Thursday, July 22, 2010
The following, according to the International Cesarean Awareness Network, ARE reasons to have an Emergency Cesarean.
Complete placenta previa at term
Transverse lie at complete dilation
Eclampsia or HELLP with failed induction of labor
Large uterine tumor that blocks the cervix at complete dilation (Most fibroids will move upwards as the cervix opens, moving it out of baby’s path.)
True fetal distress confirmed with a fetal scalp sampling or biophysical profile
True absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labour and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.5
Initial outbreak of active herpes at the onset of labor
These Next Points, according to ICAN, ARE NOT reasons to have a Cesarean.
“ Many reasons given for cesarean, especially prior to labour, can and should be questioned. This includes:
macrosomia (large baby)
maternal age and parity,10
assisted reproductive technology,
failure to progress
fetal distress or even prolonged second stage.
There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth.
A cesarean poses documented medical risks to the baby’s health.41 These risks include respiratory distress syndrome (RDS),iatrogenic prematurity (when surgery is performed because of an error in determining the due date), persistent pulmonary hypertension (PPH), and surgery-related fetal injuries such as lacerations. Preliminary studies also have found cesarean delivery significantly alters the capability of cord blood mononuclear cells (CBMC) to produce cytokines. An elective cesarean section significantly increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial cost. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications. Far from doing better, even premature and at risk babies born by cesarean fare worse than those born vaginally.
A cesarean poses documented medical risks to the mother’s health. These risks include infection,19 blood loss and hemorrhage, hysterectomy, transfusions, bladder and bowel injury, incisional endometriosis, heart and lung complications, blood clots in the legs, anesthesia complications, and rehospitalization due to surgical complications, rate of establishment and ongoing breastfeeding is reduced, and psychological well-being compromised and increased rate emotional trauma. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions. One-half of all women who have undergone a cesarean section suffer complications, and the mortality rate is at least two to four times that of women with vaginal births. Approximately 180 women die annually in the United States from elective repeat cesareans alone.”
It's scary as hell, but it's the truth.
Next time, I'll try to discuss the definitions of many of the words used above.
More Information and References for information collected from ICAN:
Attempting a vaginal birth after a C-section is safe for most women, including women who have had two cesarean deliveries and women carrying twins, according to new guidelines issued Wednesday.
The guidelines, which update previous recommendations from the American College of Obstetricians and Gynecologists, widen the pool of women for whom natural delivery should be considered "safe and appropriate" after a Caesarean.
Ninety percent of pregnant women who have had a C-section opt for repeat surgery, while vaginal birth after C-section -- known as VBAC -- accounts for just 9 percent of deliveries.
"Moving forward, we need to work collaboratively with our patients, our colleagues, hospitals and insurers to swing the pendulum back to fewer Caesareans and a more reasonable VBAC rate," said Dr. Richard N. Waldman, president of the gynecology group.
While some will still be untrusting, it is my hope (call me over-trusting) that these new guidelines will be the catalyst for hundreds of hospitals (Including Community Hospital) to reverse a ban on Vaginal Birth After Cesarean. Let's hope so.....
If not- I'll be there, ladies of Community... in three years.. and I'll be there as a doula as early as Thanksgiving.
Monday, July 12, 2010
Birth in the Family: a Response to midwives and Individuals opposing hospital birth in all contexts.
My mother is one of eight children. My generation has 19, and the one following more than 20. My grandmother is about to become a great-great-grandmother for the first time. My Grammy had five sons with her first husband, AC, between 1947 and 1960, the peak of the Twilight era. She jokes that she was too poor to “get the good stuff” and is able to recall, though not in detail, each one of her births. in 1966 she met my grandfather and divorced AC. She was pregnant with my Aunt K before the divorce was final- when the judge asked, Grammy was told to tell him that Aunt K was a hernia. My grandparents were married two days after Aunt K was born at a Portland hospital.
Three years later, she had my mother. Although she had never carried twins before, my grandmother was adamant that she was having twins, despite the Doctor's assurances that she wasn't. Luckily, Papa was the kind of man more likely to believe his wife when it came to her body that some strange man, and they were prepared. Wasn't that Doctor surprised when my mother was followed five minutes later by my Aunt S!
Now in my family, the ladies seem to have a pattern going. Grammy was 17 when she had Uncle B in 1947. When Aunt K was 18, she had Cousin KT. I don't know much about the pregnancy and birth experience K had with KT, but she was born in the hospital, like the rest of us.
Three and a half years later, my mother, at 19, had me. This is a birth story I know intimately. My mother was due with me on Dec 5, and like clockwork, I began my journey into the outside world around noon time. Maybe I was prompt, or maybe, it was just from my mother's insistence that I arrive on time, since she regularly arrives extraordinarily early. My mother labored with me for 36 hours, six of those spent pushing in the lithotic position. I went into fetal distress and we were wheeled into the operating room where I was born to a mother under general anesthesia. A glance by the doctor at her chart the next day told him something he should have read the day before: my mother had a tilted pelvis that prevented me, or my brothers later, from being delivered naturally.
10 months later, My Aunt S had my cousin SG at the age of 20. SG's birth is the kind of thing you see in movies, full of anecdotes that became the stuff of family legend. At one point my mother offered her twin her hand. Aunt S bit it. “You bit me!” exclaimed my mother. “I'm sorry!” Aunt S literally cried. The doctor decided to assist Aunt S with a vacuum extractor (or as told in the story, a suction cup. like on “baby on board” Signs). He broke 3 or 4 of them. The family legend has it that all of these broken cups were blue. “Maybe it's a girl and we need to use pink.” the doctor suggested. The doctor braced his feet on the bed, and pulled with the pink extractor. Out came SG, and Snap went Aunt S's tail bone.
For nearly 20 years, Aunt S hadn't an idea as to why her tailbone had broken. It wasn't until she discussed SG's birth with me that I understood and told her She'd had a fused tailbone, the same as Aunt K and My mother (part of the problem that prevents her from natural birth).
Only a month Later, Aunt K ended her pregnancy with my cousin A3. She had been very sick throughout, developing a condition she has yet to rid herself of completely called Alopecia Ariata Totalis, in which someone loses all the hair all over their body, not just that on the head with Alopecia. She had been prescribed Ice Cream to help her put on weight.
In between A3's birth and the birth of his sister's first child 17 years later, Aunt S had my cousin RG in a routine hospital birth and my mother had my brothers, BD & KD via scheduled Cesareans.
KT was diagnosed with Juvenile diabetes at the age of 12. When she was 21 (the next number in the pattern) she found out she was pregnant. KT's birth story terrifies me.
KT was given two options by her 34th week of pregnancy- a schedule C-Section because of Hypertension, frank and to prevent Macrosomia, or die and take her baby with her. KT had no problem with the C-Section... it was the epidural she had trouble with. KT was told she wouldn't receive treatment at all unless she signed a release for an Epidural weeks before her son was born. When she cried and refused, the Doctor attempted to rope her husband into convincing (Read:manipulating) her to be complacent. KT's treatment after the birth of her son resulting in the reporting of 2 nurses, 1 for refusing to help her access the bathroom so she didn't bump her Incision and the other for refusing to change her bed pad after being asked, resulting in severe bedsores.
KT didn't have the option for an out of hospital birth, because of her diabetes. If my mother had decided to attempt to birth me at her then-home, at the point that I went into fetal distress, it's likely we wouldn't have made it.
I do not agree that if you “buy the Ticket” you have to “Take the ride”. There are women who have no choice because of location or extreme high-risk status. It is these women who must make the fight of their lives... We shouldn't be condemning them, we should be helping them... and that's exactly what I plan to do.I am an advocate of birth, the way the mother wants, the way she deserves, whenever safe.
KT has an annual exam next week, and she plans to lay everything I've included here and more out on the table. She knows for a fact that she's a victim of Birth Trauma, and she doesn't want it to happen again. For the last 2.5 years, she's had nightmares of birth, and she's on a journey to take it back... unlike others, she can't go home from the hospital... But KT has decided to bring home TO the hospital. While I do not plan on stepping on anyone's toes via examination, I do plan to advocate and help KT stick as closely to her birth plan as possible without causing harm to herself or her child. I'd do this for ANY high-risk woman or ANY woman who chooses a hospital birth. We need change, and we need it now- being complacent about “The Ride” we paid for isn't going to change a damn thing.
Friday, July 2, 2010
Sometimes I get scared... doubtful really, that despite my prayer on the subject that I may be wasting my time... that I won't finish Midwifery School almost as surely as I've failed to finish most everything else.
But then I remember that I've prayed on it... repeatedly. When I was just working on getting in, I prayed again and again that I would take The Universe's word for it, this one shot- if The Universe wanted me to be a midwife, I would get in... If that wasn't the path I was meant to be on, I wouldn't get in... and I got in.
I think my big problem is all the challenges and barriers I'm facing now. Get the money, get the license, get the car... It seems like so many of these things are so dependent on others that it gets frustrating as the days go by. I owe someone $220 dollars right now... but I need another $500 just to start classes and be prepared... nevermind the license, the car, and food.
I know the phrase “If it were easy, then everyone would be doing it.” I keep reminding myself of that when finances seem particularly tight. This is my challenge, and I need to remind myself that the roadblocks I'll face two years down the road are not important right this second when I'm worried about having food in my stomach come August, or a way to get to school.
Focus on the challenges faced today. Worry about tomorrow when today is over and you've found your solutions.