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Posts from the ‘Obstetrical Violence’ Category

11
Jun

“At Risk” or “High Risk” – We Should Say What We Mean

Over the last few years, I keep using the term “normal, low-risk VBAC” and I’ve found others have begun to use it as well. After all, isn’t less than 1% of a risk really a LOW risk of it? Especially if the actual risk of death or severe complication is even lower?

Evidently, It’s all in the eye of the beholder.

When I did searches for ACOG and defining what “high risk” means, there really isn’t any true definition. It’s like there is an imaginary line wherein doctors get the heebie jeebies and they call any risk a “high” risk.  So where is this cut-off and why is this word so prevalent in our society when it comes to medical care?

One definition states “of, relating to or characterized by risk” and another states:

                             high-risk

                             adjective Referring to an ↑ risk of suffering from a particular condition Infectious disease Referring to an ↑ risk for exposure to blood-borne pathogens,                                     which occurs with blood bank technicians, dental professionals, dialysis unit staff, EMTs, ER staff, IV therapy teams, lab, and medical technologists,                                             morticians, OR staff, pathologists, phlebotomists, surgeons, etc
So, according to this definition, ANY risk above average risk is suddenly “high” risk and average or normal risk isn’t readily defined.
And this is how having twins comes to be called “high risk” when some might be absolutely normal risk for having twins and others might be of a slightly higher risk or a much higher risk for certain conditions.  So how do we know what is normal risk, what is average risk, what is high risk? I’ll be exploring this through the next few posts.
Right now, many women are at high risk for having a cesarean just by virtue of walking in their local hospital. Normal women having healthy pregnancies have a 1/5 chance of having a cesarean without any further rise in complications during birth. So, all women are now at high risk? Are their doctors telling them?
There will be more on this over this week because I really want to explore this topic but we need to start holding doctors and nurses accountable to their language.
There is no “high risk” there is only risk. And my risk is either a relative risk or an absolute risk and you really only have a guess as to what my risk might be.
If we spent more time explaining to women that really, we don’t know what their risk IS even though we have an idea of what it MIGHT be in pretty rigid circumstances, then perhaps women would start understanding their care better.
Unfortunately, we’ve created a society where once you’ve told a woman she is high risk, she immediately agrees to whatever the doctors/nurses/hospitals say because she’s convinced that she and her baby are in very real danger of something that is very large and immediate.
This chart of ACOG’s helps outline exactly why they use terms like “high risk” in order to get women to consent to care rather than giving them choices and explaining individual risk. Are any of these procedures advisable? Recommended? Safe? Most individuals won’t feel it matters because they are told they are at “high risk” and it needs to be done. It’s horribly sloppy critical thinking on the part of the public, even if they WOULD choose these particular procedures, etc. And it’s intellectual laziness on the part of medical care to not allow individuals actual informed decision-making.
15
Apr

Cesarean Awareness Month Day 15

There is a difference.
A world of difference.
Between choosing a cesarean at need. In knowing that your baby needs to be born now, in this moment.
And being told you have no choice.
That it’s not your choice.
That it’s not your decision.
That you will give birth alone, give birth without the support and care you wanted,
The type of support and care you need, desperately, to bring a baby into this world.
There is a world of difference in the ice cold OR gripping you when the tears flowing down your face are ones of lack of options.
And the ones that say “thank god, they are here, and safe”.
There is a world of difference in a mother who wonders if she could have done something differently and a mother whose confidence is in that this baby needed this now.
There is a world of difference in being a strong, compassionate woman who looks down, daily, at her belly and thinks “I would do anything for you”
And that same woman being led down a hall, to a wheelchair, to be taken back, unwillingly and against every fiber of her being, knowing there is no reason, lying down on a cold table, looking up at the ceiling and thinking “I would do anything for you”.
#cesareanawarenessmonth Day 15

14
Apr

Cesarean Awareness Month Day 14

We all know that sex is an amazing thing.

It can be beautiful and powerful, exciting and enjoyable. We also know it can be something to do to make a partner feel satisfied or to fulfill a need even when we know that really isn’t where we are *at right at the moment.

We also know that sex can be a nightmare. An act of power and coercion. Used against us to further another person’s goals, whatever they may be. When a person we know and trust uses us in that way, we are left wondering how we wound up here. Date rape, coercion, force. How did we wind up here and why did it happen this way. We are left, not broken, but fractured and trying to put the pieces together.

Birth is an amazing thing. It uplifts. We give, we strive, we are overwhelmed in the moment, we feel powerful, excited, and finally, overjoyed. Sometimes, we know certain things have to happen in order to bring our babies here safely and we know that need and weigh it against our own and make the choices that we need to make, for the good of that one we love. We even know that respectful care can happen under these circumstances.
We also know that birth can be a nightmare, out of control, a trauma, with others forcing us to unneeded procedures, telling us we are killing our babies if we continue, or that we will harm them, that we are stupid for trying homebirth, that we are broken and unable to give birth, that our babies being born through our bodies will result in brain damage and death. When a person we trusted uses their power in that way, telling us an induction is our only choice, that we can’t VBA2C, selling us a cesarean that will be “gentle” rather than giving us relationship, trust and good care, when we are forced to accept a coerced cesarean, it twists us inside. We wonder how we wound up here when we were desiring of a normal birth, we are fractured into the mother who wants to celebrate her love and look into her little ones eyes and the mother in pain who only wonders why she wasn’t stronger, more capable, why her doctor or midwife were so incapable of giving good care without the unnecessary procedures.
We are not broken but fractured and trying to put the pieces together.
This isn’t all cesareans and not all providers but with a virtually 40% cesarean rate, we need to stop buying acceptance and giving in because our providers have the capability to use power over us. We would never tell our daughters to accept date rape, we should stop giving them the example of birth rape. No means no, not convince me by making it nicer.
‪#‎cesareanawarenessmonth‬ Day 14

14
Jan

Florida Hospital Violates Women’s Rights

Petition to get North Florida Regional Medical Center to give women back their rights

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.
http://www.change.org/petitions/north-florida-regional-medical-center-respect-the-right-of-mothers-to-choose-who-may-visit-them-during-childbirth

28
Dec

The Evidence is In: The Evidence isn’t Working.

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

16
Mar

How Many Ways Can You Miss the Boat?

I got the following abstract in my inbox today:
Mothers’ Satisfaction with Planned Vaginal and Planned Cesarean Birth
American Journal of Perinatology, 03/08/2011 Blomquist JL et al. – Women planning cesarean reported a more favorable birth experience than women planning vaginal birth, due in part to low satisfaction associated with unplanned cesarean. Maternal satisfaction with childbirth may be improved by efforts to reduce unplanned cesarean, but also by support for maternal–choice cesarean.

After reading this small blurb not once, not twice, but three times…I couldn’t help but wonder what the hell the researchers were thinking to come up with that conclusion and the way in which they stated it.

The researchers think maternal satisfaction with birth MAY be improved by efforts to reduce unplanned cesarean???? MAY BE? Let’s be real here. Women didn’t like that they wound up with a cesarean. The solution to that is not about supporting maternal-choice cesarean over vaginal birth. Obstetricians as a whole already choose most cesareans and when the mother chooses, the medical providers are typically so relieved and happy that they cave to just about any demands from 3 support people in the OR to specialized music. Planned cesareans are encouraged and supported (as well as often coerced) at a level that increases daily.

It is a subtle thing, isn’t it? Make the cesareans nicer and nicer. More mother-centered, more baby-centered. As long as we are being nicer and nicer to mothers who have made the choice obstetricians want them to make, then more women will go that route to avoid the other route. And mothers are quick to learn that they are being treated much better when they are scheduled.

If we are trained to think of a planned vaginal birth and wind up with something far different, wouldn’t we naturally feel less satisfied? So rather than work on preparing women for childbirth, lowering inductions, lowering cesareans, we should instead prepare them for a choice cesarean and then say it was all their idea to avoid that nasty unplanned cesarean which is inevitable after an attempt at vaginal birth. After all, wasn’t it an ACOG president years ago who said something to the effect of, “If we can get the cesarean rate over 50%, then the only vaginal births that are left will be so bad, the risks will be equal.” Congratulations, we think you are almost there.

If obstetrical “care” continues to degrade at the rate it has currently gone, then women are naturally only going to get more and more unsatisfied with vaginal birth. After all, vaginal birth right now means:

  • being monitored without respite in most cases
  • denied food and water
  • being in a bed and/or denied personal movement beyond a 6 foot space
  • being on an iv in the hand you are trying to grip, move, control while pushing
  • being induced
  • being told what to do
  • being stripped of your dignity and choices
  • being told you can’t say no.
  • and the list goes on…

Who wouldn’t want a compliant OB, an easily scheduled event and the illusions of control over THAT?

This is an iatrogenic problem. I guess the way you fix those problems is to give the obstetrical system whatever they want instead of giving women better births.

Other points to address: How far out does this study go? Did the mother still think this a year later? 2 years? Was the mother asked during the immediate postpartum period or was she asked 6 weeks down the road? Women’s perceptions of their births change as they learn over time and as they try to have more children and this can also be very dependent on complications after the cesarean. Do they perceive them as normal or as part of the cesarean?