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5
Apr

Cesarean Awareness Month Day 5

I have often seen mothers who talk about how broken they felt after their cesarean, watched how hard they worked for their VBAC but then as labor came closer, how much they begin to rely on the “well, whatever happens, happens” scenario as they begin to mistrust themselves, their support and their providers.

Screw that.

Life is going to hand you a given set of tokens and as you play the game, you can’t always tell which way things will go but when you get to the end, would you rather say “I didn’t want to be disappointed, so I didn’t try” or would you rather say “I tried like hell but that wasn’t what was meant to be”.

Believe in yourself, trust your instincts and be the Mother Your Child Believes You To Be, before they ever get the chance to look at you and trust that you would fight tigers for them.

#cesareanawarenessmonth Day 5

4
Apr

Cesarean Awareness Month Day 4

Cesarean section after induction is not a sentinel event.

#cesareanawarenessmonthday four

 

edited to add:

Sentinel Event is defined by The Joint Commission (TJC) as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient’s illness.

Cesareans are not an UNEXPECTED event after an induction, they are a common byproduct.

3
Apr

Cesarean Awareness Month Day 3

If you are a mother who has had a prior cesarean or two who wants a VBAC, don’t let some doctor sell you on a better cesarean because they are not ethical enough to offer good care. And if you are having a cesarean for medical indications, you don’t need to give up skin to skin, delayed clamping and appropriate care for your baby.

Know your options.

#cesareanawarenessmonth Day 3

2
Apr

Cesarean Awareness Month Day 2

In 1980, the NIH held a consensus conference on Cesarean, including VBAC.

In 2010, they reiterated the same information. Knowing the science isn’t half as effective as walking the walk and standing up for yourself.

Day 2 #cesareanawarenessmonth

1
Apr

Cesarean Awareness Month

I awoke to this: “Happy Cesarean Awareness Month”. Really? Are you KIDDING me? What part of a national health crisis endangering mothers and babies that we are all already aware should make me HAPPY this fine beautiful spring morning? Yeah, it didn’t. The following series of posts were instigated by that moment in time.

Don’t be happy, do something about it.

Cesarean Awareness Month.

Stand up, talk to other women, help them make the choices even when they feel like they don’t have any choices.

Help them have healthy births based on their intuition, their intelligence and their autonomy as well as for the love of their babies.

No more unnecessary surgeries means moms who are capable of saying no without a medical indication and with the ability to be TRUST that those around them will help them. Believe in her.

And help her have the courage to walk away when the care provider in question isn’t supporting her and help her find whatever she needs.

We are not innocent in this cesarean rate.

We are culpable in every time a woman is induced or cut because her physician saw her continuing pregnancy as a liability.

And it affects us all.

27
Feb

“Risk” as a Reducer of Women’s Informed Decision-Making and Autonomy Rights

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?”

5
Feb

Got Links?

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:
http://www.sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby

28
Jan

“High” is not a Clinical Diagnosis.

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.”

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

6
Jan

First Time Motherhood: Finding Care

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.

False

Evidence

Appearing

Real

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.

Good luck!