Tuesday, January 26, 2010

Prenatally Pertaining Punitive Paradigm

Ordinarily, the circumstances surrounding anything "punitive" would be in my railing against many behaviorist theories about raising children. I'll stick that on hold for another day (or another few days, unless anyone feels like reading a novel).

In talking to various women of various generations about pregnancy and birth experiences, a very common, common refrain is the lack of ownership in the language used regarding their own bodies.

"I wanted to... but my doctor didn't allow it. "

"What will your doctor let you do?"

"I knew I was in trouble, I gained a few extra pounds more than the doctor wanted me to."

"They require that I ..."

Depending on my audience, I sometimes make the effort to re-script. "Oh, you mean they objected to this because it wasn't what they ordinarily do?" Usually, they stand firm in their coy determination that the almighty doctor knew what was the very best for them. And for the other three-thousand patients at their care facility. Don't you know- we're all factory assembled. All alike, no variance between any of us! Naturally, a textbook is the first thing to consult when there is any question.

Now. I'm sure I don't have to tell you how the rest of their pregnancy and birth story goes. Even though the majestic, wonderfully masterful doctor controlled every square inch of what was or was not allowed with their bodies, they end the same way- mamas totally out of control of their bodies, the doctors stepping in to do *whatever,* and baby and mama ending up on meds, attached to tubes and/or wires, and the sensation that crisis was averted.

Mothers of the world- I ask you:


Don't get me wrong. Humans are innovative and clever, and have derived genuine ways to revive and maintain the life of mothers and babies who are in very dire circumstances. But when the exception begins to become the norm, it's time to pay attention. A lot of attention is paid to the reasons why, and how come, and the many hundreds of facets behind the legal, political, economical reasons why human birth in the 21st century in one of the biggest superpowers of the world can be so colossally screwed up. All of those reasons do fit into the giant puzzle that makes this up.

Little is discussed about women and the choices they make. No one likes to think that sometimes, people themselves can be a reason (trust, not the reason). We are the most over-informed people of any generation that has ever preceded us. How can we know so much about the state of the Dow, where our stock portfolio stands on an hourly basis, and the current Facebook status of our neighbor's cousin, but we typically don't try to find out what really is going on with our very own bodies? When a doctor says that a woman isn't designed to push out a nine pound baby, why does that woman typically just accept it, shrug and tell the world, "Well, that's the way the ball bounces," without even bothering to look at actual medical statistics? Many people, upon receiving a forwarded email that states that a particular company is putting some slogan in teeny-tiny words along the edge of their product, or that a certain law is in the process of being passed, will Google or Snopes the claim. Part and parcel of this over-informed culture. But the doctor mentions that he only "allows" labor for a certain period of time, and then it's out with the scalpel? And this is blindly, overwhelmingly accepted?

I think a large chunk of it lies with how people, particularly girls, have been raised. The same strange cultural floop that makes it a crime to not be smiling while walking through a store ("Smile! It won't kill ya!" inexorably yells someone, directly breaking the concentration required to remember what I'm locating), and that makes my sister's auto mechanic rub his hands in wicked glee as he watches her approach, seems to turn women into the very stereotypes of obedient children in the presence of a white coat. Pee into a cup? Sure, gladly. Step right onto this scale- harmless enough. Here, read this printout of what I expect all women, of all ages, body types, races, and lifestyles to do during the course of a pregnancy. Aye-aye, Doc! Oh, and by the way, I'm not liking the shape of your belly. Oh goodness, now you're not dilating quickly enough/ you're dilating too quickly, time for an injection. Because, of course, you've gotten our "Required IV," so it's now easy for anyone to pop anything directly into your veins, whether we clear it with you or not. All the consent forms are mashed into one haze of a paper storm, so you'll sign yourself away before you know what's happened...

How would this fly with any other natural bodily process? In the course of eating, eliminating, having sex, and breathing, complications can arise. I can choke on my food, of course. I can eat something that causes an anaphlactoid reaction. I can have all kinds of gastro-intestinal troubles, that range from the mildly uncomfortable, to impending doom with some kind of intestinal impaction. I can suddenly develop an aneurysm during sex. Or simply fall off the bed and give myself a concussion. But during these typical processes, no one has someone standing right beside them, prepared to give the Heimlich or do a tracheotomy. Heart monitors are not hooked up every time someone decides to get some action. Helmets, at least in my experience, are not employed. And yet somehow, the addition of monitors, IVs, automatic drug pumps, multiple examinations and lots of bright lights and poking and prodding are instantly given to each and every birthing mother in hospitals, unless she declines them, whether she wants them or not. Since declining these things are so rare, mothers who do decline them are instantly flagged as a "problem patient." Declining is the exception, rather than the norm. And until more women choose to decline, until more women decide that they're not going to ask permission to allow their bodies to function in the way they've functioned for years before anyone was around to interfere, and until women start viewing themselves as capable, thinking adults- no amount of modification of laws and studies and action taken against doctors who abuse their profession will amount to squat.

Saturday, January 16, 2010

Waking the Thought Police

Subtitle: How to have an All-American VBAC.

Firstly, I need to make it clear that for some reason, I'm famous among family and friends for having to do things the hard way. And in this case, the "hard way" is actually utilizing a hospital. The "easy way" would be a home birth.

So, why in the name of all things good and crunchy and wild-strength-of-a-woman-unleashed are we purposely going with a hospital VBAC?

For starters, cash flow. Miscarriages when done at home are cheap. Ones that quickly turn into a frightening emergency are quite expensive. As we aspire to live as debt-free as possible, our home birth midwife fund fast turned into a hospital bill fund. And was instantly obliterated.

Secondarily, it seems that the previous miscarriages might have been hinting at some thyroid trouble. I would like this to be noted, from start to finish, what various levels of thyroid hormones are doing. I had a baseline reading at the onset of this pregnancy, and it remains to be seen what will happen later.

So after nixing four other obstetrics groups (and boy, do obstetrics groups hate to be nixed. Word to the wise- it's hard to keep a straight face while nixing someone who obviously has already started sharpening their scalpel at the sight of your positive pregnancy test), we landed on a small group that works out of the small Catholic hospital that we used for our miscarriage-turned-emergency last July. Even though this group seems slightly more VBAC-friendly than the other groups, there are still multiple brick walls.

Let's start by looking at some statistics. Click right HERE for a good table of statistics gathered in a hospital setting alone in 1995. I emphasize "hospital setting alone," because statistics gathered by many American midwife groups suggest that the VBAC success rate at home is statistically significantly higher than the success rate in the hospital. This is due to a lot of factors that we can explore at another time, namely the use of various chemicals that are given in hospitals that interrupt the bio-pathway of the cascades of hormones involved in a normal, healthy birth. The statistics at this website seem to correlate The American College of Obstetrics and Gynecology, as cited HERE. So now, we have the prior, research-based understanding that it seems that, "Dozens of studies report that for women who have had one prior cesarean birth with a low-horizontal incision, the risk of uterine rupture is 0.5% to 1.0%." This, readers, is fairly close (in other words, there seems to be no statistical difference) to the rate of a spontaneous uterine rupture in a woman who is having her first baby (in other words, has never had uterine surgery).

My surgical scar is the very best type to have- a low, horizontal incision that was repaired separately from the fascia (instead of sewing everything up together, my wonderful and brilliant surgeon- the one I have lauded in previous posts- took the care and time to repair the uterus separately from the skin). My risk level for a "spontaneous" uterine rupture (that is, one that wasn't augmented by drugs) is now back down to what it was before I ever had a C-section.

Which brings us back to the OB group. I have now officially met with all of the doctors/care practitioners at this group. This motley crew consists of:

- Dr. Fashion: My (female) main doctor. I originally chose her, as I don't feel comfortable with male care practitioners. She is aloof, albeit professionally friendly, and has so far refused to give me her exact C-section rate. Red flags.

- Nurse Practitioner: The nurse practitioner gave a loud, "Great!" when I affirmed for her that I was indeed trying for a VBAC. She shrugged and said, "Whatever you want!" when I told her that none of the flu vaccines were an option for me.

- Dr. Older Guy: As his name might suggest, he's an older, gentleman doctor. Contrary to my pre-conceived notions, he actually encouraged me about the VBAC saying, "I don't see any reason why it won't happen at this point." He also seemed thrilled that I was doing my own research, and agreed with me that there was no reason to take tests or perform interventions if I felt it was unnecessary (as in, I declined the Gestational Diabetes test, and the nurse nearly laid down on the floor before she passed out and fell).

- Dr. Younger Guy: This doctor was the one who performed my (outpatient, D&C) surgery when my last miscarriage went all kooky. He appears to be even younger than me, but it's possible he's approximately my age. He stuttered and stammered his way through my appointment with him, and simultaneously wanted to make sure "they" had given me the pamphlet on the safety of VBAC (Question: Do "they" give pamphlets about the risks of repeat, major abdominal surgery to mothers who choose an elective Cesarean after a Cesarean?) while at the same time, repeating, "Okay, okay, okay," as I responded that I am confident in my own research.

I do not know if the Nurse Practitioner attends births, but of that list, I really think that I'd prefer to not be near half of these people while birthing.

To be continued...