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 30th, 2010
This is Me, Opening a Childbirth Education Business
Today was one of the most exciting, and terrifying, days of my life. As I’ve been finishing up my CAPPA childbirth educator certification process, I began searching for a place to teach my classes. I called all over my area pricing yoga studios, and found that most charge somewhere in the neighborhood of $25 per hour. If I want that space 3 hours a week, then that quickly adds up to around $300 per month, and nearly $600 per class session. It didn’t seem very economical.
So then I got the hair-brained idea of renting an office space with another educator or two. I asked around on the Chicago doula list, and immediately got responses from a few interested parties.
Fast forward a few weeks, and now I’m looking at spaces. A few more phone calls and emails, and I officially had 3 other ladies who wanted to go into a space with me. Now things were moving forward, but given the amount of space we needed, and what we hoped to pay, it was slim pickin’s in the Chicagoland area. Last week I found one storefront space that would have worked, but by the time I called the owner back to say I might want to take it, he had already rented it. Bummer.
So I drove and drove all over the areas I hoped to rent in, called a thousand different places, and finally found one little space that would have worked, but I wasn’t super excited about it. I felt it was really our last option though if we wanted to start our classes in August. Then I thought (for no particular reason), “I’m going to drive down one more street, just to see…”
And then – I drove by this…
I hopped out of the car and ran to check the window. It looked perfect size – actually slightly bigger than we hoped for. I immediately dialed the number on the For Rent sign, but it rang to the flower shop next door that was closed. I would have to wait until the next day to find out if the space was in our budget.
Other than my labors, that 24 hours of time passed more painfully than anything else I’ve ever suffered through. I wanted this place. I wanted it yesterday. I fell in love with it. In the words of the mouse Chrysanthemum, “It was absolutely perfect.”
When I finally got the owner on the line this morning, I found out that the place was just a bit beyond our price range, which I had expected. I couldn’t let it go without a fight though, so I immediately ran to the space and begged the owner to work with us. She did, and we brought the move-in price to something that I could swallow. By 4:00 pm today, my name was on the lease, and I became the proud renter of the space that will become West Chicagoland’s premiere childbirth & parenting education studio.
Between the four of us, we’ll be teaching comprehensive childbirth education courses, Hypnobirthing, prenatal fitness classes, breastfeeding classes, newborn care classes, sibling classes, and anything else that may come up. I’ve even talked to a photographer who may come in and do affordable maternity shoots once or twice a month for our students. We’re also hoping to work with local green parenting retailers to share business. The possibilities for our space are endless, and I’m feeling great about this decision.
Introducing….
Birthing Babes Childbirth & Parenting Education Studio
728 South Main Street
Lombard, IL
Classes start August 1st! More details coming soon!
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.
June 21st, 2010
A Birth Plan is More than a Wish List
I often hear birth attendants refer to a mother’s Birth Plan as a “wish list.” They want to convey to the mother that having a birth plan is nice, but she needs to maintain some flexibility in the event that things don’t go exactly as she planned. Of course this is true. None of us can ever know exactly how our birth will go down any more than we can predict exactly what sort of traffic we’ll hit on a road trip that we plan months in advance.
Even though I don’t believe that birth can be scripted, I do think that a Birth Plan can have a huge impact on the events that day, and is thus deserving of a better analogy than a “wish list”. When I think of the term “wish list,” I think of my Amazon Wish List which I’ve filled with all the books I want to buy but can’t afford, or will probably never get around to reading anyway. It seems like a term “wish list” is better suited to describe some fantasy about what we could have if only we won the lottery, or hit a patch of good luck.
I prefer to think of a birth plan as a quiet advocate. This piece of paper shows interested parties how a mother expects to be treated during her labor. It also shows that she has educated herself about the possible choices she may be faced with, and has made clear-minded decisions about what she is comfortable with before she is in a vulnerable position.
A Birth Plan forces a mother to ask herself:
- “If my hospital expects all women to have a routine IV running, do I want that?”
- “Do I want to be tethered to the bed by continuous monitoring, or can I have intermittent?
- “Do I want my fluid and food intake restricted by an arbitrary and outdated hospital policy?”
- “Do I want access to the birthing tub, a birth ball, and other natural tools?”
- “Do I want the nurses to suggest the epidural during every contraction?”
- “Do I want immediate contact with my baby, or is it okay if they take him/her away for routine tests?”
- “In the event of a cesarean, do I want the surgery to be family-centered, or plainly surgical?”
- “Do I want my newborn to have routine tests and vaccinations?”
It is true, though, that many mothers create their birth plans, laminate them, and hand them out to every nurse on shift, yet L&D staff may never take it seriously, or may be flat out annoyed by it. Remember the Facebook conversation we all witnessed a few months back? I’m sure those type of attendants see the Birth Plan as a Wish List, as in “haa haa.. yeah… you wish.” Many providers, and mothers, don’t recognize that a woman has every right to refuse the routine tests or procedures she is confronted with. The birth plan may not be a legal document, but mother’s desires during her birth are her legal right. Yes, a mother can Just Say No to anything she is uncomfortable with during her labor, and the Birth Plan is the first draft of that assertion.
I always advise mothers to start a Birth Plan early in their pregnancy and present it to their provider. If their provider goes through it with a big red pen, crossing out all the things they won’t “let” her do, I say that’s a huge red flag to find a different provider. A birth plan can be an excellent barometer when scoping out a supportive VBAC provider, too. For example, if a mother wants to eat and drink during labor, and the provider says “No way!” then it’s easy to see they are probably already prepping the mother for surgery in their mind, and not using evidence-based medicine.
Though certain providers and hospital staff may never take a Birth Plan seriously, I believe that the Birth Plan is most useful to the mother and her labor support team. It’s too easy for a mother to get railroaded by The System when she’s busy working hard in Labor Land. Having a birth plan enables her birth partner(s) to remind her of her desires, and suggest acceptable alternatives if her labor begins to look a little different than she had hoped.
A commentor on my blog recently made the analogy that a Birth Plan is like a road map – and I like that a lot. No, we cannot predict the traffic we’ll hit (i.e. complications during labor) but that doesn’t mean we shouldn’t plot our preferred route. If we have to take a detour, at least we have a sense of what the surrounding terrain looks like, and can make better informed choices in the moment. This “road map” can also help us get back on track if we do find ourselves a little lost.
Let’s reserve our “wish lists” for the things of lesser importance. I don’t think that a mother should have to win the lottery of birth luck to have the experience that deserves.
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Let’s take this opportunity to administer an oh-so-scientific poll about Birth Plans…
