women's health industry vs. the health of actual women

Okay. So. As I mentioned earlier, I am pregnant with our second child. Yay! So happy about this.

What I am NOT happy about is how I am being forced to somersault around in order to appease the interests of the women's health industry in order to have a safe, natural birth.

Background: I knew very early on in my pregnancy with Colin that I wanted to pursue natural, unmedicated vaginal birth. I believed, and still believe, that in all but a few cases this is the safest, healthiest, most rewarding birth for both mother and child. I knew I had to be proactive about pursuing this, because the c-section rate in the United States is just skyrocketing; in 2003, 27% of all live births were via c-section.

(As I understand it, basically, the typical scenario is some variation on this: a woman goes to an OB during pregnancy, fills out all the forms, takes all the tests, does what she is told, and is for the most part a passive recipient of healthcare. She goes into labor, she goes immediately to the hospital, and she's popped with an epidural by the time she's dilated 3 cm. The epidural relieves all the pain, but it also relieves her, for the most part, of a vital connection to and sense of what her body is doing. If she's allowed to get to the point of pushing-- which she may not-- she cannot feel the natural urge to push and has to be directed by the OB. But usually, she doesn't get that far, because while each woman's labor is as unique as the woman herself, if she's not reached XYZ series of progression markers by a given point in time, the OB shoots her up with Pitocin or similar to "help things along." The Pitocin interrupts the natural progression of labor by making the contractions harder and more frequent, but this may or may not help her dilate more. What it does do is increase the sense of medical urgency on the part of the laboring woman ("Something's wrong with me!") and impatience on the part of the OB ("We need to get that baby out of there."). So if the Pitocin hasn't worked by ABC point in time, well, good try, but let's cut you open and get that baby out.)

Now, I know that there are many, many, life-saving, medically necessary c-sections performed every year. I know that. But do I think fully a quarter of all live births require it? I do not. I think busy OBs and busy hospitals want to move patients along. I think hospitals make more money on c-sections than on vaginal deliveries. I think that pregnancy and birth, which are natural, healthy parts of a woman's reproductive life, have been pathologized-- treated like a disease or a sickness that reuires a cure.

Pregnancy and birth are not a disease. They are things my body was designed to do.

So I researched local facilities and found out that The Birthing Inn at Loudoun Hospital has an excellent reputation, private rooms, nice facilities, midwives practice there as well as docs, etc. So then, because I was a chicken about going to a midwife the first time, I chose an OB practice that delivered at the Birthing Inn.

This was my first mistake. I knew going to a midwife instead of an OB for my prenatal care and delivery would massively decrease my chances for a c-section. But because I was a chicken about it, I went to an OB instead. I was naive enough to think that if I wrote out my little birth plan (which no one at my OB's office ever asked about) and had my doula at the hospital with me, everything would be okay. It was not.

My second mistake was permitting them to use Pitocin on me during my labor, when I wasn't dilating fast enough to please the OB. I resisted this for a while, with the support of my excellent doula, but I was on the receiving end of terrible pressure from my OB.

This led, i believe, to my ultimately capitulating to a c-section after 22 hours of labor. When labor is allowed to progress naturally, the pains build up gradually over the course of several hours. When you jump-start it with Pitocin, the sudden onslaught of painful contractions is something you have had no time to adjust to mentally or physically. So, I was still resisting an epidural, and the contractions suddenly were acutely painful. And I was exhausted, and the OB was really pressuring me. So I gave in-- my third mistake-- and submitted to the c-section.

I cannot tell you how disappointed I was with myself and my care providers in the days that followed. Not only was I now recovering from major abdominal surgery at the same time that I was learning to care for an infant, I was also unprepared for some of the after-effects of the c-section. For instance, nobody told me that after a c-section, breastmilk can take over a week to come in, and this led to a whole other nightmare involving my poor little Colin dropping over 10% of his birth weight in five days. I will never forget the nightmare of the first night we had him home-- this poor tiny baby was screaming and screaming for food, and we had nothing to give him, and I couldn't even stand up straight because of my incision, and poor sleep-deprived Peter had to do everything. I will never forget the sound of my baby's hungry cries, not ever, for the rest of my life. It was the worst sound I had ever heard, and there was not a thing I could do about it. We had no formula, of course, and the roads were covered with ice and snow and I was terrified to send Peter out for any lest he never come back. It was the worst night of my life.

Anyway, to sum up, I can now say both from research and from personal experience: c-sections are bad. Do not have one, ever, if you can avoid it in any way.

So now, pregnancy number two happens. I know better, in so many ways. So as soon as I find out I'm pregnant, I call the midwives for an appointment.

They don't do VBACs (VBAC = Vaginal Birth After C-section), the receptionist tells me. I was floored. I got off the phone, looked on the internet at what felt like every midwife practice in Northern Virginia, and they all either don't attend VBACs at all or will only attend a VBAC if you've already had a successful one since the c-section. So I went in for an initial checkup with the midwife, anyhow, and asked her, "Where do I go to get that first VBAC? It feels like the whole system is designed to keep me under the knife."

The midwife, who was very supportive and kind, explained that at Loudoun Hospital they are required to pay their on-call doc to come and basically sit around the hospital while I am in labor. And they can't afford to do that. Also, in a horrible ironic twist, the very rarity of VBACs makes them more difficult for the midwives to offer-- if they did them, they'd be swamped with women from all over who couldn't get one anywhere else.


So the midwife gave me the number of an OB they work with on occasion, a woman who is known to be supportive of VBACs and willing to attend them. So I have an appointment with her later this month; we'll see how that goes.

But. I was kerflummoxed by this requirement that they have a doc just sitting there during my labor, just in case. Didn't the midwives always have a doc on call, anyway? Why did the doc have to be right there? The major risk of VBACs is uterine rupture-- a tearing of the uterus at the site of the incision-- and that is in less than 1% of VBACs, and something like 0.67% in the case of women with my particular type of incision (low transverse with a double row of sutures). So that seemed an unnecessary precaution.

So I read up on it, and it turns out that, in 1999, the American College of Obstetricians and Gynecologists changed their guidelines from saying that a surgical team should be "readily available" during VBACs to saying they should be "immediately available." And while "readily" means 30 minutes away, "immediately" means in-house.

Why? They give lip service to its being for the health and safety of women. Don't you believe it. It's all about liability. There have been major malpractice suits in the last few years involving uterine ruptures and the argument that a c-section was not performed quickly enough after the rupture. This is not about women's safety. This is about doctors and hospitals practicing good old CYA. If this were really about women's health care, they would be encouraging VBACs, which are still safer than c-sections. In addition, every repeated c-section increases the risk of complications in subsequent pregnancies.

I was right. The system is designed to keep me under the knife. But this time, I'm putting up a fight.


Kimberly said...

If you want to keep your ire really high, you should see what the malpractic PREMIUM rates are for OBs (and I mean in the hundreds of thousands of dollars a year)...which is why fewer and fewer doctors are becoming OBs. I do think it is CYA on the part of the docs (and prob the midwives, though I don't know about their malpractice ins) which I can't blame them for, because their homes and their families are on the line due to the huge litigation mentality of the American populace. Not at all a cool thing to do to the women, but, on the other hand, their job ends at the birth of a healthy baby and a mom who isn't hemorraging. And so they aren't thinking ahead,

Feel for me. I love my doctor but she and her partner only deliver at Fairfax Hospital. Can you say more than 900 births a MONTH? But my doc is very cool, doesn't even encourage an amnio (even though I am, GASP, 35). So that made me happy. If you don't like your doctor, you can come talk to mine!

quarto said...

Good luck my dear. From what I can tell, you'll be fighting an uphill battle all the way. I'll be praying for you.

Your real-life example is more frightening to me than anything I read in Misconceptions. There is a sense, in the book, that unncessary surgery can be avoided with a frothy mix of education and sheer bullheadedness. And it would probably work, too, if there wasn't an innocent third party involved. Who could forgive themselves for refusing the surgery and losing their child? I'm assuming this is what it comes down to, at the last minute: you're tired, in pain, and a qualified professional is pressuring you to have a c-section. And you don't know if it's a good idea, but it's better than losing your child. So the question is: how do you prepare for that?

I'm really suprised that there aren't more options for people who want vaginal births after c-sections. If I hear of anything or see anything in the area, I'll let you know.

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