Thursday, December 17, 2009

Having babies

Today I read an article on (see Mom fights, get the delivery she wants.) that got me inspired to share again.
First I would like to state that I understand each pregnancy is as different as each child that is born. What works for some does not work for others. Every parent has personal reasons for the choices they make and I would never want to unintentionally step on anyone's toes. (disclaimer closed)

This mother was having her second child and had to fight with the doctors in her local hospital on what kind of delivery she should have. Her first child was born by C-Section (due to labor not progressing) and her doctor insisted that she have another C-Section scheduled. She wanted to try a VBAC (Vaginal Birth After Cesarean) but she was told that her hospital would not deliver for VBAC's because of a slightly higher risk associated. Instead of agreeing, she traveled 2 hours to a larger city and a better hospital so that she could have the birth she wanted. Baby number two was delivered fine and Mom and Baby are both healthy.

This is a touchy subject for many moms. The medical community is polarized on the topic as are mothers and mothers-to-be. It really comes down to these points - safety and preparation vs. unnecessary medical procedures and old fashioned "man run" medicine.

It is extremely disturbing to read that 1/3 of all births in the US are by Cesarean.
There are many reasons that OB's suggest C-Section births, and most of them are completely legitimate. According to this article, the number one reason is "failure for labor to progress." If there is any distress to the infant or the mother most OB's will opt to take the baby as fast as possible because a child and a mother are easier to treat separately than together. This does make a lot of sense. In the situation of a breech birth (especially for a first time mother) or a compressed umbilical cord a C-Section is almost always the route that is taken for the health of mother and baby.

A C-Section is major abdominal surgery. You are cutting muscle, tissue, nerves, your inner girl parts - it is nothing to be taken lightly. The recovery can be difficult, and as risky as the recovery for any other surgery, except more-so. The body is recovering from birth as well as from a medical procedure. There is indeed pain involved, and most women (not all, but most) do not regain their pre-pregnancy shape as easily or quickly as they would had they had a "natural birth."

If it is to preserve the health of mother and baby then of course, the benefits outweigh the risks. But, what about when it is not medically necessary at all? How many of those C-Sections are actually elective? Those numbers are a little bit more fuzzy. When I say "elective" I'm not talking about when a mom has been in labor for 36 hours and is exhausted and the baby just isn't moving. I'm talking about a pre-scheduled operation to remove the baby for convenience sake. How about when an OB is going on vacation and the mother (or doctor) would rather have the baby delivered before they leave? What about a mother who wants to take care of things quickly and doesn't want to attempt a vaginal birth? Why on earth would doctors, and mothers for that matter support a practice that involves promoting elective surgery on healthy mothers?

The most distressing reason, I believe, to schedule a C-section before the mother's due date is that the mother has had a previous C-section with a lateral incision (hip to hip as opposed to navel to pelvis.) The medical community has been a swinging pendulum on this over the last several years. Many years ago, all C-sections were done top to bottom. This damages the abdominal muscles and the uterus in such a way that normal labor contractions can often cause a uterine rupture. Every birth after that has to be a cesarean out of necessity. These days, virtually all incisions (except for rare emergency situations) are made laterally which greatly reduces the risk of rupture and other complications. For awhile doctors felt that the risk was low enough to recommend a VBAC when there were no other extenuating circumstances. Then, reports came out that the risk of uterine rupture was higher than first thought and the number of Malpractice Lawsuits began to rise and doctors quickly switched sides again.

Can't there be an in between? Why can't VBAC's be attempted more with the option for a C-Section if things do not progress. The OB's I have spoken to about this feel that it is preferable to have a baby in a controlled environment instead of an emergency one. When decisions have to be made under stress, mistakes happen and people are hurt. I can agree with this, but most cesareans are not done under emergency or even urgent conditions. They are frequently done out of choice by either the doctor or the mother, when other options are still available.

I think maybe doctors have lost sight of the actual goal here. Pregnancy is not a medical condition in and of itself. It's a perfectly natural part of life that can progress pretty much on it's own. Women conceived, were pregnant, and gave birth for hundreds of thousands of years on their own or with only the help of a family member or midwife. Introducing the medical staff into this equation is not necessary in every case.

Now, I am not trying to imply that women stop seeing their OB's for pre-natal care or that every baby needs to be born at home. I am merely suggesting that doctors take a step back and try consider more natural alternatives before jumping at the chance to perform major surgery for and expedient outcome.

I have had three babies under three very different circumstances. I have also helped to coach a few more and I am honored to have been able to. This gives me quite a unique outlook on this sort of thing.

My first girl was by C-Section. I had started out my pregnancy with her wanting as natural a birth as possible. I was seeing a midwife and I planned to give birth at the birthing center instead of in a hospital. Thankfully, I chose to have an elective sonogram where they found the defect in her heart at just 16 weeks along. (At this point, I must personally thank Dr. Christine Brown at the pregnancy clinic on Swiss avenue. She found what many other doctors would have missed and made sure I was taken care of.) Plans quickly changed. I started seeing the doctors at the high risk pregnancy clinic and a neonatal cardiologist (Dr. Jane Kao) and surgeon (Dr Cleveland.) Of course all hopes for a non-hospital birth were right out the window. After arresting pre-term labor 10 weeks early, and holding it off for only 6 weeks, she was still four weeks early, breech, and had already been diagnosed with an extremely serious CHD. In this case I agree that the C-Section was completely necessary. It ensured my baby was cared for the way she needed to be and was not under any stress that was not strictly needed. I bore the scars gladly, (I call it my mommy smiley face) knowing that I sacrificed just a little bit of pain to make sure she had the best start possible. After 12 years, she is a poster child for kids with her condition and I have no doubt it stems from the wonderful care she received before and just after her birth.

Three years later, my husband and I decided to expand our family, but now I was considered High Risk from the very start. My OB was adamant that a VBAC was entirely too dangerous and refused to consider it as an option. I was healthy, the baby was healthy, and the pregnancy was normal so there was no medical reason for this other than the history of a C-Section. Instead of fighting for my birth plan (or finding a new OB,) I let the doctor make the choice and I was scheduled for a C-section three weeks before my due date. This is a decision I regret to this day. The spinal block they gave me was even more uncomfortable than the epidural I had with my first one, and the recovery was much more difficult. I had a toddler to look after as well as my new baby and I overdid things and nearly hemorrhaged. Six weeks after #2 was born, #1 went into the hospital for her third open heart surgery, and was there for four weeks. Chaos ensued. I was barely recovered, physically and mentally drained, and I had to go back to work full time after just 10 weeks. Let's just say I have better memories of cleaning toilets.

After another year or so, I became pregnant with my third baby. The day I found out, I was flooded with mixed emotions. I was so excited to grow our family, but the very thought of going through the same birth process again filled me with a sense of dread that I really didn't anticipate. I realized the apprehension I felt was due to the idea of another baby, but the idea of another birth. I made a decision that I would not go through that again if I had any choice in the matter. I opened up the phone book and called every OB/GYN in my area until I found one that would even consider a VBAC after two cesareans.

I had done a lot of research on it since my last pregnancy because I felt cheated and railroaded by my last OB. I knew the risks involved and I simply wanted a doctor to give me the benefit of at least trying to give birth naturally. I understood that it might not happen, and that if there was any sign of complications at all, I would be immediately moved to the OR for surgery. I just wanted the opportunity to at least go into labor on my own.

I went into the first stages labor about two weeks before my due date and after helping things along naturally, I gave birth to baby #3 vaginally with minimal intervention - no epidural, and only a small amount of pain medicine via IV. The whole process was so much easier than it had been before. I was able to walk within an hour of giving birth and I was able to keep the baby with me in the hospital instead of relying on the nursery to care for her because I was loopy from pain medicine. Back at home I was able to recovery more quickly than ever before. I was actually able to enjoy the first few days of being home instead of feeling like I was in a pain-filled fog of immobility. Dr. Theilen is a great doctor and a wonderful, down-to-earth man and I am so thankful to him for allowing me to experience that.

After experiencing things all three ways - Emergency Ce-Section, Scheduled C-Section, and Natural Birth - I can say I wish I would have been able to have all three naturally. For those moms out there who want to have an elective C-Section because of the fear of pain or out of convenience - I must say, give Mother Nature a try. She knows what she's doing.

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