Joy Szabo has been in the news lately for desiring a second VBAC for her fourth baby (vaginal birth, emergency cesarean, and vaginal birth).  She has been denied locally in her area of Page, AZ to have a vaginal birth. Due to this situation, the International Cesarean Awareness Network has been assisting her in fighting the VBAC ban along with seeking out additional options.

After reading the latest article regarding Ms. Szabo, I am completely dumbfounded by the remarks made by other readers of her story.  I am stunned by how it seems the general populous regards a woman’s autonomy and medical rights.  I am also including positive comments as counterpoint. Where do you fall?  What do you believe? Many of these comments point me in the direction of what is so wrong with the system.  That of physician and hospital trumping patient.

You decide is the comment pro or con?

“…..it seems like many people do not grasp malpractice and insurance companies. This is not about the hospital, but about medical professionals and hospitals not wanting litigation. Can you blame them? After spending tens of thousands of dollars on an education before making a dime, I would do what I needed to to avoid a lawsuit, too! … we go to doctors because they DO know what is best for our health! Like another poster said, in health care, the customer is NOT always right.”

“My son was born by c-section, then my daughter vaginally, with no adverse affects. While I agree it’s the doctor’s decision to take the risk or not, it seems over-the-top conservative. Does the doctor’s insurance premium go up if this procedure is performed? Then charge more and give the patient the option.”

“C-sections are done in the US more routinely than in any other developed country but our infant mortality rate is not lower but higher. Doctors do not want to deliver on weekends, at night, if the mother is one week over her electronically determined due date. Yes complications can happen, more so if you are made to stay in a bed hooked up to monitors, a monitor screwed in to the baby’s head, your water broke prematurely, inducement before the baby or mother are physically ready to give birth. All of this leads to more injuries and deaths than needed. Doctors look upon birth as an illness, not the process that it is – an inexact human birth. I am not suggesting giving birth in a field alone, but a c-section has a greater risk than the V-Bac especially if she has had one already. C-sections for true emergencies yes, otherwise no.”

“Did anyone else notice that when they list the risks of a C-section, they failed to mention that the mother is 4-7 times more likely to DIE than with a vaginal birth.?!?!?! They also fail to mention all the potential complications to her health, the roughly 30% rate of problems following the surgery (some severe enough to require rehospitalization) and the challenges associated with caring for children while recovering from major abdominal surgery.  Good for this mom and I hope more mothers will take courage from her”

“This story is exaggeration. If the woman wants a vbac, she just has to show up at that hospital in labor and refuse a section. They can’t force her to have a c-section no matter what they would prefer she do. You can’t force a woman to have a c-section under any circumstances, so as long as the docs and nurses say she and the baby are tolerating labor, she has no reason to fear being forced into an operation.”

“I worked in the hospital for 5 years and then in a birth center for the last 4 years. I had to get out of the hospital because I started feeling guilty about my complicity in that system in which so much goes on behind closed doors of which the patient is never informed. I’ve had docs tell me in the lunch room that they are doing a c-section because they have an important golf game, fishing trip, or hot date. Then they go into the room, lie to the woman and say, ” oh your baby is too big, your progress is too slow, it’s never going to happen.” the woman believes them and thanks them so much for saving their babies lives. Over and over and over again. In Miami we have over 50% c-section rate, and it’s way more convenient for the docs. If VBACS are not allowed at more and more hospitals, the rest of the country will soon be like it is here…..”

“I find this decision by the hospital(s) to not do a VBAC as a little crazy. My older brother was born (in 1955) by C-section; both me (in 1958) and my younger brother (in 1962) were born vaginally. NO COMPLICATIONS. It could be done 50 years ago, but not now??”

“The risk of MAJOR complication from a second cesarean is TEN TIMES that of the risk of uterine rupture in a VBAC mother. Someone please explain to me how an “elective” repeat cesarean is safer than a VBAC? Especially since more than 75% of uterine ruptures occur PRIOR to the onset of labor. How is a scheduled cesarean at 39 weeks (which is the ACOG recommendation) going to save the mother who ruptures at the dinner table at 34 weeks? Using their logic, we should all go live at the hospital the moment we become pregnant after a previous cesarean, just in case our uterus blows up and we need an OB and an anesthesiologist “immediately available”.”

So what do you think?  It worries me that is seems the mother’s rights do not count for much. That in some of the comments the idea of  forcing a cesarean is no big deal if it makes the doctor’s position safer.

I think that most people are woefully under educated on childbirth and what safety really means.  A conservative physician errs on the side of evidence not defensive practice.  Do your own research. Be your own advocate.

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

• AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
• PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
• SROM – Spontaneous Rupture of Membranes during labor.
• ROM – Rupture of Membranes
• Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
• VBAC – Vaginal Birth After Cesarean
• HBAC – Home Birth After Cesarean
• WBAC – Water Birth After Cesarean
• UBAC – Unattended Birth After Cesarean
• CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
• ERCS – Elective Repeat Cesarean
• RCS – Repeat Cesarean
• Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
• Vaginal Birth – Baby born vaginally with or without medication and intervention.
• First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
• Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
• Third Stage – Delivery of baby to delivery of placenta.
• Fourth Stage – First hours after placenta is delivered.
• Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
• Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
• Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
• Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
• Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
• Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
• Perineum – The area between the anus and the vulva (the labial opening to the vagina).
• Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
• Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
• Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
• Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
• Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
• Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
• Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
• Mucous plug – The mucous that blocks off the non-dilated and non-ripened cervix for protection.
• Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
• Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
• Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
• Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
• Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
• Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
• Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
• Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
• Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
• Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
• Epidural – A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
• Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
• Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
• Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
• Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
• Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

So let’s chat about childbirth education. Of the reported 30% of expecting parents who attend childbirth classes the majority go to the hospital where the birth is planned instead of seeking out independent options. I want to challenge you to think about how strange that is. Does it make sense that the information presented will REALLY be balanced, unbiased and evidence-based? Many protocols and practices used during labor and delivery in the hospital are designed as a one size fits all, no suited to each individual mom and baby. More importantly, they are not designed to suit the usual low-risk mom and baby (the majority of moms and babies are normal and low-risk), but can actually make a mom and baby appear or become high-risk. Some refer to hospital classes as “good patient preparation” classes because of lack of inclusive information. I will admit, that all hospitals do not offer education in this manner, however, in my experience and research many sadly do.

If a car salesman tried to sell you a car and actually insisted you purchase the specific color, make and model he/she decides for you, would you buy it? You would hopefully say no thank you and leave. How dare some one make such a huge decision for you. How long do you research a piece of electronics or a computer, even a cell phone plane before deciding? Even the pair of shoes you are wearing. Did you have to try on several before finding the right pair?

So why not think outside the big box, one size fits all class? Every mom, baby and partner deserve to know the wisdom of birth, understand what is normal and how to stay that way, when the abnormal happens what to do and be a skilled consumer.

There is no re-do here. This time is too important to leave to chance and inadequate education.

This is at the essence of why I teach my own childbirth classes at a location outside the hospital. I am able to freely give full spectrum information without restriction, bias or without the fear of losing my position.

Your birth matters to both you and your baby, to your future fertility, to your confidence as a mother

Below is a list of options available to families all across the US and variations in other countries as well (if if any class types have been overlooked, please let me know and I will add it).

• Independent – philosophy based (CAPPA, Lamaze post-2000, ICEA, CBI, ALACE, Birth Works, Birthing From Within)
• Independent – method based (Bradley, HypnoBirthing, Hypnobabies
• Self education

There are many other great ways to find a class that suits you.

• Ask around in your community
• Attend birth circles, Birth Network, La Leche League and/or ICAN meetings
• Seek out local doula groups and information nights
• Check out sites like Independent Childbirth

Here’s to finding the perfect fit and gestating in peace.

Desirre

Picture this: An expectant mother is preparing for the birth of her baby. She chooses the care provider her friend, co-worker or family member recommended, she is reading the most popular books on pregnancy and birth (she doesn’t know there are any others to choose from – everyone is reading these), she cannot help herself as she watches hour upon hour of those baby and birth shows on t.v., people tell her their birth stories and to just get the epidural (after watching those birth shows and hearing THOSE stories she is beginning to think it might just be a good idea). Right now, she is pretty sure she doesn’t want to be induced (she heard it hurts more, but knowing when the baby will come is appealing) or have a cesarean but other than that she is leaving it up to her care provider.

Now she starts her childbirth class. This class is based on normal birth and evidence-based practices. Hm those books she was given are SO different than what the instructor says during class. The instructor doesn’t even recommend those books but a host of other books and websites. She begins to wonder what her care provider really thinks and believes about birth. Also, what birth philosophy and practices her chosen birth location has.

I have written a list on choosing a care provider and birth location that is right for you. This is too important to make decisions without extra thoughtfulness and investigation. The key to this information is remembering you are the one purchasing a service. Essentially you are hiring a catcher with medical expertise and renting a room to birth your baby (if you are going to the hospital or birth center).

Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books.

• Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, etc.)?
• What are standard protocols that are followed?
• Does location routinely use methods that turn a low risk mom and baby into high risk patients?
• Are waterbirths available?
• Are birthing stools or non-reclined pushing and delivery positions encouraged?
• What is the no/low intervention rate?
• What is the epidural rate?
• What is the cesarean rate? Does the hospital support VBAC’s?
• Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, etc.)

Points to Ponder afterward –

• Will I be able to have the type of birth I truly desire?
• What location will I ultimately feel most comfortable in?
• What location is ultimately safest for my specific needs (I am currently low-risk or high risk)?
• Is insurance or lack of it the reason I am choosing the location?
• Do I have realistic expectations for the location?
• Am I willing to take responsibility for my birth in the location?
• Is staff open to working with a doula?
• Is staff willing to work with natural childbirth practices?
• Are there any compelling reasons to choose one location over another?

Choosing your care provider – Use this as a template for the interview process or to be certain you are of the same philosophy and belief system.

• What is his/her birth philosophy?
• What is philosophy of pregnancy?
• Has provider seen normal labor and birth? How often?
• What percentage of patients have medicalized births?
• How is the “due date” approached? When is “overdue”?
• Will you answer questions over the phone?
• How much time will you spend with me during each appointment?
• What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?
• Do I need a childbirth class? Breastfeeding class?
  o Are there restrictions on the type of childbirth or breastfeeding class? If so, what and why?
• What routine tests are utilized during pregnancy? What if I decline these tests?
• What are routine intervention rates? (IV, AROM, continuous monitoring, etc.) Cesarean rate? VBAC rate?
• Induction rate? What induction methods are used?
• Is natural, normal labor and birth supported?
• What positions is care provider comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing?
• If I choose an epidural, when can I get it or when is it too late?
• How often is episiotomy used?
• When would forceps/vacuum be used? Which method is CP comfortable with?
• What about a birth plan? Will desires be put into my file at the hospital so the nurse and/or back-up will know what has been agreed to?
• Are there any protocols that are non-negotiable?
• What if I choose to decline something after careful consideration?
• Is an on call rotation utilized or does CP attend all own patients? If there are partners or an on call rotation, do EACH of the others share in the same birth philosophy and approach to birth?

Points to ponder afterward–

• Did you feel immediately comfortable at the interview?
• Were or are questions specifically answered or is the answer “only when necessary” without additional information unless pressed?
• Was or is care provider willing to answer questions in detail without being annoyed?
• If already with a CP, do you feel comfortable and heard at each appointment?
• Is choosing your care provider based on your insurance or lack of insurance?
• What are you willing to do in order to have the birth you really desire? Birth location?
• How much responsibility are you willing to take for the health care decisions for you and your baby?

Yes you DO want to avoid a cesarean whenever possible. Cesarean is MAJOR surgery. It is not just another way to give birth. Both women and babies are well designed to give birth often never needing intervention of any type.

Cesarean can be a life-saving technique and used well for some serious medical conditions, including but may not be limited to placenta previa, HELLP syndrome, uterine rupture, placental abruption, cord prolapse, some breech presentations, true fetal distress, vasa previa and high order multiples.

Approximately 50-67% or more of all cesarean surgeries performed in the U.S. are likely unnecessary or become “necessary” from iatrogenic influences (non-medical inductions, AROM, pitocin augmentation, epidural or spinal anesthesia, “fetal distress”, suspected big baby, lack of mobility, continuous fetal monitoring, pushing positions and/or technique).

Here are some tips to help you avoid a cesarean and have a positive vaginal birth.

• Get educated: Book to start with – The Thinking Woman’s Guide To A Better Birth by Henci Goer, Ina May’s Guide to Childbirth by Ina May Gaskin, The Official Lamaze Guide. Giving Birth with Confidence by Lothian and DeVries. Seek out websites that use evidence-based information and normal birth practice information. TURN off the t.v. from the dramatic birthing shows unless you watch with a discerning eye to figure out what could be done differently and why. Seek out local resources such as La Leche League, Birth Network, Birth Circles and/or a local ICAN chapter to learn from other women. Take a childbirth class that is not a good patient preparation class. Take an independent evidence-based class that gives you tried and true techniques along with the communication skills to use your consumer voice. Study and learn about your rights as a pregnant woman, informed consent/refusal and all the usual interventions and medications (induction, augmentation, AROM, epidural, monitoring, etc.).
• Interview Several Care Providers: You want to find out what the raw data is for inductions, interventions, epidurals, episiotomy, cesareans, VBAC’s and so on. It is important to get at the core philosophy of the care provider. Email me at desirre@birthingtouch.com to receive my handout on this.
• Interview several and hire a Doula: You want a doula who will fit into your philosophy of birth and labor/delivery needs. One size does not fit all.
• Use normal birth practices: Stay home as long as possible in labor (if having an away from home birth), choose a care provider who supports and believes in you, use a variety of natural coping techniques, opt out of routine induction, opt out of continuous monitoring unless high risk, opt out of routine augmentation, opt out of routine epidural or narcotic use, opt out of routine pushing position, limit vaginal exams, use mobility, TRUST yourself, LISTEN to your body and baby, accept responsibility for your decisions, BE confident that you are designed for this task.

I hope this has given you a jumping point to go out and birth!

Happy Thanksgiving.

Desirre

http://www.cdc.gov/nchs/data/hestat/prelimbirths05_tables.pdf#1

http://www.ican-online.org/

http://www.lamaze.org/Default.aspx?tabid=171

http://www.birthingtouch.com/

http://www.childbirthconnection.org/

http://www.hencigoer.com/

Ah the joys of video and the web….

http://youtube.com/watch?v=roFVkDV45MM Question CPD
http://youtube.com/watch?v=2dRF4RtdJdo 1 in 3
http://youtube.com/watch?v=lfoR0fAUD34 Becky’s Birth
http://youtube.com/watch?v=Am0aykTPL2M&feature=related My Unnecesarean
http://youtube.com/watch?v=aQd0hPHWOlQ&feature=related My HBA2C
http://youtube.com/watch?v=3lYAKu8k_T0&feature=related A Birth Story
http://www.onetruemedia.com/otm_site/view_shared?p=2a4e81fbf0f66accb8afce HBA3C

These are REAL women and families. This is a very real way our current birth climate takes a toll every minute, every hour, every day, every week, the ripple has become a wave…..

Thank you to ICAN http://www.ican-online.org/ and the women of grit who are taking their power back.

Your body. Your birth. Your life. Use them wisely.

Pass them on!

Pax,

Desirre

These days political correctness seems to rule the world (at least the United States). We have become so easily offended that we often miss the truth and follow parcels of truth weighted down by vast untruth for someone else to gain from in some way, not for the health and safety of our bodies or our children.

Language matters. Language can affect how we perceive our bodies, our designed in capabilities and our baby. Language has the ability to strengthen confidence or smash it to pieces in one single moment.

Below is a list that is purposed to make you the reader stop and think. Take the almost ho-hum usual and shed new light on it.

Take a scroll down this inaugural blog and tell me what you think?

cesarean = “controlled” uterine rupture (read in Pushed)
planned epidural = planned paralysis
OB = high risk surgical specialist
Family Practitioner/Midwife = low risk normal birth expert
cesarean rate = epidemic
rising induction and cesarean rates = daylight obstetrics (read in Pushed)
induction = forced birth (Ruth Trode)
ACOG = trade union
Formula=stagnant (Ruth Trode)
Breastmilk=life (Ruth Trode)
Failure to progress = failure to wait (Henci Goer?)
Episiotomy = surgical cut
FEAR = a False Education Appearing to be Real (heard from many places)
AROM (artificial rupture of membranes) = artificial readiness of mother
unneccesary cesarean = unnecesarean (heard from many places and Joni)
CPD = care provider distrust

Please email me at desirre@birthingtouch.com if you have a word change up you would like to see on an updated post in the future. For more information on me, go to http://www.birthingtouch.com/.

Thank you to the women of www.independentchildbirth.com for working on this list with me.

Be BOLD, find the truth and spread it!

Until next time,

Desirre