Tag Archives: C-section

How to be supportive of women’s birthing choices

*Note: throughout I got tired of writing ‘women and their partners and families’, so I just wrote ‘women’. But I do believe wholeheartedly that birth decisions affect the whole family, and so should be a somewhat group decision.

Ah, the Mummy wars. Just as we might be close to reaching some kind of rapprochement over one issue (breastfeeding), we really hammer into a new one: birth. For the unenlightened, a war is indeed brewing. On one extreme, you have the group who think that any intervention is ‘birth rape’ (not kidding…). On the other side, perhaps as a backlash, you have the women claiming that allowing any kind of pain in childbirth is anti-feminist, and women who don’t give birth in a hospital are baby killers. It’s just another incarnation of the nipple waving breastfeeding sluts vs. the poisoning lazy formula feeders debate.

It would be nice if we could just ignore this. Let the extremists be extreme, and live in a happy middle road. But the knock on effect is that women are becoming miserable – people feel judged and found wanting, guilty, denied a right, some even feel violated for a medical professional doing their best. While I support attempts to improve medical care, and thus women’s birthing experiences, this does not seem the right way to go about it. I understand that is hard when people think they are fighting risk to babies, or denial of rights to women – both highly passionate issues – but it seems to me that the path we are going down is not working. Families and caregivers need to unite in support of one and another to enable informed choices and happiness with those. That’s not the same as inaction, nor will it lead to stagnation. I believe that within this modus operandi, there is still room for encouraging change and I also believe it is the way to help women and their partners make better choice.

Here is how I try to be supportive of all birthing choices:

(1) Everyone: Be realistic and scientific.

Don’t lie. Home birthers: admit that the risks to mother and child are higher (but very small) and note openly that scientific evidence shows that epidurals at the right time do not increase C-section rates. Hospital birthers: be open: yes, a C-section is more likely, even when other factors are controlled for. Yes, pitocin increases the likelihood one will want an epidural, and not due to this, also increases the likelihood of a C-section. Be honest: you are more in the doctor’s hands, and you may be pressured to make an alternative choice. Home birthers: women in hospital may also not be pressured to make choices against their will and may work with professionals who are incredibly dedicated to following their birth wishes.

I have seen both done. At my Bradley classes (a natural birth class), our instructor was having a home birth. In the discussion about risks and benefits she noted that the risk were higher, but in absolute terms extremely minimal. She told us to go away, read, and make our own decisions. When my OB told me I needed an induction and I was resistant, she honestly talked through the increase in C-section occurrence. She told me to go away, think and read, and make my own decision.

Only by talking through openly and honestly about the facts and figures can women* make informed choices, and research ways to mitigate unwanted outcomes. When my OB was open about the increase in C-section risk with pitocin, I was able to research how to deal with this, and constructed a careful plan which took 2 days to effect, but resulted in a vaginal birth.

beliefs

(2) Anti-home birthers: Accept that you cannot save all of the babies, all of the time.

It can be a very emotive subject, and anti-home birthers usually cite the well-documented and reliable statistics of increased mortality with home birth. It is a tiny increase, but the pleading ‘won’t you please think of the children’, often accompanied by a picture of a stillbirth, can be very compelling. But here is the thing: home birth is not the last bastion of child (or maternal) risk. Children are starving to death, being shot to death in war, being shot to death because of lax safety, dying of vaccine preventable diseases, dying of non preventable diseases, dying because the basic standard of medical care is not uniformly distributed across economic strata in the US. That’s not to say that we should be cavalier about infant mortality, but some perspective helps. If you are not pouring equal amount of vocal outrage into all causes of child suffering (especially given how many more children die from these other causes, than from home birth), I would ask you to reconsider your reasons for championing an anti-home stance.

(3) Home birthers: to use your own words: anyone could do it.

If forced to, then I am pretty sure (but have not checked the empirical evidence) that anyone could deal with the pain of childbirth. Some people choose to have an epidural (or other pain relief) and there is nothing ‘weak’ about it. It’s just a choice, like the one to go to Kroger vs. Fiesta (or Tesco vs. Sainsburys for my dear UK readers), and should not have a value judgement attached to it.

(4) Anti-home birthers: We all take risks with our child.

Accept it, we all take unnecessary risks with our child. To anyone taking a ‘holier than thou’ approach to their child rearing I could point out preventable risks you take. Take your child in a car? Increased risk!! Why not stay at home or within walking distance until the child is 16 ?  You might say: that’s not practical, the benefit outweighs the unrealistic cost.

Sure – to *you*. There are people, I am sure, who follow this (small number though they are).  Ultimately: you don’t know the cost to someone of going into hospital. You don’t know their fears and needs, and how strong they are. You cannot judge for someone else whether the costs outweigh the benefits, because you don’t know them.

(4) Home birthers: We all take risks with our child.

You may tout increased bonding for a drug free childbirth, or a cite the evidence that some aspects of pain relief get to the baby and affect their immediate post-birth presentation. But again, you will do something that is sub optimal for your child’s development (although defining that is tricky), sometimes out of ignorance (and so some education is OK), but sometimes because to you and your family judge the benefit to be greater than the cost, as above. And that’s OK.

I could go on, but it has been (for me) a long post. I will always choose a hospital birth. I will always research and learn, but I will always reach an agreement with my trained medical professional. If I can’t do that, I will seek out a medical professional with whom I can, because this provider is obviously not right for me. For my birth, I agreed to an unwanted induction, but I worked out a fairly long and complicated plan for doing everything I could to ensure a vaginal birth. Indeed, this was necessary, if I had not worked with my OB on devising a 2-day induction, I would have been one of the ‘C-sections after a day on pit’ statistics.

That being said, if I had had a C-section, I hope I would have worked with my provider and still have thought it a wonderful experience. Many aspects of my birth sucked (or at least the aftermath), but I am delighted with the whole experience. Shit happens. But I got this thing out of it:

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My plea: chill, relax, channel your energy / outrage somewhere else [send refugees donations, volunteer at your local hospital, whatever], remember that you are not a bat, and don’t know what it is like to be a bat. Gain some perspective: birth is important, but it is just one aspect of a whole lifetime of wonderful experiences.

Peace. Love. Babies.

 

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39 weeks (nearly) and preparing for birth

37 week bump

37 weeks 2 days

Well, hello 39 weeks. And now we have a date, I know I really am in the home stretch. Firstly a big, big thank you to everyone’s support after my last pregnancy update, given in the comments or on Facebook. When I wrote 2 weeks ago, I was very sad about not being pregnant for much longer. Many people were kind enough to write and say ‘I felt the same’ and even – ‘now I am a Mommy I STILL feel the same!’. Everyone adored their babies, but it looks like I would not be the only person to choose the baby and the belly if I could.

37 week bump

37 weeks 2 days

Hearing ‘you are normal’ or ‘your feelings are valid’ made a huge difference. Yes, I remain sad that I have – maximum – 5 more days left to be pregnant (more on that later). But I am much more cheerful knowing that feeling like that is fairly common, and a wonderful life ahead still awaits. I haven’t really addressed the issue further, except in one small way. Mostly, I just chose to be comforted by so many people’s kind words, but I have done a little positive visualization / positive list making about what I am looking forward to about the baby coming. Both have perked me up considerably.

38 week bump

38 weeks 5 days

The other thing I have done, is address my mental issues with the birth a little. I had hoped for a natural childbirth. I was going to fight to go over 42 weeks, if necessary. I wanted to go into labor naturally, to labor naturally, and to birth naturally, if possible. The reason why is not so important (come on, this is the girl who chose Tough Mudder – I like a challenge 😉 ), but do know that I recognize natural childbirth as my personal choice – as much for my benefit as the baby’s. Very much ‘each to their own’ and this was my chosen own. However, it looks like things will not go that way. The polydramnios situation is not getting better 😦

38 week bump

38 weeks 6 days. Trying to make it stick out more!

What does this mean? Well, my fluid levels at 25-30 weeks were in the 95th-98th percentile, generally 25-28, but mostly around 25. Average AFI (amniotic fluid index) is 10-14 (dependent on week), and cut-offs for ‘high-risk’can be 20, they can be 25, depending on the country, hospital, person etc. So, I was just on that borderline or just at ‘worrying’ – as Dr Dildy, the high-risk OB put it “You’re not off the charts… you’re just not on a very good position on the charts”. Dr. Dildy said some places would not consider me high-risk, if their cut-off was 25, but Baylor (where he practices) is a little more conservative so does. However, more in a ‘needs to be monitored’ way than a ‘holy crap’ way. So.. they did just that. Monitored me and watched the baby closely with weekly biophysical profiles and all looked pretty good. Plus, we scored cute face pics from our very friendly sonographer. Those who know me well, how much to do recognize the expression below? What Clio calls my locking horns, digging hooves in expression.

37 week 4D scan

Ha! He may look like his father, but he has his Mum’s obstinate expression down to a tee! (37 weeks).

The problem came later on. Usually people’s fluid decreases, starting at around 30 weeks, going from an average of 14 to about 8-9 at 37 weeks. Mine did not decrease at all, it stayed stubbornly at 25. So, as the bell-shaped curve shifted more and more the the left, but my position stayed the same, I was more and more of an outlier. So, technically, I became more and more high-risk. I chatted to no less than 3 OBs (the one I didn’t like, Dr. Dildy who I really do like, and my OB whom I love). I did proper research (i.e. hit up PubMed and read real research papers, not just Google). And I ended up agreeing, of my own volition, that going past 40 weeks was associated with significantly higher risk. Significantly. My OB was actually happy to wait right up until 40 (some would have pushed for an induction at 38-39), so it seemed a good situation, because I felt she was trying to accommodate me and the baby and not just ‘get things done’. Induction is booked for 39 weeks and 5 days from today.

I am still scared of a cord prolapse. Because of all the fluid, the baby doesn’t want to fully settle deep into the pelvis, head down – there is a little gap between his head and the.. er… exit. When my water does break there is likely to be a lot of force to it, both because there is nearly 3 times the usual amount, and because it is under a lot of pressure (think of an overfilled balloon). So, it could force the cord out before the baby, the baby’s head would fall down into it, and the baby’s oxygen would be cut off. In hospital, this would just mean an instant and emergency C-section. If it is before hospital… well… we hope I get there pretty quick. The chances are just under 10% statistically (they are under 1% of you have a normal amount of fluid) so non trivial. But, hence, we hope that I won’t go into labor before the induction, and if I do, at the first sign of labor, rather that waiting at home until I am in ‘active labor’ I am to go straight to hospital. I am as at peace with this plan as I can be.

38 week scan 4D

Sleeping peacefully at 38 weeks. This baby is photographed more than Suri Cruise 😉

So, in a nutshell, I have had to prepare for a different kind of birth. That’s OK, but I am someone who likes to be in control of what is happening to my body, and my baby, and generally my life. I am rarely good at handing over large aspects of my life to others and saying ‘OK, do what you will, I will go with the flow’. It tends to leave me in a cold sweat. If I have ever said to you ‘sure, I’ll come over and you can decide what we do / what we eat’ you know I like and trust you a lot 😉 So, I have been preparing (for preparing is calming) for other plans.

I have tried to strengthen my uterus to be good at labor, in a situation where it may not be ideally ready: evening primrose oil, raspberry leaf capsules, dates. I have tried to help the baby prepare my uterus / get into a good position when HE may not be fully ready: bouncing on a birthing ball, squatting 20 mins a day, walking. I have been rehearsing birthing techniques for withstanding an epidural because pitocin may lead to a more painful labor than a natural labor (pitocin contractions MAY be stronger and harder, and pitocin, unlike its natural form oxytocin, does not cross the blood-brain barrier and give pain relief).

I am also preparing to be accepting of an epidural: the hard part of labor may be longer and if I need more strength, an epidural may help me conserve my strength. I am preparing not to resist the epidural just to be bloody minded – mainly I just want to resist it to the point where it will not slow down labor. And, I am preparing to accept a C-section with grace (the risk is doubled with an induction), and not feel disappointed, or like I failed, or miserable about it. Just to be grateful that it is an option in this day and age!

Oh, and I am packing my hospital bags! I finally did it last week. For me, 2 bags. One for labor containing snacks, gatorade (YUCK), hairbands, warm socks, snacks, my birth plan, protein shots (old habits die hard), a bikini. Snacks…

All encased in my new diaper bag:

And then for ‘postpartum’, hair & make-up stuff (WHAT? My Mum allowed no cameras into the room until her hair and make-up were done! Seriously!), pads, comfy clothes, reading materials, chargers (phone and iPad) and nipple cream / pads (snigger):

A ‘going home outfit for me (YES I AM GOING TO WEAR HEELS IF IT ISN’T A C-SECTION DAMMIT):

And best, best, best of all. For Firework, a ‘first day’ outfit (a little tiger one) and his going home outfit (Alabama T-shirt and shorts like his Daddy wears) + a random onesie ‘just in case’.

All ensconced in an old gym bag. We also have a much coveted and finally obtained Aden + Anais swaddle blanket, a nursing pillow (coz I just love my boppy) and a going home blanket with little racoons on, given to me by my mentor at work. Of course, these bags are packed for a dash to hospital and a regular birth. If we have an induction, we go in at 8 pm for a special gel, stay overnight, start pitocin at 7 am and keep it going for as long as I and the baby can take without distress (which could be 36 hours, but is likely less). So.. then I won’t have two separate bags. We’ll be less birth focused and more focused on just entertaining ourselves in hospital. If it gets to the day we’ll throw in some puzzle books and more entertainment.

Pretty exciting really.

…Hello third

29 weeks

Nicely zooming into the third trimester. We have insurance, we have an OB, I feel great (although my body is giving up a little) and we have a high risk doc monitoring us (but all seems to be well)… yes, quite a bump ride to get here 🙂

New Obstetrician

Just a small bit of politicizing and I will move on, I promise: Look, I’ll even put a spoiler so you can skip past my bleeding heart liberal views if you like – just scroll right down until you see the ‘end spoiler’.

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Hmmm… well, I finally found a doctor who would give me prenatal care. Due to Texas’ wonderfully sensible state laws… I could not have health insurance sponsored by the state (I am technically a state employee) for 2 months. And due to health insurances reticence to cover any ‘pre-existing conditions’ (which I do understand) I couldn’t get temporary care. Wonderful. To those like the genius Ron Paul (and I use the term ‘genius’ in the same tone as ‘wonderfully sensible’ above) who say:

Know this: your views are as old as you. You do not understand that we now save lives (and a heap load of money) initially through learning to enact preventative care programs, and then latterly through increasing the efficacy of those programs by enacting screening programs. Some would say NIH are investing vast sums of frikkin’ money on developing the best early markers with which to screen for diseases… so we don’t end up in emergency care. But you know – what do public health researchers know?

To Mr. Paul I say: My ‘routine doctor visits’ for the last 3 weeks have come in at over $3,000 (holy smokes). Covering the 6 week gap would obviously have been even more expensive. Do you really think it is reasonable to expect couples to find that money over the course of a whole pregnancy?? And what happens when you expect them to over a short period? No healthcare. Which is what I, a public health researcher, chose. Aye.

So no OB wanted to care for me as I had had a ‘gap in care’ until I stumbled upon the lovely Dr Boswell at Texas Children’s (Women’s Specialists of Houston sub branch). OK, no more politicizing for the whole of this post.

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Gaily I went off to see Dr Boswell, where we discussed (1) my signs of early labour, coupled with (2) my battered cervix (a colposcopy, cone biopsy and laser treatment in the past) which means it could either (a) not open at all, or (b) act like a pressure-triggered trap door at the slightest pressure like… er… a growing baby, tripled with (3) a septum (large piece of fibrous tissue) across my uterus, which means some of uterus is ‘cut off’ leading to more pressure overall as space becomes a premium. All-in-all she felt this combination of things may not be a good thing. So… off I went to Baylor to a high risk OB / GYN.

Woo-hoo extra ultrasound. This is Firework lying at the bottom, face up, flexing his muscles like his douchey Mum used to.

So the high risk OB did a whole anatomy scan, which (shutting my ears to the crusty side of me that wants to listen to voices saying that scans are not a good thing) we thoroughly enjoyed. Firework did not, he kicked and wriggled away, and kept PURPOSELY putting his hand in front of his face so we couldn’t see it. Git.

We did get a picture of the young ‘un though. He obligingly acted like his Ma in her pre-pregnancy days and flexed his muscles for larks (I used to be a body builder). I am suspicious that he was also acting like his Dad and showing off to any passing nurse. Hmmmm. He was also quite big at 3lbs when they would expect 2.5lbs. Good lad.

Anyhoodle. We discovered that FW, like the MMA fighter we would love him to be, had just kicked aside my septum and made himself some nice room. And that I have one hella long cervix (4.8 cm at 29 weeks, when they expect ~3 cm) which should hold him in tightly. Of course, you can’t go to any doctor and actually come out feeling healthy: they did find that I have vast amounts of amniotic fluid. Vast amounts, but not quite vast enough to panic.  Usually they suspect a baby with no stomach, or a genetic abnormality: but much searching found no evidence was found of such.

Personally, I am not worried. Back in my initial scans they said I had a giant uterus. No one was concerned then, and I am not now. I go back in 2 weeks to see if the fluid is increasing, decreasing or staying the same. Alrighty then. They did say that big ol’ amounts of fluid are heavy are so preterm delivery is more likely, but hey – nothing we can do about that now. So basically in the ‘will I give birth too early, or have to have a C-section in the end’ battle it is just a battle between:

Big baby and his excessive fluidy surrounds

vs.

scarred up (movement resistant) big ‘n’ tuff cervix.

I could deliver hella early or basically not at all and need a C-section (which TERRIFIES me). I am removing myself from the whole thing and tired of the medicalization, and – while I LOVE my whole OB practice, especially Dr. Boswell – just letting them poke me and prod me while I mentally skip through fields of daisies and ignore them and see what happens. THEY can fuss and worry, I can deal with the birth as it happens.

How I am feeling

29 weeks, 4 days

Other than that, I am blessed to be feeling super well. My bump has remained pretty small (in the clothes pictures I angle it to look nice and big) which has made it easy for me to sleep and move about and not feel icky and encumbered. I do generally sleep very well (even on my stomach sometimes) and can quite forget I am preggo.

My body is starting to give in though: my feet are swelling like balloons, my hips and legs often hurt if I try and run anywhere (like for an elevator) and I do get pretty tired pretty early (which does allow for DELICIOUS 10 hour sleeps). Also, as Firework and his home are very large (all that water) and I am pretty small still (a situation I like to call ‘bloody ideal and I am glad I worked on my abs for so long’) my insides really are squished. Really squished. But again, as FW seems to be getting all the energy he needs, I am happy my appetite is controlled and I have been able not to gain a whole heap load extra so far.

Weight gain at 29 weeks: 14 lbs. Just back from a road trip though (mmmm… ice cream) so I wouldn’t hold me to that trajectory at the next update 😉

Finally

FW is breech! Which is OK for now, but I am going try spinning babies alongside being better at doing my Bradley exercises – why not?

28 weeks, 3 days looks like:

This when in clothes!