Tuesday, May 25, 2010

Shouldn't it be about more than just pushing out a baby?

I'm not going to link to the birth stories I'm about to discuss because I want to respect the feelings of these moms. They are happy because they achieved something that seemed impossible: they VBACed! They VBACed against the odds- with an unsupportive doctor, or after being told they had to induce to avoid a big baby. They VBACed triumphantly: a big fat I-told-you-so to the establishment that told them they couldn't. They should be on a good strong high for a good long time- they deserve it, they DID IT, they proved they are capable.

And yet, my heart wrenches reading their stories. A woman told she had to induce because her baby was getting too big, a doctor who cuts an episiotomy that extends into a 3rd degree tear and significant internal damage, a mom whose blood pressure crashes and who passes out due to blood loss. Another woman with an unsupportive OB who tells her she better push her baby out in 10 minutes or she'll be cut open again- amazingly, mom is able to do it, but not without sustaining a 3rd-degree laceration in the process. Someone else whose epidural dose is upped right before she starts pushing, another 3rd degree tear.

Reading all these stories so recently, a part of me wonders if this is really better than the alternative RCS. Are OBs punishing women who choose VBAC, women who "force" the doctors to be on the L&D floor waiting for them to deliver, who increase the potential for a malpractice suit? Is there a subconscious bias encouraging OBs to think "She wanted to VBAC a huge baby, this is what she gets" as the scissors slice through the mother's perineum? (by the way, that baby was barely over 8 pounds...) Or, even scarier, is there a conscious thought process on the OB's part: "I told this woman I don't like vaginal births, period, so if she can't push this baby out in the time it would take me to get the OR prepped, I'm cutting her."

Or were these OBs going to be awful no matter what? Are these the OBs who talk about their dinner plans while performing RCS, completely forgetting that the mother and father are there for the birth of their baby? Would these doctors have asked the mothers to get their tubes tied as they were lying there on the operating table? Would they have lied, telling the mothers they were moments away from rupture, so they could add to their own perception of themselves as saviors?

Though I will never regret encouraging women to choose VBAC and pursue it even when the odds are stacked against them, my heart aches because the women whose stories I've read this week deserved so much more. They deserved support, respect, encouragement, so much more than the simple triumph of pushing their babies out. A long time ago I read a line about how our goal in promoting VBAC needs to be more than simply having babies come out of vaginas. These birth stories really brought that home for me, and made me realize once again the scope of what birth activists are up against.

Saturday, May 15, 2010

Prove me wrong!

Over the past few years, I've been trying to track down a source for a statistic that I am fairly sure doesn't exist. More and more frequently I am hearing from women who've been told the risk of uterine rupture in VBAC is the same as the risk of uterine rupture for a first-time mom, or for an induced first-time mom.

Listen, I am all about putting the risk of rupture into perspective, but just as I hate it when the risks of cesareans are understated or misrepresented, I can't tolerate the same thing from my own camp. Every single source I have been able to find shows rupture risk in VBAC many times higher than risk with an unscarred uterus, regardless of parity, induction of labor, etc. I can not find a single reference in literature to a study showing a 1/2% to 1% risk of rupture in a non-VBAC labor. All I find are dead ends, and data confirming that a uterine scar is the single biggest risk factor for rupture.

I've asked multiple people in multiple forums for a source substantiating this claim, and no one has ever been able to provide one. So I figured I'd ask here too: does anyone have a source that will prove me wrong?

Tuesday, May 11, 2010

Happy birthday to me!

About this time 37 years ago my mom was in labor with me. It was a Friday, and I was 10 days "late." Nobody had talked to her about induction, or how big I was going to be, or how dangerous it was to be pregnant for so long. Awesome, right? She was also required to have an epidural, be shaved, and have an episiotomy. Not so awesome.

I think it's interesting to contrast my own birth experiences with my mom's. So many things are better today, but many things are worse as well. Even as we have demanded- and to a certain extent received- the right to make our own decisions in the delivery room, we have stopped viewing pregnancy and birth as a normal and natural part of a woman's life.

Hopefully when my daughter is having her children, she'll get the best of both worlds.

Thursday, May 6, 2010

When natural birth doesn't come with a glow

Some people run marathons, others climb mountains. My personal challenge was natural childbirth. I wanted to deliver my baby spontaneously, with no drugs, and with minimal intervention. Having my first birth end up in the OR following virtually every intervention known to womankind only strengthened my resolve to have my next child "the way nature intended."

And I did. Spontaneous labor, no drugs, very little intervention. I arrived at the hospital 4 cm dilated and delivered an hour and a half later. I still laugh to myself remembering the nurse freaking out about not having an IUPC in place, and the OB telling her "I'm pretty sure she can tell us when she's having a contraction." It was surreal to realize the nurse was still watching the monitor, waiting to "see" a contraction that I was already pushing through. And push I did- after only 15 minutes my son flew into the world, hale and hearty. This was my moment, victorious, triumphant. I had done what I set out to do, crossed the finish line, reached the summit. It was amazing.

And almost immediately afterward, it was terrible. I fully expected to feel amazing after my birth. I was going to have my baby in my arms, nursing contentedly, while I lay in the afterglow of having just given birth. I was going to feel strong, sure, empowered. But I didn't. I had torn significantly and it took longer for those repairs than it had for my c-section closure. I didn't get to hold or nurse my baby for over 4 hours due to concerns over possible meconium aspiration. The first time I got out of bed I passed out cold. And when my nurse asked how I felt, I replied without missing a beat: "I feel like I was just raped by King Kong." Afterglow? Hardly. Where the hell was the experience I'd been promised by all the natural childbirth advocates? Why didn't I feel amazing? If this had been Everest I would have reached the summit only to vomit all over myself and pass out from lack of oxygen before enjoying the view. If this had been a marathon I would've crossed the finish line and been rushed to the hospital for heatstroke before I heard the first "congratulations!" It certainly wasn't what I expected.

I went on to have 2 more babies, and while I still completely believe that birth is a normal event in a woman's life, and drug-free low-intervention delivery is the best and safest thing, I had epidurals with both of them. I spend a lot of time justifying this to myself because I am such a strong advocate of natural childbirth. I also spend a lot of time wondering if I'm really being fair to other women when I advocate natural birth without talking about how my own experience was so far from what I expected- so there you have it. Full disclosure.