July 22nd, 2010
BREAKING NEWS: ACOG Admits What We Already Knew
In a long overdue press release, the American Congress of Obstetrics and Gynecologists finally steps forward to revise the old guidelines that had once caused so many hospitals and doctors to “ban” VBAC. In a revision released today, The ACOG now states,
“a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…”
Hallelujah! It’s about time!
But they didn’t come to this decision on their own. Back in March, the National Institutes of Health held a conference on Vaginal Birth After Cesarean – a conference that I attended, wrote about, and was even featured in during the “Mother’s Stories.” I was so proud to see that at that conference, birth activists from all walks of life – doctors, researchers, midwives, and mothers – gathered to help try to convince the panel to see what we’ve all been seeing, which is that women’s rights are being trampled on when they are denied the safe option of vaginal birth. The ACOG President himself sat in a theatre listening to stories of doctors who couldn’t help their patients because their hands were tied. They heard stories from mothers who had to battle hospitals for the right to birth vaginally, or instead birthed unassisted at home because they could not find a provider able to help them. And they listened to highly respected doctors and researchers present the latest available evidence, which is that VBAC is a safe option, and in fact, it is a safer option than a repeat cesarean for most women.
They were also shown a slide listing grassroots organizations and activists who tirelessly battle to preserve patient autonomy and protect the rights of childbearing women. Thanks to those women who stood up and demanded that this was a human right’s issue, the ACOG also included this in their statement:
“restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC.”
Do they know how long we’ve waited to hear those words?
I know many of us don’t care what the ACOG says, and we’d be VBAC’ing whether they got on board or not. But this statement could actually change maternity care in this country. They have now admitted that women are being “forced” into surgeries they do not want or need. They now admit that cesareans have risks, and that the risks of vaginal birth are much lower than previously implied. They are now admitting that despite their claim as the authority on All Things Obstetric, it took a government panel to investigate this issue for the Truth about VBAC to be exposed.
And I don’t think they get the credit here. I think we do. That’s right – you and me. So thank you to the the women like Joy Szabo, and Jill from Unnecesarean. To the women like Desirre Andrews, and Jennifer Block. To Nicette Jukelevics and Jen from VBACFacts.com. To the women of ICAN, and the midwives who risk prosecution to attend a home birth after cesarean where the state doesn’t support it. To all the women who Tweeted, and Facebooked, and Blogged this issue until government health experts couldn’t help but take notice.
We did this. We made this change happen because we spoke up and insisted on being treated better. But the work is not done yet. Now, we must take this statement to our providers and hospitals and challenge those VBAC “Bans.” Send the statement to your sisters, coworkers, and friends who may be considering a VBAC. Write about it, talk about it, and keep spreading the message until VBAC is no longer a four letter word.
Change is coming. I can see it in the horizon.
June 25th, 2010
The Power, and the Patriarchy, and the Birth Plans, Oh My!
This has been quite a week of justified outrage toward The Establishment and all that they do to undermine women’s health and autonomy. Let’s recap, shall we?
I started this week by encouraging women to make birth plans, fully acknowledging that most hospitals and doctors hate them, yet still finding them critically necessary as a tool in the personal discovery of your own beliefs about birth (and whether your provider shares those beliefs).
Then, I read a little book by Dr. Marsden Wagner, who agrees that most obstetricians hate birth plans (and autonomy) and having a birth plan may annoy the L&D Staff to the extent that they could make sick jokes about cutting the mother open.
WHAT!? They wouldn’t dare! Would they? Yes, they would… on Facebook even.
Some said the table Wagner used to illustrate his point was out of date and couldn’t be taken seriously because it was a (published and widely referenced) joke.
Well, in what is almost entirely too coincidental to even be believed, Kingsdale Gynecologic Associates from Columbus Ohio recently sent out letters to their patients, banning trained labor support (doulas) from a woman’s hospital room, and discouraging birth plans created by a mother.
Instead, they have their own birth plan, which ignores all the current research and scientific evidence regarding doulas, food/drink in labor, electronic fetal monitoring, epidurals, episiotomies, etc, etc, etc. In fact, it’s hard to believe that such an egregious misrepresentation of these interventions is even legal.
Kingsdale’s birth plan is a must-read. Notice that if you just remove the wordiness, what they’ve written is this:
“We…make the…decision for you.”
Apparently, not only have they deemed it legal to remove a woman’s legal right to informed consent, they aren’t the only group practicing this way. Yesterday, after noticing the post at Birthing Beautiful Ideas, a photographer in Chicago sent me a copy of the birth plan she had to sign when she delivered her baby 20 months ago.
WomanCarePC (with 7 locations around West Chicagoland, practicing out of Northwest Community Hospital in Arlington Heights) offers this “birth plan” to all their expecting moms. (I’ve bolded the parts that I consider condescending, those that go against evidence-based birth practices, or that which makes it obvious this is not a hospital with the “Baby Friendly” seal of approval. Also, notice how many times they use the “healthy baby” language as a tool of manipulation – implying that if you do not do what they say, you don’t care about having a healthy baby.)
Birth plans have become a popular concept for patients over the past several years and with access through the Internet, patients have been able to print one and present it to their physician. Often times, these birth plans can be erroneous, therfore as your physicians at WomanCare, we have developed a philosophy for our own patients that can utilize during the birth of your child. Our philosophy incorporates many “Birth Plan” concepts and options. Please take time to read our philosophy to become familiar with it, then sign and return it to your physician to discuss it at your next visit.
Our Birth Plan Philosophy
As your physician at WomanCare, we want to provide you with a positive birth experience with the goal being “healthy baby, and healthy mom”. We have developed this philosophy to aid us in achieving this goal. We have recommendations for each stage of labor. We want your husband and/or support person, to be part of all the decision making.
Onset of Labor
1. If this is your pregnancy, please call your physician when your contractions have been painful and every five minutes for one hour or you believe your bag of water is broken.
1. If this is your second or more pregnancy, please call your physician when your contractions have been every ten minutes for one hour or you believe you bag of water is broken
~Early Labor~
- During early labor we encourage walking
- You will be able to drink fliuds, ice chips, or Popsicles
- Fetal Monitoring will be done for 15 minutes once and hour to assess your baby’s health status.
~Active Labor~
An IV will be started, as we believe it is important to have venous access in the even you become nauseous and are unable to tolerate fluids orally. An IV is required if you desire and epidural. We also believe having venous access is necessary in the event of an emergency.
We encourage any position which is comfortable for you during labor.
Pain management is ultimately your decision. It will be offered at your request.
Internal fetal monitoring is necessary in the event when external monitoring does not provide enough reassuring information regarding the health of your baby. If your bag of water breaks and there is meconium present, internal monitoring is required. Keep in mind our goal of “healthy baby, healthy mom”.
~Pushing/Delivery~
- Pushing during labor can be done in any position, which is safe, such as on your side, squatting, or on your back. Keep in mind, average pushing time is 1-3 hours.
- Forceps and/or vacuum assisted deliveries are only done when necessary. Episiotomies are only done when necessary. Keep in mind if it appears your perineum is going to tear; it is better for healing purposes to perform an episiotomy.
- Once your baby is delivered, we encourage your husband and/or partner/support person, to cut the umbilical cord. Of course if they don’t feel comfortable doing so, just let us know.
- We want you to hold your baby as soon as possible to initiate the bonding process. Remember our goal “healthy baby, healthy mom”. The baby may need to be assessed by the nursery staff first.
~Post Delivery~
- We would like the baby to stay with you at all times. If you agree with this, please let the hospital nursing staff know.
- If you will be breast-feeding, we encourage you to do so immediately after the delivery and you are in a confortable position.
- Erythromycin eye ointment will be administrated to your baby after the first hour from delivery.
- Please notify the hospital nursing staff if you want you baby to receive breast milk only.
~Emergency Cesarean Delivery~
- In the event of an emergency cesarean delivery, time is of the essence with our goal “healthy baby, healthy mom”. We will keep you and your husband and/or support person updated and informed in the case of this event. If it is appropriate and safe, your husband and/or support person can be present for the delivery.
The birth of your baby is a partnership with your physician, and your impute is important to us. We want your delivery to be a positive experience and meet your needs. As always, our goal is to have a “healthy baby, healthy mom”.
(According to the photographer who sent this to me, the typos and misspellings were included the birth plan. This is verbatim.)
We all want to believe that it’s just angry women making hostile accusations toward well-meaning OBs and hospitals. Calm down honey, it’s all in your head. However, it’s pretty hard to ignore when the obstetricians are the ones sending out their patriarchal beliefs in writing, and then asking pregnant women to sign it.
There is a solution. Fire them. Take back your body. Refuse to be treated as a wombpod. Let them know that we ARE consumers in this process, and if they won’t treat us with respect, then by golly we’ll get our birth attendants elsewhere, thankyouverymuch.
And with that, I exhale. This week has been just about all my blood pressure can take.
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Did your provider ask you to sign a “birth plan” like this? If so, send it to me.
June 23rd, 2010
Independent Women Will Be Cut
Without trying to sound ageist or condescending, every time I see a 20-something year old on Jezebel bragging about the cesarean she’d sign up for if she were ever pregnant, I want to butt in and say “Don’t you see?!?! That’s what they WANT you to do!!!” Toward the end of this post I’ll explain what They want, and why we shouldn’t give it to them, but first, let’s talk about the language of “choice” in relation to birth.
So many young women today think that drugged-up births and cesareans are the “feminist” choice, and that labor pains are oppressive or patriarchal in nature. I understand… I really do. I once was that girl. I thought anything that could disconnect me from my biology meant freedom, and even joked about wanting a hysterectomy before I ever had kids.* I didn’t necessarily want a cesarean (I’m scared of surgery) but when I became pregnant, I had blind faith that the obstetrician I hired could easily and painlessly remove the parasite I was growing in my womb with a nice epidural cocktail and some forceps. Simple, right?
Of course I had no education whatsoever about epidurals or forceps or cesareans, and how much damage they could do to a woman’s body. I just assumed that if the technology existed, then they must have perfected it, and if it could keep me from feeling a contraction then by golly, I had to get me some of that.
We all know how that worked out for me. I learned the hard way that attempting to circumvent nature had a miserable outcome for me, and once that happened, I started to wonder why I’d had so little faith in (or love for) my body’s amazing abilities to begin with. And then I started to discover that my mistrust and contempt for my biological functions came from years of programming by The Establishment.
See, if I stay home to have my baby, the local hospital, OB, and pharmaceutical company doesn’t make a penny, and exercises no control over my body. However, if I go get me one of those cesareans, well… a whole lot of people are making money; obstetricians, anesthesiologists, drug companies, makers of surgical supplies, hospital administration, etc, etc. And me? I’m left with a scarred uterus for the rest of my life, which will greatly limit my choices in the next pregnancy, and further compromise my health.** Thanks Doc!
So, what if you decide to take control over your birth? Ah, well, The Establishment doesn’t like that. In this brilliant 2008 expose, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
In his book, Dr. Wagner (an obstetrician and former Director of Women and Children’s Health for the World Health Organization) explains,
“This table heaps contempt on women whose ideas and preferences for giving birth inconvenience the doctor. Many obstetricians find the table hilariously funny. Isn’t it frightening that the ultimate weapon obstetricians use to punish overly “independent” women is to cut into their bodies, using a surgical procedure (cesarean section) only obstetricians can perform, which completely deprives the women of control over their own bodies?”
Yes, Dr. Wagner – it IS frightening. Even more frightening is the fact that so many young women frivolously joke about electing a procedure that you describe as nothing short of violence against women. All the while, women and babies are dying at a higher rate in the U.S. than in most other developed countries. In a fact sheet offered by The Safe Motherhood Quilt Project, it is noted that,
“The maternal mortality rate for cesarean section is four times higher than for vaginal birth and is still twice as high when it is a routine repeat cesarean section without any emergency.”
In fact, our U.S. maternal mortality rates are so high, earlier this year Amnesty International released a report titled “Deadly Delivery: The Maternal Health Crisis in the US”, calling for the United States to make dozens of changes to women’s health care, including “establishing clear national guidelines… for the appropriate use of medical interventions and procedures such as c-sections.”
How did we get here, and how can we turn this around? Well, so many brilliant authors and film makers have already shown us the many ways that handing over the keys to our biological castle has backfired for women. All we have ever wanted to do is be treated as equals, yet instead we discover that The Establishment has found ways to capitalize on our desire for independence, and ultimately, punish us for it – during the most vulnerable and transformative period of our entire lives, no less.
All of this sounds very Debbie Downer, and my intention isn’t to scare women, or inject fear into a woman’s birth experience. Contrarily, books like Marsden Wagner’s are focused on exposing the problems, and proposing solutions to the mess we’re in. Independent women need to be aware of the real price of trying to buy the “perfect, painless” birth experience from surgeons, and think about ways to change the system for the betterment of all women and babies.
Last year I gave a 10-minute talk in an advanced public speaking course on this very topic. When I finished, one young woman raised her hand and said,
“Wow, I never knew any of this. I always figured I’d sign up for a c-section the minute I got pregnant, but you’ve really got me thinking.”
And that’s all I hope for. I want more young feminists to ask “Are we taking control over our own bodies, or are we really just unwittingly giving all the control away and labeling that a choice?” and “When I enter my birth environment, am I sure I’ll be treated with respect, or are the residents joking that my desires for an autonomous birth just bought me a ticket to the OR?” If it’s the latter, then it’s time to demand better, and to keep demanding it, until our maternal and infant mortality rates reflect the amount of money women are paying into our maternity care system.
I won’t put up with a doctor joking about cutting me just because I hyphenated my last name or wrote a Birth Plan, and neither should you.
Now… what’s your gut reaction to seeing the table above?
UPDATE: For those who were even one bit skeptical about whether or not I could possibly be right about physicians opposing autonomy, this week Kingsdale Gynecologic Associates in Columbus Ohio sent a letter to their patients banning doulas and birth plans. Here’s their letter: http://birthingbeautifulideas.com/?p=1922
There you have it. RUN LIKE HELL LADIES!!!!!!!!!
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*In a display of pure irony, the period I wrote about in that post ended up being my Last Menstrual Period (LMP) before I got unexpectedly pregnant with my first son. Sometimes the Universe has a way of forcing us to deal with things.
**No matter how many times I insist that SOME cesareans sections are 100% necessary and life-saving, people always complain that I don’t leave that disclaimer enough, so here it is again. SOME cesareans are 100% necessary and are worth the risks involved. However, The World Health Organization estimates that a national cesarean rate of 15% is “a threshold not to be exceeded,” yet our current national rate is 32%. In some hospitals, it’s twice that. This says a lot.
April 12th, 2010
Just Say No to Wars Over Breastfeeding
Last week after my post about breastfeeding blew up so big that it broke my servers, I got an email from a nice lady from AOL who was interested in having me continue the conversation over at AOL’s ParentDish. She said she liked my blog and would like to give me the opportunity to get my voice heard on such a mainstream site.
I was sitting in class when I got the email, and all I could think was,
“holyshitohmygod AOL likes me this is crazy oh my god oh my god!!!“
But then, quite quickly, reality set in, and I read through the email a little more carefully. They were asking me to come on to “debate” another blogger in the context of last week’s breastfeeding news. I was immediately quite confused and conflicted, because on one hand:
Breastfeeding does not need to be debated. Babies were born to be breastfed. You cannot argue with fact.
BUT – on the other hand:
Having this discussion on ParentDish, with its 8 million viewers a month, could raise awareness of the issue and hopefully effect some thought change.
And seriously, who doesn’t want to gain more exposure for their cause? I wouldn’t be making health law my career if I didn’t think that I could make some real changes by talking about these issues.
However – there is quite a difference between a circus and a debate, and I was dying to see how AOL would be setting this up. After a panicked phone call to my experienced and intelligent breastfeeding lawyer mama friend, I told AOL I was reluctant to accept the invitation, but asked if they could explain further in case there was something I was missing. As it turns out, they wanted to feature me, and this other blogger, in a forum called “The Smackdown.”
HUGE BLINKING RED FLAG.
The Smackdown, huh? That begs the question – which one of us is supposed to be the one getting smacked down? Is it the blogger with science, evidence, research, and billions of years of evolution on her side, or is it the blogger ranting about projected guilt? Either way, sounds like a soap opera to me, and no place for a real discussion about health issues impacting our family, and our status as women.
The other blogger’s piece, which was published elsewhere today, was titled “Quit picking on moms who don’t breast-feed.” I was supposed to have some sort of counter-argument to that statement. But, exactly what is there to argue with about that? No mom should be picked on. I don’t think anybody IS picking on these moms. I just think we’re trying to give women information and help them meet their own goals instead of sabotaging them – right?
See? There – I fixed it. Nothing left to argue over. 
And dudes – As much as I welcome healthy disagreement between smart women, I do NOT need to be in another fight with a popular blogger again this year. As it is, I’m sure one author wants to choke me to death with her “sexy nursing bra” after I didn’t like her anti-feminist sex book. Another one calls me nasty names all over the Blogosphere because I didn’t appreciate her calling a homebirthing mother a “criminal.” Sheesh, standing up for other women has really gotten me a beating this year, and between just those two, frankly, I’ve had about all the Blog Wars I can stomach for 2010. Do I really need to take on another blogger in an emotional battle that NOBODY will win? I can be really, really stupid sometimes. But not that stupid.
Still though – this is AOL we’re talking about here, and this could be my in with them. I don’t feel like I’m at a place in my career where I can turn down opportunities (well, this could be a symptom of my personality that explains my constantly overfilled plate because I never, ever say no to anything in the unlikely event that it actually may help me in even the smallest way.) I’m trying my hardest not to burn bridges before I’ve ever seen them.
But after stressing about it for days, and hemming and hawing, I finally politely told AOL that this was not the way I wanted to discuss this issue. Breastfeeding – and mothers – deserve far more respect on such an important topic. We can all argue on ParentDish over Jon & Kate drama, or whether texting at the playground makes you a disengaged parent, but serious public health issues like breastfeeding and reproductive rights deserve more than trite bickering.
No hard feelings, AOL. I just have to sit this one out. And I would encourage us all to shift the focus off of the cyclical “Breast vs Formula” debate, and start talking about the real issues. Says Amie Newman at RH Reality Check,
“work towards equality and justice and we’ll allow women to make decisions they feel are right for themselves.”
That’s what we need to be discussing now. Issues of “guilt” are just a straw man argument that distract women from the real barriers to breastfeeding. Creating a soap opera out of this issue is like pulling the fire alarm so someone can loot the building.
I said this last week but I’ll say it again. We MUST give women the tools and the support they need to reach their own breastfeeding goals. Anyone who is offended by women getting their hands on information doesn’t have any other mom or baby’s interest at heart.
Can we move on now?
April 6th, 2010
When It Comes to Breastfeeding, We Can’t Handle The Truth
Every single time a new study is published proving that formula feeding costs the lives of mothers and babies, people come from the farthest corners of the internet, flame throwers in tow, to argue with the research. But no amount of denial is going to change the truth. This week the Journal of Pediatrics published some very serious new findings indicating that 911 babies in America die every year from not being breastfed. Usually when we talk about infant deaths related to formula feeding, people assume it’s in other, impoverished countries where there’s no running water and rampant disease. But this time, we’re talking about the deaths of American babies.
So what’s going on right here on our own soil? We have clean water. We have a welfare program. We have free vaccinations. It is clear now that the formula itself, and the lack of breastfeeding, is what’s killing these 911 babies. Okay, so how are they dying? As CNN reports,
“Nearly all, 95 percent of these deaths, are attributed to three causes: sudden infant death syndrome (SIDS); necrotizing enterocolitis, seen primarily in preterm babies and in which the lining of the intestinal wall dies; and lower respiratory infections such as pneumonia. Breastfeeding has been shown to reduce the risk of all of these and seven other illnesses studied by the study authors.”
And for those Americans only interested in the bottom line, it should be noted that the same study found that if we can get 90% of mothers breastfeeding for the minimum amount of time recommended, then we’d save 13 billion dollars a year in medical costs. (that’s BILLION, with a B, people.)
So what the hell is the problem, then? Why can’t we get on board with this research? The problem is that people don’t want to hear it. But I’ll say it anyway.
Breastfeeding. Saves. Lives.
You know what else saves lives? Car seats. So, why aren’t people spitting mad at the NHTSA for saying that? Why aren’t they leaving thousands of comments on car seat articles saying “But I just couldn’t afford a car seat, why are you trying to make me feel guilty?!?!” Well, maybe it’s because our society will admit that car seats save lives, and we’re willing to give them out free at fire stations and hospitals if we have to because it is that important.
So why aren’t we doing the same for breastfeeding? Why won’t they hand out free breast pumps and visits to a lactation consultant when we know it would save lives and money? Well, I think the obvious answer is that there are breasts involved, and people just lose their minds when female anatomy comes up in conversation.
Of course then people say “It’s her CHOICE to formula-feed – leave her alone!” But I don’t believe that most women are making this “choice.” The CDC shows that 3/4 of women are initiating breastfeeding in the hospital, but only 13.6% of women are still exclusively breastfeeding at 6 months. What this tells me is that somewhere along the way, they gave up on themselves, and the reason I hear most often is, “But, I tried! I just couldn’t make any milk!”
Here is the cold hard truth ladies: You have been lied to.
If only 13.6% of us could make enough milk, the human race would never have survived. And it’s not your fault. It’s the fault of this system that completely fails mothers and babies, and sabotages a mother’s good intentions. Somewhere along the line, some one told you that you couldn’t make milk, and you believed them because we’ve all grown up in a culture that tells women their bodies aren’t good enough for much of anything except being toys for men. Is it easy to make this milk? No, not always – but neither was bringing that baby into the world and your body did a fine job of that. Think about that. Think hard. Your body created an entire human being inside from nothing more than the joining of two single cells. Your body is a miracle worker. So what leads you to believe that, after creating a whole person with organs and tissue and a beating heart, that your body would call it quits when it came time to feeding this thing? The major problem here is that someone in your life probably put their own ignorance ahead of the short and long term health of you and your baby, and you believed them because women are used to feeling shamed.
But it’s really difficult to change this thinking when we have popular bloggers perpetuating myths and projecting their own guilt onto others, like here:
So, what can we do? We have to keep pushing back against this misinformation, and luckily there are strong women who will go to bat for mothers and babies, as seen here:
Or here
Or here
At this point, if you are arguing with solid, consistent research, you are on the wrong side of the issue. Your anger over these breastfeeding studies is completely misdirected and juvenile. Get mad that we have no paid leave to help support the breastfeeding relationship. Get mad that moms aren’t being given free breastpumps, lactation consultants, and healthier food. Get mad at a system that puts Girls Gone Wild tits on the cover of every magazine, but bans breastfeeding pictures on Facebook. These are the issues that need our attention as mothers, or as feminists, or simply as women with brains. But perpetuating the myth that women are incapable of utilizing their own biological functions won’t get you any respect from me. I believe women are capable. Give them the tools. Give them the time. Give them the respect they need. Women are creators and sustainors of LIFE, and there is absolutely no reason to feel guilty about saying so.
And this about sums it up (thank you Noble Savage):
End. Of. Story.
