Friday, December 21, 2007

I wish I'd written this!

This is one of the best bits of birth writing I've come across in a while. So check out Looking glass Alice examines birth and parenting in our culture. Her other stuff is good too -- I like the fact that she's not afraid to "offend" and seems to have a good handle on why we shouldn't be afraid of "offending".

After all, which one of us ever changes if we aren't offended to begin with?

Saturday, December 8, 2007

Cesarean Rate Rises. Again.

So I'm a bit behind in the blogging (what's new?). But I will add my voice to all the others expressing our outrage and grief (though not surprise) that the National cesarean rate for 2006 was reported by the CDC to be 31.1%, a 3% rise from 2005. Given what I see in the stories from just the women who join the ICAN email list, I'm not surprised at all. What with VBAC bans, early inductions and cesarean surgery becoming the "treatment of choice" for suspected macrosomia....I knew the numbers would be bad.

You want to know what's really bad? These numbers are very likely lower than the reality. Why? Well, because some states (Florida is one) exclude "high risk" cesareans from their data -- so if a woman has a cesarean and she was carrying muliples, or the baby was breech or the baby was premature....that doesn't "count". I'm trying to wrap my brain around why this would be a reasonable thing to do....and honestly, the only reason I can come up with is that it keeps the "official" number lower. The argument that these are "necessary and unavoidable" cesareans doesn't make sense to me (and isn't true anyway since all of those pregnancies can end with a vaginal birth)...and excluding breech alone has to raise the cesarean rate by at least 3%...what I am sure has not had any real effect on the numbers are the "patient choice cesareans"....because they really are very rare. You wouldn't know it from the popular press but anytime anyone has tried to get a handle on how many non-medically indicated cesareans are done by maternal request....a very small number is generated. Add to that the fact that most likely, some proportion of hospitals are just plain lying about their cesarean rates (we have a few cases where we know for sure it happens, I'd assume its not limited to those few hospitals) and you get a number that's higher than 31.1%.

So in my state, Michigan, the cesarean rate was 29.8%. About the only good thing I can say about that is that it isn't 37.4%, which is where New Jersey, the state that cuts more women than any other, falls. You know things are getting bad when you see a rate below 25% and want to celebrate (or move to that state). Look up your state -- and then look at the Press Release from ICAN...and then send it to all the media outlets in your area you can find, and to your state and national legislators. Let them know that you are tired of your healthcare and tax dollars being pocketed by the medical and insurance industries, while the U.S. suffers one of the worst maternal and infant mortality rates in the developed world. Let them know that you are tired of women's legal rights to informed consent and refusal being systematically trampled on.

And then, put your money where your mouth is. Join ICAN. If that doesn't appeal, join Lamaze Intl., or CIMS, or Citizens for Midwifery or birthNETWORK or ANY organization that's trying to make a difference.

If you want to get personally involved, email me -- I've got a big project just about ready to launch and I'll need people who are willing to donate time and phone minutes. The problem is huge....but you know what else? If even a quarter of the women who've been through the medical establishment while having a baby got involved....we could make a big difference. So how about it?

Tuesday, December 4, 2007

N*A*T*U*R*A*L* spells....

vaginal? boy, I thought new math was strange, this new spelling is WAY out there. I'm getting really old....

Seriously, seems (I've noticed this myself, I'm not just hearing it from other women) that "natural birth" is the new way to say "vaginal birth". Well....ok? Yes, a baby coming out of your vagina is an integral part of a natural birth...and admittedly, having a baby come out of your vagina is a HUGE accomplishment in this day and age....but natural?

So how do we decide to define a word....strictly, as in by the dictionary or by traditional usage? By current cultural usage? What are the consequences of allowing (either actively or tacitly) definitions to shift? How important is a word, anyway....I'd say words are very important, even more so because most people don't recognize how important they are!

Let's use the word "choice" for example. I could very accurately be described as someone who is pro-choice when it comes to birth options (what did you immediately think of when you read that? My stance on the "other" choice issue? Now you are probably wondering). The minute I use the phrase "pro-choice", the minute an organization like ICAN uses the phrase "pro-choice", even if we are clearly using it in the context of birth options, not abortion...people assume that we are "PRO-CHOICE". That phrase has gained a certain specific cultural definition that then restricts how I can use it in a different context.

So, if a "natural birth" has come to mean a "vaginal birth" and has no relationship at all to the circumstances of the labor with regard to drugs and other what? Why in the world do we care? Are we truly "natural birth nazis" out to make any woman who has any intervention feel guilty, forcing women to suffer needlessly in childbirth through the strength of our criticism, reveling in our obvious moral and physical superiority because we pushed a baby out our vaginas without drugs or assistance? Given the diversity of humans, I'm sure there are some women who feel like that, I've experienced my share of birth elitism when the fact that I've had a cesarean becomes known...but honestly, most women who plan a drug-free birth aren't like that at all. And certainly, the women I know who plan drug-free births don't do it to prove anything...they just want to maximize their chances for a safe vaginal birth and its clear that using as little technology as is safely possible is the way to do that.

There was a time when "natural birth" absolutely meant drug-free and implied free of other interventions too. It was certainly something that many women strived for, and I don't think they wanted a natural birth in order to get their natural birth merit badge. I mean really, if the majority of women would like to have a natural birth, meaning no drugs, realistically it just doesn't mean that the majority of women think they are superior to other women. It means that there's an underlying cultural assumption that a drug-free birth is a good idea. But now we have this situation where its really hard to know what women truly want (and the benefits of a drug-free birth are no longer understood) -- there's the "epidural in the parking lot" crowd (who I think might say that as much because they think its trendy? funny? inevitable?), there's the "oh, nobody gets a badge for not using drugs" group (which I suspect is more about personal "failure issues" than anything) and of course, there's the "let me tell you how bad it really is" group (which I think is human nature -- we like to top each other's stories and talking a lot about something does take the mystery out of it....its just too bad we are replacing the mystery of "what's it going to be like" with false "facts" about what its going to be like). A pregnant woman surrounded by these statements is going to have a hard time believing she's capable of a drug-free birth and she's going to wonder why she should bother?

I don't know. I can't help but think about a study done in Brazil. Its been common belief that a big part of the reason the cesarean rate in Brazil is something like 80% is because women want to have cesareans (to save their vaginas I've been told). Well gee, someone actually went and ASKED...and guess what? The vast majority of pregnant women in Brazil say they want a vaginal birth, when asked at the beginning of their prenatal care. Look at that....we were wrong, it doesn't seem like its the women who are driving the cesarean rate after all! So, I have to wonder if we are wrong about women just not wanting a natural (drug-free) birth anymore....I think a lot of women do. Its just that by the time they get to the end of the pregnancy, they've been pounded with horror stories of how torturous labor is, they've been told (at least implicitly) that they are crazy or elitist to plan a drug-free birth, they've been told quite explicitly that they can't do it and they might as well not bother (you don't have to be a martyr, after all, you wouldn't get a filling without anesthesia. Actually, I would and have but that's neither here nor there since its an apples to oranges statement anyway) and they certainly haven't gotten a bit of support from their OB. If you set someone up to fail, well, most of the time they fail.

Ah, failure. A word that is very loaded in the context of labor and birth. But see, I don't have to tell a woman she's "failed". I really don't think of it in those terms anyway, to be honest. I know women are failed by those around them all the time when it comes to pregnancy and birth. That's where my criticism falls. Women tell themselves that they've failed, all the time about all sorts of things. I think that's where a lot of the stuff about not being a martyr comes from....because we DO judge ourselves based on what other women do (not just in pregnancy and birth). I don't think its a conscious effort to make another woman feel bad in order to feel better....but I do think that's some of it. Some of it is probably a (misplaced) desire to save your friend/sister/sister-in-law/cousin from the feelings of failure that you struggle with. It does make for a pretty damn touchy topic, especially when we are talking about "natural birth", a thing that most women "fail" at.

The question of whether one should "correct" the definition of "natural birth" when used to mean "vaginal birth" came up on the ICAN list. Boy oh boy, that was heated (though polite). It also showed up the limitations of email for discussing something that is going to be extremely nuanced and depend strongly on the context of the conversation that might need to be "corrected". For the record, I don't like the term "corrected" here -- birth is a tender topic...corrected implies "did it wrong" and honestly, there's a difference between the wrong use of a term and a "wrong birth". Do I believe that we need to fight against the trend making natural equivalent to vaginal? Yeah, I do. Its yet another erosion in safe birth....because it takes the very idea of a drug-free birth out of common language. If you don't hear it talked about, you don't think about it, you assume it doesn't happen. But for me, that doesn't mean stopping a woman in the midst of her telling her birth story for the first time and correcting her, when she says she had a natural birth with an epidural. It might mean asking some questions...if she's part of a group and everyone is swapping stories around, I might say something like "hey, that's so cool you had a vaginal birth, they are getting rarer and rarer, especially with all the stuff they do to you in the hospital these days" or depending, I might just ask "hey, did you say natural or did you say vaginal, I missed that part" or any number of more indirect ways to point out what I see as a disconnect. As long as they aren't threatened, for the most part, women LIKE to talk about their experiences. I like women to talk to me about birth because then I can share my experiences too. And then we can all think harder about pregnancy and birth and the state of things and what it should be like rather than what it is like. Because ultimately, that's what it is all about -- helping women fully understand what choices they have and what those choices mean -- giving women all the tools to make safe choices for their babies and themselves, something that most women just don't have the knowledge or confidence to do. And I believe that the vast majority of pregnant women will do whatever it takes to have the safest birth they can...they just don't know what a really safe birth looks like, and the only people telling them are us -- the crazy, hysterical natural birth nazis....

So yeah, let's make sure we are clear on terminology. But let's mix that with a healthy dose of empathy and compassion for the women who've never had a chance to hear about a really natural birth.

Thursday, November 29, 2007

Nobody Wins

I'll preface this post with the statement that while OF COURSE any allegation of child neglect or abuse must be investigated, it is obviously too much to ask that such investigations be done with even an iota of common sense, much less responsibility to the legal rights of the children involved, not to mention anyone else.

I had an experience the other day I hope NEVER to repeat. I suppose it could be considered "enlightening" if that word can even be used when talking about the mindless, heartless monster that is "social services" (to be fair, I should say "social services in my state" since maybe its better elsewhere? Right next to that bridge for sale....). I have a friend, I've known her for years. She's a smart woman, loves her kids and has had a really hard time for awhile now. She's not perfect (I've yet to meet that person) but she's sure as heck not stupid or lazy or criminal....she's just a mom struggling to keep a roof over her kids' heads and food on the table.

So one day, CPS shows up at her door, demanding to be allowed into her house. A complaint has been filed. The nature of the complaint pretty much proves that it has to be a malicious in nature. Sadly, my friend knows that there are several people who could and would do such a thing. So, she does what she is legally entitled to do -- she refused to allow the CPS agent into her house and instead required them to follow the formalities. Perhaps this particular agent had never before dealt with an educated parent, willing to advocate for herself and her kids....because she sure acted like someone had just pissed on her would be amusing if it hadn't ended up causing a lot of distress to my friend and her kids and costing ME, the taxpayer, a bunch of money that could be better spent, oh, finding kids that are actually being abused? Or perhaps, if that's too much to ask, funding schools, since my state is pretty much bankrupt at this point, with no relief in sight and the schools are taking the brunt of the budget cuts.

So this whole farce drags out....and earlier this week, I found myself sitting in the lobby of the local Welfare office (oh, there's some nice sounding name they call it now -- I can't for the life of me remember what it is -- Family Assistance something? Health and Human Services? Bend Over and Smile? I was the welfare office.) I got there early so I had a chance to sit and watch. I'm not sure I've ever before been in a place that so sucked any life, any dignity, any hope out of a person. People coming in, with varying degrees of frustration or futility in their eyes. People who I would bet are just trying to make ends meet. Yeah, I'm sure some of them are there because they made stupid decisions but as is said, there but by the grace of God go I.....fluorescent lights, humming just below hearing, cheap plastic chairs that look like they came from a bus station 15 years ago (you know the kind, they sorta but not really are formed to fit your butt -- which means they really don't fit anything), broken toys over in a corner for the kids to play with, clerks who are more robot than anything, unless you don't stand in the right line or fill out the right form or sign the right sheet....anyway, there I sit, waiting to wait with my friend while CPS interviews her kids, which supposedly will be the end of this unless they find something (which they won't). Again, my friend knows her legal rights (and more importantly, her children's legal rights) and so she has a lawyer present, to sit in on the interviews. Oh my goodness, if the agent's hydrant got pissed on before, this was chest thumping I'd expect from chimpanzees, not government employees.

I think it took almost an HOUR for CPS to figure out that they weren't going to find a copy of the law stating that they didn't have to allow the lawyer to be present (since it didn't exist) but they did get to say "the prosecutor" a lot (which is amusing in a sick way -- if they actually DO get the prosecutor involved, then the presence of a lawyer is more than guarenteed!). They did try to get the lawyer excluded on the grounds that they are allowed to interview a child without the suspected abuser present. I realize that lawyers are generally unpopular but this was not at all fair to the very nice woman who was representing the children as I must say I didn't see anything about her interactions with the children I'd consider abusive.

Finally someone figured out that if they weren't willing to just say "oops we were wrong, we're so sorry for wasting your time, have a nice day" then they needed to come up with an alternative. (In the meantime I'm getting creative in the "visitation room" with its own collection of broken toys, keeping a bunch of kids occupied as best I can -- imagine what it would have been like if they'd actually refused to let me in, the way they first wanted!) So, it turns out if they do a different sort of interview THEN the lawyer can be present (in the process of this compromise they got to say prosecutor a few more times) that's what they did. Including trying to interview the barely verbal baby who's in that special separation anxiety stage....I'm sure there was some box on some form that had to get checked off and heck, the kid got a piece of gum (bribery) out of the deal.

So finally, oh, about 2 hours later, we all traipse out to a chorus of "thank-you-so-much-we'll-be-in-touch-have-a-nice-day (if they just could have said that, oh, about 2 hours earlier it might have been a nice day) and run the gauntlet of the hopeless to get the heck out of there.

So now I get why hospitals like to threaten difficult parents with CPS -- they've sprung from the loins of the same cursed mother! And I suppose, ACOG's members would be their multi-headed evil triplet. I know the answer to this institutionalized paternalistic bullying with its implicit misogyny IS knowing one's rights and standing firm (at least the immediate short-term answer, I'm at a complete loss as to the long term solution). I can also now very clearly see the conflict -- you know you need to do what's right but in doing that, your kids have to suffer to some degree or another -- be it something as (hopefully) slight as spending the morning in a decidely unpleasant place with decidedly unpleasant people who want to separate you from your parent (though I'm sure it didn't seem slight to the younger kids) to something as horrifying as the fear that your children could end up in foster care while the whole thing is "sorted out" -- the temptation to just do what they want and get it over would be overwhelming. Principles only get you so far.

And you know, I'd say that the people (mostly women) who work for the system are ultimately victims too -- because I believe that the majority of these people go into the job really wanting to make a difference, really wanting to save abused children, or help struggling families....and somehow they too get the passion, the fire, the life sucked out of them. So what is it? Is it Western culture? Human nature? What is it that makes it impossible to know when to sit still, when to reach out to assist and when to rescue? Sounds an awful lot like obstetrics, doesn't it? Humans just don't do institutional compassion very well, do we....

Monday, November 26, 2007

Howling At an Uncaring Moon (ADULT language follows)

Here's the obligatory warning. I'm gonna drop a number of F-bombs and equivalent offensivenesses so if that's a problem, stop reading now.

I'm so FUCKING sick and tired.

I FUCKING tired of people being surprised at my hurt. I'm FUCKING tired of being nice, political, detached, dispassionate, reasonable.

Today I had someone (who I like and respect) express surprise that I would call a midwife (who answered a query in a public forum) on the fact that she thinks women who express their birth trauma in terms of rape are just crazy, basically. Oh, she phrased it in terms of prior experience, bad expectations blah blah blah. Its bullshit. Unadulterated BULLSHIT.

You know what? My cesarean felt just like a rape. Because I've BEEN raped, I can pretty accurately make the comparison. But you know what? I don't think a prior experience of sexual assault is necessary for a woman to KNOW she's been raped. Of course, the fact that something like 1 in 3 women in the U.S. have experienced a non-consensual sexual contact before the age of 18 means that there's a whole bunch of women who DO know what they are comparing to. So pretty much all I have to say to those who aren't happy with my comparison of my "good" cesarean with my rape is FUCK YOU. How dare you. How fucking dare you.

My cesarean was 9 1/2 years ago. It wasn't even a "bad" one compared to the horrors that most women endure. And I CRIED tonight on the way home about it. THAT'S what happens when I let myself think about it. Me -- controlled, professional, even-tempered, fair-minded, appropriately detached, 2 VBACs later, well on the way to being healed ME. Also the me who since the cesarean has had to deal with anxiety disorder, depression and substance abuse...oh, the cesarean certainly isn't the only "reason" for these problems but it sure as hell didn't help, now did it?

And you know what? I'm FUCKING tired of the Business of Being Born (Ricki Lake's movie). Why? Because everyone who cares is all about how wonderful it is and how profound it is and blah blah isn't going to make one stinking bit of difference. Because the women who NEED to see it wouldn't GET it even if they did see it. They are so fucking brainwashed that the very thought that their precious OB might not have the same dreams they do is impossible for them to fathom. I'm also really really sick and tired of the fucking choir. I'm tired of midwives carrying on about how important they are. Oh I get how they have to protect their living, their licences, etc. I get that, really I do -- the prosecutions (persecutions) against midwives are nothing less than immoral and maliciously hateful to boot....but frankly, most of them are so fucking full of what a great job they are doing that they won't see the slaughter and if they do, they have to blame it on the women who run so willingly to it. And ok, I can't be that mad at them, after all, part of the reason I'm ranting here is because the slaughter is so damn depressing and overwhelming.

And I'm really really tired of women not getting it. Who do I blame for that? What the hell has happened that women are OK with getting their genitals mutilated for no good reason? What the hell has happened that women ARE abused during birth, more often than not, and they don't care? It pisses me off that women don't care. It pisses me off that somehow, they've been so manipulated from the time of their own births that they think it really is ok to be sexually abused (in all sorts of ways, having a baby only being part of it). Because that's exactly what it is, sexual abuse (aka rape -- oh, I can't believe she said that! whatever). Except part of me KNOWS that every single woman does KNOW that what happened to her was wrong. Most of the time, she just shuts up, stuffs it and acts like the good little girl that she's supposed to be, to the degree that she'll rip you a new asshole if you DARE imply that she might have reason to be hurt....whatever. I'm fucking tired of that woman too. Fighting with each other when really, we are the only hope we have. Why is it ok for a virtual stranger(s) to stick his (her?) hands up your vagina for no good reason on any number of occasions and then require you to submit to conditions that are pretty much the same as bondage/torture leading to nasty drugs, deliberate cutting of your vagina (and anus, if you are really lucky), or your stomach, muscles and uterus, putting you at risk of serious and life threatening complications for THE REST OF YOUR LIFE. Oh, and did I mention the fact that IT ISN'T GOOD FOR YOUR BABY EITHER????? Your Obstetrician LIED to you. Gasp.

Oh wait. I'm just an angry woman, probably unstable, certainly hysterical, projecting my own mental illness on poor innocent you. Well, that's ok, I'm well acquainted with the finer points of denial so I get it.

Catch me as I fall
Say you're here and it's all over now
Speaking to the atmosphere
No one's here and I fall into myself
This truth drives me
Into madness
I know I can stop the pain
If I will it all away
Don't turn away
(Don't give in to the pain)
Don't try to hide
(Though they're screaming your name)
Don't close your eyes
(God knows what lies behind them)
Don't turn out the light
(Never sleep never die)
I'm frightened by what I see
But somehow I know
That there's much more to come
Immobilized by my fear
And soon to be
Blinded by tears
I can stop the pain
If I will it all away
Don't turn away
(Don't give in to the pain)
Don't try to hide
(Though they're screaming your name)
Don't close your eyes
(God knows what lies behind them)
Don't turn out the light
(Never sleep never die)
Fallen angels at my feet
Whispered voices at my ear
Death before my eyes
Lying next to me I fear
She beckons me
Shall I give in
Upon my end shall I begin
Forsaking all I've fallen for
I rise to meet the end
"whisper" -- amy lee and ben moody

right now, that song describes what it feels like to me to get cut open and then told it doesn't matter. yeah, even 9 1/2 years later....I wish more women didn't close their eyes.....

Ok, so I'm winding down now. I really don't even know exactly what to do with all this....I'll gather myself together and keep plugging away, at least for the sake of my kids, if not for any real change now.

Sunday, November 18, 2007

Ramblings of a bored Veterinarian

Funny the things I can figure out when its actually not the middle of the night (which is usually when I have time to even contemplate writing). I figured out how to make the screens smaller with the embedded youtube videos. Yay! So I now have 2 videos prominently displayed on my sidebar....and links to several others that I hope you will check out.

I also added a bunch of blogs and websites to my lists...there's a lot of action right now. We'll see if it lasts. Everyone is all excited about Ricki Lake's movie...I haven't seen it yet, though I'd like to. But many women are actually going to see it? Who aren't at least halfway in our choir anyway? And how many women are actually going to make the jump OUT of the, they'll just persist in believing that a good birth plan and a doula will guarantee the birth they want...and sadly, in many (most?) cases, hospital staff are very good at getting around both those things.

I try really hard not to get too depressed about the state of things. I think I must be in a "down" phase right seems like its the same old thing over and over and over....I want to have a VBAC hospital banned OB won't do husband doesn't want me to....there are no midwives in my area....we can't afford a homebirth....or....I planned a VBAC OB told me it isn't as safe as we thought....the baby looked big and they wouldn't induce me....I went to 42 weeks and the baby had to come out.....the ultrasound showed my placenta was getting fluid getting low....I didn't want another cesarean but.....

Which leads to a fairly controversial topic, I suppose. The "godly submissive wife". I don't know enough about other faiths to know for sure if this bit of doctrine exists elsewhere -- I suspect it does in some form or another in both Islam and Judaism but I'm familiar with it as an expression of Christian belief. It is a wildly debated topic, since the Bible actually doesn't define it very well....and certainly doesn't define it in terms of modern society and culture. First, the disclosure -- I am an evangelical Christian (by a more traditional and non-political definition -- you can't call me fundamentalist or right wing) and I do believe that a wife should be properly "submitted" to her husband (of course, all believers are to be submitted to each other, too. And, it always pays to remember that the same scripture that urges wives to submit to their husbands instructs husbands to *die* for their wives. Personally, I think I got the better end of that deal). Anyway, the rub is "properly". There are some groups that believe this means the wife has to get her husband's permission for any decision of import. There are some groups that mean this gives a husband complete veto power over any choice his wife might make. There are some groups that believe this means a wife has to do anything her husband demands of her. And I suppose, if a husband were also properly laying his life down for his wife, all the potential abuses inherent in this sort of extreme interpretation probably wouldn't be an issue. But, guess what....humans pretty much will screw anything up. And so, we screw this one up. I have heard too many times "I'm a (Godly/Biblically) submissive wife and my husband doesn't want me to have a VBAC. (or home birth. or midwife. or something of that sort) Unless God changes his mind, I have to have another cesarean because I'm submitted to him." My response to that is "if your husband said any of the following, would you do it? 'I want you to watch porn with me.' 'I think car seats aren't that important and I'm not going to pay for one, you can drive without one.' 'I want you to sign this tax form, even though I haven't been honest on it.' 'I want you to tell your mother we are busy this Thanksgiving.' 'I don't want you talking to your sister, I think she's a bad influence on you.' 'I don't want you going to that Bible study, you need to be home.' 'I want you to have a boob job/tummy tuck/other elective surgery so that you are more sexually attractive to me.'" The fact is, the Bible *never* provides justification for immoral behavior. Lying, cheating, sexual sin, withholding oneself from the body of Christ, endangering children, frivolously endangering oneself....there's never a good reason for any of those things. It doesn't matter if the husband "thinks" any of those things are ok. If I know that what my husband is demanding of me is contrary to God's plan and purpose...I'm not obligated to do it. I'd say I'm obligated to NOT do it, rather the issue is my attitude toward my husband as I choose to obey God. What does this have to do with birth? Well....if a woman truly believes that a given choice is the safest one for her baby, then I'd argue is it immoral to then choose to do otherwise. The fact that the overall risk of something bad happening to mom or the baby is small regardless of the actual choice doesn't matter. The fact that most people might disagree with the conclusion a woman comes to doesn't matter (after all, most people would probably disagree with the overbearing interpretation of submission but she chooses to live that way). A husband has no right to demand immoral behavior from his wife, even if it is "his child too". But, you say, its different. Is it? Is how our children enter this world not that important? If that's what you truly believe, then why are you bemoaning the fact that your husband says you have to have a repeat cesarean. If it isn't important then it really shouldn't matter. (For the record, in my marriage, wifely submission means that in a situation where we disagree on the path we should take, as long as both choices are morally acceptable choices, he gets to choose. IF we absolutely can not come to an agreement. We never rush to this conclusion. This has happened exactly 2 times in over 16 years.)

I'll end with another potentially hot opinion. All of the excuses for why a woman can't have a VBAC or home birth or whatever are just that -- excuses. Women hide behind "my husband would never agree to it" or "we just don't have the money" or "neither of the hospitals in my town allow it" or "there aren't any midwives in my city" or "it's my husband's baby too" or "I don't want to ruin my marriage fighting about this" when in fact, the issue is that while they think they *should* plan a VBAC or home birth or whatever, they actually don't want to. Not really. I know this will be unpopular....but too often I've seen that where there is a will, a way is found, too often I've seen it to believe that a woman can't get what she wants for her baby if she really wants it.

I suppose I sound rather cynical right now. In some ways, I suppose I am. It just seems like we are going round and round and round in the very same circle while most women quietly run toward slaughter and then spend the rest of their lives telling themselves its ok.

Sunday, October 28, 2007

Again, not nearly enough time to write like I'd like but...I came across this and I really like it. I seems SO obvious...why don't more women get this?

When you think about how much many women (at least educated women) WON'T put up with...the things that they find inexcusable...the things that they do allow (certainly educated women are even MORE likely to allow birth abuse) are mind-boggling.

So what does it take to open eyes?


Friday, October 19, 2007

My Video

Ok, I'm gonna try to do video is embedded at the bottom of my blog (when I put it as a sidebar, it got cut off) but I doubt most people will go look for it there....of course, when this disappears, they won't look for it here either -- not quite sure how to get around that :-)

Anyway, I made this video. And when I have a bit more time, I'll explain why I did (or didn't do) some of the things in it.


Friday, October 12, 2007

Fox in the Hen House hunting Witches

I recently learned about something very disturbing...the American Medical Association formed a group called the Scope of Practice Partnership (SOPP), whose mission is to launch investigations of unlicensed “midlevel providers” and to support initiatives to fight legislation expanding the current scope of practice for licensed “midlevel providers”. If you search "Scope of Practice Partnership" you'll find some interesting and really scary stuff -- unlicensed "midlevel providers" would include non-Certified Nurse Midwives ("lay" or "direct entry" midwives) in states where licensure isn't available, even if those midwives were CPMs and thus, license "ready". If you read between the lines (and on top of them too) you can see that "investigations" is a nice way of saying prosecution and of course, they also oppose legislation introducing licensure to these sorts of health care providers. Licensed "midlevel providers" include the following: chiropractors, advanced practice nurses (aka nurse practitioners), nurse anesthetists, optometrists, podiatrists, physical therapists and psychologists. This whole thing is being sold as an attempt to "ensure quality health care" but my answer to that would be deal with your own lousy health care before you started trying to "fix" someone else's. We all know how well most physicians do with individualized care...Log in the eye anyone?

Alternatively, I've seen it described as a "clearinghouse of information about non physician providers' educational preparation, licensure requirements, and state legislation and regulation regarding scope of practice." The big question is, what do they plan on doing with the information? Oh, well, whenever there is a "scope of practice question" (that would be some non-physician profession encroaching on the income source of the physicians in that state or states) this information can be used to "address the issue" or even better "develop model legislation that can help resolve that concern." A specific example would be nurse practitioners -- currently, the education level to be a nurse practicioner is at the Master's level. There is a move in the nurse practitioner community to move to a Doctor of Nursing Practice degree, rather than a Master's degree. Why is this a bad idea? Why, it would allow nurses to call themselves doctors! And heaven knows, we can't have that...gosh, are they going to come after me too? After all, I call myself doctor....I'm sorry, but physicians don't have a lock on the generic term "doctor".

I think it is most baldly put in this direct quote from AMA resolution 902 : “that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state, notwithstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities.” Needless to say, they define "practice of medicine" very very broadly. Resolution 902 also asserts that “patients may be put at risk for injury or death . . . receiving care from persons
who are not physicians (MD [medical doctor] or DO [doctor of osteopathic medicine])” It is important to realize that there is NO evidence to support this statement and the AMA has been unable to substantiate it. But then again, we all know that patients are never "put at risk for injury or death" by the actions of physicians....who practice only the most scrupulously careful, up-to-date, gold standard medicine, of course.

This is a bully stealing the lunch money from the smart kid, who also happens to be a really nice kid too.

If you'd like to read some analyses of this, I've collected links here:

Coalition for Patients' Rights
Dynamic ChiropracticJune 6, 2006, Volume 24, Issue 12
Dynamic ChiropracticDecember 31, 2006, Volume 25, Issue 02
National Alliance of Professional Psychology Providers
Clinical Journal of Oncology Nursing • Volume 11, Number 2
American Dietetic Association
The Integrator Blog
Maryland Optometric Association
American Association of Nurse Anesthetists

Interestingly enough, I had a chance to discuss the quality empathetic and humane care pregnant women get from "doctors" the other night. For those who don't already know, I'm a Veterinarian and I work at a Veterinary ER Center -- I'm the person you see when your dog gets hit by a car or your cat blocks in the middle of the night (or on the weekend or the holiday, of course). I really love my work and the hours allow me to be other things besides a Veterinarian as well. When I'm working a weeknight overnight shift, I usually have 1 LVT (Licensed Veterinary Technician -- basically the Veterinary equivalent of a Registered Nurse -- they have 4 year degrees and have to pass a written and practical exam to be licensed). Anyway, we were discussing the recent birth events of another employee and I was expressing my disgust at how predictable things are most of the time -- this woman ended up with a cesarean she really didn't want at all and the way she got there was distressingly familiar to me. And my LVT, who is single, childless and in her 50's said all the right things...she was absolutely horrified that over 1 in 3 babies is born surgically. She was amazed that anyone could possibly think its a better way to have a baby. She was shocked that more women are dying in childbirth now than they were a year earlier...she was disgusted at the way OBs manipulate women at the end of their pregnancies when they are tired and exceedingly hormonal.

Too bad I'm not surprised any longer.


Monday, October 8, 2007

VBAC bans and other nonsense

Well, look at that, here I am again. I should probably be sewing Hallowe'en costumes...gonna be a busy couple of weeks I think. Anyway, I'm going to ramble this time about VBAC (that's vaginal birth after cesarean if you don't know, and if you are google searching blogs for that particular term ;-) and how much harder it is to have one now.

There's a lot of research on VBAC out there. For the most part it can be pretty easily summed up as follows:

The one complication that's relatively unique to VBAC is uterine rupture. Uterine rupture can be catastrophic, so it isn't something to ignore but catastrophic ruptures are also rare unless you do some stupid things. The rate of uterine rupture in labors that are spontaneous (that means no induction) and in the hospital is roughly 0.5% (1 in 200), but not all of those are catastrophic. Other than uterine rupture, there's no difference between a VBAC labor and any other labor. If you use things like pitocin or prostaglandins, you will increase the rupture rate. If you've had more than one cesarean, the rupture rate will be higher but its looking like it isn't really much higher (in one recent and very large study, it wasn't higher at all). If successful, VBAC is much better for the mother (obviously -- surgery really isn't "good" for anyone, it can be necessary but not good) and probably better for the baby too. It certainly isn't worse for the baby. The rupture rate is higher with incisions in the upper part of the uterus but we really don't know what the rates are -- all the numbers are quite old and women with these sorts of incisions are rarely "allowed" to have VBACs, so we don't know what the uterine rupture rates would be in this population. Things that do not increase the uterine rupture rate include being past your due date, having a "big" baby, having twins, being old, being young, being fat, being skinny or being short. Unless of course you are being induced because of any of those things.

Back in the 90's, the medical community "supported" VBAC. I'm too cynical to believe that this support was because of some noble desire to see women avoid the knife -- well, ok, maybe that was part of it....but really, it was about managed health care and cost cutting. And that's not a good reason...the good reason would be because its better care for mothers and babies to encourage VBAC (which it is) not because it makes the profit margin look better to the share holders. The reason I say this is because the OBs just couldn't keep their hands off ... birth of any sort goes better if you just leave it alone...and they couldn't. So they started doing stupid things like inducing women willy nilly and getting very casual about the whole thing...and so, because bad behavior begets bad behavior, there were some spectacular lawsuits. Though, I've been told that this has been somewhat overblown by the obstetrical community....I don't doubt it but I can't confirm it either. Anyway, ACOG (American College of Obstetrics and Gynecology, functionally the trade union for OBGYNs) came out with a practice bulletin that made "suggestions" about how to manage a VBAC and basically VBAC became an endangered species...ACOG claims that the practice bulletins are just "suggestions" but realistically, if an OB does something counter to the bulletin, they have little to stand on if they are sued. Which leads to VBAC bans.

ICAN is in the process of updating our list but as of a few years ago, there were over 300 hospitals in the U.S. that officially banned VBAC - in other words, you can't have one at that hospital, even if you've had one or more already. At least, that's what they'd like you to believe. Many more hospitals have de facto bans in place because there aren't any attending physicians who'll accept a patient who wants one or the restrictions on having one are so outlandish that it just never happens. I don't know about you but I find it really offensive that anyone, much less a hospital administrator or Board of Directors can tell a women how she's allowed to have her baby. Plus, I'm pretty sure its illegal. Why, you ask?

I'm still figuring this out but I think there are two different laws/regulations that actually make it illegal for a hospital to refuse to allow VBACs. The first is EMTALA (Emergency Medical Treatment and Active Labor Act) which says that if a woman shows up at a hospital in active labor, that hospital may not turn her away, no matter what. The hospital is required by law to admit her and stabilize her (defined as both the baby and the placenta out) OR if they are not able to provide care, transfer her to a facility that can (if they can transfer her before the baby and placenta are delivered. A physician friend explained to me that if the baby and placenta are delivered in transport, the hospital that shipped the woman gets in big trouble because obviously, they could have handled it). What EMTALA does is get the woman in the door. THEN there are the Medicare Conditions of Participation (CoP)- these are the rules any hospital that accepts Medicare dollars (most of them) must follow. The CoP has some very specific things to say about a patient's right to refuse treatment in the section on patient's rights:

"The patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient's rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate."

Now...the one thing that I see a potential problem with is that last sentence -- "medically unnecessary or inappropriate." If someone did request a judgment on whether or not VBAC bans were illegal under this clause, I have to wonder if the argument would be made that VBAC is under some circumstances "medically unnecessary or inappropriate". The notion that VBAC is a "treatment" or "service" makes me crazy -- might as well say pooping is a treatment or service, it would make as much sense but that's not how it is framed much of the time -- I see VBAC referred to as a "procedure" rather frequently, even though the best way to have a VBAC is to not do anything at all (that's an odd sort of procedure). I wonder if the powers that be in the CoP world would look to ACOG for an "expert" opinion -- calling ACOG an expert in VBAC is like calling the oil companies experts in alternative fuel sources so needless to say, I have no faith that they'd give an unbiased opinion when asked. Its an interesting dilemma...should we push for a ruling on this? Or would it possibly backfire badly. To me it seems SO obvious that it is against everything we say is important in this country with regard to individual rights to bodily integrity, etc...but we are talking about pregnant women (who in some states are not allowed to draft advance directives or living wills because they are considered incompetent by virtue of being pregnant), particularly their uteri and we all know uteri aren't all that important (50% of all women will die without theirs -- hysterectomy is the second most common surgical procedure after cesarean. Can't help but wonder if things would be different if babies came out of prostates or something...) So here I sit wondering....should we push this? Where oh where is a lawyer familiar with Heath and Human Services law when you need one?

If you know of a hospital in your area that does outright ban VBAC, keep an eye out for the online survey that will be on the ICAN website soon. I'd love to have your information.


Sunday, October 7, 2007

I want Google to find me too!

So, though the chances that you're here reading this and don't already know me are probably pretty slim, just in case you don't, I'll tell you a little bit about me. And yes, I have ulterior motives, because I'm trying to "do my part" and get birth issues onto the radar screen of the mainstream (yeah, I know, set a reasonable goal there). On the advice of a friend, who also happens to be an ultra cool cyber-savvy person and the Publications Director for the International Cesarean Awareness Network (ICAN) I'm trying very hard. She told us to go out and blog blog blog. I get the Google alerts for various topics, including "International Cesarean Awareness Network" and I want my blog to show up one of these days!

Now, you ask, why is this something you care about? Surely with 3 of 4 kids in a charter school (that means LOTS of parent involvement and 120 miles of driving each school day), a preschooler still mostly at home, a full-time job (for the moment) and all that goes with that, having a blog and actually writing in it can't be such a good idea. And maybe you are right....I've yet to prove that I can keep up with this. But, since my job does include a lot of down time in the middle of the night, maybe I can pull this off (sleep? who needs sleep....I lost that biological imperative about 9 years ago. Ha!). But seriously, why do I care?

The first reason I care is because I had a cesarean over 9 years ago and I hated it. I knew I would (it was "scheduled" so I had lots of time to anticipate just how fun it wasn't going to be, given what I'd actually planned for) but I didn't anticipate how having it would completely shatter me. I mean, really, it shouldn't have, right? -- my husband and I had a lot of trouble conceiving and maintaining a pregnancy so we ended up in treatment (somehow I guess because I didn't just fall pregnant, I was supposed to really not care how the babies "got here"), the surgery was scheduled so I was able to request (demand) certain things to make it a better (less worse?) experience, my recovery was "good" (aka not medically complicated by anything)...and it shattered me. Pain that didn't just magically go away in 8 weeks (that's when they tell cesarean moms that they'll be back to normal), delightful depression that morphed into an impressive rage, a profound disconnect with my babies (fraternal twin boys), an even bigger disconnect with my husband (you can resume "relations" in 6 weeks. yeah, right. try 7 1/2 months and then not because you actually want to, you just feel that the likely damage done to your marriage is worth prostituting yourself to prevent), doubts and regrets that never ever stop and keep you awake night after night, the inability to take a shower without sobbing (because that's the only place you can do it and not be heard). The incessant fear that you are not a good mother that in fact you are a terrible mother because if you were a good mother, the overwhelming love you instantaneously feel for your babies (that I didn't feel at all) would make all the cesarean stuff just go away....yeah, I hated my cesarean.

When I found ICAN and joined the email support group, I found other women who had very similar experiences, very similar reactions, women who really didn't like their cesareans. And, they weren't afraid to talk about it! That was a sanity saver. THEN I started to realize how many women there were....that was many years ago, and the host for the list at that time was a program that was really difficult to use -- it was complicated and somewhat arcane to join, so I'm sure there were lots of women who never made it there (took me 3 tries and I'm pretty computer literate). Imagine how many there would be if it was easy and everyone had an Internet connection? As I started to move through my journey, I developed a passion for giving other women the help I'd gotten. Eventually, I took over ownership of the list, we moved to Yahoo and the number of women who joined each day was and still is staggering. Clearly, there is a problem with cesareans....and I can't turn my back on those women who are grasping at any hope that they aren't crazy and there was a way out of the place where they find themselves.

And things just get worse....the cesarean rate keeps going up and up (in 2005 it was 30.2% of all births, kinda -- turns out they don't even count things like multiples or breech or preterm in that number! Hey, I didn't really have a cesarean No seriously, the real rate in 2005 was probably more like 36% or so...) The infant mortality rate is going up....and guess what? The maternal mortality rate is going up too! And the interpretation of this bit of news didn't even have to be spun by ICAN -- the government stated quite clearly that the increase was most likely due to the increasing cesarean rate (and obesity, though that is likely not independent of the cesarean rate, since over-weight and obese women have cesareans at a much higher rate than other women, often for no apparent reason other than being heavy), along with better reporting. That last bit is interesting...we've suspected for a long time that childbirth related maternal mortality is woefully under-reported (as much as 4-16x by some estimates) so actually, things have been a lot worse than anyone could prove for a long time.

If you have any awareness at all that our health care system is way screwed up, you'll love this factoid: the U.S. spends more (total and per capita) on maternity care than any other country on this planet. And our measures of outcome, those good ole mortality rates, suck. We rank somewhere (depending on the list) between 21 and 25 in the list of developed nations. There are lots of developing nations that have better numbers than we do. We are throwing money away, while women and babies die. How come I never hear any of the presidential candidates talking about that? Oh, I forgot, the American Medical Association uses a lot of those health care dollars to pay really good lobbyists and to make contributions. Wait, wouldn't that be illegal? Uh huh, and nothing illegal EVER happens in health care OR politics. Your insurance premiums at work there. And you thought they were going to buy you good medical care, silly you.

Needless to say, I could go on and on and on. And I suppose that's the point of a blog...but...maybe we'll just save the rest for another time. If you are desperate to read more, you can go to my website. Start with You Should Be Grateful, the first thing I ever wrote and then go from there.


Sunday, September 30, 2007

So here I am

I've been pretty disappointed with the traffic I don't get to my other, I'm not going to abandon it, I'll probably just cut and paste between the two, since I really do love my website (and I've paid for it :-) so I thought I'd try out they assure me that just because this is a google product, it doesn't mean I'll automatically search higher....but then again, I get Google alerts and most of the blogs in the blog alerts are blogspot. Can't hurt, right? Plus, I do have access to more widgets here and I'm needin' some widgets!

We'll see if I can import some of my other stuff....or maybe no one really cares.