Tuesday, December 7, 2010

The Standard of Care Conundrum

When you think of the Standard of care in obstetrics, what comes to mind? Obviously your views on pregnancy and birth will dictate what you think the standards of care in obstetrics should be. However if you were to look up what the standard of care means in obstetrics, you'd get wide variety of definitions. Most commonly there are two schools of thought. The first is the Legal definition. This applies to the various standards of practice that should be done in order to maintain a good legal standing. For example, continuous fetal monitoring is considered a good way to indicate to a court of law (if you are doctor who finds him/or herself on defense there) that you gave proper standard of care to a mother whose baby ended up stillborn. The other school of thought is defining the term as the means of care that would be rendered by the majority of well-trained individuals. The latter is a little more tricky because it begs the question; which well-trained individuals are we talking about? Furthermore, with this definition, who sets the standards? Certainly many would say ACOG, but we must remember there are guidelines ACOG encourages that even members of their own group refuse to practice. It's also worth noting that not all practitioners, namely skilled and trained midwives, agree with some if not most of the practice guidelines set forth by ACOG.

The most compelling of the two main definitions is the implications for promoting the practice of defensive medicine. For those who are not familiar with the term, defensive medicine is basically medical practices designed or applied to avert the future possibility of malpractice suits. Let's take for instance the example I gave before of continuous fetal monitoring. Research and evidence shows that this practice is not only often times applied unnecessarily for every woman in labor, but in fact can cause more harm than good. Continuous fetal monitoring is connected with increased risk of false alarms, unnecessary interventions, increased need for pain medication, and even an increased risk of cesarean section. Yet with all the research that shows that intermittent monitoring with a doppler is just as effective and safe, doctors still apply continuous fetal monitoring with an EFM to many if not every woman, largely due to the fact that it protects them in case of a law suit.

One can now ask how policies such as continuous fetal monitoring be considered the Standard of Care if they can cause so many complications? Furthermore, how can true standards be set if there is not clear cut understanding of who has the authority to set them, or if they aren't guided by the best evidence? These questions expose what I like to call the Standard of Care Conundrum. It's the inherent flaw of our maternal health care system. Sure on the surface they all seem like gold standards, that is until you asked the dreaded three letter question: Why? Why exactly does a woman with a normal pregnancy have to be strapped to a bed throughout her labor? Why is it standard and widely accepted that a mother have a non-medically indicated induction at 39 weeks? Why is the cord clamped immediately after birth? Why, why, why? If any of the answers to these questions come from a place of legal protection to the physician this should be unacceptable! If any of the answers are skirted, ignored, or meet with an explanation from the stone ages of birth practices this should be unacceptable. Furthermore, if your questions breed contempt or agitation from your physician, not only should this be unacceptable, but you should run for yours and the life of unborn child!

Now we come to what the answer to all of this is? While many would say home birth is the answer, I strongly disagree with this. Home birth is the answer for some (I am having one this winter myself) and it's an option certainly every woman should be able to explore, but it's not the answer for all. Nor should it be. We have a system adopted long ago that was always broken. As much effort that is applied in making home birth a viable option for all women who can choose it, should be put into repairing that broken system. We need to fix it so that it becomes a viable option for women who want it, and an acceptable alternative for those who must choose it due to complication with their pregnancy. In short, as consumers we need to see to it that better standards are set and applied. These standards should not only put the safety of mother and baby first, but honor the mother's desire to birth in a way that she chooses. It's important for us not shy away from the fact that if we truly want better standards we are going to have to demand them. Change only going comes from the voices of dissent!

- American Academy of Family Physicians, May 1, 1999

Thursday, November 11, 2010

My choices are better than yours!

A short while ago I was reading an article about the safety of home birth. The article was well written, concise, and to the point about how home birth can be a viable option to many women in the United States, however what really struck me was the overall theme of the comments section. Over and over I read comments that stated something that amounted to this: It's more important to birth your baby in a hospital where it is safe, than to have some spiritual, or hippie like experience. This sentiment is echoed by doctors and women alike. Even ACOG stated that "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby"

I find this line of thinking somewhat hypocritical and here is why: Many times the same women who make comments like the ones above, are the same that can be heard saying she wanted to enjoy the birth of her child and not be in pain. How many times have we heard of the nurse trying to convince a woman she isn't a martyr and that there are no rewards for women who endure the pain? Doctors are always selling the experience of easier, pain-free birth through epidural. Yet epidural does not come without risks, some of them very serious. By the previous rationale, aren't the women who choose epidural putting the experience of having a pain-free birth experience over the goal of having a healthy baby as well?

Now before anyone gets all riled up, I want it to be known, I believe epidurals have their place, but so does natural birth. It does come down to personal choice. So why as a whole, does our society value one personal choice over another? Some out there in pro-medication land may be quick to say that home birth holds more risk than a medicated birth and let me be the first to go on record and say you don't know what you are talking about. Yep, I said it and what's worst, I am NOT going to cite any references to back that statement up. I am not playing the statistics game today. I am blogging from a different place. Matter of fact it can be quite liberating stating my opinion as fact! Now I know why so many do it, but I digress. More or less risk is really irrelevant. The risks are there regardless and most times the risk of epidural is completely downplayed.

I've been pondering this double standard for sometime and while I can speculate on many different reasons one thing that comes to mind is ignorance. This is going back to my previous statement about people not knowing what they are talking about. The bottom line, people are ignorant. They are ignorant about home birth. They are ignorant about the real risks of interventions. They are ignorant about the driving force of hospital policies and procedures. They are ignorant about midwives. They are ignorant about the reasons so many women truly choose home birth. They are ignorant about the kinds of women who choose home birth. They are ignorant about their rights. They are ignorant about their choices. Wow, that's a buttload of ignorance. Now, I'm well aware these aren't the only reasons this double standard exist. There is the Hospital, Insurance, Doctor factor. We all know that song and dance, so let's get back to the ignorance.

See, the underlying problem that keeps coming up in these article's comments section and in conversations I have with people, not only in person, but all over the internet is that this ignorance often morphs into something I like to call willful ignorance. You try to share statistics, research papers, medical articles, journal entries, books, and just plain common sense with people and it falls on deaf ears. They say the information is tainted, bias, unreliable, or the completely ignore the evidence and harp on one regurgitated statistic of their own. Yeah I am looking at you she-who-shall-not be named! This is why I am writing this totally opinionated blog post. I'll write another one chalked full of evidence later, but for now I just want to get this off my chest.

So what is the solution? How can we allow for value to be placed on both choices. I think first we have to teach everyone, women, men, doctors, nurses, insurance companies, hospitals, to value choice . Because let's face it, many do not. The system isn't set up for valuing choices or informed consent and decision making and that crap way of thinking just spreads in our society like a disease. We devalue the choices women make that do not mirror our own, and what's worst, we devalue our own right to have choices and this couldn't be more evident than in the birth practices. So I guess once again, my opinion is that everything begins with choice. Owning them, having them, respecting others, and understand what they are.

Wednesday, September 29, 2010

Naysayers, hijackers, and Angry B*tches...OH MY!

Warning - Strongly worded rant, read at your own risk!!

I've had the privilege of being in some pretty heated, balls out, inspiring, eye-opening discussions over the course of just three short days. Some of these took place in person others over the internet. Indulge me for a few while I talk about the debates of the latter.

If you haven't already seen the post Racism and Low Birth Weight 101, by The Unnecesarean, it might be hard to completely get where I am coming from, but then again I think my point is kinda basic: When it comes to racial injustices, you don't have to fucking buy it, because it aint up for sale!

In regards to some of the many comments about the aforementioned post on The Unnecesarean, let me be the first to say, I understand healthy skepticism. I understand exploring other causes of infant mortality in blacks. I understand just having a different point of view. What I don't understand is this incessant need to divert the discussion from what the post is originally about, without really opening yourself up to any real discussion. Examples of the diversion/hijacking:

*Not all white people are racists (I don't remember the studies drawing that conclusion but whatever)

*I don't even know any racist people where I live (my personal favorite because, what the fuck does that mean?)

*What about Native Americans or Hispanics? Why is just about African Americans?

I'd like to address that last one. Here is the answer: Quite simply, because it is ONE study about African American rates of Infant mortality and any possible links to systematic racism. What the hell is wrong with that? It could as easily been a study about the Native American Community or another minority, and still be worth our attention and important enough for us to have an open mind with meaningful dialogue about it. I would find any study about any culture and their infant mortality rate compelling and worth my interest. We could, of course, debate the merits of how that study came to be, but doesn't that in and of itself require an open mind, a level of respect and understanding. Would there be as much resistance if we were talking about a culture of women in some foreign land or would we all be shaking our heads and fists in disgust and anger, outraged at the mistreatment of these other women? Of course, I can't say for sure, but I'm curious.

Lastly, the thing that really grinds my gears (this is a rant remember) is the sentiment I've seen these few days about how linking racism in this way is not scientific. The underlying feelings and some outright comments have been that you can't prove racism because it's how a person feels, namely the victim of it. Therefore, it has no real place in the debates about birth and especially birth outcomes. It's so utterly amazing that some of the same people I've seen make this argument about racism, champion a woman's right to use the term "Birth Rape", citing how you can't deny what the woman felt as she was victimized and her right to categorize what happened to her in birth this way. I know there is a huge difference between racism and that of rape (of any kind), but why does a woman's feelings in this aspect deserve our attention and respect, but the other does not. Why is the outcomes of trauma in birth and say the link to postpartum depression, or even negative outcomes on the mental well-being of infants, more plausible and worth more time and attention, than that of any links to negative outcomes of birth in African American women who suffer systematic racism? Further more, how did that post fail to link racism and it's outcomes on birth in a scientific or at the very least plausible way?

Saturday, April 10, 2010

Battles of The Birth

I woke up on the morning of September 28, 1996 feeling as I had for the last several weeks, like I'd be pregnant forever and starving. Whenever I look back on that day a surreal and eerie feeling comes over me, knowing how oblivious I was to the events that were about to unfold. Not only was I going into labor that day, but I was going into a battle that had bittersweet consequences. A battle that I lost, but set me up to fight a war I intend on winning.

It all started because of my feet. I spent the later part of the morning and early afternoon at my mother in-law's house, taking walks and standing around talking and having fun. After one of her sons noticed how badly swollen my feet were, I was convinced to go have it check out, "just in case". My instincts told me it was no big deal, but I sold out my instincts to her experience (she was the mother of four after all) and felt insecure due to lack of my own.

At the hospital I saw a doctor who check my blood pressure, my urine, my swelling, and my weight, then deemed it, drum roll please, edema! After looking in my chart he ask would I like to have this baby today. I thought he was humoring me so I said that would be great! He said something like, "Let's check your progress" and so now I was laying flat on my back naked from the waist down because of swollen feet. I was 4cm (as I had been for a few weeks), 50% effaced, -2 station. I can't really tell you why I remember all of that, but I do. He asked if I wanted to be induced and because I'd just read in my trusty "What to Expect When Your Expecting" book that induction entailed drugs, I said no thanks. Then things got weird. For the first time in all my vaginal exams I felt pain. It wasn't super intense, just painful compared to all other vaginal exams and by far more uncomfortable. So just like that, my membranes were stripped. No informed consent, no permission to do so, he didn't even tell me what he'd done. I had to find that out later. Also, for the record, I wasn't "due" until October 5th.

My first contraction came very soon after that, in the parking lot actually. I remember dismissing it as a stronger Braxton Hicks, and pressed on in my quest to get my fifth meal of the day. It was about 6pm. As the early evening progressed, my contractions got stronger and closer, but I kept waiting for them to be unbearable. My naive mind kept telling me I have want to cry or scream before it's time to go to the hospital. Sadly, it wasn't until I actually got to the hospital that I felt that way, and not because of any physical pain.

I arrived at the hospital shortly after 11pm and was greeted by a nurse who I felt clearly did not like her job or women. She moved without a purpose, practically cleaning her nails while talking to me. Everything she said was either dripping with sarcasm, disdain, or both and I swear she was popping gum. After I checked in, got the gown on in the bathroom, she insisted the first thing I do before going to my labor room was pee in a cup. I actually took the cup in the bathroom and tried a few times but I simply had no pee. When I told her this she stared at me blankly and replied: "We can't really do anything until we check your urine". I looked her squarely in the eyes, grit my teeth through the contraction and asked her: "What the hell does that mean?" Her reply: "Ma'am, we need your urine." My contraction was stronger and longer than ever before so I closed my eyes and rode it out. When it was over, I didn't open my eyes right away. In my minds eye, I glimpsed what this must have looked like. Me standing in the bathroom, door half opened, in a stupid Kaiser hospital gown. Her standing arms folded with that indignant look in her eyes. It irritated me. I opened my eyes and said: "I have no pee, I peed earlier use that." Then I pushed my way passed her. Round one over.

I have to admit that short exchange between me and the nurse took a lot out of me. I was feeling anxious and intimidated that I pissed off one of the people who would be "delivering" my baby. I felt like I'd made an enemy. It wasn't until I got into the bed, and had my first cervical check that I felt some relief. I was 8cm dilated. Awesome news! Then the doctor told me he was breaking my water. I remember looking over at my ex-husband who quite frankly looked like a lost tourist in all of this, and asked the doctor if we had too. He looked at me with extreme annoyance and said: "Either I break your water or your going home". My jaw literally dropped and the harshness of his tone brought tears to my eyes. I looked at my ex-husband again for help and before I could reply he did it. He stuck that hook into my vagina, rather roughly I might add, and broke my water. Coming from a woman who grew up with domestic abuse in my family (my dad beating my mother), both parents on drugs, and surviving sexual abuse myself, I can safely say it was the single most humliating and terrifying thing I'd felt since my childhood. He didn't just break my water, he broke my spirit that day as well. Round two over.

Everything after that was blurry. I remember vomiting. I remember not wanting my ex-husband more than a foot, if that, away from me. I remember being asked if I wanted something for the pain, but I don't remember what I said. I know I didn't receive pain medication, but I just can't remember what I said. Then I remember being told it was time to push. I didn't believe them, because I'd read that women felt the urge to push when it was time. I had absolutely no urge to push, but I didn't want to argue. God knows what they would have done if I argued. An image of foreceps delivery came to mind. It scared the hell out of me. However, when the nurse said to push during the contraction, I got a bit of my spirit back. Surely she was joking, I thought. She wants me to push when it hurts the most. I stalled. One contraction went by, then another, and another. Still no urge to push. In all honesty I had no urge to birth anymore. I wanted to crawl into my own bed, pull the covers over my head and cry. I didn't do that though. I held my breath, chin to chest and pushed. Just like they told me to.

As I was pushing, I heard the doctor (A totally new doctor by the way. Somewhere during my haze I guess they must have changed shifts or some such thing!) say something about tearing. I don't know exactly what she said, but I blurted out: "I don't want to be cut". Very shortly after that, my friend who was present for the birth, said: "Do you know she is cutting you". I didn't know. All I knew is my bottom was on fire and I felt like not pushing but people were yelling at me to push. All my focus was on that. I heard what my friend said, and I wanted to scream, but I didn't. I pushed. Then at 2:14am, my baby was born. Less than four hours had passed but it felt like a lifetime. Round three over.

Josiah, my son, was loud and strong from the beginning, but at the time I didn't care. I had very little interest in him. I just wanted to go to sleep. I can remembered feeling exposed as she stitched me up. The tugging and pulling I felt as she did it made me sick to my stomach. I remember feeling like nothing but a piece of meat. When she was finished, I mumbled something like everyone has seem him, you can go home now. I am not even sure anyone heard me, but after that everything was a blur. I don't remember what my ex-husband said or when he left. Or his mother, who was there, or my friend. I don't remember transferring rooms. I don't remember how. I just remember being in the bed and having my my uterus pushed on and my pad checked. It hurt like hell and was again humiliating having someone pulling at your underwear to check your pad. I asked if I could do it, and the nurse said something like I heard you were trouble. I shut up and let her do it. She was so smug and her touch was rough. I felt scared and alone and wished they allowed husbands to stay overnight. Round four over.

I remember not wanting to nurse Josiah anymore like I'd planned too. I know that I loved him, but I just didn't have anything to give just right then. I laid there, with him beside me in that glass crib that they put babies in and at that moment I needed him near me. I picked him up and as stared at him. I didn't really know what to think, except that he looked like his father to me. The thought made me smile. The smile warmed my heart and then I cried. I didn't really know why I was crying. Was I happy or was I sad?

Later that evening, I made the mistake of allowing him to be circumcised. He wouldn't nurse after that. I thought, he knew I didn't want him earlier when I refused to nurse him and now I let them hurt him, so he no longer wants me. I cried again, but this time I knew why I was crying. After an hour of sheer heartbreak, I tried nursing him again, and after he got on with a very painful latch, I decided I wasn't going to be sad, because I didn't want people thinking I was weak and looking for pity. There are women in the world being beat by their husbands, raped, and I am not going to let myself be selfish enough to wallow in any grief over what happened to me.

Then, just like that, I had a hard time remembering what happened to me. Out loud I pondered: "What did happen?" I remember, deep inside, being afraid to ask why did it happen. That was the scary question. I buried it, let it go. Didn't think about it again. As time went on and I learned about other women and their birth trauma I vaguely remembered being unhappy with my birth. I thought, Boy was I being a brat. Women have had worst birth trauma's, unnecessary c-sections, terrible iatrogenic injuries and even death. I felt guilty for ever thinking I had a bad experience and so I buried it further. Not until sometime in September of 2004, about 5 hours after finding out I was pregnant again would I recall to memory what happened in the early morning of September 29th as if it was yesterday. It was as clear to me then, as it is to me now. I cried and cried alone in my bed and silently I vowed never again.

Thursday, March 18, 2010

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Thursday, March 4, 2010

Informed Consent - The Myths Vs. Reality

When discussing maternity health care practices there is one phrase that will inevitably be mentioned and that is informed consent. The belief is that women should have informed consent before any procedure, intervention, or alternative action is taken by the provider before, during, or after labor and birth. This supposedly ensures that she is given the optimal chance at being involved in making choices regarding her health care, but does it really?

The Surgery Encyclopedia defines informed consent as: a legal document in all 50 states. It is an agreement for a proposed medical treatment or non-treatment, or for a proposed (emphasis mines) invasive procedure. It requires physicians to disclose the benefits, risks, and alternatives to the proposed treatment, non-treatment, or procedure. It is the method by which fully informed, rational persons may be involved in choices about their health care.

Let's examine the language and implications of that definition. On paper and at first glace, informed consent seems like the gold standard in allowing for participatory practice in maternity health care, but upon closer examination there are some limitations. Because informed consent begins with the caregiver proposing a certain course of action, it suggest that the caregiver has already decided that action is best. Yes, the practitioner may disclose information on not taking that particular action, or other alternatives, but is this enough to be considered participatory care? Let's look at an example of how informed consent may be given:

A first time mother arrives at the hospital, membranes still intact, having regular contractions at about 6-7minutes apart. She has already labored at home for more than 8 hours. During her cervical check, it is discovered that she is only about 3cm dilated. Her contractions are manageable to her, but she can't help but express disappointment that she isn't further along. She doesn't have a written birth plan, but wants to labor without pitocin or other forms of drug augmentation because of fear of what it might do to her labor. After an hour of laboring in bed on monitors, her labor begins to slow. Her contractions are spacing and getting weaker in strength. Although her baby is fine, and she is doing well, her doctor suggests (trying to honor her wishes to avoid pitocin) that her membranes are artificially ruptured. He goes on to tell her that because they rupture her membranes, they may have to monitor the baby more closely as labor is better tolerated by baby with membranes intact, and that there is a slight risk of infection and fever if she labors too long with her membranes ruptured. He tells her the benefit is that it may put her in a better labor pattern and make the contractions longer, closer together, and generally more efficient. He also tells her that her that she could wait a few hours and see what happens considering the baby is looking good, but that in his experience, once a labor stalls, it usually requires some action to get labor going again. He reminds her that, although he knows she doesn't want pitocin, it is still a viable option that usually yields the fastest results. After hearing all of this, the mother decides to have her water broken, and in 7 more hours goes on to delivery her baby vaginally. She did, however, require an epidural (which she was also trying to avoid), not only because of the intensity of the contractions after her water was broken, but because she wasn't allowed to labor outside of the bed. The lack of freedom of movement increased her perception of pain.

In that scenario many would argue that she was given informed consent and in the truest definition of the word, she was. The doctor proposed a course of action, told her the risks and benefits of that action and also discussed the option of not taking that action. He also presented another option (although the patient was already aware of the option and had already declined it) However, when we consider that scenario closely, it's then we can see the true limitations of informed consent. Did the doctor prescribe that particular course of action without bias? Since that action was the only alternative mentioned besides one the patient clearly did not want, I would be inclined to believe no, he did not. The bigger question is why weren't more alternative augmentations discussed? There are a host of different options that could have been presented but were not.

Having said all that, it has been clear to me for a long time that we need more than informed consent to really be participants in our maternity care. We need informed choices. As I learned from both my Doula studies and experiences, the act of informed choice is a process. It suggests that a dialogue is opened between the practitioner and patient. The communication is such that in certain situations the patient may face, multiple options are presented to the patient, with risks and benefits of each, in addition to the option (if possible) of doing nothing. The patient can then carefully weigh the pros and cons of all viable options, without pressure or bias from the practitioner, and then can give her informed consent. Informed choice invites the patient to truly become a participant in her care, and should always be the first step before obtaining informed consent. In this scenario the caregiver has engaged the patient and in doing so builds a positive atmosphere in the birthing room. No longer is the caregiver inviting the patient to "sign off" on a procedure or course of action the he deems necessary, but is "engaging in a dialogue to help the client take responsibility for her own choices."

In closing this post, I want to add that it is important for expectant mothers to know that there can be situations that are true emergencies. In these situations it goes without saying that discussions will have to be limited, if there is time for any at all. This is another reason why informed choices are so valuable, because the act of discussing choices and options should happen not just during labor, but throughout pregnancy at prenatal visits. The open dialogue and subsequent trust the practitioner fosters as result is invaluable in those instants of true emergencies. Not only does the doctor get to understand his patients wishes more deeply, but the patient in turn is able to trust the doctors expertise and opinions if an emergency should arise.

Monday, February 15, 2010

If you are happy with your choices, why does mine bother you so much?

I'm not usually one to go on a rant. Not that people who rant are doing this, but when I do I always feel like I am jumping to conclusions. Perhaps I over analyze things for fear of making assumptions. Having said that, I feel a rant brewing. I believe it's been cooking up from weeks of reading articles and then foolishly going through the dreaded comments section. Seriously, if you for some reason want to change positive energy to negative energy, read the comments section of any controversial story and that outta do trick!

My rant is about peoples choices. Yes, I write about choice a lot, because I, like the great Morpheus of the Matrix, believe everything begins with choice. Let's examine the word for a minute. Choice in it's most stripped down form, implies ownership, yet I don't think people always own their choices. They may think they do, but their actions, emotions, and words say otherwise. I believe when people don't own, or take responsibility for their choices, it's usually because they are not happy with them. When you are happy with your choices, you don't feel the need to defend them or explain them. Or my favorite, get defensive and hostile when a person makes a choice opposite yours.

Example #1. I chose a natural birth. I blog about my experience and my satisfaction with my choices. You, having chose a medicated birth, read my blog and immediately become defensive. You launch into explaining why you had the birth you did. You also accuse me of trying to make people who don't birth "naturally" feel bad.

So, not only are you seemingly unhappy with your choices, you are also not owning your feelings, by blaming me for how you feel about your choices.

Example #2. A story is written about the high induction rate, and how many of the inductions done are not medically indicated. The article talks about the risks of inductions, one being the cascade of interventions that can sometimes lead to unnecessary cesarean sections. Again a woman who chose an induction reads the article and feels attacked. She explains her baby was suspected to be too big at 39 weeks. She needed an induction. Later as the induction failed she found out her baby was in danger and she needed an emergency c-section (that took 2 hours to happen from the moment the doctor say c-section time, to the moment she was on the table). The baby is delivered and low and behold her baby was 8lbs and she is only 5'4! She is pissed that anyone would assume her induction and subsequent cesarean was unnecessary!

In that scenario, one might argue that the women really didn't have a choice, because she was not given true informed consent and while I can agree with that, I don't agree that she sees it that way. She is angry that her decision to have an induction is questioned, and so again I have to wonder how secure she is in her decision. Perhaps maybe she feels she didn't have all the facts. Perhaps she secretly wonders how necessary her cesarean section was, but if she allows herself to question the events, she questions her judgment and role in the events that took place. That is an admittedly hard thing to do.

There are other examples I could give, but I'll stop with those two. The bottom line is that when a person is happy and secure in the choices they've made, another person words or actions can not make them feel otherwise. If you've felt defensive, angry, or guilty about choices you've made, you have to explore why, instead of blaming others. Own your feelings and take ownership of your choices.

Sunday, January 10, 2010

Are we advocating for Choices or The Choices we would make?

You are sitting at your favorite in-door play area with your little one, talking to another mother who frequents the spot. She just had a baby and you are super excited to hear about the birth. She begins to tell you that at her 38 week check-up her OB said the baby was measuring big (oh boy, here we go), and so an induction was scheduled. Of course she remarks on how the doctor said it was safe and she was full term, so she agreed. By this time you've kept that smile on your face, but are feeling you could easily continue this story for her. She goes on.

At 6am (why are those things scheduled so damn early in the morning), she arrives at the hospital, does the paperwork, changes into the gown, blood work, yada, yada, yada the doctor comes in at 9am. Wait, why did she have to come in a 6am? Oh well, you keep nodding. The doctor decides because she a multip (she tells you admitting she didn't know what the hell a multip meant, but didn't ask either) and already dilated to 2cm that he would break the water and start a low dose pitocin drip. You nod at her, but your heart drops inside.

So she talks about how as soon as that pitocin was put in she is deep pain. She kept wanting to get up, but the nurse kept telling her no. She says the nurse said the best thing to do was to get the epidural, but she would have to wait until she was 4-5cm. Of course, she thought that was pure torture, but she made it. She got the epidural and everything was copasetic. She tells you how she was playing cards with her husband, chatting on the phone, and it was hard to believe she was actually in labor, because with her first baby, she didn't get the epidural until she was 8cm. Wait, why did she get the epidural at 8cm? Never mind that's a whole different story.

So, by now it's 7pm and she has been stuck at 7cm. You nod, ready for what you've known was coming. Yes, you guessed it. Decels! The doctor tells her that he will give it one more hour. Wow, a whole hour really? And by now your friend is getting really scared. She says she didn't know what to do, but understood that the doctor knew what he talking about and decided to try and relax and pray.

So the prayers worked because in an hour, she became fully dilated. You perk up again, happy to hear that she wasn't sectioned! But wait, baby is hasn't moved down the birth canal. Oh, yeah, she's been laying her back this whole time. So after 2+ hours of pushing it's c-section time because after all, that is a big baby in there.

So you ask. How big was she? When the mother tells you 7lbs 8oz you force a smile and say she is so precious, because, what else can you say?

So you ask your friend how she feels and she says good. She is just happy the baby is healthy, and nothing bad went wrong. She completely understands that those things happen, and that's why she chose to birth in the hospital with a doctor in the first place.

When you re-tell her story to your group of natural birthing advocates, the first thing you say is, How do I tell her that her c-section was unnecessary? And therein lies the conundrum. You don't, because quite frankly, did she ask you? Telling her that is tantamount to telling her that her choices were wrong. She doesn't feel that way and it certainly isn't anyone's place to try and convince her otherwise.

Almost everyday I read something like this from one of my colleagues and associates and I am frustrated on two levels. I am frustrated for the women who got put through a system that doesn't always have the best of interest of her or her child in mind; and I am also frustrated by the advocates that seem to forget that it's not about changing a person's mind. It's about educating women, giving them all the facts so that they can make the best choice for them and on a bigger level it's about bringing change to that system.

I would ask myself if I were the woman listening to the mother's birth story; Did I offer up information, advice, resources to this woman while she was pregnant? Did I talk to her then and really listen to her? If you did, in the end, that's all you can do. It's her choice. If a woman makes a choice to be induced, knowing the dangers of induction, it's still her choice. Just as it the woman who chooses not to be induced, or to have a home birth or an unassisted birth. Are we really advocating for choices, or just the choices we would make?

Friday, January 1, 2010

Cesarean Scar Care in the Post-Partum Period: Hosted By ICAN

ICAN (International Cesarean Awareness Network) is hosting a Webinar at the end of this month designed for new moms and healthcare professionals alike who are looking to understand and implement some real-world techniques to get relief from pain, itching, burning, and tingling. It is also to learn how to restore the abdominal muscles and posture so that you feel like yourself again.

If you are a woman who is going to have a c-section or had one in the past, you can benefit greatly from this webinar. Please click the link here http://ican-online.org/webinars/cesarean-scar-care for more information.