Asking Questions: AHRQ
I got an inbox item that sent me to a link from the Agency for Healtchare Research and Quality (AHRQ) titled “Ten Questions to Ask Your Health Care Provider.”
Always the skeptic, I went to the link to find this list:
- What is the test for?
- How many times have you done this procedure?
- When will I get the results?
- Why do I need this treatment?
- Are there any alternatives?
- What are the possible complications?
- Which hospital is best for my needs?
- How do you spell the name of that drug?
- Are there any side effects?
- Will this medicine interact with medicines that I’m already taking?
All in all, not bad, right? There are some basic assumptions that don’t really apply to pregnancy well or don’t give you much choice outside the realm of allopathic medicine but that was to be expected. Our government has yet to accept that many people want options that don’t include medicine or surgery. Which led me down the skeptic path.
Many times, those in the government who are leading the charge are specifically trained in a manner which doesn’t apply to a normal situation such as pregnancy. Or, the government agency is forced to do so much covering for the risks of the larger population that they lose the reality of the situation. What women see is “this is normal” then ten paragraphs on all the not-normals. In this case, though, I was just concerned about the medical bias not leading women down a path that would give them the opportunity to explore non-medical choices as a part of the normal of childbirth.
So beyond the concern of limiting our mindsets, what about those women who have that other mindset and know their options and choices? How will their providers react when they walk into a situation where their client suddenly questions their decisions or wants things that a doctor or midwife will not provide or are limited in their own knowledge? What if everything you are learning to question then threatens how they practice? Or is against the way they’ve set up their livelihood?
If women are learning to ask questions of their providers, what happens when their providers are outright deceptive or bound by laws or governmental agencies that are more concerned with the control of lawsuit risks than the average healthy pregnancy?
In short, if you ask all the right questions but can’t find a provider who has good answers, did it really matter?
Contemplating Motherhood
At my house, we don’t do the dreaded M Day if we can help it. I’ve never been able to get past my dislike of all the expectations to enjoy the day.
This year is no different.
Mothers everywhere give to their children and while I believe in respecting your mom and caring for her, I don’t believe that requires flowers or dinner or any kind of gift. I don’t think that women should be encouraged into expectations that will leave them sad for doing their jobs well and not getting a monetary reward for it, in some form.
I wish that we respected motherhood enough to contemplate it, celebrate it and researched the effects and made better decisions about it, recognizing when the decisions we make aren’t the best ones and not being defensive about those choices but honest and demanding support for the decisions we know are the right ones we should make.
I wish more mothers had normal childbirths, breastfed their babies and did so in a culture that supported that versus a culture that spends their time subtly looking down their noses repeatedly using words like “well, I didn’t do that and my children turned out FINE” as some sort of insult to the mothers who made those good decisions.
I formula fed two children. I really, truthfully, screwed up in doing so. I didn’t know any better but worse, I didn’t try to find out any better and then do it. I wasn’t supported by family to make good decisions and so, I didn’t.
I didn’t know any better when I simply acquiesed to a cesarean with Kid 1 because she was breech. I didn’t fight, I didn’t learn and I spent years relying on the luck of the draw before I became active in my own health care and my children’s healthcare.
I admit to these things because I could say “well, my kids turned out FINE” but you know…that would be denying the truth of how this all worked out. I respect motherhood too much to look other mothers in the face and try to justify stupid choices and ignorance.
I know moms who adopted, moms who tried everything and breastfeeding failed, who tried everything and birth didn’t work, I know moms in so many situations who take responsibility for the reality of just saying what is, rather than feeling the need to protect others from the very real science that promotes nursing (yes, even well beyond 2 years!), not inducing your babies without a medical indication and not giving in to an elective cesarean without medical indication.
We have to stop being so defensive that we stop looking at what is real. I know my older two children are alive and relatively healthy. I don’t deny that human beings are resilient and fairly high on the Darwinian scale of being able to recover from their own stupid mistakes. I don’t stop questioning simply because they survived and I don’t stop educating myself and I won’t justify bad choices based on “well, they turned out fine!”
Trust Birth Conference Recap
For years, when I spoke of the kind of conference I WANTED to attend, I’ve discussed ditching the sessions on state of the science. Women need skills. Notice I didn’t say “midwives”, I said women. And women learn through shared experience and discussion. We who will teach the next generation to walk and talk need to express ourselves, learn through self-exploration and questioning. We are why our children learn to ask questions.
The Trust Birth Conference was exactly all of those things.
You were met at the door and told by Rachel Reed that if you help women, if you are with women, you matter. Your knowledge matters. And she begins to educate you on what the textbooks don’t say. And teaches you with appropriate materials, pictures and videos of births and women, not torsos or diagrams that don’t reflect the real actions of a woman and her baby.
You are told by Gloria Lemay that people will tell you repeatedly that you are not what you think you are and you should continue to strive anyway. It reminded me much of the Jewish tradition of denial when someone wants to be converted. You must first prove that you are strong, capable and unwilling to give up the fight. After all, years of schooling will educate you but it won’t prepare you for the 3am emergency, for the pregnancy that would never end or the emotional toll that serving women can take on your soul when, as each baby is born and each mother is born, you will be a part of their lives forever, some small piece of their experience taken away and with some small piece of you always left behind.
You learn to respect women and to leave them undisturbed from Sarah Buckley, understanding at some deep, inner level that this is not simply common sense and good midwifery but it’s science, it’s biochemistry and there is an equal and opposite reaction to each thing that you do.
You reach for connection at 10:35pm in a fantastic rebozo class, hanging on long past the time you are weary simply to learn from Gena Kirby about the support for women but also how to support her relationship with others, encouraging connection and love from her partner, her lifemate, her true supporters as you transiently pass through her life. And after all, birth happens at all hours, in all places. Even business centers.
You hear from Lisa Barrett how others may affect your life when they rush in, not understanding the fragile balance of life and strip you of your dignity, searching your person, your home, your friends and families homes and scaring your children. And in the same breath, you hear how those same family members, friends and women reach out to protect you, shelter you and love you because when they needed someone, you were there. The law is a cold bedmate in a time where everyone abandons a mother and her soon to be born babe. When the law is wrong, then what is right is simply to love, accept and trust. She embodies that, full of fire, spirit, emotion and belief.
You sit at lunch, watching Claire Hall well up with emotion as she discusses the plight of women stripped of their aboriginal heritage, rounded up and forced on a plane at 36 weeks pregnant, away from home and family and tradition and regulated into giving birth in a hospital where they have no vested interest, no support, no family, no life. In heartbreaking truth, she tells you of these women and yet, has the uninhibited laugh of a woman who has such joy in helping them to birth “on the land”. I won’t lie, I think Claire’s depth of emotion and sheer love of life will carry me through many days of my life.
You discuss supporting women through trauma. Internal, external. You talk about the things women do to women. The struggles of midwifery. The struggles against force, coercion, aggression and the need to “do” things at a birth when all is going as it should. You learn to watch, to wait and to be the woman who listens. We learn through story at lunches, at dinners and well into the night. It’s as if we are the sentinels at the edge of the chasm. We see the harm, we help those we can save and we reach out to every starfish in the ocean that we can touch. We talk to strangers, we ask them not to follow us but instead to follow research, to follow passion and above all, to love the women in their lives and watch out for their safety and peace in birth.
Katy Bowman encourages you to reach out, touch your pelvis, become involved with your body and walk. After all, you can’t do those things with your body it was meant to do well into later life if you don’t begin somewhere small and care for yourself. Look past the assumptions of how you think you stand or how your body works and listen to the science of biomechanics, understanding how knees, hips, feet, back and body all compensate for one another. Realize 2 days later that if you don’t continue to do those things, you will go back to that body memory and do what you’ve always done but if you continue to work through it, to stretch, to squat, to move, then eventually the pain of new use of old muscle will subside and you will feel freer in movement and more capable to sit, stand and birth without pain.
And you talk about freedom. The freedom to choose, the freedom to walk away, the freedom to think critically and apply information. The freedom to understand that it’s not about oxygen or chest compressions. As you listen to Jill McDanal and Karen Strange talk about not just the drive to breathe and how carbon dioxide triggers a baby to take those first lung-clearing breaths but how to bring a baby around to awakening in this life while respecting that the journey is not always easy and leaves us in respect of each and every mother and baby that comes through our lives, never taking for granted that we are the gatekeepers, not the saviors.
I found women from all walks of life sharing different perspectives on how to handle different emergencies and listened to Gail Hart well into the night, discussing what has been researched, what hasn’t and how you learn to apply what you know. It is NOT about “getting your numbers”, it’s about learning to be patient. Keep the medical, medical. Transfer when abnormal occurs. Watch enough women birth normally to know when abnormal occurs.
You discuss all the problems of hospital birth and entrenched, institutionalized policies that drive women away from care providers who no longer listen or respond to them as individuals. You talk about the maternal death rate and infant mortality rate and wonder how on earth the hospitals and their providers don’t see the corresponding incrimination of the practices we perpetrate on women. How many inductions and cesareans does one have to do before one becomes numb to the idea that recovery from surgery, from trauma, and diversion from normal causes harm that is NOT inherent in birth.
When one talks about Trust Birth, you may hear that it’s about women. You may hear that it’s a party. I won’t lie to you, it was. It was a party of information. A party of learning. A party of listening. A party of joy and sorrow. This is the lives of women, on display in it’s vast multi-colored splendor. Women want to learn. They are not capable of hiding and remaining ignorant. Their brains are continually re-routing and multi-tasking.
At it’s heart, midwifery means “with women” and that is how I feel this week was spent. Connection. Support. Belief.
Trust.
For more, look at the Facebook page “See you at the Trust Birth Conference 2012″ or Twitter Hashtags #trustbirth12 and #birthfreedom
I’m tired and going to sign off. I will probably post more later. Suffice it to say, I learned skills this weekend. Not mythology, not to ignore risk, not that life is perfect.
See you in Sydney, 2013
More on Single-Layer Closures and Types
We don’t often get real reporting or studies on actual procedure types during cesarean, so this was good to have to start eliminating what the risks are and help women make further decisions:
Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture
International Journal of Gynecology & Obstetrics, 08/10/2011 Roberge S et al. – Locked but not unlocked single–layer closures were associated with a higher uterine rupture risk than double–layer closure in women attempting a TOL.
Methods
•The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL).
•The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
Results
•Nine studies including 5810 women were reviewed.
•Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66–4.44).
•However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58–9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21–1.16), compared with a double-layer closure.
“Bias in the Media” Moments: Doctors made assumptions but lest we forget…
I connected over to an article at Today, and of course, the article begins with this:
“Doctors have long assumed that Cesarean sections might be the best choice for babies that will be born preterm.”
Which almost looks like doctors are taking responsibility for making these choices.
But read through the article and you will notice the tone changes until you get to this:
“When you start to look at 37 maybe 38 weeks, there’s an increased belief now that the longer a baby stays in the womb, up to 40 weeks, the better the outcome is for the baby,” she said.There are women who want a C-section to avoid labor pain, Snyderman said.
”They say ‘I don’t want the pain, please let me just do a C-section,’” she added. “You have to remember the ultimate outcome should be a healthy baby.”
So. Which is it? Mothers are causing this wanting to get out of labor? Or physicians were doing cesareans to prevent babies from getting to full-term to “protect them from vaginal birth”?
Yet another fine example of the media really doing a bad job of reporting because they are trying so hard to look “balanced” rather than authentic or accurate.
Interview with Dr Michael Klein
Brio Birth talks to a leading researcher here:
http://www.briobirth.com/articles/exclusive-interview-childbirth-researcher-dr-michael-c-klein-says-birth-technology-overused?page=0,1
I have heard him speak and was highly impressed with a lot of what he said. You can check him out on Lamaze previous conference sessions as well
My Daughter’s Problem
Yeah, she only has HALF this problem right now but I’m looking for more research on it just in case she ever decides to bring home “The News”.
So…Can women scuba dive while pregnant?
Here’s one answer that really isn’t an answer but is kinda scary:
http://www.scuba-doc.com/prgdiv.htm
I don’t want to stop women who are doing action to keep from being active while they are pregnant so…what else is out there?
Living “At Risk”
Living “at risk”
Obstetricians do know how it feels to be a VBAC mother. They live every day, wondering when someone will give them a gut wrench and hand them a court summons to appear. Knowing that someone else controls their livelihood in the blink of a moment, that gut check controls their existence.
- An OB could lose their practice, their livelihood, their home or their car.
- VBAC mothers could lose their life or their baby’s life on that table.
Reposted from my personal blog, original date 10/22/2007
Burning the Midnight Oil
Recently, BirthAction’s been a little quiet. We’ve been regrouping a bit with changes in staff and I’ve personally been doing a lot of soul-searching, changing and self-education. We’re looking for more volunteers to help create resources that moms need to have and information going beyond what normal birth is about and getting into those other realms of how we can do something about it. Even if it’s just that one starfish at a time.
We’ll get back to the Starfish on the 15th. I have a particularly one in mind, you see.
Now, that sounds like a lot of jumble, I know.
The point is, there are things brewing in the distance. This is your wake-up call. Get in and be a part of the action. Pay attention and do what you can. You are not just a mom. You are a force of nature.
Oh and for those of you who like to sit on the fence and play devil’s advocate about medical care, maternity issues, etc., that’s fine. You play the fence. I have no problems with you deciding after informed consent that you want your inductions, your epidurals, your cesareans. But someone out there is holding the line for you, protecting your rights, making sure that there is safety in your procedures.
Don’t all those women deserve that from you, too?
