Did a mom REALLY loose her baby due to refusal to consent to a cesarean?

When I last blogged on this topic, I said in the comments:

Right now I’m not willing to string the appellate court as far up a pole as many people are doing… Continue Reading…

A Woman’s Right to Refuse Cesarean

When I teach my classes I always tell my students that they have the right to refuse any medical intervention, even if doing so endangers them or their baby.  I often point out that there is no situation where one person is required to have surgery to protect the health of another, which is essentially what many cesareans boil down to–a woman having a surgery that she likely does not need, but her baby might need.

Don’t get me wrong.  I’m very much pro-life.  I wouldn’t encourage any woman in labor to endanger her baby–and I truly believe that most women would not endanger their baby.  But so often, Continue Reading…

Pit to Distress…Does it Really Happen?

The blog-o-sphere is buzzing right now about a practice called “Pit to Distress.”  Apparently Keyboard Revolutionary started it all with her post, which was quickly followed by Unnecesarean the same day.  Now both of these blogs are written by “lay women”–that is, “JUST” moms, not medical professionals.  So I was quite happy to see one of my favorite L&D nurse blogs jump into the fray–Nursing Birth.  The Nursing Birth piece should be required reading for ANY woman who is planning a hospital birth, so that she doesn’t let this happen to her.

Pitocin seems to be almost synonomous with hospital labors anymore. I wonder how many women who labor actually manage to get through without using it at some point. One client I had switched OB practices because she had been informed that when she arrived at the hospital in active labor she would be put on Pitocin. No waiting to see how labor was progressing and if it was really needed…it was just the policy of this practice to use Pitocin on all laboring women. Medical staff will often explain away any concerns with the use of Pitocin by saying that it is just a synthetic form of the same hormone that your body produces. Which is true. But that doesn’t mean that putting it into an IV is the same as letting your body produce it!

I’ve seen some “interesting” things happen with Pitocin in my doula experience. 

• One mom was induced with Pitocin, Continue Reading…

  Posted 1 year, 1 month ago at 12:50 am.

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The Latest on Breech Birth

In a previous post I had written that the opinions of ACOG (American College of Obstetricians and Gynecologists) are not the “be all and end all” of legitimate opinions on safe birth.

Right on cue, ”SOGC” or the Society of Obstetricians and Gynaecologists of Canada, has issued a statement on the safety of vaginal breech birth. 

ACOG, as you might know, reccommends Continue Reading…

Do You Doula?

This is a fabulous video that was put together as a part of a contest for birth support videos.  I think it has a powerful message.

Do You Doula

What is Midwifery?

A friend expecting her second baby this coming October recently lamented to me in an e-mail:

…most of the women who go to OBs do not know - or at least believe popular misconceptions - about what midwives do. Every woman would want midwifery care for herself and baby if they knew what it truly was…. All the women I know who used midwives were women who wanted individualized care and somebody to be there to support them through their whole birth experience. Somebody who knew them and who they trusted; rather than a practice where you rotate through providers and get whoever is on call. Some had natural births, some with epidurals, etc. but the most important aspect was that relationship and better care. (Jennifer Harper)

A Pioneer Midwife in Pennsylvania

As a childbirth educator and a doula, and most importantly as a mom of 5 children, I couldn’t help but Continue Reading…

Birth in the News

Recently 3 major news organizations have had articles about birth related issues:  The LA Times, The Wall Street Journal, and Time magazine.  All of these articles have merit, but also have some short comings, which I’d like to address.

LA Times

The LA Times article, Childbirth:  Can the US Improve?, I thought was over all very good.  I liked that it featured a mom who not only had to look around to find a Dr. willing to support her VBAC, but that she successfully birthed a reasonably large baby (8 lbs 11 oz) vaginally.  I thought it dealt with the risks of cesarean and interventions very well, such as the increased risk of “ICU” admissions (that should be “NICU) for babies with planned births–that is, planned inductions or planned cesareans.  They pointed out that when some hospitals institute rules banning “planned” deliveries prior to 39 weeks that are not medically indicated, NICU admissions dropped by 46%.  Amazing.  Here are some of my favorite quotes:

“We’re going in the wrong direction,” said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls  Continue Reading…

A Poll About Birth at Lehigh Valley Hospital

I’m going to do a bit of an informal poll on births at Lehigh Valley Hospital. Here is what I would like from you…please tell me about births that you have DIRECT knowledge of at Lehigh Valley Hospital in 2007, 2008, and 2009. That is, either you were at the birth, or you were told about the birth by someone who was at the birth.

What I would like to have is the year of the birth, the first name and last initial of the mother (this is so that I can make sure I’m not counting the same birth more than once), what baby this was for the mother, whether the primary care provider was a midwife or OB, and whether the birth was cesarean or vaginal. So that would look like this:

2007 Donna B first OB cesarean
2007 Jan H first midwife vaginal
2008 Renee C first OB vaginal
2009 Lynn D. second OB vaginal

I’m hoping to collect data on at least 200 births (and have gotten info on 25 so far on Facebook)…so…can you help me?

Thank you!

May 21:  An update on the stats so far….I have data now on 52 births.

Overall cesarean rate: 36.5%
Midwife cesarean rate: 16.0%
OB cesarean rate: 55.6%

Half of this data is from midwife attended births…but The Midwives attended less than 3% of births at LVH in 2008…so you can expect that LVH’s cesarean rate is much closer to the OB cesarean rate than the “overall” rate.  I will note that I suspect that there might be a bias in the OB data in that women who have a cesarean birth for their first baby and then were seeing The Midwives for a planned VBAC might be highly represented in the data set…yet another reason for me to want data on a LOT of births.

Patient vs. Disease

A “facebook friend” is attending the 2009 Reache Conference, and she’s been posting updates periodically.  I think this quote that she just posted is worth spreading around.  She reports that OB/GYN Dawn Russell, MD, in discussing medical education in the US said:

You begin to see the patient as the disease…You are trained to understand, to believe, that no matter how small the risk, it WILL happen to your patient.

How true it is, how true it is.  Instead of seeing a laboring woman as most likely to have an uncomplicated birth, the typical OB really believes that the birth WILL end in tragedy…and thus they are quick to intervene in an attempt to prevent that tragedy.  Which would be okay if the interventions were harmless, but they aren’t.

Dovetailing very nicely with this quote, is one that is found at Rural Doctoring (I paraphrased a bit to make it fit my blog):

I once told a [wo]man I didn’t care if [s]he ruined [her birth with interventions]. “I mean, you’re a nice [woman], we get along, I appreciate your honesty,” I said, “but, let’s face it–if you [need a cesarean] ten minutes from now, I’m going to say ‘Aw, that’s too bad, [s]he was a nice [girl],’ and then I’m going to move on to the next disaster because that’s what I do. I’m a doctor, I got a hundred [girls] like you. So I don’t care. But I bet you do, and I bet your kids do, so think about that. You need to get honest with yourself and quit making excuses…

Seriously…the original quote was in context of the Dr. talking about not caring about a patient DYING…so do you think it is a stretch for me to substitute having your birth end in surgery?  NO!  Most OB’s don’t see any particular value in vaginal birth…their only goal is to get the baby out as quickly as possible, because once that baby is out, it isn’t their liability anymore.  As a mom, OF COURSE you want a healthy baby.  But maybe, just maybe, you assign some value to not having to recover from major surgery while caring for a newborn.  If you do, then you need to take responsibility for choices that will minimize your risk of having a cesarean.

Top 10 Ways to Have An Unnecessary Cesarean

In “honor” of Cesarean Section Awareness month, this post has been making the rounds, with a new “way” being added by each blogger.  I first saw the list in “Faint Star Light” with 7 reasons.  Then “Nursing Birth” joined the party, and finally “Enjoy Birth” jumped on the band wagon.  And now…me.  ;-)  (you should note that each author has put her own spin on the text–so go read them all!)

#10 Only take the hospital sponsored childbirth classes, or no classes at all.  After all, an independent viewpoint isn’t important–you’d accept a Ford dealer telling you that the Ford Windstar is the ONLY option for a family vehicle, and never consider a Honda Oddessy or Toyota Sienna, right?

#9 Choose a care provider without research – Some OB’s are cesarean happy.  Some OB’s say they support vaginal birth or VBAC’s but their statistics don’t back it up.  Make sure to ask your care provider about her cesarean rate–if it is over 20%, she ISN’T committed to avoiding cesarean–and that is being generous!  My OB practice in my first pregnancy had a 16% cesarean rate (and they aren’t VBAC friendly, despite “talking the talk”), so I know it is possible for even an OB to have such a rate. 

#8  Agree to a labor induction without medical indication. – This is a sure fire way to make a birth more of a challenge.  Ask LOTS of questions.  Or, the variation on this, the “back door induction“…allow yourself to be convinced that you are in labor and in need of “augmentation” when you aren’t really in labor.

#7  Go the hospital in the early phases of labor.   Because hey, what helps you to relax and allow your body to “do its thing” more than entering a bright, noisy environment where people you’ve never met before want to touch your most private parts.  Remember…(assuming you conceived naturally)…the environment that was necessary to get the baby *in* is the best one to get the baby *out.*  Including some smooching if you are so moved.

#6  Don’t eat or drink during a long labor.   Because you really don’t want to do what I did.  I mean really, eating a breakfast befitting a lumberjack while having contractions 3 minutes apart was just CRAZY.  I didn’t have a crystal ball that told me I wouldn’t eat again for nearly 24 hrs.

#5  Get an amniotomy too soon.  Because hey, after having 2 or more vaginal births, it’s fun to have an emergency cesarean for cord prolapse (yes, despite what one of my cousins is being told to scare her into a primary cesarean with her second baby, it is QUITE common for babies to still be “high and floating” until a multipara is in active labor–even my 5th baby, who was a petite 6 lbs 3 oz didn’t “engage” until well into labor).  Scaring all your family half to death is fun!  (Yes, I do know someone who had this happen–and frustratingly enough, the family was singing the praises of the Dr. who broke the water because he knew just what to do to save the baby!)

#4  Accept pitocin to induce or stimulate contractions.

#3  Request an epidural.  Despite having 5 babies with nary a pain medication on board (okay, I did take one dose of Tylenol with Sophie after my midwife confirmed that I wasn’t making progress), I don’t begrudge women epidurals.  I just think women ought to be aware that being restricted to bed increases your risk of having a posterior baby, which increases your chance of cesarean.  Having an epidural (or Pitocin) also means constant fetal monitoring, which has also been shown to increase the risk of cesarean–without improving fetal outcomes.  And finally, I’ve had clients who needed to change positions in order to birth–two in particular needed to use hands & knees.  If they hadn’t been able to get into that position, they would have either needed a cesarean, or had a very poor fetal outcome (9 lb 11 oz baby with shoulder dystocia–mom flipped to hands & knees and the baby slid right out with no tearing.  Had she been stuck on her back she would have needed a big episiotomy and possibly forceps).

#2  Accept hospital staff’s comments on lack of progress without challenge.  Don’t concern yourself with stats that shown that “failure to progress” cesearans are much more likely to be performed at 4 p.m. than 4 a.m.–its not that your care provider is just wanting to get home for dinner. 

#1 Just ask – or Failure to Ask Questions! – Sure, some moms ask for cesareans, though despite media reports that make you think it is common, survey research indicates that it is very rare.  It is more likely that moms are told they need a cesarean because of xyz (breech baby, twins, big baby) and they don’t ask questions, get second opinions, etc.