The AABC came out with another one of their policy changes that closely reflects ACOG. The masses are celebrating.
Am I happy that more women will wind up with a VBAC? Sure. That part is simply a matter of opening the gates of access.
The problem I have is the corollary equation:
Only women without risks deserve rights.
AABC allows (allows?) only women who have:
- a specific placental location (forced ultrasounds will ensue with no right of refusal either the ultrasound or the informed consent process of being allowed to say “I know my placenta’s location, it’s okay, I still want to plan a VBAC. I understand my risks.”)
- a low transverse incision. (once again, where is a woman’s right to understand her risk and continue forward with her birth?)
- only one prior cesarean (do I need to repeat this again?)
This came up last year when a mother who had risks that went beyond a provider’s comfort level refused surgery. The provider thought that his comfort level overrode the woman’s right to make autonomous choice. The law said he was wrong. But many women who would normally choose VBAC also thought they had the right to judge her for her choices. We set her up as some sort of “high risk” and didn’t allow her the freedom to understand her risks and make her own decision. Turns out, she made a decision in the end that she wasn’t happy with but that met her perceptions of safety. She was capable of making that decision but her risk set her up to be abandoned by women’s advocacy groups all over because, well, she wasn’t a good “candidate” to back in women’s rights. I totally disagree. It’s women WITH risks that deserve the MOST informed consent and time to make decisions while trusting that they are capable adults.
So why are birth centers getting a pass and everyone being all giddy about the possibility? Why are laws being passed in states that are more and more paternalistic and protectionist that somehow override a pregnant woman’s right to control her own healthcare and/or where she gives birth and which provider or health modality she prefers?
There is a real perception in the world that a woman with risk somehow becomes incapable of making decisions or isn’t capable of understanding the real or perceived risk. Risk is not a guarantee of bad outcome but somehow, we have equated the two and decided that no matter how much a mother loves her baby or how thoroughly she understands her risk, societal PERCEPTION of risk takes away her rights and gives them to…in this case…the AABC?
Where is a woman’s right to refuse these “conditions” and continue on with her pregnancy with an understanding of her risks?
In short, “Ar’nt I a Woman?”
I’m always on the lookout for relevant links to post for mothers and right now, I’m trying to heavily upgrade the site, so I’m looking for “best articles EVER” on specific topics. Do you have a “best article ever!” on your list that you think is totally relevant to pregnant or new mothers who need more information?
Here’s one from me:
For the record, neither is “normal” or “low” and what the heck does “low normal” mean anyway?
Test results should never be given to mothers as “high” or “you failed the test” or “your numbers are low”. If numbers like this are given to you, here are some questions to ask:
1. What were my actual numbers?
2. What do you consider the range of normal? **
3. Why do these numbers concern you?
4. What is the chance of a false positive/negative or false reading?
5. Is there somewhere I can go to learn more about this?
6. I’d like to do more research before treating this, can you tell me what my options are in the meantime?
**THIS can be very important. One doctor might have an utterly different range of normal from another or one lab might use a different range of normal from another. There is also a serious concern arising with many mothers that a mother may be experiencing symptoms or testing that is abnormal for her even though the tests results show normal. Or that an individual’s normal may be a testing abnormal.
Example: A 15 year old active athlete or dancer might have a pulse rate in the 40s and a bp of 102/49. A heart rate of 72 and a bp of 120/80 might be a sign of serious illness. Same for a marathon runner or an individual with naturally low blood pressure. You should always know YOUR normal numbers when you aren’t ill, if possible.
And in regards to urine tests or other tests where a comparison is done vs. a color on a stick, you can put the little stick in the box, go out of the bathroom and stick your head into the diagnostic room and say “I’d like to see the comparison, please” or tell the nurse “I’d like to see the comparison, please, the stick and the bottle you are comparing it to. Thank you.”
I ask you to sign this petition if you want, but please, contact the hospital involved. Send letters, emails, phone calls. PLEASE. The women of Gainesville and the surrounding counties deserve the care they were getting without having to give up their rights to support. This is in violation of Federal law as well as Florida State Statute. There is no legitimate reason for this policy and frankly, NFRMC and HCA should be ashamed as it’s clearly a power grab over women and their support.
I think the people in this world that do the most harm are the ones who sign up for these kinds of regulations or laws based on good intentions. Laws are not there to grant freedoms. Laws are there to set limits. Regulations in this instance are there to set limits based on what the hospital wants, not on anything else, JUST on who they can control and put that control in place. They don’t want doulas not hired by them, who are not on board with their policies. This is the entire reason that doulas exist. To support women to have the births that they want, sometimes while not agreeing with hospital policy. They are there to be the woman’s advocate FIRST. Allowing this policy to continue means that doulas have given up their basic freedoms and rights as well as the woman’s right to hire who she will or have who she will as support.
It’s important to remember that this past year, doulas were helping women and supporting them and now, only one doula is ‘registered’ and supporting women and therefore, the hospital is sending her referrals. Unless we change this NOW, more doulas will be inclined to agree to this registration process simply from a financial standpoint and keep in mind, these are not hospital employees, but visitors who are non-medical in nature. They are being asked for invasive medical information and being required to violate their own privacy, even if they do as little as ONE birth a year at this hospital. Even more importantly, women have power. They can refuse to give in to this. If doulas stood up for themselves and said, “No, we have rights, our mothers have rights” then the women know that they can get support, and that they will have to exercise their power. Signing up for registration to save women to keep from having to do that is just one more way we act as if women need saving from birth. They don’t.
Please help change this NOW.
The sticks don’t lie, right?
Well, sometimes they do, sometimes they don’t. The most reliable test for pregnancy is still the oldest. Miss periods, wait for baby to kick, wait for baby to be born.
Spend your entire pregnancy thinking like this and you will be much more relaxed.
Try to remember as you move through pregnancy that the entire experience is one of “new” and the message you should be giving back is one of “trust”.
Trust your instincts, trust yourself. Learn to tell the difference between what your body is telling you and what your fear wants you to think.
can really mess up an entire pregnancy, while instinct can guide you to get better care when you need it and remind you to walk away when/if you realize that things are out of your control or being done unnecessarily. Trusting yourself can mean never peeing on a stick or it can mean demanding a cesarean at 41 weeks because you feel something is way off. Trusting yourself can mean walking out on providers any time during your pregnancy all the way up to labor or it can even mean signing your newborn out AMA when there is way too much testing going on for a normal newborn. Fear is when you agree to a cesarean ‘just in case’ or when your doctor schedules an induction and you just don’t want to pick up the phone to tell them no because you are too pregnant to want a confrontation. Fear is when you do whatever other people tell you to do because you don’t want to be responsible if “something goes wrong”. Walk away from fear and learn to educate yourself about a variety of issues, but most of all, learn to trust yourself because your instincts about YOURSELF, YOUR BABY, and OTHER PEOPLE’S REASONS will be more important than anything else.
Start with midwifery when you are looking for care.
You want a completely decked out, epidural-laden, take me to the OR type of birth? It doesn’t matter. Go talk to a homebirth midwife first. Don’t have one in your area, go visit some homebirth websites, call some friends who have had homebirths. Talk to them about the real of it. The normal of it. You need to know these things because this is how pregnancy goes and labor occurs. This is how birth works and finding out more about it will help you make better choices even if you have an epidural on board. Women educating themselves about normal is how we know not to cut cords immediately after birth, even during cesareans. It’s how we know it can take skin to skin up to 2 hours to get breastfeeding started after an epidural. Normal is where we should all start to get the facts about birth.
If you really don’t want a homebirth, birth centers are essentially homebirths with a few negatives. You drive during labor. You don’t stay all day after the baby is born. There is no more safety to a birth center than a homebirth but you won’t be having a baby on your mother in law’s floor and there is the potential for some moms who live very far from a hospital to have a quicker transfer in the event of a true emergency but that’s unlikely (both the quicker and the transfer!)
Hospital births have a lot of variety, depending on who you use (CNM vs OB, Large OB practice, Small OB practice, etc) and the reality is that you’re going to get a lot more than what you want if you don’t have good support (dad, grandma, doula) who is on YOUR side when it comes to decision making and supporting your efforts and desires. You will also get a lot more than what you want if you don’t hire a provider who you don’t have to convince to your choices. You can always “just say no” to everything in a hospital but it can make for a much harder labor as the staff isn’t really appreciative of having their normal disturbed, even if it’s for your having a normal birth. Their normal is not physiologic birth and it’s important to remember that.
There are tons of websites out there about interviewing care providers so go and read through a lot of them if that’s your thing. Or look closely to see whether or not your interview process is normal and allows for time to discuss options, discuss nutrition, discuss care. There is no reason for a vaginal exam or a pap smear at the first appointment, even if you get a positive pregnancy test. Pap smears are notoriously inaccurate during pregnancy, and irritating the cervix or introducing germs into the vagina or cervix via the exam is not conducive to healthy pregnancy. Nutrition is heavily important during early pregnancy so if all you get from your doctor or midwife is an info sheet on what not to eat, then ask more questions because it’s far more important to eat well than it is to gauge weight. Weight gain during normal pregnancy can be between 25-50 lbs and for many women, there will be pressure to NOT gain weight, even at this early an appointment. Restricting carbs, protein or salt is NOT healthy and neither is eating ice cream either meal. You’ll need to kind of figure out what you are eating and go from there…80-100g of protein is recommended daily and salt to taste. It sounds like a lot, but your blood volume is increasing and this will really help to maintain the balance your body needs. Vegetables often have carbs but are full of different vitamins and minerals you need to be eating.
Also, if at your first appointment with a doctor, your provider begins mentioning induction or cesarean, I would ask them why they consider that an issue at this time. It’s a good reason to leave their care and it’s better to know up front. Ask them their rate of induction, their rate of medication, their rate of cesarean. And the answer should not be “only when appropriate” because then you would want to know “and how often do you feel it’s appropriate”? The WHO says 15% is a high number but the US, 20% is considered low even though homebirth midwifery care overall has a 3-8% cesarean rate, and has a much lower rate of women who become high risk during pregnancy, even of those who would be deemed “high risk” in a hospital. The problem is that many hospitals and providers in the US have an over 30% cesarean rate with some as high as 50 or 78% and you have to take that into an account when a provider gives you his rates. You aren’t just using YOUR doctor or midwife. You are using a specific hospital or facility. Their rates matter because that is who is supporting you during labor. If they only know how to support a 50% induction or augmentation (adding induction drugs to an existing labor) then you aren’t going to get care that is normal. If they have an 85% epidural rate, don’t expect them to know how to support you without medications, either. You don’t want to be having these discussions at 36 weeks so have them now.
In fact, your provider should be open to you asking any questions within reason. There should be a contact person to answer questions within a reasonable time (1-2 days) for non-emergencies and within an hour for emergencies. You should know how to find these people and your providers should be open to this. Especially for a first time mom.
Don’t be afraid to call. Don’t be afraid to ask questions. This is the most important thing you will ever do, bringing life into this world, because it can only be done this once with this one baby. If you need more information, it should be within your grasp. It should be easy to access. You shouldn’t feel stupid for asking. You should feel like there is a human being out there, reaching back to you, to answer, to help and to support.
I am always reminded at the oddest times that the biggest enemies women have are themselves. Midwives pitted against midwives. Women pitted against other birthing women. Personal choices and autonomy are lost in the fight of defensive women who feel they must protect their own choices.
In the 20th century, midwives were reduced to isolated pockets of education and experience then a resurgence occurred because women wanted to have home births, not because they wanted medical care providers at their births.
They walked away from medical care and into their bedrooms, supported by other women.
Then the rise in midwifery caused midwives to walk away from women in order to establish themselves as a profession. They compromised women’s authority at their births and autonomy for their choices in order to rise to what they assumed would be professional acceptance. It has yet to happen. They chose licensure over women’s autonomy and fought for that cause instead of women’s rights to give birth. It became about their right to a profession and their right to access to specific women under very refined guidelines. Since then, they’ve been steadily decreasing the control women have over their own births at home.
Now, I see a variety of movements occurring rapidly and the same issues over and over, with individual organizations rising and falling that keep trying to talk about evidence-based birth.
The reality is that the US birthing community that includes and is controlled by hospital-based obstetricians has never been about safety and never been about evidence. In order for us to continue the pretense that somehow, birth is safer in hospitals, we would have to ignore the vast majority of women who are walking out of those facilities with significant morbidity, emotional and physical trauma. We would have to ignore the headlines of women asking why they can’t find providers who won’t induce or demand cesarean sections. We would have to ignore the women seeking postpartum depression and PTSD care for the after-effects of their hospital births. We would have to ignore the impacts on breastfeeding of these events. And the disgusting reality is that we are ignoring those impacts. Daily.
So why are we choosing to ignore so much? Is it our allure for the preemies that are saved by unique measures? The mass media “we will promote whatever sells on any given day so you don’t get the real picture of either side”? Government agency-driven healthcare through Medicaid that has to be rigid in order to determine payments and “equal” care? Are we just not wanting to believe that an OB can threaten a woman with CPS and/or forced cesareans? Or are we busy telling other women “I did it/I needed a cesarean/What if something goes WRONG?” that we don’t stop to assess our fears and simply apply across the board that, despite evidence to the contrary, anyone who doesn’t birth in a hospital isn’t like “us”?
Or is the truth much uglier?
That women feel helpless and powerless because of exactly what CAN happen.
When a woman is told “if you try to have a normal birth, we will put you in a helicopter and make you go somewhere else” or
-”You have to show up for a cesarean” or
-”you can’t have a VBAC in our hospital, we will put you on the sidewalk if you attempt it”
-What about “if you try to have a VBA3C, we will call CPS to take your newborn”?
WHO THE HELL DO WE TURN TO?
Who do you call when your doctor can do that to you?
Their medical associations shrug.
The Department of Health considers this STANDARD OF CARE.
The NIH repeated during a 2010 conference, over and over, “We can’t make the obstetricians do anything.”
Ask any woman on the street who is 40 weeks and she will tell you: “My doctor won’t LET me go to 41 weeks”
“I had to have…an induction, a cesarean, a….”
“My doctor said they would drop me if I didn’t do XYZ”
And WHO is protecting her rights? No one.
If an ob says you must, you must. If a law created to employ midwives says you must, you must. If they both act out of fear, you have to submit. Their best interest is higher than yours. Always.
And if you don’t believe me, wait until it happens to someone you know. Wait until you are sitting holding the hand of a crying woman at 36 weeks whose doctor just told her “schedule or leave my care” without any reason.
So instead, we have women across the country once again fleeing midwifery care which is bound by obstetrical vision, they are fleeing hospitals where this kind of intimidation, fear and maltreatment is normal. They are choosing unassisted births. They are learning what they need to in order to give birth by themselves with their families. And many of the midwives they relied on are turning on them for making these choices.
Other women are writing their doctors and midwives. They are sending notes and requesting evidence-based care. They are coercing their doctors into better care via social media. They are trying to fight this but always with the knowledge that it’s at the WHIM of the doctor or hospital that they will be treated well.
Women are being abused and as a society, we not only tolerate it, we’ve institutionalized it and we punish women if they go against it and anything bad happens. We are brutal and nasty and post things like “see, her baby died” and the obstetrical trade union society CELEBRATES someone who does this kind of disgusting abuse for a living and rewards them with attention. If she’s lucky (and normal, as almost all birth goes pretty well if left alone) then we tell her how lucky she is and how someone we know almost DIED giving birth, never realizing we’re simply adding to the evidence pile that perhaps those elective inductions that lead to almost dying and emergency cesareans just perhaps aren’t warranted. And then so many women have families who were born into this system who are happy to tell us we are killing our babies if we go against, not evidence-based care, no…but obstetrical opinion or midwifery law.
We think that by acting like professionals, by writing those letters, we can appeal to the intellectual, that educated doctor fellow that spent all those years in school and will surely understand the evidence and will then allow “evidence” to rule and ethically allow women to participate in their care. We are convinced that it is somehow a lack of knowledge on the part of obstetricians rather than this institutionalized willful ignorance and bad legislative policies being coupled with a complete lack of oversight and consumer choice.
And so tonight, I got an email saying that because I help women, I am being “watched”. Let’s address that. How do I help women?
-By telling them they CAN give birth.
-By telling them to educate THEMSELVES.
-By telling them that a midwife’s protocol is not necessarily YOUR plan.
-By telling them they are ADULTS. AUTONOMOUS ADULTS.
-By telling women that they have the right as human beings to determine their own health care, their own beliefs, their own tolerance for risk and their own decision-making skills.
Women can use obstetricians and midwives as services and still be respected as adults with intelligence, capable of understanding. They can refuse specific parts of care. They can ask for others. They have the right and the obligation to their children to vote with their feet if the kind of abuse mentioned above is how they are treated.
STOP LICENSING MIDWIVES BASED ON OBSTETRICAL OPINIONS and STOP TOLERATING OBSTETRICAL VIOLENCE.
START ENUMERATING THE RIGHTS OF PREGNANT WOMEN TO GIVE BIRTH WITH WHOM THEY CHOOSE, WHERE THEY CHOOSE
The site crashed a while back and nothing restored properly. I’m working on it. If you want to help build YOUR state resources, I have 10-12 links I need on each state. Feel free to email me: director at birthaction.org or contact me on Facebook!
I have had some fantastic help from a few sources and much of the website content is being restored. I’m so relieved! I can’t always retrieve comments left in the past but the site itself is here!
In a discussion this morning, I came to the thought that every time I hear birth workers talk about lack of options, something bugs me.
Oh yeah, it’s that it’s our fault to begin with. Ours. Not “hers” or “The OBs” or the “Midwife Down the Street”s fault.
It’s my fault. I am taking responsibility for my pieces in it.
If you are a CNM in a birth center who turns away VBACs “because”
If you are a licensed midwife who turns away breech mothers “because”
If you a mom who gives into induction “because”
If you are currently a woman on this planet who has a pap smear every year just “because”
If you are a woman who let someone take your baby to another room after birth just “because”
If you are a doctor who induces women because of fear
If you believe not doing VBAC protects you from the natural consequences of being a pregnancy-related practitioner
If you are a doctor who does cesareans for breech rather than discussing risks and allowing the woman to decide…
yes, YOU bear responsibility in this.
So what are you going to do about it? When are you going to start taking responsibility for not changing it?
I saw this recently and felt it was worth posting. If you have concerns about your midwife using O2 or if you feel your baby has other issues resulting from hospital or homebirth use of O2, this may help you to understand why those concerns may be valid:
His accent can be a bit heavy: Dr Sola on Neonatal Dangers of Too Much Oxygen via PatientSafetyMovemnt on YouTube
“The issue that we have all been taught this for decades and that medical schools still haven’t changed the teaching. Because hyperoxia is as bad as hypoxia and that’s where we got involved. So I can tell you that hyperoxia can lead to all sorts of mental disabilities, associated. Associated 3 minutes of oxygen, pure oxygen in delivery room has been associated in 2 large studies, one from Sweden, and the other one from the United States, with cancer in childhood. Oxygen changes our genome, oxygen in excess. DNA, endocrine function, interestingly enough, cardiac function is decreased by too much oxygen. (Editor: Unidentified syndrome At :45), cerebral palsy, has been associated with too much oxygen. And actually, some people say that actually what we have done with our hands (he reaches out and turns his wrist like turning a knob), people talk about out of our hands, and has been studied, possibly inappropriately in animal studies or even in baby studies, is not the problem there was with hypoxia but is the treatment that we give, increase perfusion and give much more oxygen to all the system. “
and please take the time to go watch his entire commentary on the panel, it’s worth watching:
And in light of the recent changes back toward appropriate physiological cord closure, we need to remember that a baby’s perfusion initially is from the placenta, through the cord and that when they are born, compromising THIS “scuba tank” of oxygenated blood by cutting the cord in a baby who is DESIGNED for lower oxygen levels in the first few minutes and is transitioning to room air which is NOT 100% oxygen, is leaving that little diver without air.
In honor of Pregnancy and Infant Loss Remembrance Day, October 15:
Surviving Loss: Defining Your Triggers
A deeply bereaved friend of mine is describing on her blog how losing her son has changed her very existence. She, along with so many other mothers, experience loss. Reading their pain causes your eyes to well with tears. You cannot imagine, you hug your children a little tighter. You can glimpse for a moment what your life would be like if your living children suddenly weren’t, if your little person in your arms was suddenly gone or if the life inside you never becomes that laughing child you dream of. The ache terrifies you and you shut that off into a space far away.
Or, you live with the acknowledgement of that ache. Of knowing that little life for so little time. Of feeling that loss. The cloud passes your eyes and shadows your soul and for a moment, you are lost inside of yourself, remembering.
This post is for you.
In watching Samantha talk about Bram, I realized that so many of us don’t talk about loss in a real way or tell people how we really feel. We walk around protecting them from the truth because the truth would rip us apart and leave us simply screaming and rending our hair and rejecting our loss while keening on a sidewalk in some public place because we cannot take this One.More.Minute.Give.Them.Back! Because every little thing seems to be a trigger for some and so many things are a comfort for others, I wanted to say this:
Define your triggers. Tell people. Not just “don’t ever say this to a mother” but “these are things I cannot take right now in my grief.” It should be passed out at the services, posted on your facebook, dropped on your blog, imo. Let people know “THIS” hurts me.
It can be a short list, a long list, a paragraph or 2 words or a sentence. But let people know because they need to know. Not just for you, but for them. One day, they will stand here in this space of loss and knowing that it’s safe to say, safe to hear “I can’t talk about that right now, I can’t do that right now. Tell me XYZ” really helps Telling me XYZ simply hurts.” As simple as “Please don’t tell me God has a plan. Please feel free to say you are sorry for our loss. Please feel free to stand nearby and love me. Please feel free to bring food. Please clean the house and the bathrooms. Please don’t tell me you are doing it.” or as complicated as a full page of phrases that drive you crazy right now. You can always change your mind later, it’s okay, you are in mourning and grieving changes every day.
Defining your triggers also might give you space to help sort through some of your own emotions as well. There are so many complexities to grief and sometimes, we have to listen to them in order to let go or make changes in how we do things to protect ourselves for a little while. If noises, sounds, smells, locations set off deep grieving, it may give you the chance to really sit down and think of ways to avoid them until you are ready to come back and deal with them in small ways, little by little.
Grief is not something you get over but defining these things might help you and those you love to move past moments that hurt without need.