched as they labored beautifully, and then reached down to welcome their baby into their own hands. The incredible moment where they learned that their body worked just as it was designed to do. When they didn't have any separation from their baby. No nurse taking baby off to the nursery for "observation". No separation, but immediate bonding. Immediate smell, touch, love. Breastfeeding as soon as baby is ready, not when a nurse says it's okay.

I have the honor of attending women in birth, and watching as they unfold in childbirth, and regain their power.

Here is a video of women who were told that their body failed them...and went on to discover that it was their care provider, rather than their body, that failed them.




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Bishop Score and Risk of Cesarean Delivery after Induction of Labor in Nulliparous Women

http://www.ncbi.nlm.nih.gov/pubmed/15802392

Risks of Epidural Anesthesia

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

http://www.breastfeeding.com/helpme/epidural_anesthesia.html

http://www.transitiontoparenthood.com/ttp/foreducators/ceinfo/Side%20Effects%202.htm


Risks of Vacuum - Assisted Deliveries:

http://www.fda.gov/cdrh/fetal598.html

http://childbirth---labour-delivery.suite101.com/article.cfm/the_truth_about_vacuum_deliveries

http://jama.ama-assn.org/cgi/content/full/289/1/46

http://content.nejm.org/cgi/content/extract/341/23/1758

Color me a feminist?

It's interesting to me how people are labeled - either according to beliefs, personality, opinions, or affiliations. I have been labeled so many things that it appears I am quite the hypocrite, depending on how you look at it. ;)

I've been labeled a feminist by some Christians, because I don't believe that the husband should be the governing authority when it comes to childbirth.

I've been labeled a right wing Christian for my staunch Pro-Life beliefs, and beliefs that the husband is the head of the household. We won't even get into the fact that I believe that women have no place, biblically, in political authority. Hehe.

I've been labeled as Anti-Cesarean as a whole...because yanno...ALL cesareans performed are necessary. A doctor would NEVER do something that isn't necessary.

I've been labeled as too militant when it comes to home birthing, unassisted birthing, etc. Silly me for believing that birth MATTERS. ;)

I've been labeled as too much of an advocate.

I've been labeled as not enough of an advocate.

I've been labeled incompetent by someone who portrays herself to be whatever the people in front of her are. Talk about a chameleon!

I've been labeled knowledgeable by those who have taken the time to inquire about me.

I've been labeled naive.

I've been labeled dangerous, for believing that a woman has the ability to birth safely without any sort of "professional" around.

I've been labeled a smart ass. I don't mind that one so much. ;)

I've been labeled as passionate.

And on rare occasions, I have been labeled as life changing. Sometimes, my beliefs and opinions and passion have been able to make a difference in someone's life. It's quite an honor to be told this!

Do I flip flop because I can often see a point to two sides? I don't think so. I think this makes me a contemplative individual. For example, as I already said, I am staunchly pro-life. I don't think that there are any good reasons for aborting a baby. And I've heard all of the arguments, so don't think that this is an open invitation for an abortion debate. It isn't. However, I am actually NOT for deeming the baby to be an individual with rights of it's own in the womb. Why, you may ask?

Laura Pemberton. She is a mother of 8 in Florida. In her last pregnancy, which was a VBAC, she had decided on a home birth. During labor she felt dehydrated and went into the hospital for an IV ( I'll leave comments about this to myself ), and once there was refused treatment unless she consented to a cesarean. She was told that if she didn't sign consent, that a court order would be started. So she fled out of the back of the hospital at 7cm, to go back home.

She resumed a labor pattern at home. Not long after returning, she had the local sheriff and state attorney in her bedroom. They had court orders for a cesarean. They forced her onto a stretcher, and into an ambulance. She pleaded and screamed. She was 9cm and was able to feel her baby's head when they cut her open.

Why did they do this? They deemed that she was acting in negligence, and that she was violating her baby's rights to a safe birth.

The government tells us that they deem it negligent to birth our children at home. They tell us that it is negligent to teach our children at home. They tell us that it is negligent to refuse vaccinations. They tell us that it is negligent and abusive to spank our children on the bottom when they misbehave. Most families don't stand for their homeschooling rights to be taken away. Most families don't stand for their disciplinary rights to be taken away. Why is this a lesser issue?

So for the first time in my staunchly pro-life life...I can agree with the pro-choice side. I am a VBAC mom. What if someone had gotten a hair up their butt, and had decided that I was being negligent with Megan, and had strapped me down and cut her out of my body? When is it up to the government to decide that it is their job to tell us what we can and cannot do with our families? And that's such a sticky statement, because I don't believe in true abuse being ignored. Birthing at home, homeschooling, spanking children on the butt....these are not abuses.

And in all of this...the once Republican me ( because of my parents ), really opposes McCain and Palin in the White House. I am dumbfounded over the information that keeps coming out about Palin. Most recently, the information that she cut funding on Rape Kits being available at no cost to rape victims, because it includes emergency contraceptive. And on the flip side of that, she hunts ( for sport, not survival, obviously ) wolves and bears from planes. So she can be pro-life when it comes to babies ... to the point where she will not fund help for rape victims ... but she can murder helpless animals from a plane. So incredibly noble. :-/

I don't know what I am politically. I'm really not keen on labels for this either. But boy I wish that Ron Paul had stayed in the race! LOL

So there ya go. Political and personal rants all in one blog. :phew:!

A Healthy Baby Isn't ALL That Matters

This was a post from March 26th, 2008. It is being published in one of the upcoming issues of Midwifery Today. :)



There are so many details of my cesarean that I have either left unwritten, or have written in fragments in various locations. A reply back to an online thread regarding the “safety” of a cesarean; or to a mom who is being told that her baby will be too big and she needs to have her baby surgically removed.

But you see, my story doesn’t just end when we brought our son home from the hospital on Palm Sunday in 2004. My journey began when I found out I was pregnant in 2003, and it continues every day. Some days I wish it would all just be over with. Be done with the deeply seated emotional pain, be done with the physical pain of ongoing adhesions and endometriosis from my cesarean – even 4 years later. The ongoing torture of the emotional pain could have been avoided, I suppose. However, in 2005 I made the decision to take the red pill. And for those of you who paid attention during the movie The Matrix, you’ll get my analogy here. The red pill enables us to see truths that we otherwise would have never believed. The red pill takes us out of the “habit” beliefs – simply believing what we are told or what we were raised to believe. On the other hand, the blue pill enables us to live in the “ignorance is bliss” state. Never digging deeper, simply being happy with the things we believe and never questioning the origin or the author. So, in 2005 I made the choice to swallow the red pill. The reality that had been mine in childbirth, was shattered as I learned more. And as I gained more knowledge, my guilt and anger grew over what I had done to my son; and also pain for the vast number of women who do the same to their children unknowingly.

Just before my son turned one, I found the ICAN support list. To this day I don’t remember exactly how I found it, but I did. I was still of the mindset and belief that some babies simply grow too big for mom to deliver safely, inductions are perfectly acceptable, and epidurals should be used by every woman. I joined the support list, totally oblivious to what I was walking into. Women who were totally angry over their cesareans, marriages compromised due to lack of support or differences in birth beliefs between a woman and her spouse. Women having their babies at home, after having undergone a cesarean with a prior pregnancy. Basically, a group of crazy women. Or so I thought at the time. I defiantly challenged their arguments that claimed it was intervention, not size, that caused my very difficult first birth and recovery. The harder I fought it, the more information and resources they flung my way. After a few days of this, I sent out a post calling them all crazy, and then unsubscribed. Six little words posted by a woman who is known for pulling out a wet fish when needed, haunted me and really made me think. “Damn. She took the blue pill.” The nerve! Crazy, fanatic, rude women! Who were they to tell me that my cesarean was unnecessary and avoidable? But it planted a seed…

I began to research all of the things that they had challenged me with. Little by little, that seed began to sprout. Three months later I returned to the list, apologized for calling them all crazy , and asked for help.

So why am I telling you about ICAN and my beginnings with it if I am not writing this about my VBAC? Well, because without ICAN I would have continued to believe that my babies were just too big for my body. I would have continued to believe that there is nothing wrong with cesareans. The day that I re-subscribed to the ICAN list, is the day that I chose the red pill. I no longer wanted to live in ignorance, because after all…ignorance is what led to my son spending 9 days in the NICU.

Ironically, it was my son’s 2nd birthday that hit me the hardest. On his 1st birthday, I was still learning, and not quite convinced yet that the cesarean wasn’t necessary. But by that 2nd birthday, not only did I know from research that it had been unnecessary, just five months earlier I had pushed out my VBAC baby onto my bed. She was 10.10lbs and posterior. By body had never been broken – I was only told that it was. As I began to really process through this, I realized just how alone and misunderstood I was outside of the ICAN list.

“He’s healthy now, that’s all that matters.”

From my friends, my mom, and even my husband. No one knew how damaging those words were, even though they were not meant to harm. I didn’t understand. How is him being relatively healthy now, negate all of the harm that was done to him in his first seconds, minutes, hours, and days of his life? When a woman is trying to heal from a rape trauma, do people essentially tell her to get over it…at least she’s safe now? But people are almost offended when the two are compared. Cesareans take place every single day and are accepted – even CHOSEN. So then, would it be different if many women didn’t mind their rape experience? What would happen as a society if we as women told rape survivors, that their experience was acceptable, because women are raped all the time? How damaging and belittling would this be? Cesareans are major abdominal surgeries. And so many women are lied to, coerced, and convinced to have one. Many occur because of a cascade of intervention during labor that never belonged there to begin with. As a society, we have strayed so far from what birth is – a normal, physiologic process. We’ve turned it into an ugly, scary, medical procedure. No wonder so many women are scared of it. All they hear are horror stories. You have to dig for the beautiful and unhindered birth stories that ARE out there. They are just not as common as the “You’ll be begging for the epidural…” stories. I’m afraid that until women take a stand for their babies, that our daughters are going to have to figure this out for themselves.

So, back to my cesarean.

The story is quite simple. I was young, I had delivered a larger-than-average baby vaginally 2 ½ years prior. The recovery from that birth was long and hard, and I had always been told that it was because she was 9.1lbs. Not the pitocin, AROM, stadol, or the forced pushing that ended up in a large episiotomy and vacuum extraction. I was terrified of another birth and recovery like this.

I met with a new OB late in pregnancy, because my former OB refused to induce me even though my son was showing to be over 8 ½ lbs already, and I did NOT want to go through the hell that I went through with my first. Yes, I warned you…I was completely ignorant. This new OB agreed with me about size, and went on to tell my husband and I stories of large babies and shoulder dystocia, nerve damage, and broken collar bones. He said our best plan of action was a cesarean, and soon, since my son was only putting on weight at this point. We agreed, even though my husband and I both discussed later how we had a slight uneasy feeling about all of this, but shrugged it off as uneasiness over the unknown. The very next morning I went in for an ultrasound and NST. During the NST it was discovered that I was contracting quite regularly. Upon a vaginal exam, I was told that I was 4cm dilated, and would be having the cesarean that afternoon, instead of the next morning. I was nervous, but the thought of finally meeting my son was what I kept focusing on.
A lab technician came in and drew several vials of blood. Then a nurse came in to start my IV, administer Terbutaline to stop my contractions, and to insert a catheter. My mind was in a whirl as I was being prepped for surgery, and trying to get a hold of my husband to get back to the hospital. He had dropped me off, thinking that I was just going in for routine pre-surgery stuff. He arrived, as did my grandmother in law and my mom. My husband was told that he could not go into the OR with me, until my spinal block was in place, and they were ready for the surgery. I was terrified, and I had to leave the one person that I trusted most in this world, behind. The one thing I asked before walking in was that they cover the instruments. I didn’t want to see what they were going to use on my body. They found this a bit strange, as they said that they have never had a patient request this before. Surely I couldn’t have been the only one afraid of being cut open, could I?

The nurse walked me into the OR. I remember how cold it was. It was like walking into a sterile vortex. Bright lights, blue paper sheets everywhere, trays, oxygen devices, and nurses in full face masks and scrubs. It was surreal. I sat down on the operating table, trying to brace for the spinal. I was absolutely terrified beyond my wits that the spinal would not work, and I would feel them cutting into my body. I began to cry as the anesthesiologist prepped my back for the insertion of the catheter, and a nurse stood in front of me in efforts to console me. She made eye contact and told me that everything would be okay. I just cried. I don’t remember a whole lot of the tiny details from here. I remember seeing my husband’s face come into view above me when he entered the room, and felt him touch my hand. I remember my Obstetrician “joking” about how we’d better get the show on the road if he was going to make it to his office in time for furniture to be delivered that evening. I remember slowly falling asleep from the drug cocktail that was placed in my IV, and desperately trying to stay awake. Then, it hit me. The smell of my flesh burning as my OB cauterized at each step. I tried hard to tell myself that it was the oxygen mask on my face. I was smelling the oxygen. I am only smelling the oxygen.

My OB announced that the baby would be here in just a few moments, and that I would feel lots of pressure as the nurses pushed on my fundus to get baby out. I said that it felt like she was sitting on my chest, and they joked and said she was. I heard a suctioning sound as they announced that his head was out. I felt the tugging sensation release when his full body was pulled from mine. I waited to hear him cry. Waiting, waiting…and nothing. I kept asking what was going on, and received no answers. I turned to the side to see people in blue working vigorously on him. I was falling asleep. Then, I finally heard him cry, and let go a little bit. They bundled him up, and put him to my face to kiss quickly, and while he was in front of me, he once again stopped breathing. I have pictures of us in this moment, and he was so very grey. As soon as I had kissed his cheek, they pulled him from me, placing him into an Isolette and whisking him off to the NICU. I fell asleep as I was being sewn back up, and wheeled to recovery.

Then, a moment in time that I will never forget. The neonatologist visited my husband and myself in the recovery room, and stated that my son had experienced two seizures. They needed to find out why. I was asked to sign a consent form for a spinal tap. You’re probably thinking that it’s unforgettable because I learned that he had experienced two seizures, right? Well, it’s unforgettable because I remember thinking that it was no big deal. I was so drugged up, so out of it, that it never even occurred to me to feel worry about my son. To even ask if he was okay. I signed the consent form, and fell back asleep. Later on that afternoon, as I was moved to my post partum room, I remember asking about him and not understanding that he needed to stay in the NICU. I was on the phone telling a friend that he had arrived, and then told her that he was in the NICU being checked out and would be in my room with me later that day. No one told me otherwise. No one told me much of anything, come to think of it. I continued falling asleep off and on throughout the day, sometimes even while my poor husband was mid-sentence. It wasn’t until he went home that night and I sobered up a bit, that I asked about my son. They said he was having some breathing difficulties and that I could see him in the morning. I was again confused, but again didn’t worry much because no one was seeming to make a big deal out of it. I requested a pump to help my milk come in, so that I would be ready the next day. I pumped every 3 hours that night.

The next morning my husband arrived, and I had already had my catheter removed and had the nurses help me up to the bathroom. We prepared to go to the NICU to see our son…for the first time since the surgery. No one did or could have prepared me for what I was going to walk in on. I was under the impression that he had mild breathing issues, and just needed observation. What I walked into was a mother’s worst fears. He was in his own little room, because he needed around the clock observation. When I entered the room, I couldn’t believe what I saw. He was in an open isolette, sedated, horribly swollen, and hooked to many lines and machines. He wasn’t moving. I began to cry as over and over in my head I kept repeating “This isn’t my son. This can’t be my son, they’ve made a mistake. This isn’t my son.” This fragile and broken baby couldn’t possibly be the one who was too big and healthy for me to deliver vaginally. He was swollen…he didn’t look like me or my husband! That couldn’t possibly be our son. I could not hold him, so I touched him and cried quietly. I stayed for a while until I couldn’t stand anymore. My belly was hurting, as was my back and the rest of my body. As my husband and I went back to my room alone, I just cried. He remained strong and just held me and told me that everything would be okay. I wasn’t so sure. After all, they had told me that my son would be big and healthy.
One of the hardest parts of the hospital stay was being the only mom on the floor who was without their baby in their room. I listened as babies cried in the next room, and then were promptly consoled by their mother’s touch. By nursing at the breast. By their mother’s soothing voice. My baby was in another place. He was in darkness induced by drugs. He was listening to the sound of the machine’s beeping, and by the sound of the nurse writing notes in his chart. My arms felt so empty, and I felt so helpless.

Two days after he was delivered, as my husband and I prepared to see him again, we were stopped by a NICU nurse. She explained that they were intubating Noah, and to please wait in the family waiting room for the neonatologist. I was confused, worried, frantic, and crushed. He had been doing just fine on the CPAP. I was so afraid that he wasn’t going to make it. The neonatologist came in after 15 minutes or so of agony, and explained that Noah had taken a turn that morning, and the CPAP was no longer as efficient as it needed to be. We asked questions, mainly why was this happening. He was the biggest baby in the NICU, by far, and was full term. He explained that this is a common side effect of babies delivered by cesarean. Why hadn’t our Obstetrician told us this while he was telling us all of the myriad risks of delivering a large baby vaginally? Why hadn’t we been told? He couldn’t answer those questions for us. We were allowed to go in and see our son a while later, and all I could do was cry. I couldn’t even talk to him, because it made things worse for me. I just stood and stared as I held his tiny little limp hand. There was no reaction, no ability to grasp my finger. Emptiness.

The very next day, we had been told that they took the intubation tubing out overnight. The neonatologist said that he had never heard an intubated newborn scream so loudly, and that Noah had tried pulling at it. They sedated him once again and pulled the tubes out. He was now on a nasal cannula. I still was not allowed to hold him, and it was killing my heart because I was scheduled to be discharged that afternoon. I had continued to pump around the clock to leave colostrum for them to administer through his g-tube. It was heartbreaking having to leave him there under the care of strangers, and head home with empty arms. Beginning at four days post surgery, I was driving myself back and forth to the hospital to visit Noah. Finally, on day four I was allowed to hold him for the very first time. I remember the gut wrenching feeling of placing him back in the isolette because my guts and back were hurting from the surgery. I had waited so long to hold him in my arms, and I then failed to be able to do it for long. I was told that the next day his g-tube would be removed if all was well, and he could begin feeding by mouth. I left explicit instructions for them not to feed him by bottle, that I would be there to breastfeed him. Thankfully, they respected my wishes, and I was able to breastfeed him for his first feeding. The poor baby was choked by my rush of breastmilk, as my milk had already come in. It was awkward to try and breastfeed when my belly was so tender, and he had tubes everywhere. I returned 3 times a day to feed him. I would often call the NICU in the middle of the night during pumping, just to see how he was doing.

It was finally on day 9, Palm Sunday, that we were able to take our son home. During his NICU stay, they had not figured out what had caused his seizures. They did a CT Scan, an ultrasound of his brain, X-rays, blood tests, the spinal tap, and an EEG. They found nothing abnormal. Once he was through with his round of antibiotics and did well on room air, he was cleared to come home. I was nervous, excited, anxious, and scared all at the same time. I had never cared for a sick newborn before. Yes, he was fine when we took him home…but I had images flashing in my mind of the baby that I walked in on the day after the surgery. These images still haunt me.

I know that I will carry guilt with me for the rest of my life. I have taken responsibility for my role in his delivery and his NICU stay, even though it was all done out of ignorance. I firmly believe if my son had been perfectly healthy after the cesarean, that I never would have learned my lesson. Sometimes we have to learn things the hard way, and sometimes God has a reason and a purpose for what He allows us to endure. Had I not found the ICAN support list, I’m sure I wouldn’t be who I am today, and be so passionate about birth today.

So you see, a healthy baby is not all that matters. A healthy mom matters too. A healthy birth matters. Just because a baby is healthy after a delivery, does not make everything that happened during the delivery any better or safer or healthier. And this doesn’t just apply to cesareans.

Oh…for those of you who are wondering…my son only weighed 8.8lbs.

This is my story. My journey. Today is the 4th anniversary of when I was told that my body was incapable of safely delivering my son. And tomorrow is the 4th anniversary of my c-section. Happy Birthday precious Noah. Even though this was written with tears, in a whole host of bittersweet emotions.