March 8th, 2010

My Coverage of the NIH VBAC Conference

From where I sat, today was a hugely triumphant day in the land of birth activism.  I’ll have more details later but over the next few days, please visit this page to find all my coverage of the NIH VBAC conference including my radio show, and the a view of the twitter conversations surrounding the event.

March 6th, 2010

VBAC Access is a Human Rights Issue

Despite mounting medical evidence to the contrary, women around this country are being told that if they want to have a child after they’ve had a cesarean, they must undergo another cesarean delivery for the birth of their next baby.  Though the cesarean may be unwarranted and unwanted, these women are often left without any choice but to have this major abdominal surgery for no other reason than a paper policy written by a hospital administration who has never met, nor treated these women.  However, according to the AMA, the ACOG, and the letter of law, forcing a woman to have repeat cesarean is unethical, unprofessional, and unlawful.

How is it, then, that some hospitals have found it within their right to “ban” women from birthing babies through their own vaginas?  Why are some hospitals telling women they will not provide them with treatment unless they agree to a cesarean delivery, as opposed to a vaginal delivery? According to the Emergency Medical Treatment and Active Labor Act (EMTALA), any hospital participating in the Medicare and Medicaid program (which is most) cannot refuse treatment to a woman in active labor, even a woman refusing surgery.   The law simply does not support bans on vaginal birth.   Women do not forfeit the right to make their own medical decisions when they become pregnant.  On the contrary, they carry the responsibility of making medical decisions for the benefit of themselves, and their unborn child(ren.)

Aside from the medicolegal problems with forcing a woman into surgery, one must wonder about the ethical and moral significance of denying a women her own basic biological function.  Many women feel a tremendous sense of loss, violation, or defeat if they are unable to experience the birthing of their baby on their own terms.  These women can develop such a fear of repeating that experience that they stop having children.  Many women choose to birth future children outside the hospital to circumvent the system all together. Whatever their decision, many mothers felt they had little say in the matter because their hospital or provider could not be trusted to respect their wishes.  Some mothers say their choice might have been different if they knew a hospital could support their basic human right to bodily integrity.

Our Supreme Court upholds the right for a woman to choose whether or not she carries a pregnancy, and that same autonomy should be afforded to the manner in which she delivers her child.  At the end of the day, the woman (and her baby) live with the outcome of any delivery.  It is her body.  Her baby.  Her choice.

In a civilized society like ours, no woman should feel that she has been forced under a knife.  Women are human beings, and human beings in this country have the right to keep people out of their body.  If providers want to be taken seriously, they need to start taking their patient’s human rights seriously as well.

______________________________________

If VBAC access is important to you, call in to The Feminist Breeder & Friends Radio Show Sunday night at 10 PM Eastern time to have your voice heard.  Special guests Desirre Andrews, President of ICAN, and Michele Demont, creator of Birthcut.com, will help me kick off my coverage of the National Institute of Health’s conference on Vaginal Birth After Cesarean.

March 2nd, 2010

I Am Totally Famous (and Stressed) This Week

Holy. Moly. The next few days are going to be Cuh-Razy.

Throw a stone this week, and you’ll probably hit some place where I’ll be seen.

Today, my VBAC Story was featured on the Chicago Tribune blog through an article called “Fighting for a VBAC.” The reporter wrote about the battle I had to endure, and of course the very first commentor on the article called me “stupid.”  Not to worry though — only about a thousand other wonderful, intelligent, thoughtful women came to my defense and posted replies making it clear that my choice to battle for my VBAC was anything but “stupid.”

You go, girlz.

I’m thrilled that such a mainstream site took on this story, and am equally as thrilled at the positive outpouring of support for my story.  That all kicked a tremendous amount of ass, despite the one nasty comment.  If you know me, the worst thing I can be called is “stupid.”  It’s like calling McFly “chicken.”  Them’s is fightin’ words!

Okay, next up! —

On Wednesday, my family is featured on a Discovery Health/TLC show called “Radical Parenting” which is really just a show about AP families who parent thoughtfully and purposefully (don’t let the stupid title fool you.)  Since the commercials for the show are airing just about every 15 minutes all day every day, people are seeing them, and they are all over the internet message boards speculating, discussing, and ranting/raving about the show subject and content.  From Diaper Swappers to Mothering.com to The Bump — just about everyone is talking about our show (and my family.) It’s nerve-wracking — but I’m trying to steer clear as much as I can.

Meanwhile, I’m studying like crazy for the finals exams this week on the two worst classes I’ve ever suffered through, which I am surely going to fail pass only by the skin of my teeth.  On top of that I’m preparing for the NIH VBAC Conference that I’ll be attending (and covering) starting this Sunday.  I also have a little boy in a cast who needs mama’s constant attention, and Jonas is finally fully potty trained (I’m not kidding people — the fish totally worked!), which is so exhilarating that I can hardly concentrate on ANY OF THIS!!!!

Oh, and top of all it all, I haven’t had a damn period since January, yet I also keep getting negative pregnancy tests, which, if you’ve ever been in this position you’ll know, could drive a person totally and completely out of their mind.

With all this going on, what the HELL am I doing blogging?  I gotta go cry over my Statistics book and a handful of pregnancy tests now.

February 27th, 2010

How to Have a Better VBAC

If you’ve read my VBAC story, you know what a fight I had on my hands.  My OB, and the hospital staff, worked against my intentions for a normal birth every step of the way.  Most mammals could not have labored healthfully through the stress I was put under.  The fact that I was able to get my VBAC in those circumstances was somewhat of a miracle, and I contribute my outcome only to a few small advantages I had as a well-informed consumer.  But your VBAC doesn’t have to be like mine.  Your VBAC can be peaceful, and calm, and beautiful.

In the nearly two years since my VBAC, I have had the pleasure of bearing witness to a plethora of other VBAC stories through my connection to the birth community, and through my ICAN chapter.  Even though my own VBAC birth was worth whatever stress I had to go through to get it, I now know that with the right preparation and support, it doesn’t have to be an either/or situation.  You can have your vaginal birth, and it can be battle-free.

So, knowing what I know now, here is my advice on How to Have a Better VBAC:

Before you even think about getting pregnant, get a supportive VBAC provider.

Do not assume for a minute that your doctor or midwife supports VBAC.  Don’t even assume it if they tell you they do.  The OB in my story said he would support my VBAC – even as he was stapling up my cesarean.  That’s why I went back to him for my second pregnancy.   However, his true intentions were not made clear to me until I showed up to a prenatal appointment with my natural-minded birth plan in hand during my 3^rd trimester.  When he went through my birth plan with a red pen, I realized he wasn’t going to be as supportive as I needed.  I wanted to switch doctors then, but my HMO insurance told me I couldn’t.  That’s why I was stuck laboring with, what I call, the “Bait & Switch Doctor.”

However, despite my experience, you can always try to switch providers, no matter how far along you are.  Of course, earlier is better, but I’ve seen a mother switch at 40 weeks pregnant.  Call your insurance company.  If you don’t like the answer you get, talk to someone else.  Explain to them that you feel your rights as a pregnant woman are not being supported, and that you could save them money by changing providers.  Don’t give up.  Think outside the box.  A bit of work on the front end could save you a lot of stress on the back end.

Finding out if your doc or midwife supports VBAC involves more than just asking them.  You need to ask them questions about their VBAC success rate, and what type of restrictions they’ll place on you due to their policies.  If you don’t like the answers to those questions, get out yesterday.  If your hospital won’t allow eating during labor, or requires IV’s for no medical reason, or requires any other medical interventions that are not evidence based OR warranted, having a healthy intervention-free labor with them could be a battle.

Get Informed about Normal, Healthy Birth

If you have had a cesarean, you may never have experienced a normal, intervention-free birth before.  I ended up with my cesarean for all the wrong reasons.  During my first pregnancy, I watched one too many episodes of “Deliver Me” and “A Baby Story” – which depicts all births as disasters waiting to happen.  After watching those shows, I thought birth was a dangerous, emergency, medical event that could only occur with a huge team of doctors waiting by for everything to go wrong.  I signed up for an unnecessary induction, and because of that choice, everything did go horribly wrong.  It was a self-fulfilling prophecy.

I now know that those shows are the epitome of everything that is wrong with maternity care in this country – and birth has gotten a bad rap.  Like much of the medicalized birth industry, those sensational shows prey on the fears of pregnant women and can easily convince them to become consumers of drugs and procedures they don’t know much else about.

But birth itself is a normal, biological function, where mother and baby usually fare better without those (often unnecessary) drugs and procedures.  If you study natural birth, you will see that women possess a powerful, innate wisdom about how to birth their own babies.  Through your studies, you will learn to believe in yourself, no matter what may have sabotaged your previous birth.  Take a good, long natural birth class.  Read, Read, Read.

My recommendations for the two essential natural birth books:

• Ina May’s Guide to Childbirth
• Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation

Learn About Those Interventions, and about VBAC itself

Being an informed consumer is one of the single most important steps in preparing for any birth, especially a VBAC.  No matter if you’re laboring in a hospital, birth center, or right at home, you need to have a basic understanding of the machines that go “Ping!”   Read about the risks and benefits of all the basic procedures that could be presented to you.  Otherwise, you won’t know what you’re agreeing to, whether it is truly necessary, or whether there is a better, safer option for you.  I spent my whole labor rejecting the bad medical advice I was being given, but I wouldn’t have been able to do that if I hadn’t researched the interventions and scare tactics they were pushing on me.  Of course, if you’ve taken my advice and gotten yourself a better provider, you may not have to reject a whole lot.  BUT — be prepared for anything.  If you’re having a hospital birth, your favorite OB or midwife may not be on call, and the on-call doc might have their own ideas about how to “manage” your labor.  If you’re having a homebirth, you’ll want to be prepared for the slim chance of a transfer.  The more informed you are, the better equipped you are to make the choices that you are comfortable with — even in a pinch.

My recommendations for learning about commonly used birth interventions and VBAC:

• The Thinking Woman’s Guide to a Better Birth
• Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
• The VBAC Companion: The Expectant Mother’s Guide to Vaginal Birth After Cesarean

Get Yourself a Doula

I cannot stress this enough: trained labor support is worth its weight in gold, especially through a VBAC.  If your previous birth ended in a cesarean after a long, hard labor – or, if you never got to labor at all – you may need an experienced support person present through your VBAC to help keep you strong, and to help you understand what’s normal.  Doulas usually believe in the beauty and safety of vaginal birth, so you can count on them fully support your desire for a VBAC.  Doulas have been shown to help decrease the rate of cesareans and other interventions, and mothers who use doulas report more satisfaction with the overall birth experience.  My doula saved my VBAC.  Without her, I might be telling a very different story.

My recommendations for finding a doula that’s right for you:

• DONA
• DoulaMatch.net

And on the topic of support people – make sure the people you’re allowing into your birth space are wholly supportive of your needs, and understanding of your desire to have a VBAC.  When dealing with family or friends who may not support your choice, keep the discussion about your birth to a minimum.  Provide them with good information about VBAC during your pregnancy if they’re interested, but keep in mind their opinions have no place in your birth.  It is your body, your baby. Do what is right for you, and ignore any negativity.

If you need more support — join your local ICAN chapter, and/or get on the national listserve.

Once you’ve done your homework – RELAX.

Now that you’ve prepared yourself to have a better VBAC, that is probably exactly what you’ll have.  Visualize your beautiful birth.  Will your beautiful birth into existence.  Even if life throws you a curve ball, or if your baby does truly need to be born by cesarean for some reason, the steps you have taken to empower yourself can help the experience remain as satisfying, beautiful, and safe as possible.

Good luck on your VBAC, and please, come back here and share your stories with us.  If your story is online, leave us a link in the comments section.  In the meantime, read these beautiful VBAC stories, and relish in their joy.

• Kristen’s Beautiful VBAC (after switching providers at 37 weeks)
• Jen’s Beautiful HBAC (homebirth)
• Krista’s Beautiful VBAC (she says it wasn’t pretty, but it was all hers.)
• Melodie’s Beautiful HBAC (a swift homebirth)
• Amanda’s 2nd VBAC (hospital)
• Want yours added here?  Just drop me a line!

February 2nd, 2010

The Scarlet C: A History of Cesarean

Hearing about a cesarean being performed on The Today Show* this morning triggered a lot of traumatic feelings for me. I cannot watch. Just knowing it’s out there is bad enough. Knowing that the Today Show is passing out bad information about the supposed necessity of this operation makes me feel that the odds are forever going to be stacked against healthy birth. It hurts my heart.

One thing I have not addressed so far on our journey toward conception is my very real, all consuming fear that despite my best intentions, this birth could end in another cesarean. This fear paralyzes me. Part of the reason I announced our plans to conceive was because I needed other people to be excited for me. I cannot be excited for myself right now. I’m simply too afraid. I’m trying — desperately — to get excited about conception. I do want another baby, this part I know. But I also know if I never get pregnant again, then I would never be exposed to the risk of another cesarean. It is a 100% avoidable surgery, provided that I avoid pregnancy. When we started talking about conception plans last week, for a few minutes I tried to talk the husband into getting his vasectomy right now (which he has already agreed to do after we’re done having kids). But he wants another baby. And I want another baby. And I’m trying not to let this uterine scar make these decisions for me. But — it’s hard. (<–Boy, if that isn’t the understatement of the year…)

I know that my chances of having a cesarean are dramatically decreased by my education about the birth process. I also know that my chances for a VBAC are incredibly high, especially since I’ve already had one. AND, I also know that I willed my last VBAC into existence by the sheer power of my determination. I can do anything; my VBAC taught me that. I could never let another cesarean happen to me if I had any control over it whatsoever. However, once the doctor cut into my womb, my uterine health was forever changed, and I will never get to experience pregnancy or childbirth with an unscarred vessel.

A friend once told me, as she was trying desperately to find a provider who’d let her have a VBAC, that she felt like she walked around with a Scarlet C on her chest. If we want a vaginal birth after cesarean, many providers won’t touch us. Many providers won’t help us. Many providers treat us like ticking time bombs — or worse — like bad mothers. And even when they do agree to see us, we are often forced or coerced into “mandatory” interventions that other non-cesarean moms can opt out of. It doesn’t matter if it’s illegal and unethical — providers can often talk a mother into anything when they threaten her baby’s well-being. Even when luck is on our side, and we can find a provider willing to treat us like a “normal” mom, we often still carry a fear that makes us envision an exploded uterus and the unhealthiest of outcomes. I believe that anxiety alone is what causes the vast majority of repeat cesareans. How many non-cesarean mothers fear uterine rupture? I’m willing to bet, not too many — even though it is certainly something that can happen to first time mothers.

I carry plenty of emotional baggage from my cesarean, but I also carry scar tissue — The Scarlet C.   I hope the Hypnobirthing can help me overcome this fear once and for all, but at this point, I really have no idea what will ease my concerns. I just want to feel…normal, again.

UPDATE:  To hear me speak about this subject, listen to Karen Angstadt’s radio show A Labor of Love — episode titled “A Healthy Baby Isn’t All That Matters.”