The other day as I was scanning new books at my local library, I noticed one about high-risk pregnancy. I picked it up and glanced through it.
To be perfectly honest, I stopped when I saw the list of factors that may put you in a high-risk pregnancy.
I honestly think it would put more than 50% of the birthing population as high-risk.
Some are, to be certain, legitimate. Placenta previa, where the placenta covers all or part of the cervix, is more complicated than regular pregnancy and requires education and cesarean birth in almost all cases. I can understand the worries with existing diabetes (particularly if poorly controlled) or high blood pressure, even previous birth defects or preterm births.
But some of the others had me flabbergasted at the level of fear present in obstetrics today.
Pregnancy at less than 18 years old or more than 35 years old.
Low-socio economic status
Being underweight or overweight
Fertility treatments
Having a previous pregnancy loss (yes, singular loss. It's estimated that 10-20% of pregnancies end in miscarriage, but many may feel they have had a late, heavy period).
Having five or more pregnancies
ETC.
The list was quite long.
Why is there such fear? I'm afraid - BRUTAL HONESTY FOLLOWS - that our culture has gone so far away from death being a part of life that we are fearful from the point of conception that someone might die. We are willing to do anything to prolong life. Mothers, in particular, are pushed to self-sacrifice in order to give life to children (I am not talking abortion here. I am talking general pregnancy).
I had a miscarriage before I had my son. It was devastating and took a long time to work through. I still cry thinking about my lost little one; hearing of another's loss provokes the same pain. I lost a child and will always mourn that.
However, I fully feel there was a reason my little one should not have been born. It was his time in life to go. I won't speculate as to what the reason was (that leads down a dark path). It doesn't make it any easier to accept his death, but it is what it is.
I certainly agree that obstetrics has saved some lives that would have otherwise been lost. However, we cannot use that nor the fear of death as an excuse for the mistreatment women, babies, and families currently deal with in the system. In many cases. when presented with an unknown, watching and waiting is less deadly than the "well, we must do SOMETHING ANYTHING" attitude so prevalent in modern medicine. (Certainly we've all heard the scares regarding the current radiation levels we're subjected to with unnecessary ct scans and x-rays? I've been x-rayed for a stomach virus and high fever before. Also, think of the current MRSA superbugs in hospitals due to over-prescribing antibiotics, and the chicken-pox vaccine leading to increased shingles cases. It's got to stop somewhere soon)
We need to stop being so fearful and take back our health. For the vast majority of women, pregnancy and birth are times of health. Your best bet - see a care provider who believes this to be true rather than a care provider who believes pregnancy and birth are times where something could go wrong at any time and you need careful monitoring. Ask your WHY? questions and get second opinions. Loose the "all that matters is a healthy baby" mantra.
Monday, December 20, 2010
New book - look out for similar titles!
Just came across a new book in our local library titled The Birth Partner Handbook.
Do not be confused!!!!
This is not The Birth Partner
!
I highly recommend The Birth Partner. This new one (by a different author), not so much at all. Very much in the vein of whatever the doctor says must be right.
Educate yourself and get The Birth Partnerinstead!
Do not be confused!!!!
This is not The Birth Partner
!I highly recommend The Birth Partner. This new one (by a different author), not so much at all. Very much in the vein of whatever the doctor says must be right.
Educate yourself and get The Birth Partner
instead!
Monday, December 13, 2010
How do you know when to go to the hospital/birth center in labor? An observation.
Last night as I was waiting in the ER with my dad (minor surgical complication; he's fine), I observed the strangest thing - three women entered and were directed to the OB admission area. The strange part - none appeared to be in active labor. One in particular (only 37 weeks) sat for at least 10 minutes nearby without even a peep or a squirm. The other two (both 38 weeks) talked with nurses easily, filled out admission paperwork, and climbed into wheelchairs.
The thought in my head - Why are they here yet?!
In pregnancy, among the labor and delivery horror stories, I also often heard about the women who went in too early - "Oh don't worry, I got sent home 'x' times before they kept me."
Did no one bother to tell them that they can (and should) stay at home as long as possible?
I tell women (even those planning an epidural) that in normal labor, you should look for 4-1-1 before heading in. This helps reduce the interventions you may "need" and gets you to the hospital at the point when labor is more likely to keep going rather than stall. Getting to the hospital earlier may even get you there at a point when you can't yet have an epidural (depending on your hospital and anesthesiologist).
With 4-1-1, contractions are about 4 minutes apart, last about 1 minute each, and have been doing so for about 1 hour.
Disclaimer #1: Follow 4-1-1 unless you have another reason to go to the hospital ASAP - bleeding, foul smell with vaginal leaking, feeling something through the cervix/vagina, if you feel that labor is going too quickly, or if you are not yet 38 weeks. I'm not a doctor and don't pretend to be one :)
Disclaimer #2: Don't go to the hospital at all if you can help it! Find a good midwife and birthing center or a good homebirth midwife if you're low-risk in pregnancy. It's not just a "fad"; it's good medicine.
The thought in my head - Why are they here yet?!
In pregnancy, among the labor and delivery horror stories, I also often heard about the women who went in too early - "Oh don't worry, I got sent home 'x' times before they kept me."
Did no one bother to tell them that they can (and should) stay at home as long as possible?
I tell women (even those planning an epidural) that in normal labor, you should look for 4-1-1 before heading in. This helps reduce the interventions you may "need" and gets you to the hospital at the point when labor is more likely to keep going rather than stall. Getting to the hospital earlier may even get you there at a point when you can't yet have an epidural (depending on your hospital and anesthesiologist).
With 4-1-1, contractions are about 4 minutes apart, last about 1 minute each, and have been doing so for about 1 hour.
Disclaimer #1: Follow 4-1-1 unless you have another reason to go to the hospital ASAP - bleeding, foul smell with vaginal leaking, feeling something through the cervix/vagina, if you feel that labor is going too quickly, or if you are not yet 38 weeks. I'm not a doctor and don't pretend to be one :)
Disclaimer #2: Don't go to the hospital at all if you can help it! Find a good midwife and birthing center or a good homebirth midwife if you're low-risk in pregnancy. It's not just a "fad"; it's good medicine.
Monday, December 6, 2010
Traumatic Birth – or why some women may prefer cesarean birth
Lately, I’ve found myself wondering why some women feel cesarean birth is better than vaginal birth. It’s been something I questioned before I was pregnant and was particularly confusing when I was confronted with my own cesarean.
For me, I always wanted a natural, med-free, intervention-free birth. It was devastating for me to be confronted with a cesarean. The recovery was particularly difficult, and the couple of times I “overdid it” really were painful and debilitating.
I’m looking at future pregnancies with fear, as complications during pregnancy are more common after cesarean – placental issues, tubal pregnancies, secondary infertility. The VBAC fight was never one I wanted to be faced with, but here I am.
So how could someone be not just satisfied, but even pleased, with this? I’m slowly beginning to understand.
Recently, I read an article about post traumatic stress disorder following birth; it’s on the rise. As a medical system, we need to acknowledge that in an age where 1 in 10 women suffer from postpartum depression, much less PTSD, that it is apparently not about “just a healthy baby.”
Women need to have the opportunity to mourn the births they have lost. The ideal birth, whatever it is for that particular woman, needs to be acknowledged, and if at all possible, pursued. For me – I lost my first birth to major abdominal surgery. For some, it’s losing the ideal of pain management when a planned epidural doesn’t work, or just being able to go into labor before the pressure of induction begins.
Many women see the cesarean as what saved them – whether it did or not. Maybe it saved them from another traumatic induction lasting 48 hours or more. Maybe it was a way of attempting to control the unknown. Maybe the recovery temporarily saved them from additional childcare and household responsibilities.
As a birth professional, I’ll be honest that I’m a little biased about the solution. But fortunately there are studies and guidelines to back me up. (I’ll list them at the end.)
Childbirth education should be expanded, encouraged, and absolutely available to all. It needs to involved couples working through both their fears and expectations. It must involve current research about normal labor processes and when interventions are medically necessary as opposed to simply routine. It should provide an opportunity for couples to build relationships with others in the childbearing year, expanding their network of support.
Doula care needs to be covered by Medicaid and private insurance. Having a labor doula can decrease the need for cesarean by up to 50%. Postpartum doulas can fill the role once done by the extended family – helping the new family adjust with each child added to the family.
Midwifery care should be more widely available, particularly in rural areas where OB presence is minimal. Low-risk women should be seen first by midwives and referred to OBs as necessary.
Women with negative birth experience should report these to their care providers with the intent that questions are answered and care is altered. It wasn’t too long ago that women and families decided it was unacceptable for fathers to be in the waiting room during the birth of their own children, or that women shouldn’t be forced to undergo “Twilight Sleep” and not be mentally and emotionally present at their own birthing.
It should be no different now that we refuse to accept the parts of the system that make us uncomfortable and that are not supported by rigorous research. What we’re comfortable with may be different woman to woman – med-free, highly managed, etc – but it’s time for individualized care again.
No woman should have to feel that major abdominal surgery was an easier and more acceptable solution that the birth route her body was made and designed for.
Studies and Resources:
Expecting Trouble
– written by an obstetrician who feels 80-90% of women should have midwifery prenatal care and at least 70-80% should deliver with a midwife.
The Doula Book
– numerous studies about the benefits of a doula – from childbirth satisfaction to birth outcomes.
Healthy People 2020 Guidelines - reduce cesareans, among many others
For me, I always wanted a natural, med-free, intervention-free birth. It was devastating for me to be confronted with a cesarean. The recovery was particularly difficult, and the couple of times I “overdid it” really were painful and debilitating.
I’m looking at future pregnancies with fear, as complications during pregnancy are more common after cesarean – placental issues, tubal pregnancies, secondary infertility. The VBAC fight was never one I wanted to be faced with, but here I am.
So how could someone be not just satisfied, but even pleased, with this? I’m slowly beginning to understand.
Recently, I read an article about post traumatic stress disorder following birth; it’s on the rise. As a medical system, we need to acknowledge that in an age where 1 in 10 women suffer from postpartum depression, much less PTSD, that it is apparently not about “just a healthy baby.”
Women need to have the opportunity to mourn the births they have lost. The ideal birth, whatever it is for that particular woman, needs to be acknowledged, and if at all possible, pursued. For me – I lost my first birth to major abdominal surgery. For some, it’s losing the ideal of pain management when a planned epidural doesn’t work, or just being able to go into labor before the pressure of induction begins.
Many women see the cesarean as what saved them – whether it did or not. Maybe it saved them from another traumatic induction lasting 48 hours or more. Maybe it was a way of attempting to control the unknown. Maybe the recovery temporarily saved them from additional childcare and household responsibilities.
As a birth professional, I’ll be honest that I’m a little biased about the solution. But fortunately there are studies and guidelines to back me up. (I’ll list them at the end.)
Childbirth education should be expanded, encouraged, and absolutely available to all. It needs to involved couples working through both their fears and expectations. It must involve current research about normal labor processes and when interventions are medically necessary as opposed to simply routine. It should provide an opportunity for couples to build relationships with others in the childbearing year, expanding their network of support.
Doula care needs to be covered by Medicaid and private insurance. Having a labor doula can decrease the need for cesarean by up to 50%. Postpartum doulas can fill the role once done by the extended family – helping the new family adjust with each child added to the family.
Midwifery care should be more widely available, particularly in rural areas where OB presence is minimal. Low-risk women should be seen first by midwives and referred to OBs as necessary.
Women with negative birth experience should report these to their care providers with the intent that questions are answered and care is altered. It wasn’t too long ago that women and families decided it was unacceptable for fathers to be in the waiting room during the birth of their own children, or that women shouldn’t be forced to undergo “Twilight Sleep” and not be mentally and emotionally present at their own birthing.
It should be no different now that we refuse to accept the parts of the system that make us uncomfortable and that are not supported by rigorous research. What we’re comfortable with may be different woman to woman – med-free, highly managed, etc – but it’s time for individualized care again.
No woman should have to feel that major abdominal surgery was an easier and more acceptable solution that the birth route her body was made and designed for.
Studies and Resources:
Expecting Trouble
– written by an obstetrician who feels 80-90% of women should have midwifery prenatal care and at least 70-80% should deliver with a midwife.The Doula Book
– numerous studies about the benefits of a doula – from childbirth satisfaction to birth outcomes.Healthy People 2020 Guidelines - reduce cesareans, among many others
Post Traumatic Stress Disorder After Childbirth - particularly look at Ten Questions to Ask
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