From Esther:
So spot on, it's be funny if it weren't so sad.
Have you heard about Christine Maggiore?
From WendyLou:
According to her wiki page, she passed away on December 27, 2008 of pneumonia.
http://en.wikipedia.org/wiki/
Chr...istine_Maggiore
From Jen:
Ok, so since this thread is about crazy MDC mamas, I thought I'd post this here...this is a quote I pulled off an MDC thread by a woman pg with twins with a history of severe uterine infection after her CS. Her OB is pushing for a ERCS, and she's terrified of a repeat of the last birth (understandable, I think). So, of course, the other mama's are talking HBAC and such and uterine ruptures come up and here's what one person says:
"I don't know if it helps or not, but the vast majority of ruptures (which is only like 3 out of 100 VBACs or something - not overly high chances, but maybe higher b/c of the multiples) are not even painful. No danger, just that your uterus won't push babies out at that time. The VAST majority are that way, from what I understand. Could be helpful to come in with some research on ruptures to ask her about what her thoughts are."
Someone else comes along and says that ruptures are MUCH more serious than that, and their numbers are way off. The first person responds with:
"You're right, sometimes it is serious, but the homebirth midwife I went to told me that she's had a couple scar ruptures occur and had it just stall labor... that's the only way they knew it happened. She said she looked into it more and that's frequently what happens when there's a rupture. That takes your odds of something catastrophic happening down even lower is all I'm saying."
Is that even possible?? Maybe the scar only starts to pull apart, not a full-out rupture? I've never seen anything to suggest a rupture is anything but an emergency...but maybe I'm wrong??
From Alexis:
I THINK what she's trying to get at is that "rupture" includes dehiscence. Some sites claim that dehiscence may be asymptomatic (painless, anyway) and only be discovered when surgery is performed for unrelated reasons. This is possible, even with EFM (which helps detect signs of rupture)--I know someone it happened to. (In her case, the separation was discovered because she had a persistent uterine infection following her VBAC.)
That said, it's not a numbers game I'd choose to play. Uterine rupture can happen and it can be serious--the fact that some ruptures are not catastrophic doesn't mean we should pretend the scar isn't there.
Though she doesn't even get her stats right--the usual figure for rupture in an un-induced VBAC is 1/200.
From JJ:
My OB resident friend recently experienced a patient with a dehiscence. Patient came in in labor, my friend got the baby on the monitor and did a scan. I don't think she said if the mom was planning to try a VBAC or RCS. They do a lot of VBACs at the teaching hospital, though.
Anyway, my friend thought it looked fine, but her attending looked at the strip and the ultrasound and got very worried and said to prep her for surgery immediately. There was a dihescence and while everyone was fine, it could have turned into a catastrophic rupture quickly.
I didn't get out of her what the attending saw that she missed, but whether a dehiscence or a catastrophic rupture I think any sensible person would agree that it's nothing to fool around with.
I like MDC to an extent, but those kinds of attitudes are incomprehensible to me (the blah blah blah everything will be fine because the pink pixie whispered to my soul sort of thing). OTOH, I will say that ANY message board is full of crazy misinformation and no one with two brain cells to rub together should be using an internet message board for medical advice. I've seen more idiotic message board posts than I can count, from all sorts of people posting on all sorts of medical topics, and certainly not limited in any way to MDC or any other single message board.
From Ericacrochets:
OT, but did anyone else read Rural Doc's latest and wonder why she admits to taking obstetric technique advice from commenters on her blog? Or why they didn't have an actual OB attending this woman who had a previous shoulder dystocia?
From Yehudit:
Well, she didn't just take advice from commentators on her blog. Her commentators either alerted her to something new, or reminded her of something she already knew but had forgotten to utilize in practice. She looked into it and discovered or reconfirmed that it is amongst the techniques for resolving shoulder dystocia recommended by the ALSO course etc...
From Ericacrochets:
To my untrained eye, the story just sounds terrible. The mother had a horrid SD with her first baby, Rural Doc cut 2 episiotomies, baby has to be recussitated. Mother requests c-section with second but team "doesn't think that's a good idea." 2nd baby is induced early but SD occurs anyway, sending the partner sobbing into the bathroom from the trauma of the 1st experience, but the baby seems okay.
If baby has any learning difficulties, how is the "team" going to explain in court why they didn't want the mother to get her requested c-section?
From Yehudit:
But the reluctance to perform a CS had absolutely nothing to do with the advice from commentators. Rather, it was based on Rural Docs understanding of the current evidence: that previous shoulder dystocia is not sufficiently strongly predictive of shoulder dystocia in the current pregnancy to warrant a CS. It would be wrong to conclude from the summary on her blog that she didn't discuss fully with Nora the rationale behind her recommendations.
From flim flam:
but if birth is supposed be be empowering and women centred, why the hell couldn't she have a CS?. why should she have to go through the trauma a second time?. isnt rural doc and her teams decision terribly paternalistic?. i'm betting nora wished she had one of those nasty slice and dice obs. i think it's a fucking disgraceful story to tell the truth. nora and her partner had to go through the terror and pain again just so rural doc could work through her own shit about the previous birth and post seeking crunchy approval ( oh p-lease love me natural birthers, look, i made this women have a vaginal birth, despite the risks to her and her baby just so i could feel better about myself, me me me)
From Yehudit:
Surely the point is that rights in relation to surgical procedures are negative rather than positive. Otherwise surgeons can be forced to perform surgeries against their clinical judgment.
From flim flam:
I think it's her clinical judgement that is in question. she certainly seems to have huge unresolved issues around her part in noras first birth. Ethically i think she should have referred nora to another Dr. Reading the account of the first birth it seems that they were very lucky that the baby was not brain damaged. Why take the chance a second time?. what about Noras mental and physical health? isn't that important?. Why does the anti CS ideology trump her need for a safe birth?. If women have the right to forgo interventions, despite the risk to themselves and their babies (UC, UP etc) why do they not also have the right to seek medical interventions that will increase the chances of a safe delivery for both them and their baby?. What is with this endless worship of vaginal births? safe baby, safe mother should be what counts. Not taking risks to appease the rural.doc commenters.
From Alexis:
"Why chance it?" is a very slippery slope. If she knew in advance that there would be a second SD, fine, but she believed that the odds of recurrence weren't high enough to justify recommending elective section. From the sound of it, her colleagues agreed with her. They were the ones who initiated the induction. In retrospect, maybe a section would have been better, but you can't always play Monday-morning quarterback.
Women have the right to request anything... but that doesn't mean the doctor has to do it. If doctors don't have to attend VBAmC because they don't believe it's the best course of action, they don't have to do CDMR either.
From Ericacrochets:
It sounds to me like the "team" uses bad judgement. I still don't understand why it wasn't a board certified obstetrician delivering this baby, instead of a family doctor. If a previous SD isn't necessarily predictive of a SD, doesn't it still make a patient high risk?
From JJ:
Having studied medical ethics from a legal (rather than medical) perspective, my personal view is that of the four core concepts discussed in medical ethics, autonomy is the most important and should be given the greatest weight. Many philosophers and doctors disagree. The four concepts are:
Benificence;
Non-maleficence;
Autonomy; and
Justice.
I personally think that any woman who wants to have a c-section and has been fully informed of the risks/benefits of her choice should get what she wants. Perhaps there IS additional cost, but my understanding is that non-medically-indicated patient elected c-section is not epidemic. It's quite a small proportion of all births, just as homebirth is a small proportion of all births (perhaps patient choice c/s is more than 1%; I don't know but I'm almost certain it's under 5%).
It's not the same as asking to have an elective nose or boob job covered. Either way, the baby HAS to come out and for someone looking at elective c/s there's almost certainly going to be at least a hospital birth happening there. So it is a matter of degree (in terms of extra cost, resources, etc.) rather than truly funding a wholly elective surgical procedure.
I don't think doctors should be offering a c-section to every patient who comes in the door, nor do I think doctors should encourage non-medically-indicated elective patient choice c/s. However, I do believe that if a patient makes the request and has been fully informed, it should be granted.
But I also think that birth is different from other sorts of medical procedures (and doesn't have to be a medical procedure or event at all, really). And I know that a very persistent patient, unless mentally unbalanced and totally unreasonable, will probably be able to doctor-shop until she finds a doctor who will perform her tonsillectomy using the technique she prefers, etc. I recognize this is much more difficult to obtain if you live in a more isolated area with few doctors and can't afford to travel to a doctor who is more agreeable to your preferences.
Just so happens I chose natural births, but my real interest/goal/point is informed choice, not NCB at all (or any, really) cost.
From Alexis:
However, I'm not sure it's clear that the doctor simply wouldn't do CDMR. She recommended against it (her prerogative as a medical professional) and the patient followed her advice. There's no indication that the patient listened, said "I want the CS anyway" and RD said "well, I won't do it". A doctor has the right to recommend (or discourage) a particular course of action if s/he feels it's clinically correct, and that's what RD seems to have done. She wouldn't have the right to insist that the patient follow her advice, but she has the right to give it.
Otherwise, we're headed down the other slippery slope, the one where the doctor can't go against any patient request because they have the right to whatever they want.
From Ericacrochets:
That may be so. I just can't quite understand why this group is so against elective c-section. This poor woman had a terribly traumatic first experience with 2 episiotomies, a lot of pain, and her baby nearly dying.
I just don't understand. If a woman has a horrendous tear in a first birth, a c-section is often recommended for the next one. If a woman has a previous stillbirth, a c-section may be done at 37 weeks or even earlier. Why not in this situation? A previous SD is not predictive of a future one, but it is a major risk factor.
It just seems to me unusual that the practice seemed to strongly encourage her to go ahead with vaginal birth. It also seems really upsetting that the patient had to ask for an induction when she had a previous SD, saying that she hoped the baby would fit better if it was smaller.
If I were the patient, I would want my doctor to sit down with me and explain exactly how we were going to prevent a repeat of the terrible situation she encountered the first time. I would want the most qualified person available to attend my birth as well.
From Alexis:
It doesn't seem that unusual to me. If a single previous SD isn't predictive, then the doctor has to weigh what's likely to be an normal vaginal delivery vs a CS. If you have reason to believe it will be a normal vaginal delivery, it's reasonable to suggest going forward with it.
As for why an OB didn't handle it--if she's working in a rural community situation, OBs may not be easily available and patients may not be referred to them unless they're high risk, which a single SD would not be. AIUI it's not at all unusual for FPs to do a large part of the OB care in rural areas.
From Ericacrochets:
According to this abstract:
http://www.ncbi.nlm.nih.gov/pubm...pubmed/
17531900
Shoulder dystocia recurrence is reported to by as high as 16%.
According to this abstract:
http://www.ncbi.nlm.nih.gov/pubm...pubmed/
18927947
The recurrence of shoulder dystocia is around 25%
That sounds like it should be high risk to me, but I'm just an English major (like Ina May).
From Antigonos:
Maybe the scar only starts to pull apart, not a full-out rupture?
The SCAR rarely if ever tears; it's immensely strong. What happens is that the uterine tissue pulls away from the scar, partially or fully. Since one-third of the woman's blood passes through the uterine artery every minute, it IS a major emergency.
Further, if there is intensive bleeding, the blood can lose its ability to clot [DIC], which means it can be impossible to stop the hemorrhage.
Some years ago a rabbi's wife, during her 7th pregnancy [NOT in labor] was admitted with a ruptured uterus. Following the hysterectomy it took 37 pints of blood, plus cryo and other coagulants, to stop the hemorrhage. In other words, she lost nearly double her entire blood supply.
From Caryn:
"Why chance it?" is a very slippery slope. If she knew in advance that there would be a second SD, fine, but she believed that the odds of recurrence weren't high enough to justify recommending elective section.
I'm not sure it is a slippery slope; it's just a grey area. It sounds to me like providers draw lines with respect to their recommendations, depending on things like the odds of recurrence, or initial occurence, and those lines are contingent and move with new study evidence or new data about the particular patient.
Isn't the question: why *would* she make this recommendation? rather than: does she have the *right* to make this recommendation?
From Jen:
"The SCAR rarely if ever tears; it's immensely strong. What happens is that the uterine tissue pulls away from the scar, partially or fully."
I actually knew that, lol, but didn't phrase it in a way that showed it. I should really do more than skim my post before I publish, lol. 
From Suzanne:
My last baby was a shoulder dystocia (resolved with McRoberts). My OB said her practice for future births was to estimate weight at 39 weeks and then decide if we wanted to attempt vaginal birth or do a c-section.
Since I had one normal sized baby (7 12) and one big baby (10 7), she said I would be a better predictor of size than any ultrasound.
I can tell you right now that unless I think the baby is super small, I'm going for a c-section. Repeat dystocia does not sound pleasant.
Not that I'm pregnant. But, if I were, I'm strongly heading towards a c-section.
From JJ:
I think the most interesting part of this particular debate is that the doctor's decision not to do a c-section, despite a pretty high potential for recurrence (16% or 25%, if either of those are correct), is respected and valued; whereas if under the exact same circumstances a different doctor recommended a c/s and the mother chose to attempt another vaginal birth instead, she would be blasted for prioritizing the experience over her baby's health or some such other nonsense.
If doctors can disagree about whether to recommend vaginal birth or repeat c/s, certainly an informed patient can also form a valid opinion in either direction. And that being the case (that both professional and patient opinion may reasonably elect either option), I don't see how it would be ethical to refuse to accede to the patient's final decision regarding her care.
Be honest. If Rural Doc had recommended a c-section, and the mother had chosen to attempt a vaginal birth, she would be slammed here. I don't think the same would hold true if Rural Doc recommended a vaginal birth and she went and found another doctor who would perform a c/s or insisted on a c/s.
There is something of a double standard at play here, which I believe arises from a failure to understand the actual motivations, feelings and knowledge of most women choosing unmedicated or homebirth.
From Rhiannon:
It is my understanding that at the time of the recommendation for early induction, the belief was that the large size of the baby was what caused the shoulder distocia. Abnormal pelvic floor was not considered because the mother's pelvis appeared normal, and absent pelvic abnormality repeat SD is rare.
From Ericacrochets:
I don't know exactly what the accepted recurrence rate of SD is. But it certainly seems to be a much higher risk birth than one with no previous SD.
What bothers me about Rural Doc's blog (which I've unsubscribed from) is that she gives the impression of not knowing what she is doing sometimes. The first story about Nola bothered me because of that. I hardly think a double episiotomy is the standard of care there.
I also don't like it that she seems to overly value vaginal birth. I think ultimately you want the best outcome for mother and baby, and vaginal birth in itself has no intrinsic value. I'm sure there are valid different opinions on what to do for a pregnancy after SD. Having an inexperienced family doctor deliver the baby vaginally, to me, doesn't sound like they were doing everything they could to minimize the risks to Nola and her baby. I'm glad it turned out well though.
If Rural Doc is a real practicing doctor, it's surprising the kinds of things she puts on her blog because they could certainly be used against her in court. I've decided to stop reading the blog because it does make me uncomfortable, and I do not share Rural Doc's values.
From JJ:
I absolutely agree that you want the best outcome for mother and baby, but the next part of your comment sounds odd to me: "vaginal birth in itself has no intrinsic value."
Do you mean that in the abstract sense, sort philosophically or morally that vaginal birth and c-section are equivalent? Because I would agree with that. Both are just methods of giving birth/delivering a baby, which ultimately is just a mechanical process with a particular goal. If, however, you mean that vaginal birth does not provide any benefits or has no positive aspects for mother and baby that are lacking in a cesarean birth, then I disagree.
In the end, it seems like vaginal birth really was the best outcome for mother and baby in this particular situation. It worked out. I don't think it's sensible to recklessly encourage vaginal births because one thinks "that's how babies should be born," but at the same time if a c-section isn't necessary, it should be avoided because from a strict health perspective a vaginal birth is superior provided there aren't any peculiar complications. There may come a day when surgical technique is so good or sophisticated that the surgical birth of infants is superior from a health perspective, but I don't think we're there yet.
From Squillo:
Seems to me there are four ways to look at a situation like the one in Rural Doc’s post (a bit convoluted, so bear with me):
1. Safety trumps patient concerns.
2. Patient concerns trump safety.
3. Doctor preference trumps patient concerns.
4. Doctor preference trumps safety.
I think there are valid arguments to be made for either of the first two. The only valid argument for the third would be if doctor preference=safety. There is no argument for the fourth, and that appears to be what occurred in this case.
Of course, the question of what is “safest” is somewhat subjective. Two possible interpretations:
A. Vaginal birth after SD (VBASD) is safest for the mother (if that’s the case.)
B. Elective c/s after previous SD is safer for the baby (if that’s the case.)
You could argue for one mode of birth over the other based on either of those, but that doesn’t seem to be what Rural Doc is doing. Instead, her arguments are that the evidence about increased risk of repeat SD is “weak”--it is unclear whether she believes the evidence for the rate of recurrence is weak, or the evidence of increased M & M due to recurrence is weak—and that philosophically, she thinks elective c/s only provides a “false sense of security.” Unless it can be proven that the risks to the fetus of an elective c/s are greater than the risks of a VBASD, that’s a ridiculous statement.
The patient didn’t seem to have a strong preference for either method of delivery, but she had clear concerns about a repeat SD. So what did Rural Doc do? She recommended a trial of labor. That’s fine, if she based her recommendation on her best clinical judgment, and as long as she outlined the risks and benefits for the patient. I assume she did both. But in attempting to address the patient’s concerns, she agreed to the patient’s suggestion of a course that (in this layman’s reading) has little to no evidence to support it: early induction.
For me, that’s what tips it into the realm of bad medicine (#4 in my list above.) Instead of recommending a course with a real benefit in terms of the patient’s concerns (elective c/s), she pursued a course that actually provided the “false sense of security” she claimed she wanted to avoid. Why? Not because it offered any real benefit—in fact, it introduced what I believe are small, but real and unnecessary risks--but because she wanted the patient to feel better about the choice she (Rural Doc) preferred.
From Rena:
I miss Dr. Amy's scientific postings. They are for the most part rigorous, educational, and interesting.
From Squillo:
Rana:
Me, too. I think she's been a bit busy over on Open Salon.
From Mama Liberty:
"Be honest. If Rural Doc had recommended a c-section, and the mother had chosen to attempt a vaginal birth, she would be slammed here. I don't think the same woulhold true if Rural Doc recommended a vaginal birth and she went and found another doctor who would perform a c/s or insisted on a c/s."
Exactly. There is a double standard around here. What about this situation: for my third birth, one OB told me that I would need a repeat c/s. Another OB told me there would be no problem with a VBAC. I think the knee jerk reaction around here would be to agree with the first OB.
Regarding instrinsic value to vaginal birth, there is *for me*. I've had three vaginal births and one c-section. To *me*, there is a difference. That does not mean that I believe in vaginal birth at all costs... as a matter of fact my one c/s (baby #2) was a scheduled c/s. I think Susanne has used the wedding analogy here before: you can go to a JP or have an actual wedding ceremony, either way you are married. You can have a vaginal birth or a c/s, either way you are a mother. But where I diverge from Susanne's opinion on this analogy is in the fact that I think the ceremony *does* matter. Yes, you can go on to have a successful marriage without the ceremony (as do my parents who have been married 35 years), but that does not negate the fact that for many women, the ceremony has meaning. *For me* there is meaning and value in vaginal birth and in homebirth. As a woman and as a unique human being with unique circumstances, the benefit of the doubt should be given to me that I am making the right decision for me and my family.
From Jen:
"Me, too. I think she's been a bit busy over on Open Salon."
Yes, definitely. OS has her interest more peaked it seems (especially with all the Isreal/Hamas stuff), and we've been all but abandoned, lol.
From Squillo:
Mama Liberty:
"Exactly. There is a double standard around here. What about this situation: for my third birth, one OB told me that I would need a repeat c/s. Another OB told me there would be no problem with a VBAC. I think the knee jerk reaction around here would be to agree with the first OB."
Possibly, but your VBAC situation is a bit different from the one in Rural Doc's story. The risk of a recurrent SD seems to be substantially higher than the risk of a UR. As I outlined in my abominably long post above (sorry!), my objection is that Rural Doc seemed to be advising a less safe (not necessarily an UNSAFE) course of action that may or may not have been the patient's preference. You have a definite preference for vaginal birth, which may reasonably outweigh the risks of VBAC. This does not seem to be the case for Rural Doc's patient.
Moreover, Rural Doc followed a course of action--the induction--that seems to have no benefit over simply doing a TOL. Either she was unaware of the literature regarding induction for preventing recurrent SD, or she disregarded it to make the patient feel safer, even if she wasn't really safer. Seems like bad medicine to me.
From Kat:
Rural Doc has a response to those who question the medicine.
From Elizabeth:
It's obviously false that she thought the chance of SD recurring was negligible; she had a whole gameplan mapped out for what she would do if it did! She knew that there was a chance of it recurring; whether that chance "warrants" a CS is a matter of judgment and preference. And it was her preference to expose the fetus to the unknown risks of her being able to cowboy her way through a vaginal delivery, notwithstanding that she had already done poorly at it once with the same mother, than to expose the mother to the known and manageable risks of elective CS. (Which the mother herself had even expressed an interest in! Surely the choice of whether the mother or fetus should bear greater risk should be the mother's; I can't imagine what kind of god complex it takes to override a mother's preference to bear greater risk than her child.) Induction only raised the mother's risk of emergency CS, which is more dangerous than elective, especially with the limits RD prides herself on practicing under.
It seems that one of RD's top priorities was proving that she could deliver an SD the Ina May way, and that she rationalized to herself that this was really what was best for the patient.
The whole thing is a sad joke. Her sidebar reading list tells the whole story. Rural Doc is clearly trying to split the difference between sound practice and crunchy dogma. If she really didn't care what her birth junky commenters thought, she wouldn't waste her breath explaining herself to them.
From Alexis:
I think you're being unfair. If she hadn't had a game plan for SD recurrence, you'd criticize her for being unprepared.
Also, it seems that the OB agreed with her and that the mother herself decided to proceed with a vaginal delivery. Read the response--RD says she would have referred the patient to an OB; SHE declined the referral and decided to proceed vaginally.
This is turning into a lynching, and I think it's undeserved.
From Caryn:
There is something of a double standard at play here, which I believe arises from a failure to understand the actual motivations, feelings and knowledge of most women choosing unmedicated or homebirth.
I don't think it's that. A non-trivial portion of the posters here are ex-homebirthers who had nasty outcomes.
I don't think I've seen the claim that homebirthers *hold unreasonable values.* For one thing, that would entail successfully making the argument that there's a standard of reasonableness for value judgements, and that would entail having them be propositions that could be either true or false, and there's a *lot* of dispute about that; in fact, that's pretty much the whole field of ethics in a nutshell.
Rather, posters just point out that the people who think they value experience so highly are probably either deluded about their own values, or (more likely) not accurately assessing the risks (because the high value they place on experience has clouded their perception of the risks.)
And then they weigh in with examples of their own experience of misperception of the risks. For example, I didn't have an ultrasound until I crashed into my backup OB's office at 33 weeks 5 days with severe preeclampsia, which in retrospect is deciding to walk across the street blindfolded.
From Squillo:
Alexis:
I do think a lynching is undeserved, but I disagree with your comment about not understanding the motivations of women who prefer unmedicated and/or homebirth.
Pain relief choices and homebirth have nothing to do with this story. I don't question the motivation of a woman who would choose a vaginal delivery after a SD--I did it myself (although in hindsight I probably wouldn't make the same choice.) I question the motivation of the provider(s) in recommending (or agreeing to) a 39-week induction, if it was ostensibly done to prevent a recurrence.
From Alexis:
Eh? That was Mama Liberty, I think, I never said anything about anyone's motivations.
As for the induction, well, I'm of two minds about it. From what I've seen and what I understand, it's not usually useful. Weight gain slows down in the last couple of weeks, so unless you have a condition where the baby is gaining very quickly, the advantage gained is small. If the baby's too big to fit, it's likely that's the case at 39 weeks anyway. She does admit that the decision was not based on evidence. I did get a little bit of a feeling that she felt bad about the situation, and maybe that's why she suggested the induction so readily, but that's armchair psychoanalysis.
That said, the induction was what the patient wanted, and again, the OBs agreed to it.
From Squillo:
Alexis--my apologies for the misattribution. I conflated your post w/Mama Liberty's.
From Caryn:
if a c-section isn't necessary, it should be avoided because from a strict health perspective a vaginal birth is superior provided there aren't any peculiar complications.
Have you seen this post?
From Antigonos:
Mama Liberty: What about this situation: for my third birth, one OB told me that I would need a repeat c/s. Another OB told me there would be no problem with a VBAC. I think the knee jerk reaction around here would be to agree with the first OB.
~~~~Not for me, without knowing why you had that first C/S.
From JJ:
"Have you seen this post?"
Well, it's complicated, isn't it? Elective c/s babies have problems, such as breathing problems, that are far less common in vaginally delivered babies. I'm sure you saw the article today talking about needing to wait to 39 weeks to do a c/s due to doubling the baby's risk of substantial breathing complications at birth (from about 4% to about 8%).
Here is Amy's extrapolation from the numbers in that June post:
"In other words, if 1 million women underwent C-section at 39 weeks instead of waiting for onset of labor and attempting vaginal delivery, 692 more babies would be saved, 517 cases of intracranial hemorrhage and 377 brachial plexus injuries would be prevented. In exchange, there would be 8476 additional cases of short term respiratory problems, 5536 neonatal lacerations, and 2212 additional cases of postpartum hemorrhage."
This particular study also does not address the issue of asthma, which (if I remember correctly) is higher for babies born by c-section. Asthma is often a lifelong problem, can be serious and can result in death.
Also, not to go back really far and take issue with things, but the study is just an analysis of a hypothetical cohort. Academically interesting but not exactly a great piece of science with which to make decisions. The authors also make the point that while they feel this is counterbalanced by babies saved, the ECS would result in babies dying after birth due to complications from being born w/lung or breathing problems who would have survived had they not been delivered by c/s.
It also seems flawed to me that they assume that in a cohort of 2,000,000 women, ALL of those women who plan to have ECS at 39 weeks will deliver live babies (versus women who plan to deliver vaginally). Babies die before 39 weeks; yes if the baby is alive right before the incision is made it's almost certain to be born alive, but it seems skewed to me to say that the main reason ECS saves lives is because babies die for various reasons after 39 weeks when the same thing also happens (though in less frequency) before 39 weeks. Why would you count deaths after 39 weeks just because they're vaginal deliveries but not count deaths before 39 weeks that couldn't be prevented by a 39 week c-section? You're not really saying that ECS is safer than vaginal delivery for a woman who arrives with a live baby immediately prior to birth. If that's the main factor behind the saving lives, why wouldn't you induce? Or at least consider that comparison - since none of these women are real and we're not doing this to anyone, why aren't the groups (1) women who have ECS at 39 weeks and (2) women who have an induction at 39 weeks? Wouldn't that make more sense and be a more apples-to-apples comparison? The passage of time is a confounding factor, really, and not pertinent to a direct comparison of vaginal birth vs ECS.
Does the study look at how many more women would die? Is that a relevant factor in considering mode of birth? If we're talking about a very, very small number of babies saved (and we are) and a very, very small number of women lost (and we are) then how much does mortality "count" when compared to OTHER complications or problems resulting from the different methods of birth? On the one hand, one wants to save every baby. On the other hand, what is the cost? And I don't mean financial cost, I mean the cost in terms of other short or long-term complications, maternal mortality, etc. Obviously, any individual woman who lost a baby for unknown reasons at 40 weeks would retrocatively opt for a c/s a week earlier, while any individual woman who lost a baby due to respiratory problems after a 39 wk c/s would retroactively opt for a vaginal delivery at 40 weeks (or whenver). The authors contend that the # of babies dying due to complications resulting from the c/s is more than canceled out by the number of babies saved - but again, that brings me back to asking what it would look like if you had induced vaginal birth at 39 weeks to compare to the c/s at 39 weeks group.
I'm probably repeating things that were discussed at the time, so my apologies for that.
From Caryn:
Well, it's complicated, isn't it?
Yes.
Does the study look at how many more women would die?
Here's a post on that.
From Rhiannon:
If the baby's too big to fit, it's likely that's the case at 39 weeks anyway. She does admit that the decision was not based on evidence. I did get a little bit of a feeling that she felt bad about the situation, and maybe that's why she suggested the induction so readily, but that's armchair psychoanalysis.
...
From her post, RD suggested the induction earlier in the pregnancy, and then did not follow the rest of the pregnancy. She next encountered Nola after the induction had begun. This is more the story of an on-call doctor coming on to an induction that she just happened to have had a previous (scary) experience with.
From Liz1:
OT, as we haven't got a topic at the moment exactly, can any tell me any other locations on the internet where actual "conversations" like this take place? (Not counting MDC!)I am currently housebound by the after effects of flu combined with freezing weather, and rather bored.
From CharlotteDad:
You might want to take a look at Yahoo groups and find one that has a topic that interests you. Subscribe to a few and get a feel for the type of conversation, then drop the ones that aren't a good fit for you or aren't active.
From JJ:
Babycenter used to have a pretty good debate board called Childbirth Choices. It was somewhat slanted in the low-intervention direction but most of the people there were very bright, some were birth professionals (labor nurses, NICU nurses, the odd MD). It was best when there was a real disagreement to be had and an actual debate - some really great debates. Unfortunately, it mostly died when people stopped coming and stirring up debate and some of the regulars left. It would be nice to see it hopping again.
People there tend to use scientific evidence to back up what they're saying and expect anyone debating to do the same.
I think Squillo used to post there a lot.
From JJ:
I said "used to" but it's still there - now called a "group" but the group's name is Childbirth Choices still. It's just really slow these days.
From Leelee:
Caryn: "Have you seen this post?"
That, unfortunately, raises the spectre of "if you choose vaginal birth, you obviously care more about your experience than your baby. Mothers will naturally want to take risks on themselves rather than place them on their babies; therefore, mothers who choose c-sections care more about their babies."
Hyperbole, yes, but that is the logical end of that line of thinking.
Plus, it's only one paper. I posted a reference to another one recently, by Young Mi Lee, M.D., which while conceding that c-section at 39 weeks would virtually wipe out stillbirth in healthy term fetuses, had rather more sobering detail about associated morbidity for mother and baby and concluded that physicians *should not recommend or offer CDMR*, but enter into a thorough discussion of risks involved should the patient herself request it.
From Susanne:
"That, unfortunately, raises the spectre of "if you choose vaginal birth, you obviously care more about your experience than your baby. Mothers will naturally want to take risks on themselves rather than place them on their babies; therefore, mothers who choose c-sections care more about their babies."
Hyperbole, yes, but that is the logical end of that line of thinking."
The same thing is charged about women who want epidurals, though -- that they care more about their experience than their baby.
I still don't get why people aren't deconstructing it to discuss why it is perceived that a vaginal birth is a better *experience* overall. Not medically speaking, but emotionally speaking.
From Leelee:
Well I'm not one of those that thinks epidurals are harmful to the baby, so that analogy is somewhat lost on me.
I think this is a complicated situation. From the looks of it, Rural Doc actually followed current practice guidelines, and per her clarification on her blog, the situation wasn't as simple as "patient requested c-section, doctor denied it."
I think the emotional value/non-value of vaginal birth can't be deconstructed, because it simply is not (and will never be) a universality - we're talking about emotion, which is by its very nature subjective. I could talk until I'm blue in the face about how a vaginal birth would have meant to me (or reassured me) that my body was strong and healthy; Mama Liberty could similarly go on about how her personal belief system led her to feel satisfied with her vaginal births; all that remains is that at the end of the day if you remove all emotion from the situation, YES they are only two methods of a baby getting outside the mother, BUT all things being equal, vaginal birth is safer for the mother, and usually considered safe enough for the baby. If this were not the case, guidelines would currently recommend prophylactic c-section for everyone at 39 weeks. Yet that's not what they recommend. For some, including me, the perception of what is safest *does* influence the emotional value I place on something. Since I don't have spiritual concerns, the physical is pretty much it for me.
From Caryn:
Plus, it's only one paper.
Sure. I'm not saying it's *right*; I'm saying it raises questions.
From Susanne:
"I think the emotional value/non-value of vaginal birth can't be deconstructed, because it simply is not (and will never be) a universality - we're talking about emotion, which is by its very nature subjective."
I think it's important to try to deconstruct it, though, when it leads to its impact on actions. It's the distinction between me wanting to be a size 6 because that's a reasonable size for my height and build, and wanting to be a size 0 because I've internalized that being super-skinny is the only way to be attractive. Both of those might lead to changes in my eating / exercise behaviors, but how far I'll go in that pursuit is different in each scenario.
From Liz1:
I have absolutely not problem with women (the majority?) who are "satisfied" when they have an unproblemmatic vaginal birth but I cannot get my head round the idea that that "proves" you are strong and healthy. This isn't an emotion or feeling, it is a belief, and as such has to proved true or false. Am I strong and healthy, because I recovered from two CS with none of the dire side effects people are so fond of pointing out? Are the women on MDC, one with Type 1 diabetes and one with a dodgy heart suddenly "strong and healthy" because they got the vaginal births they wanted? It seems to me a very odd bit of myth making, and certainly in need of deconstruction.
From Susanne:
"I have absolutely not problem with women (the majority?) who are "satisfied" when they have an unproblemmatic vaginal birth but I cannot get my head round the idea that that "proves" you are strong and healthy."
It's just such a random belief, though. Do you believe you are strong and healthy if you can see without glasses? Or would you take the "defect" of needing vision correction to be just How the Cookie Crumbles, and not a reflection on *you* in any way?
Why do women like Leelee do this to themselves? That's something to deconstruct.
From desiree:
It's just such a random belief, though
i don't think it's random, i think it's a belief deliberately constructed by the ncb movement. and since the ncb movement seems to have taken over the pregnancy and childbirth prep literature, its hard to avoid letting at least some of it seep into your subconscious. and then, in the hipster/crunchy areas where leelee and i live, the message is reinforced over and over again socially.
From Leelee:
Liz1: "but I cannot get my head round the idea that that "proves" you are strong and healthy"
It doesn't *prove*, unequivocally or in any measurable fashion, that I am strong and healthy. I imagine I would have *felt* strong and healthy -- big distinction -- as opposed to like a sad carcass. Really, I just felt like a sad, floppy, helpless carcass. Perhaps I was ill-advised to think I might feel otherwise in the first place - and I know, perspective, I did have a healthy baby after all - but I do find it sad that I have no positive memories from the birth day other than hearing my son cry and knowing he was healthy. When they held him close to my face for me to kiss, my primary concern was that I might be about to vomit on him.
I know the baby should be enough. But I felt awful. And I have nothing with which to compare it, since I have never had a vaginal birth, I can only imagine it just has to be more pleasant than what I went though (epidural or no epidural), if only to feel like the hellish augmented labor actually *worked*.
From Leelee:
And I have to clarify that it's not about the c-section itself. If I had had breech or previa, and gone in for a scheduled c knowing all medical evidence pointed towards the c as the best option for everyone, I don't think I would feel the same. I had a long, failed labor. First I tried it "my" way - holding off on Pitocin and trying (unsuccessfully) to move around without throwing the monitor off. Then as the hours wore on, I tried it "their" way - Pitocin, and eventual epidural. I tried it all ways, and got smacked with 24 hours of labor that accomplished nothing (except maybe, I hope, helping my son's lungs mature), and being one who is very very afraid of surgery and having things "done" to my body, naturally was confronted with my worst fear - surgery - at a time when I was already weak and exhausted and miserable. That alone is a potential strong impetus to choose a scheduled c next time around. I'm not pregnant right now, so this is just theorizing at this point.
From Caryn:
I'll agree with you that it would be preferable not to get sick and not to need surgery. I'm not sure that necessarily implies anything else, though.
From Leelee:
Caryn: right, I think that's what I'm trying to say. I don't think it says anything else about me other than that I had an absolutely horrible time, wish it had no been so horrible, wonder if something could have been done differently so it would not have been so horrible (not to be confused with being convinced something done differently would have "fixed everything," which I no longer am) and hope things are better next time, whether it's VBAC or CS.
From Ericacrochets:
"don't think it says anything else about me other than that I had an absolutely horrible time, wish it had no been so horrible, wonder if something could have been done differently so it would not have been so horrible"
That makes sense. And there probably actually was something (or several somethings) that could have made it less horrible.
After my 2nd c-section, I did get retrospectively angry at the difference in the way my pain was treated than in in my 1st c-section. After my 2nd c-section, my providers really wanted to give me enough medication so that I had virtually no pain. After my first I was told that the medication was only supposed to "take the edge off." The difference was immense. And so simple to do.
I do hope you find a better situation for your next pregnancy, Leelee, be it VBAC or repeat c.
From chris:
I have not read Rural Docs blog. But, where I come from FP Docs don't do surgery. I don't think they are surgeons. So if I am a hammer, you must be a nail. I am going to go check it out
From Susanne:
"Perhaps I was ill-advised to think I might feel otherwise in the first place - and I know, perspective, I did have a healthy baby after all - but I do find it sad that I have no positive memories from the birth day other than hearing my son cry and knowing he was healthy.
I know the baby should be enough. But I felt awful. And I have nothing with which to compare it, since I have never had a vaginal birth, I can only imagine it just has to be more pleasant than what I went though (epidural or no epidural), if only to feel like the hellish augmented labor actually *worked*."
It's quite possible you'd feel awful and gobsmacked with a vaginal labor, too. This is where I think the NCB movement in general did you a disservice, because you've read about all the women who had Blissful Perfect Experiences. Who knows how many of them are lying? Or what if they're not -- what does it mean, in any long run, if Woman A had a Blissful Perfect Experience and Woman B was like "eh, I love my baby, but I sure as hell could do without that birthing part"?
See, it's perfectly OK (IMO) to feel the latter; to be happy you have a baby, but to think that the birthing process itself isn't all it's cracked up to be.
From Kat:
Leelee, I agree with Susanne.
You really didn't miss much since you got to hear your healthy baby cry and take him home.
That was the intensely awesome moment in birth, meeting your child and becoming a mom. A vaginal birth is only more hands on (if you will) with the process.
Painful or not, mellow or screaming, it is simply about meeting the baby. Being able to be the one pushing the baby out is just something, but not everything. Not even something to think about much. When I look back on my births (vaginal) I don't think much about anything except my first meeting with my sons. THAT is the moment I remember and think of on their birthdays.
Even the moms with glorious births focus on that moment. And that moment comes however you become a parent, vaginal, c-section, adoption.
From JM:
If you haven't already read it, you should read RD's follow-up post:
http://www.ruraldoctoring.com/20...-story-
478.html
Most of you come across as very judgmental, uninformed, and loose with the facts. One of you even repeatedly called the woman in the story "Nora" when it was "Nola."
From Susanne:
Previous shoulder dystocia *isn't* an automatic indicator of a CS next time around. I can see why Rural Doc made the decisions that she did. Hindsight's always 20/20.
From Susanne:
In all seriousness, Leelee ... it sounds as though something didn't go the way you planned. Which is sort of a welcome-to-motherhood thing ... and I really despise how the NCB movement sets women up to believe that they can have "birth plans" and plan things which, fundamentally, are unplannable.
From Liz1:
Bit fascinating, isn't it? Play up the "very real" risks of CS, play down the risks of vaginal birth. And this is called "informed choice". Now I can see that choice is important, that information is important, but can't help thinking this is a bit of a parlour game.
From Susanne:
"I do find it sad that I have no positive memories from the birth day other than hearing my son cry and knowing he was healthy."
Basically the jackpot. Leelee, you might be well advised to visit an Easter Seals, an NICU, some other facility where you see babies / toddlers / children who are not well. I think it will put everything in incredible perspective for you.
From Tsu Dho Nimh:
I really despise how the NCB movement sets women up to believe that they can have "birth plans" and plan things which, fundamentally, are unplannable.
Famous German general, Helmut von Moltke, needs to be mentioned for his saying that "No battle plan survives contact with the enemy."
And no birth plan survives very long past the first labor signs ... either you adapt your plan to deal with the reality of the way things are going or you suffer a "defeat" because things aren't going according to your plan.
From Caryn:
And no birth plan survives very long past the first labor signs
Heck, something like one in five birth plans doesn't survive the third trimester.
From Jolene:
"Heck, something like one in five birth plans doesn't survive the third trimester."
There is such a wide variety of ways that someone can write a birth plan. I can't believe your quote of one in five.
You must see some extremely rigid birth plans.
How does "I want the fewest number of VE possible" not survive?
What about "I want a heplock until such time as a drip becomes medically necessary"? or "we refuse newborn eye ointment" or we "choose rooming in unless NICU is medically necessary" or "I want an epidural as soon as possible".
These are just oddball things I've chosen off the top of my head. I can't imagine why these requests wouldn't be honored.
I personally have never had a birth plan. But I discussed each and every possible situation with my provider ahead of time, and our conversations were documented. So I felt comfortable that my decisions would be honored. (and I had assurance that my own provider would attend me... the lack of which would have prompted me to write a birth plan)
From Emma B:
I think what Caryn means is that a substantial number of births happen prematurely or go so high risk as to make birth plans irrelevant. The US prematurity rate is about 12%, so 1 in 8 pregnancies don't even finish out the third trimester.
From Katie:
Susanne,
I guess I should eat a 16 ounce steak, an oversized baked potato, and a pile of green beans even if I'm not hungry for it all because to do otherwise would somehow hurt starving children in Africa. Seriously, that is exactly how your suggestion of going and looking at sick kids sounds to me. Pointless! Yes, those kids are sick, and that sucks, and I'm glad my kid's not sick. But having a healthy baby doesn't necessarily mean you have to be happy with the way the birth goes. You love to ignore the fact it is possible to be thrilled with the result and disgusted with the method. This happens to me all the time when I'm cooking. I do not enjoy cooking. I hate it, every part of it. But I love the food! Even when I'm making my favorite dish, chocolate cake with chocolate icing, and I know the results will be fabulous, I hate the process of making it. The same thing can apply to birth. Sure, the results could be ideal, but the process could've well sucked. Ask all those women denied epidurals "how was your labor?" I'm sure most would say "it was terrible!" Should we deny they had a crappy time of it? In that case, which is what it seems you are implying, then a woman really has no say and should expect no rights when having a baby, since "a healthy baby is ALL that matters."
From Alexis:
Yeah, that's bogus. I know someone who had a 24 week micropreemie. Am I grateful that I and my baby didn't have to go through that? Hell yes. Does that make my experience acceptable? No.
Telling someone to get over their bad experience by seeing other people worse off is actually pretty callous, IMO. Your pain is what it is. It would be wrong to pretend your experience is as bad as that 24 week micropreemie, but being less bad doesn't make it good.
From Ericacrochets:
"In that case, which is what it seems you are implying, then a woman really has no say and should expect no rights when having a baby, since "a healthy baby is ALL that matters.""
I felt sorry for myself for a little while after my first birth. I was very happy about my baby but wished my experiences over the next 24-48 hours had been more pleasant because it sucked to lie there on magnesium sulfate in horrible pain when I wanted to be taking care of my child. But after I realized that women die from what I had, and that the preeclampsia at 35 weeks could have killed me if allowed to progress, it seemed (to me) to be morally wrong to be anything but grateful. It's kind of like crying that you had a bad meal in a 5 star restaurant when people are outside dying of starvation.
It's fine with me though if people continue to be upset that they had a bad hospital experience for the rest of their lives, that the doctor yelled at them, or gave them an unnecessary intervention, or the nurse asked them 20 times if they wanted an epidural. Susanne is just saying that it doesn't have to be that way. If you want to cry into your pillow about your ruined birth experience for 30 years, go ahead. But don't pretend that it isn't YOUR choice not to find a way to cope and that in the scheme of things, it is trivial.
From Ericacrochets:
"Your pain is what it is."
Your pain is what you choose to make of it.
From Adrianna Joanna:
I absolutely believe that experts and research have a place in parenting and understanding children, but every family is different and there are many ways to meet the same goals.
In most cases, research should only be used as a guide, not a mandate.
That said, I don't visit parenting sites for just this reason. A lot of people take it WAY too far. Parents become neurotic over the most inane things, like high fructose corn syrup, and many parenting experts are arrogant and, more often than not, ignorant. It is not uncommon for such authors to slander people that don't agree with them. Criticizing, if you have evidence to support your case, is fine. Slander is not.
I don't like being called a moron, incompetent, etc. at every turn, that I'm coddling or neglecting my kids, or they don't like the lifestyle that I live. Screw off then, and get the hell out of my house if you have such a problem with it, you know?
If I want to make new friends, I stay far, far away from communities of mothers. I don't find children's bowel movements terribly interesting, sanctimony and boasting frost me over, and I have a brain that needs to be stimulated. That's what my bridge club is for (I want to be a life master SO badly!)
Oh, and God forbid your husband stay at home and you be the principle bread winner, especially at a "man's job."
ZOMG, your children are going to grow up to be serial killers. Yes, I have been accused of confusing my children's identities by choosing that and damaging them emotionally because Mommy is never there by MDC types.
From Susanne:
"But after I realized that women die from what I had, and that the preeclampsia at 35 weeks could have killed me if allowed to progress, it seemed (to me) to be morally wrong to be anything but grateful. It's kind of like crying that you had a bad meal in a 5 star restaurant when people are outside dying of starvation. It's fine with me though if people continue to be upset that they had a bad hospital experience for the rest of their lives, that the doctor yelled at them, or gave them an unnecessary intervention, or the nurse asked them 20 times if they wanted an epidural. Susanne is just saying that it doesn't have to be that way. If you want to cry into your pillow about your ruined birth experience for 30 years, go ahead. But don't pretend that it isn't YOUR choice not to find a way to cope and that in the scheme of things, it is trivial."
Exactly. It's not mandatory that you continue to react that way. It's completely a choice. And if you get stuck reacting that way, most emotionally healthy people would seek professional support to get OVER it, as opposed to continue to wallow in the Unjustness of It All.
A lot of my own self-pity was cut short because I saw babies in NICU who were doing far worse than mine. And when my best friend had a mentally disabled son just a few months after I had mine. Boy, that makes you sure grow up quickly, eh? And realize what you have to be grateful for? And realize, like the old saying, "If we all threw our problems in a ring and had to chose, we'd likely choose our own problems back."
But hey, continue to look at the glass which is 9/10 full as being partially empty. That's a winning life strategy.
From Susanne:
"Telling someone to get over their bad experience by seeing other people worse off is actually pretty callous, IMO."
It might help people grow up and get better perspective. How is that a bad thing?
My son was developmentally delayed and needed treatment at Easter Seals. I distinctly remember going there the first day with him and when he was with the therapist, I sat and cried in my car because I was (obviously) very worried about his development.
And then I dried my tears, walked back in, and took a good look around. My son's issues were NOTHING compared to some of the children there. He was going to walk and talk and run and play and do all those things; he just needed some extra time and extra help. He wasn't going to be confined to a wheelchair, or never tell me I love you, or never be able to read a book or live independently. How could I NOT then put my own sorrow in greater perspective? Really, what a shallow and morally bereft person I'd be if I *couldn't* put it in greater perspective.
From Caryn:
Emma's right; I'm referring to the frequency with which birth plans can become meaningless, in the sense that they've no potential to change your care.
How does "I want the fewest number of VE possible" not survive?
Oh, it survives, in a meaningless sense. I mean, once every vaginal exam is medically necessary, there you are.
"I want a heplock until such time as a drip becomes medically necessary"
Again, survives in a meaningless sense, if immediately when you get to the hospital they suggest they hook you up to mag sulfate for PTL or PE.
And so forth.
I had assurance that my own provider would attend me... the lack of which would have prompted me to write a birth plan
See, that right there would disappear in many, many pregnancies, right about when care had to be transferred to a MFM Right Now, one you'd never met. Or if your midwife's backup OB had a family situation of her own, so you were handed off to her backup a few hours before delivery became necessary (which happened to me, btw; I had two new MFMs and two new OBs within the 48 hours preceding delivery, and was delivered by a perfectly competent OB I'd met 6 hours beforehand.)
I was trying to make this point before above: the question isn't always "do care providers have the *right* to do these things?" but "why would my care provider recommend this?" The interesting bit is *why* -- is the care evidence-based, can my care provider make a good argument for this care given my circumstances (which, from what little I can tell, may well be what happened in the Rural Doc case, though of course we shouldn't speculate), was my care provider trained to believe false things during his education (as is the case for DEMs wrt the Brewer diet and preeclampsia), and on and on.
Insofar as a birth plan prompts discussion about this sort of thing I suppose it's a good, but then, as Dr. Tuteur has pointed out, if the pregnant woman comes in *certain* that she knows more than the care provider does about pregnancy and delivery because she knows more about her own body and she's done some research, then it's just needlessly antagonistic and a not a bad indicator that the patient in question has been reading crazy stuff on the internets.
(I once lived in the same house for 12 years, but that doesn't mean I knew anything about the plumbing.)
From Caryn:
And because that sentence is *very* convoluted:
We shouldn't Monday morning quarterback care we know nothing about. It's entirely possible that Rural Doc had a good argument for the care of her patient given the totality of the patient's circumstances. I am not venturing (and have not ventured) an opinion.
From Katie:
Who is playing the one-up game now Suzanne? You! (everybody does it you know, be it the NCB crowd or the "gimme an epi now" crowd, so I'm not at all surprised). Since there are always people in a worse situation than someone else, really that means everyone shouldn't have any problems. I mean, come on, you might live in the ghetto, and get harassed by cops and drug dealers alike, and have an assortment of health issues because you don't have access to good food, and get beat up on a regular basis, but at least you don't live in the Gaza Strip. So smile! Life's just grand!
Bullshit. A person's pain is NOT objective. What could be catastrophic to one may be no more than a bump in the road and vice versa. Also, you ignore the high probability that the vast majority of people don't go weeping about their birth experience all the time, but when they are asked to remember it do not remember it fondly. A coworker described hers as a "blood bath" and has no interest in ever doing it again. Does that mean she cries in her cereal every morning? No, but she has no interest in thinking about it since it is not a good or pleasant memory.
And why should the possibility of things not going to plan negate having a plan? Sure, tomorrow I could lost my job, but does that mean I should plan how to spend my money in three months?
From Alexis:
There's a difference between having perspective, and basically telling someone to get over themselves--which, Susanne, is really how you came across.
I have perspective. I know that in the grand scheme of things, what happened to me is peanuts. That doesn't make me less angry, because it happened to ME. By your logic, no one can ever really be angry, or upset, because there's always someone worse off to put it in "perspective". The mother of the micropreemie? Well, at least she didn't have a stillbirth. It's always tempting to tell someone to just get over themselves, but it's rarely very effective.
From Adrianna Joanna:
"He wasn't going to be confined to a wheelchair, or never tell me I love you, or never be able to read a book or live independently."
Ah, you're describing me.
I began speaking normally on time and then I regressed to the point where I almost never uttered a sound, and most of what I said was a word salad. I didn't tell my parents I loved them until I was 17, and I have yet to ever say it spontaneously. I also didn't start asking for what I wanted until I was about 12, and I couldn't order anything, on the phone or in person, or talk on the phone without first being called until I was 15.
I simply pointed to what I wanted, or, if absolutely necessary, I wrote notes. I also have never spontaneously hugged them. They had to start slowly approaching me from behind, but only if I knew they were coming, and hugging me around the neck. They only recently have been allowed to hug me head on, very gently, approaching me slowly.
If I saw one of my family members in a totally unfamiliar place, I might not even recognize them. It happens all the time with teachers and classmates. If I see them outside of school, it takes forever for me to recognize them. And voices? I almost never recognize those.
I always used to hear conversations between my parents, or between my parents and their friends about how hard it was to never know if your child loved you. They took it very personally, and they were always worried about me because I was so silent and distant and they could never get a clear idea of what was happening in my head and in my life. They knew that there was a wealth of things happening inside me, and none of it was normal. I always seemed, in my face and body, and behavior, like I was angry, heartbroken, nervous, or simply, very lost in my thoughts (most people don't seem to be lost in their thoughts unless something's upsetting them.) And no one had any answers. If I had the choice, I was either alone in my yard or alone in my room with the door closed.
But, oddly enouogh, I never had a problem communicating an endless stream of facts on ancient China or the physiology of lupus or whatever else I was into at the moment.
I bring this up because other people used to always give us heartbroken looks, curious looks, or disgusted looks.
The worst, for my parents, were the sad looks. The "Oh, I'm so sorry your little girl's slow" looks. My parents had their challenges, but they looked on the bright side of what their daughter had to offer, and said to themselves, "This is the card I was dealt. I can cry about it or I can play it. What's it gonna be?" And they delighted in my gains. It got them through the losses. It just on the whole didn't both them. Life happens, and it goes on, and there are still so many precious things to be gained.
That's the attitude you (general you) have to take when faced with life's challenges. You are entitled to feel upset about them, but, obviously, use tact around people's whose problems are worse than yours. And remember, long-term grief about the hand you are dealt is not productive. Grieve for a while, and move on.
Don't like the way your birth went?That's totally fine. You are entitled to your emotions and perceptions. Denying them will only allow them to build up and cause you more trouble down the line.
On the other hand, perpetual grief is totally unproductive, especially if there was no long-term damage from the event about which you grieve. And no one wants to feel like that forever. It sucks.
If you and your baby are safe, grieve for a while, get some rest, and go home and celebrate that you and your baby are here. Really, sometimes you have to take a breather and just let stuff go.
From Leelee:
"A coworker described hers as a "blood bath" and has no interest in ever doing it again. Does that mean she cries in her cereal every morning? No, but she has no interest in thinking about it since it is not a good or pleasant memory."
Right, this pretty much describes me (except I would stop short of calling it a 'blood bath,' and do want another baby). Except whenever I end up discussing my actual personal story on here, it ends up hashed and rehashed, so I spend a lot more time thinking about it than I really ought to. Which is my fault for airing it on here in the first place, but it does make my head spin to be so frequently told *how* I'm really feeling, *why* I'm feeling that way, *what exactly influenced it*, and how I should be feeling instead. It was a bad experience. I even feel guilty calling it a "bad experience," because I must out of necessity associate it with my son's being here. I have at least processed it enough to know that it doesn't have to do with the simple dichotomy of c-section/no c-section. But I think I will leave off discussing it on here, and take a hiatus, because it's not good for me. I actually ended up telling my birth story to someone new today, and it was really pretty tame - there were no tears, I didn't feel some overall sense of dread, just recounted the sequence of events and my overall impression and that was that. And in truth...that's how it's been for months. I think that's as over it as I am going to get, or even as I need to be. It's only on here that I get emotional about it, and that's a bad sign.
From Ericacrochets:
"It's always tempting to tell someone to just get over themselves, but it's rarely very effective."
I agree. People either decide that they are responsible for their own happiness and move on or they don't.
From Caryn:
And why should the possibility of things not going to plan negate having a plan?
What are the odds that the plan will affect the outcome?
From Emma B:
But hey, continue to look at the glass which is 9/10 full as being partially empty. That's a winning life strategy.
See, I think there's a lot of distance in between wallowing in self-pity over trivialities, and waving off any and all disappointments with a cheery "could be worse!".
I'm still working through some very complicated emotions about my last pregnancy and the aftermath, and still trying to resolve the physical fallout. I don't think it's wallowing to acknowledge that it's been painful and unpleasant, and I don't feel obligated to pretend that everything is peachy-keen. I wouldn't go complaining about my situation to my friends whose babies have died, or who remain childless, but being upset about it is a perfectly normal reaction.
The "at least your baby's healthy" thing is another version of the Pain Olympics, where only the winners have earned the right to complain. I don't like the Pain Olympics mentality, because the truth is that there is ALWAYS someone else that's worse off than you. If you lost a baby, well, there's someone else who lost two babies, or who lost the baby conceived after five rounds of IVF, or who lost her baby and nearly died herself. That does nothing to help your own grief run its course -- can be counterproductive, in fact, if you don't deal with the grief because yours isn't as bad as someone else's. Your grief may not be the worst thing in the world, but it might be the worst thing that's ever happened *to you*, and it deserves respect.
The other thing is that perspective is distance. Your children are significantly older than many of ours, Susanne, so you've had a lot longer to process all your emotions about their birth and illness. It's one thing to have moments of gratitude, and another thing entirely for it to be the dominant emotion and replace the anger/fear/sadness. Most of us here have small children, some just infants, and we just aren't far enough away from it yet, timewise. It doesn't make us immature whiners, just means that we're not done working through it yet.
Again, that's not to justify people whose "birth trauma" is nothing more than having to have cEFM. It's just that I don't think it's fair to demand that all of us who have had less-than-optimal things happen to us in our pregnancies be instantly OK with it, simply because worse things happen to others.
From Ericacrochets:
"It's entirely possible that Rural Doc had a good argument for the care of her patient given the totality of the patient's circumstances. I am not venturing (and have not ventured) an opinion."
She may. I don't like her philosophy of birth, and the tone of her Nola post just annoyed me.
From Adrianna Joanna:
"The "at least your baby's healthy" thing is another version of the Pain Olympics, where only the winners have earned the right to complain. I don't like the Pain Olympics mentality, because the truth is that there is ALWAYS someone else that's worse off than you. If you lost a baby, well, there's someone else who lost two babies, or who lost the baby conceived after five rounds of IVF, or who lost her baby and nearly died herself. That does nothing to help your own grief run its course -- can be counterproductive, in fact, if you don't deal with the grief because yours isn't as bad as someone else's. Your grief may not be the worst thing in the world, but it might be the worst thing that's ever happened *to you*, and it deserves respect."
It also doesn't help those who are worse off than you. How does not recovering from your pain, physically or emotionally, help someone whose worse off than you? Will their babies come back to life? Will their brain damage be reversed? Will that woman have her uterus back, and so on. Of course, the answer is no.
It's better to acknowledge and deal with it instead of feeling you aren't worthy. You'll get it out of your system faster and in better ways. Only then can you resume your life.
After all, isn't the point that you learn from the experience, be able to help others and reduce the risk of it happening again? And most of all, NOT allow the situation you're in to become one where you win the Gold Medal for the Pain Olympics? You can't do that if you don't process it. Again, how will someone whose situation is worse tha yours BENEFIT from yours being ignored, or worsened?
Besides, maybe they got in their fix because they waited too long to address the issue, the "stop whining" mentality. They might want to shake you for making the same mistake they did, and not want you to go there. You never know.
Even Buddha advocates the middle road.
From Susanne:
"Again, that's not to justify people whose "birth trauma" is nothing more than having to have cEFM. It's just that I don't think it's fair to demand that all of us who have had less-than-optimal things happen to us in our pregnancies be instantly OK with it, simply because worse things happen to others."
No one said instantly OK.
From Yehudit:
"Your pain is what it is."
Your pain is what you choose to make of it.
+++++++++
Anyone else see the irony of this being spoken from the "anti-NCB" side of the argument?
From Basiorana:
When did it become a problem for someone to get over something, but still acknowledge it was not a good thing and not want to go through it again? I mean, I don't think anyone here spends all their time mourning their birth. When they have a new birth coming up, they might try not to replicate a bad experience however they can (and yeah, some means are more effective than others), but I don't see any problem with "God, giving birth was miserable last time. Maybe this time if I practice breathing more, I can help control the pain" or something similar.
I mean, it's like, if you get your appendix out, and the cut gets infected and hurts, you don't lose the right to complain and wish it didn't happen that way, even though someone else may have had their appendix burst inside them and died. And maybe next time you have surgery you're more careful about wound care to make the experience better.
I think the mourning is artificially shown here, since we're talking about birth anyway so it comes up; same on MDC, though the people who come on after 10 years to start a birth trauma thread about getting over their "traumatic" epidural probably need some mental help. But the ones who mention it as "you'll get past it, and can do xyz next time, if that is comforting to you, I mean, this is what I did" are just responding to someone else's pain, they aren't crying into their Cheerios.
Also, you kind of have to forgive anyone on that board who mourns within about 3 years of giving birth; PPD seems really common there and they all seem to eschew real treatment for it, so I think some of that is just PPD.
From Ericacrochets:
"Anyone else see the irony of this being spoken from the "anti-NCB" side of the argument?"
Not really. Mental pain is somewhat easier to deal with in the mind (over a long period of time) because it is caused by one's thoughts.
From Ericacrochets:
"Also, you kind of have to forgive anyone on that board who mourns within about 3 years of giving birth; PPD seems really common there and they all seem to eschew real treatment for it, so I think some of that is just PPD."
I think you're right. It's unfortunate though that the response is to say, "Yes, what a bad birth experience, get a lay midwife next time," rather than, "I'm sorry that happened to you... maybe it's time to talk to a professional about it?"
When I first moved here, I briefly visited an AP mother's group. One of the women there, who had 3 children very close in age, talked about how overwhelmed she was after the 3rd was born (all homebirths). She said she couldn't often bring herself to get out of bed, and that she and her children just "lay in bed and nursed" for a year. I'm sure she was exaggerating, but the preschool teacher in me was horrified at the idea. I soon realized that group was not for me, as some of the members were on the extreme fringes of AP.
So much better that the children have a mentally healthy mother than that they get breastmilk.
From Basiorana:
"I think you're right. It's unfortunate though that the response is to say, "Yes, what a bad birth experience, get a lay midwife next time," rather than, "I'm sorry that happened to you... maybe it's time to talk to a professional about it?""
Oh, yes, I definitely agree.
From Susanne:
"It's unfortunate though that the response is to say, "Yes, what a bad birth experience, get a lay midwife next time," rather than, "I'm sorry that happened to you... maybe it's time to talk to a professional about it?"
YES.
It's the difference between saying "I wish I weighed less" and having your friends say:
A) "Here are some tips I've found that help me eat healthfully and get my body moving more. Perhaps they might work for you. But you look great! And don't lose sight of the bigger picture, that you're a beautiful woman even if you never wind up looking like Kate Moss. The number on the scale isn't as important as the bigger picture -- that you are healthy and taking good care of yourself."
and
B) "You're right. There's nothing like the feeling of getting on the scale and having it weigh 100 pounds. There is no feeling so wonderful in the world, and I pity all the sheep who haven't experienced it like I have. You can do it -- I know you can. Here, let me tell you how to go about skipping meals and putting your finger down your throat. And here's a 100-Pound Support Group you can join. Don't you feel so Sad when you see women who weigh more than 100 pounds? Yeah, me too."
From Susanne:
Emma B, I'm going to take your post out of order for a moment. You said:
"The "at least your baby's healthy" thing is another version of the Pain Olympics, where only the winners have earned the right to complain. I don't like the Pain Olympics mentality, because the truth is that there is ALWAYS someone else that's worse off than you."
But then you said "I wouldn't go complaining about my situation to my friends whose babies have died, or who remain childless."
But why not? At some level, by not complaining in front of the women whose babies have died (etc), aren't you implicitly saying that there's a hierarchy and that you're recognizing that your situation is "lower on the totem pole of awfulness" than having the baby die? I'm not minimizing your pain or your situation at all. But for example, when my best friend had a baby with Down's right after I had mine, I simply couldn't help but think ... what I went through was nothing compared to her, because her son won't ever (blah blah) and mine will. How could I not take comfort from having a broader perspective? Isn't that emotionally healthy?
From Amy Tuteur, MD:
Ericacrochets:
"It's unfortunate though that the response is to say, "Yes, what a bad birth experience, get a lay midwife next time," rather than, "I'm sorry that happened to you... maybe it's time to talk to a professional about it?"
It's especially unfortunate when you consider that PPD is associated with a history of depression and not associated with type of birth.
Unfortunately, it is much easier to pretend that a depression that follows childbirth is due to something the doctor did, rather than to a mental health problem. That may make women feel better in the short term, but it does nothing to alleviate the real problem.
From Amy Tuteur, MD:
Susanne:
"It's the difference between saying "I wish I weighed less" and having your friends say:
A) "Here are some tips I've found that help me eat healthfully and get my body moving more. Perhaps they might work for you. But you look great! And don't lose sight of the bigger picture, that you're a beautiful woman even if you never wind up looking like Kate Moss. The number on the scale isn't as important as the bigger picture -- that you are healthy and taking good care of yourself."
and
B) "You're right. There's nothing like the feeling of getting on the scale and having it weigh 100 pounds. There is no feeling so wonderful in the world, and I pity all the sheep who haven't experienced it like I have. You can do it -- I know you can. Here, let me tell you how to go about skipping meals and putting your finger down your throat. And here's a 100-Pound Support Group you can join. Don't you feel so Sad when you see women who weigh more than 100 pounds? Yeah, me too."
Exactly.
From Karen:
Dr. Amy is once again drinking at "crazy Mothering.com" kool aid bowl. I think when she has nothing better to write about she figures not many will speak up for the moms there.
Okay, it is absoultely true that I think some of the moms at mothering are extreme, sometime unhealthy and I do try to steer them back, however, if these women are extreme, I think it is direct relation to how much the mainstream hospitals have attempted to discount the NCB movement, as some slightly hokey religion of sorts. If you didn't have Doctors who believe...
...that every patient needs pitocin.
...that they can never fault you if you "section them".
...induction at 39 weeks should be standard practice.
...any woman who wants to give birth naturally (not all women do of course, but some women do,) are deluded, and isn't it funny when they beg for the drugs.
...etc.
....I doubt you would have such crazy counter reactions.
I could be wrong, but I doubt you have many women in Europe and Japan eating their placentas in order to get over postpartum depression. They just don't feel the need to react so opposite from their country's birth practices.
Maybe, we should also look at what these women are reacting to.
Karen
From Emma B:
But why not? At some level, by not complaining in front of the women whose babies have died (etc), aren't you implicitly saying that there's a hierarchy and that you're recognizing that your situation is "lower on the totem pole of awfulness" than having the baby die?
I'm not saying some things aren't objectively worse than other things. I certainly am grateful that Andrew didn't have Trisomy 18, that he wasn't born at 24 weeks, and that I conceived him in the first place, just to name a few things. All of those things could have gone the other way, which absolutely would have been objectively worse, and I thank the good Lord above every day for that.
What I do object to is the idea that, unless I have a certain score on some birth-disaster rating system, I shouldn't be upset. That may not necessarily have been what you intended to say, but it came off as saying that unless you have a developmentally disabled child or a NICU baby, you need to suck it up and get some perspective.
From Liz SUPW:
I don't think anyone can be TOLD to suck it up and get some perspective, but I find it puzzling why some people cannot do that for themselves. I think it is difficult when you are ill and miserable and in pain but I do not understand when people are still distressed months or years later.
"
Bad experiences mark you, they change you. You don't get over them, but they can be assimilated, the damage controlled. You can LEARN things, valuable things - about other people, about yourself, about how resilient we can be. I don't believe in "count your blessings" but I think I do believe in "what doesn't destroy you makes you strong"
From Jen:
Slightly OT, but MDC related - ya know how all of the NBA's who come on here absolutely balk at the idea that giving birth w/o drugs is a kind of contest or pissing match? At least, I can't think of a single one who has conceded that it even MIGHT be. Then why is it that MDC has an ad that states "I make milk. What are your superpowers? I gave birth without drugs. What can you do?" Cause that really sounds like trying to out-do each other to me!
From Pharmacist:
--But after I realized that women die from what I had, and that the preeclampsia at 35 weeks could have killed me if allowed to progress, it seemed (to me) to be morally wrong to be anything but grateful. It's kind of like crying that you had a bad meal in a 5 star restaurant when people are outside dying of starvation.--
I agree, too often people have no sense of perspective of the ability to look outside of themselves. I suspect we all fall in this trap at one time or another, and a reminder about all the stuff we aren't grateful for can be what is needed to bring us back to reality. Although, I also recognize that many people don't want to be brought back to reality and want to wallow in their grief.
Someone mentioned the comparision of living in a ghetto and living in gaza--I would just clarify that there is a difference between realizing a bad situation and doing what one can to change the situation, and just being overcome in grief by past experiences that can not be changed.
Someone also complained that somebody was calling "nola", "nora", well by Rural Doc's comments are her stories are "fictionalized" accounts anyway (and of course she has to say because of patient privacy laws), so why worry if someone mispells a made-up name that Rural Doc is using? Indeed, my assumption would be that she is changing details that would make it likely for patients reading her blog to think that she was talking about them--it would certainly open her up to legal trouble if she wasn't, and I'm pretty sure that Rural Doc is smart enough to know that.
From AA:
"It's especially unfortunate when you consider that PPD is associated with a history of depression and not associated with type of birth."
ITA.
I had PPD after my first child was born and it went undiagnosed until I was pregnant with my second child and freaked out. My thought process: I became a mother in the hospital, I had a really hard time adjusting, it must have been the hospital.
I sought therapy too late in my second pregnancy to get over the fear of the hospital-in searching for a doula I found a HB midwife who promised me the moon and stars and no PPD. I hadn't been in therapy long enough to realize that my depression was a disease and that yes, my first birth was not ideal but it wasn't bad enough to trigger what I was feeling.
Thankfully my HB went well, my child is healthy and strong and alive. Since I stayed in therapy I've come to accept my history of depression and anxiety and figured out how to move on. I have a great new OB-referred to me by my therapist and for the first time in my obstetric history I feel like I have a doctor who "gets me." She didn't freak out that I had a homebirth-she didn't judge me for it (a real fear I had when finding a provider). She is supportive and gets my history.
It takes time to separate and deal with feelings and its hard work. I cried-a lot. There were days when I was so emotionally exhausted I couldn't imagine another day. But that's mental illness. I got through it.
I have no interest in comparing my journey to others regardless of whether they are better off or worse off than me. I have friends that struggled with infertility, a friend that just had a stillbirth, another friend that lost a 22 week baby and than had a 32 weeker (who is ok). We don't dwell on experiences and at the end of the day, we all get up and put our pants on one leg at a time.
I am someone who believed fully in the medical model of childbirth, turned 180 degrees and went NCB there for a bit, and now I finally feel right where I need to be. Somewhere in the middle with a provider who gets me and my history.
But with my oldest son I now have the distance (4.5 years) to say "ok, it really wasn't about the birth."
Honestly though-I'm not sure I was there yet until about 6-7 months ago.
Professional help was a godsend for me, but I am fortunate to be able to afford it. Unfortunately, the vast majority of women probably don't have the same access that I have-and that is the real tragedy.
From LDS:
I had PPD following after 3 of my four pregnancies. One hospital delivery, 3 at home, none traumatic and at least two "ideal". Fortunately I had a CNM who recognized it as a real illness and recommended I see a doctor instead of trying XYZ herbs or munching some placenta tablets. Unfortunately I was too embarrassed by the stigma attached to mental health issues to see anyone until last year when my youngest baby was already 2.
From CountryMidwife:
Doctor Amy T - reveal yourself. I *know* you can't stay away!
From CountryMidwife:
And your failure to comment through your own name is hypocrisy to the Nth.
From Ericacrochets:
OK, CM, exactly who is an imposter on this blog? Dr. Amy is certainly a master of characterization, if there are any "imposters."
Maybe we should ask Ina May Gaskin what she thinks. That (English) is what she has a graduate degree in, isn't it? Mine is only undergraduate.
From Jen:
CM, I'm trying to understand your point with the last two posts of yours...it seems you're implying that Dr. Amy has been replying to her own blog under an assumed name, but not her own? What would make you think that? Because she hasn't been posting recently? If you read a little of the recent comments, you would see that we've been discussing DA's absence due to her OS blog taking more of her time, and her deliberation on the direction of this blog in the future. These seem like perfectly reasonable and plausible reasons to me...do they not seem so to you?
And, of course, if I have completely misunderstood you, I apologize in advance. Would you care to clarify?
From Liz:
I can understand Dr. Amy's dilemma. How many new ways can you say the same thing? But it does seem to me that there is something worth keeping here. How many other blogs get such interesting comments, in their hundreds? I feel that people do make a real effort to communicate here, in a way which is quite unusual (and if it isn't please tell me other places) And if one woman is made a bit more aware, a bit better informed, then that is, Dr. Amy, a job well done. The internet has such huge potential which is often wasted.
I do hope something can be preserved of this.
From Kat:
I think the threads get very interesting when trying to deconstruct what it means to "mother". The philisophical and societal implications, the one-uspmanship, the styles of mothering, it can get very interesting.
It is worth keeping an open dialogue with science calling out the woo, with our more philisophical bent posters on what it all means (Liz, A Sarah) to discuss not only birth, but mothering today.
Perhaps just opening the discussions to more broad topics would suffice, while still mentioning birth and all of the fallacies about it as well.
From CountryMidwife:
Oh, jeez, are we on Dr. Amy's blog? I clicked a link and thought we were on Rural Docs. Thought I was banned from here for transgressions long ago. Anyway, I don't wanna be here!
BTW -- my suspicions come from past evidence, and from Erica's repeated devaluation of her own education, etc. Smells like Amy. But, nevermind anyway, no more from me...
From Ericacrochets:
Dr. Amy invented my blog and wrote all of my posts including my most recent one on worm compost?
It doesn't take a degree to know you're certifiable, CM.
From CountryMidwife:
Sorry, Erica - not into stalking posters so I don't routinely check creds. I really did think we were on Rural docs comments.
From Squillo:
You may not be into stalking posters, CountryMidwife, but if you're going to make an accusation, basic ethics require you to make at least a perfunctory effort to ascertain its validity.
From flim flam:
i have some doubts as to your sleuthing abilities CM, being as you don't seem able to diffentiate between homebirth debate and ruraldoc.
i've noticed this tactic a lot in the non reality based community, they have no decent evidence based arguments so have to resort to name calling and accusations of sock puppetry.
i would be sad to see this blog die. i find open salon a little bit precious and find the personal attacks and comment wars tiresome. this blog truly has some of the best debates on the web. i have learnt a lot and will miss the intelligent, well argued posts. It isnt easy finding rational people on the web!. on an entirely unrelated topic, just something that's driving me mad , all the celebrity mums in the trashy mags flaunting their "good as new" post baby bodies, 2 weeks after the birth and they're trim and taut as teenagers. i find myself furious that women are not even allowed to look like they've given birth, no stretchmarks, no saggy bellies, nothing to remind people of the reality of pregnancy, the toll it takes. not only are we pressured to look like glamazons during pregnancy, but apparently we should be pooping out the baby then getting straight into our bikinis. i like to think i'm immune to it all but still i look down at my belly that has held my two babies and realise it will never be flat or taut. everything is soft and stretchmarked and i want to love my belly, my son loves grabbing it and giving me baby kisses but i cant help feeling yuck!. just once in a while it would be nice to see a women who looks like she's had a baby. i read an interview with a very minor australian actress who's just given birth for the second time. she told how she had followed a strict no fat low carb diet throughout pregnancy, good for her and the bub!. aghhhh!!!! makes me want to throw things!. how are we ever supposed to feel good enough?. bah, grumpy today. It's so hot here , just want a nice summer frock but eveything in the shops is designed either for teenagers or 90 year old ladies.
From Esther:
Sorry to bump this up, firewall issues.
Anyone seen this?
http://www.timesonline.co.uk/
tol...icle5822051.ece
From Esther:
Especially in light of this:
http://www.nhs.uk/news/2009/
01Ja...skslowered.aspx
From Liz:
Well, I believe I have suggested that NCB rhetoric was not just an issue for people who want to homebirth and that the constant hammering away at a particular ideological view of how birth "ought" to be fed rather neatly into other concerns - how to control women, how to cut costs.
I particularly like this line: "Epidurals should not be done without reason;" How about "because it hurts" or "because women want them" as reasons?
Don't think I will be sharing this bit of news with my daughter. She had half her (induced) labour without an epi, half with. Don't think she would take kindly to being told she shouldn't have one. If she can manage without, she will - but I don't think it should be a midwife who decides whether she can.
UK hospitals have been looking for excuses to restrict them on the grounds of cost ever since they were first introduced, but their popularity meant they did not succeed. Don't really think they will this time, either.
From Alexis:
It's all about money. And the fact that in the NHS today, everything has to have a target. it's not enough to say that you'll provide the choice and let the woman decide; there has to be a target and a goal and a policy.
Ugh, the report summary (downloaded from the NCT) talks about "employing midwives who promote normality". Do they mean those patronising women who tell you you don't need pain relief when you ask for it?
From Liz:
Yep - that is who the mean. And, unfortunately, there are a lot of them about. Like the one who told my daughter she won't get pre-e. She is probably right, I hope, but I would like access to the same crystal ball.
Women do need, and benefit from, reassurance and support. But it isn't always enough.
From Alexis:
Also, the summary says that some participants suggested that other things shouldn't be considered "normal" birth--they wanted to exclude AROM, active management of 3rd stage. opioids, and augmentation. That (especially the 3rd stage part, since AIUI that's very much in vogue) would reduce the "normal" birth rate to almost nothing.
I'm all for supporting women and enabling unmedicated birth to take place where it's wanted--but a hard target is going to end up with women being denied pain relief because they need to keep their figures in line.
From Liz:
And the funny (though not very) part is that this enables an unholy alliance between a kind of anti-choice, cost conscious, authoritarian strain that has always existed with the Brave New World of NCB. The former can get the control they desire by pretending to espouse a "woman centred" approach.
From Esther:
http://www.nctpregnancyandbabyca...s-
statement.pdf
Oh my.
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