What do I do now?

(written to a woman who transported from a homebirth and had a cesarean)

Control. Seems to be a strong theme in my life right now. Or rather, my ultimate lack of it. I may get a bit spiritual here, so reader beware.

One thing that I can guarantee is that your next pregnancy and labor will be different from your last one. Every pregnancy, every baby, every labor is unique to itself.

As I wrote in my last letter, in the end, the only responsibility we have is to plan the safest birth we can. There are lots of things we can do, techniques we can learn, knowledge we can gain, expertise we can hire, wisdom we can cultivate, trust we can give, surrender we can make....and all of these things are really important. All of these things can be something that the outcome of a birth hinges on. And every single one of them can be trumped by the universe. And the universe resolutely refuses to give us the guarantee we demand. If you believe in a deity, then you may believe that you are guaranteed an ultimate outcome to your life....but my experience has been that specific outcomes are often, quite deliberately, not revealed to me -- all I'm given is the assurance that there's a plan I'm part of and it is bigger than I can understand....if I believe my God is good, then that needs to be enough in the end (not saying this is easy or that I'm any good at it. I'm not.)

Most of the time, left alone, women have vaginal births. You have the extra burden of not having made the usual mistakes you could then blame your cesarean on. You get to face the universe not caring the same way you do a lot sooner than many. You "should" have had a vaginal birth; after all, you really did do so much "right". That's a scary place to be...what if there's something fundamentally wrong with you? Hang around ICAN long enough and you'll have the opportunity to meet some women who've had to deal with that -- planned a homebirth with a good midwife...ended up cut. Now what? What more can they do? A former president of ICAN had 3 cesarean, the third a failed homebirth...while president of ICAN. And then she had a homebirth with her fourth. Why? I don't know.

I don’t know.

I hate that phrase. Everything in me rebels against not knowing. Why was I in the 10% of clomid users to have twins? I don't know. Why was I then in the 10% with double breech twins? I don't know. Why did this happen to me, who cared SO much about not having a cesarean. I don't know. To make me stronger, bring me to ICAN, this excuse, that rationalization and so on? If any of those are true, that's not good enough. I didn't want a cesarean. Period. I don't know why I had one, not really, and I have a feeling there's no reason out there that I can understand that would make me say "oh, ok, that's why." What I do believe, because, well, that's my world view, is that there was a reason and that no matter what the reason, good or bad, for my betterment or because this world just sucks sometimes, the experience can be (and has been to a great degree) redeemed....over a lot of years with a lot of mileage between then and now.

So what? Well....chances are good that you'll never find a "reason" for your cesarean that you can "fix" and then not have to worry about another cesarean. I can tell you that you'll always have to worry about another cesarean because all pregnant women have to worry about it. Even if you do find a thing to
fix....there are other reasons to have a cesarean and we just can't control most of them (any of them? I guess we can control elective repeats by not signing up for them and we can control for failed inductions by not consenting to induction but are there any others?)

I don't like fake it till you make it. I believe it’s fundamentally dishonest to one's own self. But, sometimes we do have to keep moving even while we look back and try to figure stuff out. If you don't find something to pin your cesarean on, what will you do the next time you are pregnant? Will you plan a repeat cesarean? Or will you go ahead and plan another vaginal birth, maybe at home....and do it, even though you are scared to death you'll have another cesarean? You do have control over what you plan. So keep asking the questions, keep picking through the wreckage and know that ultimately, we all reach that moment when we have to surrender to something that's just a lot bigger than we are, whether you call it birth, universe, fate, karma, evolution, luck, random chance or god.

I've really come to believe that those women who have the sorts of births (or VBACs) where they pat themselves on the back and say "see, I did this, that and the other thing and that's why I got my VBAC" are mistaken about how much credit they can take. They may have made good choices and that may have made a difference (then again, saying "no, I won't sign up for a repeat" might be all it takes for some women to have a VBAC – heck all it takes for a lucky few is to go into precipitous labor before the scheduled cesarean – talk about the importance of plans and choices! ) but in the end, they were blessed that the universe had an outcome in mind that fit what they wanted. Don't get me wrong, bad choices can certainly change an outcome...but think about all the bad choices that end in a vaginal birth.

This is like trying to resolve free will and predestination if you believe such things...they are both true and they are both at work. I guess birth really is life. I don't know why you had a cesarean. I really wish you hadn't. And I really hope you have a VBAC next time. And I know that chances are, you will. And until you do, you won’t know whether it will really happen or not.

What If?

I do not think you are kidding yourself about planning a VBAC and this is why. Your responsibility as a mother is *not* to not have a cesarean or to have a VBAC. Your responsibility is to plan the safest birth for you, your baby and your family. That's it. Now, obviously and for lots of really legitimate and important reasons, we all hope that the safest birth for everyone involved is a vaginal birth, because no matter what the circumstances, necessary or not, surgical delivery can really suck. So the question I would ask you is this -- are you planning the safest birth you can? If your physical condition does change for the worse, will you continue to plan the safest birth you can even though doing that might be incredibly painful and disappointing? Are you doing everything you can to keep as healthy as you can? Do you understand your risk factors and how they could impact the choices you have? Are your circumstances now different from what they were the previous two times? If you answer yes to these questions, then I can't see that you are fooling yourself or kidding yourself or in any way delusional.

The part of all this that is so hard to come to terms with is that there are very real factors that can make or break plans for a vaginal birth that are completely out of our control...boy, does that grind...but in the end, it is possible that your body will not stay healthy enough for a planned VBAC in spite of you doing everything you possibly can. It is also possible that the events of your last 2 pregnancies will NOT repeat, because this is a different pregnancy. Previous pregnancies can seem predictive but often they are not. Each pregnancy, each labor, each baby is different. That you CAN be sure of. You can't do anything at this point about having had 2 previous cesareans. Oh, we wish we could! But we can't. You can make plans with those 2 cesareans in mind, and you should. You do have control over all sorts of things. But what you (and anyone else -- ICAN, midwives, physicians) don't have control over is the final outcome.

Remember -- it is NOT about having a VBAC. It is about planning the safest birth you can. Period.

What did I do wrong?

I have 2 good friends who’s VBACs turned to repeat cesareans for "no good reason" that anyone can figure out....yes, the babies were likely (subtly) malpositioned, even after prenatal chiropractic care and great attention to optimal fetal positioning and they hired midwives who knew many tricks to straighten out babies...and the tricks didn't work. They labored for many many hours...they did "everything right"....and still ended up back in the OR...it is heart breaking. And both have asked, many times “What did I do wrong?”

What did I do wrong?

And I have to say that the "answer" I have is two-fold....first, the baby is an independent player in the whole labor and we can't always predict or dictate what the baby will do. Second, there is a very real element of "luck". Just plain bad luck. It is SO much easier if we find something that looks like a cause. A reason gives some closure, some sense of "if I'd just" to help it NOT mean that you really don't have control over the outcome....but the truth is, for those women who make all the plans, "do everything right" and end up with a VBAC? They were lucky too. We almost automatically take credit for "doing it right" being the reason we have our VBACs but we are fooling ourselves if we think we have that kind of control. The flip side of believing you have that control is to then believe an unwanted outcome means you didn't do something you could have or should have. I'm convinced, after a decade of hearing stories, that this just isn't true. Sometimes you do everything you can and it doesn't work. I don't know why.

When the labor is done and you are in that soul searching place, the compulsion to second guess decisions made during labor is overwhelming...because we forget the intensity and immediacy of labor. My friends had good and patient midwives. There was a reason they trusted them -- with the labor and when the decision was made to transfer to the hospital. Whatever that something was that led them to decide on transfer and ultimately to agree to the repeat c/s, it was real. And since no one can recreate that inarguable something now, its compelling to say "if I'd only"....but there *was* a real reason they didn't just keep laboring, even if no one could put it into conscious thought or words then or now. It is SO tempting to think "if I'd just labored for another x hours, I would have had my VBAC" but we have no idea if that is true or not...maybe yes, they would have. Or maybe they would have transferred later. Or maybe the baby would have been in a lot of trouble by then. Or maybe the baby would have been fine but nothing else would have changed. Or maybe something else would have happened...we just have no idea.

I don’t tell women to stop asking questions or to stop trying to understand what happened. I don't think they can stop, I know I couldn't when I was trying to figure out why I made the decisions I did around my c/s. But the advice I do give is to consider that the answers you may get through your searching may have more to do with your understanding yourself rather than you understanding that birth. There are answers there but they may be to a question that you don't yet realize you are asking. They likely will come later than you hope and slower than you think you can handle, but you will.

I haven't been good about writing lately, but I did want to get this out there -- of course, its in many, many blogs, but hey, never hurts to get it out there once more. This is a great video about cesareans -- and one that would be very easy for someone with more mainstream ideas to accept, i think. Anyway, if it works to get it embedded here, here it is:

Won't play nice anymore, part 2.

The President of ICAN, Pam Udy, had a conversation with a person, I’ll call him Mr. Smith (name changed to protect us, the innocent), in which he told her that ICAN would never be welcome to speak at any event he organized because “we don’t have initials behind our name and no one wants to listen to women crying about their birth experience.” He believes that it is a priority to have an event where mainstream medical professionals (OBs, etc) would attend, so as to foster dialog between them and the “activists” who are concerned about the state of maternity care in this country. Pam quite coherently explained to him why it is important for ICAN to have a voice and why we cannot continue to let the “medical experts” have the last say in what is best for mothers and babies. He responded with a series of questions, which I have included below. More importantly to me, answering his questions allowed me to think through the role that ICAN does play versus the role that ICAN MUST play, if any of the things we all agree are problems are to be solved.

What makes us believe we speak for the majority of women?

Superficially, I don’t think we do, but only because the majority of women who’ve had traumatic births (not just cesareans) do not acknowledge that — for any number of reasons, but one big one is that they think they are the only one who feels that way and they are ashamed of it. If they knew other women are also unhappy, then they wouldn’t be ashamed. We are the voice telling women it’s ok to be unhappy about something that was a bad experience and that it doesn’t make them a bad mother to be unhappy, nor does it say anything about whether they love their child.

What makes us think our experiences are representative of most women’s experience?

There are quite a few studies that look at "satisfaction" after birth and it is quite easily demonstrated that if you look out farther than 3 months, women with interventive/surgical births aren’t very happy about it. But you have to ask them, they won’t volunteer that information (for the reasons listed above). Is this "most" women’s experience? I don’t know….but as the cesarean rate climbs higher and higher, it’s getting to be more and more women’s experience….do we have to wait until it’s a big majority before we say anything?

What number of women can we say we speak for?

I’ll answer that with another question — what is the threshold at which we have a moral obligation to speak? If only 5% of women identify as traumatized, is that too small a number? Is 10% big enough? (Would we be ok with 5% of all women being abused in a domestic partnership?) Or do we need to wait until over 50% of women have traumatic births before we are obligated to speak? If the cesarean rate is 30+% and half of those women are unhappy about having one (which I believe is a conservative estimate), are those 15% not important enough to speak to and for? If we know that cesarean surgery isn’t the optimal way to have a child, do we have any obligation to speak out about that? If a woman and/or the culture she lives in don’t perceive her experience as abusive and yet it is, do we keep silent? (Some cultures think its ok for a husband to beat his wife and children, so is it ok in that culture?) What about the babies? The evidence continues to accumulate that interventive births, including elective non-medically indicated cesareans are bad for babies — who speaks for them? Do we not speak, since they aren’t indicating that they are traumatized by their birth experience?

Do we only speak for the women who identify as traumatized? Or do we speak for the women who don’t understand that they were traumatized, and yet behave in ways that show they were? (Look at the studies that show women with cesareans elect to have fewer children). Many women in the cultures that allow for wife-beating probably think its "ok" for the most part, even if they really don’t want to be beaten. So we don’t say anything about it?

Mr. Smith doesn’t get to decide what the threshold is. I suspect the notion of setting such a threshold for some other issue would be repugnant to him (female circumcision? male circumcision? domestic violence? lack of access to medical care? hunger? homelessness? child abuse?). The notion that abusive maternity care isn’t in exactly the same category as other forms of abuse is beyond offensive to me. When Mr. Smith persists in calling us "angry women" as an excuse to deny us a voice, he is actively participating in the insidiously persistent patriarchal and misogynistic culture that has in the past considered things like violence against women, lack of political voice or power, lack of property rights, unequal pay, unequal educational opportunities, perfectly reasonable and defensible, and which STILL does condone versions of all these inequalities. I’d be willing to bet a sizable sum that Mr. Smith doesn’t identify himself as a narrow-minded misogynistic fool but the more I think about his "concerns", the more I do identify him as such.

The hypocrisy and willfully close minded attitude are astounding in someone who claims to be concerned about the state of maternity care and childbirth in the U.S. He can support a session titled "Why Men Leave: The Epidemic of Disappearing Dads" that identifies a condition called "Male Postpartum Abandonment Syndrome" and then complain that if we speak out, the MD’s won’t come? What exactly is it that he thinks we want to say? Mr. Smith has bought into the lie that we are a bunch of angry, hysterical women who are only reacting out of irrational emotion. And he conveniently doesn’t notice that the MD’s aren’t coming to these forum/conferences/congresses already, and that they aren’t likely to. Mainstream medical professionals aren’t going to attend something that bears no resemblance to what they must believe is reality (that what they do is necessary and right and to do otherwise would be unethical and unsafe). A sprinkling of MD’s speaking on various birth-friendly topics at this last event certainly didn’t prove me wrong. I’d go so far as to say that my talk on uterine suturing techniques is more likely to attract an MD than any talk on water birth or male PPD. And yet, I’m sure my initials aren’t the letters Mr. Smith is looking for. It is interesting to look at a list of speakers from this last event, to see just what collection of “initials” Mr. Smith did find acceptable:

Karen H. Strange, Midwife
Barbara Harper, RN
Dianne Garland, RM
Cornelia Enning, Midwife
Laura Erickson, LM, CPM
Sarah Buckley, MD
Kathy Forrister, RN
Ellen Margles, CNM
Duncan Neilson, MD
Sandra Bardsley, RN, LCCE
Robert Newman (who’s implied Y-chromosome seems to be the right letter)
Mark Fisher (of a Prime Insurance Corporation and owner of a Y-chromosome)
Robbie Davis Floyd, PhD
Yeshi Neumann, CNM
Carol Penn, DO
Amy Gilliland, Doula Trainer and researcher
Marcy Axness, PhD
Joe Dispenza, DC
Alan Huber (Y-chromosome anyone?)
John W. Travis, MD
Susan Roberts, ND
Stephanie Cave, MD
Eneyda Spradlin-Ramos, BA, LMT, CD
Judith Rooks, CNM, MPH
Zina Bakhareva, MD
Jose Louis Grefnes, MD
Fernando Molina MD
Nils Bergman, MD
Jeanette Schwartz, RNC
Beth Genly, CNM
Zinaida Bakhareva, MD
Bianca Lepori (an architect! and no Y-chromosome — how open-mined and daring)
Nikki Lee, RN, IBCLC
Joni Nichols, BS, MS, CCE, CD (DONA), (CBI)
Jose Louis Grefnes, MD
Yves DeSmedt
Isabelle Gabriells
Veerle DePauw, MD
Sandy Williamson, CNM, MSN
Richard Morris, Administrator
Lonnie Morris, CNM
Anna Verwaal, RN, CD
Susan Jenkins, JD
Karen Strange, CPM
Anna Verwaal, RN, CD

11 MDs. And then a collection of other professional degrees/certifications that will not impress your average Fellow of ACOG in the slightest, not to mention a few that have no degree/certification that I can see. Don’t get me wrong, I’m not doubting that these presenters are very knowledgeable or even experts in the topics they are presenting (I’ve heard many of them speak and they are extremely knowledgeable in their fields of interest/expertise) but the excuse that we don’t have "initials" after our names is a smokescreen behind which Mr. Smith is hiding his prejudice and fear.

It is about time the established "birth activists" quit their vaguely masturbatory inside-crowd-only exercises in preaching to the choir and realize that they’ve been doing exactly the same thing for decades now and things are only getting worse for the women and babies they purport to care about. It is about time they realized that without the consumer, they are going to continue to cycle through a round of conferences and congresses and forums every year or two, saying the same things over and over and over and making absolutely no difference whatsoever and never registering at all on the mainstream radar screen (medical or otherwise). They actually need us a lot more than we need them, since frankly, I can’t see that they’ve helped us much with all their pontificating about safe birth and birth choices and how to have a satisfying birth experience, etc etc etc. We can offer them something new, something different, something that isn’t the same old same old ineffective inaction. We don’t have to tell our sob-story birth stories…we can speak just as knowledgeably on any number of birth topics (from the academic/scientific to the alternative and controversial) as any "doula trainer" or "LM" and thus gain both acceptance from the old guard and wider "name" recognition as an organization that is much more than a “bunch of angry women". We bring in the consumer — the women who’ll write the letters, switch providers, picket hospitals, support the struggling midwife and her independent birth center, vote with their feet. That’s something the experts haven’t managed to pull off yet and I don’t think they can. The consumer, the woman who doesn’t have any qualifications other than a scar, on her belly, perineum or heart, is the KEY, without which, all of this is just a bunch of self-proclaimed experts in an irrelevant discipline complaining about an unacknowledged crisis, to which they have no answers anyway. Women weren’t emancipated and given the right to vote by a group of trained constitutional lawyers, experts on social change and experienced activists. It happened because the women who were affected by the injustice decided to stand up and do something about it. If we ever see real change, it will be because of us, not the trained experts.

So once again, it’s time to stop being nice. Quit worrying about what people “in power” might think and just do what is right. There has NEVER been any social change for good that didn’t require regular, ordinary people to stand up and say no, no more. For me, that includes both the medical mainstream and the established birth activism community. No. No more. You can’t marginalize us anymore and you can’t accomplish anything without us. So quit blaming us for the problem on the one hand (“women just don’t bother to educate themselves/care/think for themselves) and then refusing us a place in the fight on the other (“no one wants to listen to a bunch of angry women”). You can’t have it both ways. Right now, you haven’t got anything worth a protectionist attitude anyway.

Did it again

Ok, so I'm a bit obsessive-compulsive about some things. While I was certainly glad to get it done, I was almost immediately dissatisfied with my first version of 1 in 3. So, I re-edited it. And because I'm sure you are all SO dying to see the new version, it is right over there, on the right, for you to click on and watch. Or, you can go to YouTube and see it big screen here. And for those of you who've asked for copies of it in the past, now you can just download it from YouTube.

Read This!

Women of Size and Cesarean Sections: Tips for Avoiding Unnecessary Surgery

A fantastic article written by a fantastic woman. Kmom is probably the best resource for information about birth and breastfeeding for women of size, and is also just about the best resource out there for information on "Gestational Diabetes". She has a real gift in synthesizing and summarizing the research in a non-biased way -- after you read the above article (a companion piece for Our Bodies, Ourselves: Pregnancy and Birth) check out her website: Plus-sized Pregnancy (it isn't just for plus-sized women).

If it ain't broke, well, break it!

One of the blogs I get regular updates on is ElementalMom. Laureen is a friend and birth activist and a generally really cool person....and she finds some of the scariest stuff. So, I present the newest entry in the "heck, who cares if we break it, we can just fix it and make more money in the process" annals of Obstetrics...

Popular Science: Compassion Cure

Just when you think they can't possibly screw it up any more. Sheesh. I suppose it is another reason for women to just luv their OBs....

Finally saw The Business of Being Born

I finally had a chance to see The Business of Being Born, Ricki Lake’s documentary about birth and midwifery care in the U.S. I’d heard a lot about it and I’ll be the first to confess that initially, I was very cynical about the whole thing – it seemed like more of the same preaching to the choir was going to be about all we could expect. Well, it turns out that I was wrong, much to my delight – it seems that a lot of people have seen it and it seems that some people are a bit rattled by it (If anyone doubts that, just read ACOG’s latest statement on homebirth and their supposition that it is a choice made to be “trendy and fashionable” – they never quite mention Ricki or the movie by name but I can’t think of anything else that would provoke that sort of language.) Anyway, one of the criticisms that I’d heard from various sources was that the movie ended on a bad note, with the director Abby (who was unexpectedly pregnant during the filming and thus became a subject of the film as well) ending up with a cesarean, instead of the homebirth she’d planned. There has been some discussion of how she talked about “maybe this was just the way he needed to come” as if she were totally fine with the outcome and this was in direct contradiction to the message of the film. Maybe it’s just because I see her with the eyes of a woman who has shared the experience of an unwanted cesarean completely derailing plans, maybe it’s because I’ve spent so much of my life listening to and walking alongside other women as they journey through life post-cesarean, but it was incredibly obvious to me that Abby was NOT ok with the cesarean at all, and that at 8 months post-cesarean (not very long at all) she was still wrestling with trying to make sense of the experience. Even though her cesarean probably was the best choice for her baby, even though her cesarean wasn’t a doctor convenience or institutional protocol cesarean, but in fact, her baby was sick and needed to be born quickly, her grief and loss were real and understandable. I was sad with her while also being thankful that her boy was healthy and thriving 8 months later. Her experience actually illustrates how safe homebirth really is, because her midwife knew when they needed to go to the hospital, because the prenatal care she got might have been the reason her baby did survive, because planning a homebirth doesn’t mean refusing to change plans when it becomes in the best interest of mom and baby to do so. It is very common (and very wrong) to assume that those of us who work against the rising tide of cesarean surgery are opposed to any cesareans at all – nothing could be farther from the truth. Obviously there are times when a cesarean is life saving and we are happy that they are available and reasonably safe. More than anything, I think what I oppose is the normalization of cesarean surgery – and the refusal to acknowledge the loss that having a cesarean entails (I’d argue the loss is there even if the woman doesn’t perceive it) even when it does save the life of the mother and baby.

So I hope the next movie is about VBAC and the struggles that we post-cesarean moms face when we try to plan a normal, non-surgical birth the next time. And I hope, if and when Abby does get pregnant again, she is able to plan and have the birth of her dreams. The birth that is both what she wants AND the best birth for her and her baby.

Ask Dr. Amy

Dear Dr. Amy -

I'm writing you here because I'm pretty sure you wouldn't publish anything that I write on your blog, since it seems that you pretty ruthlessly censor opinions that don't fall in line with your own. I suppose maybe somewhere in your blog lie the answers to some of my questions but to be very honest, I have no desire to go read your blog, so I'll just ask here. I have to wonder - why you are so vehemently anti-homebirth? Some people think you are an ACOG plant, stirring up the internet so that when women search "homebirth" they'll find your "information" before they find something more balanced. I think that's probably pretty unlikely. Since you don't actually practice medicine (and since it appears you aren't even licensed) I know it isn't because of things you see in practice (did you even ever practice anything related to maternity care?). Did you or someone you care about have a bad experience with a planned homebirth? Are you conflicted about the choices you've made in childbirth? A lot of women are, you know. Usually the sort of rabidly biased information that you present about homebirth comes from an emotional base(or a financial one, like ACOG's but I don't think you are losing money when women plan homebirths), not an intellectual one . I have to assume that there's some irrational basis to your hatred of homebirth for you to so willingly ignore the body of research about homebirth, for you to depend on intellectually feeble arguments against the safety of homebirth, because I'd like to assume that you are, in fact, a reasonably intelligent person. Do you really believe research done in Europe isn't legitimate? Of course a lot of the research on homebirth has been done outside of the U.S., with such a low homebirth rate here, its very difficult to do studies on it in the U.S. (not to mention pretty much impossible to get a study on homebirth published in one of the obstetrical journals!) I'd guess the Dutch and other European countries would be saddened to hear that their research and medical care is so substandard (I suppose the editors of The Lancet and the British Journal of Medicine would also be surprised to learn that their selection process for papers is so flawed), since we can't really admit their homebirth studies into the discussion. I wonder how you'd respond to the argument that midwives aren't capable of knowing pathology when they see it because they aren't trained in how to treat pathology if the argument was turned against physicians -- its irresponsible to see a Family Practitioner, rather than a Cardiologist because we all know that Family Practitioners don't have the training to treat something like heart disease. Of course, that's ridiculous -- Family Practitioners specialize in basic medical care -- well-care visits and minor illnesses and injuries and they know very well when to refer to a specialist (at least that's my experience with them, and I have always used a Family Practitioner as my primary care-giver). If you can think about it logically, it actually makes a lot of sense that a trained midwife (if a midwife is CPM qualified, she is very well trained, maybe you might want to go look and see what's involved with NARM credentialing) would be very good at seeing when a pregnancy or birth is deviating from normal -- and she would have no real incentive to ignore that. I've never quite understood the argument against homebirth based on "what we see when they transfer from home" because I'd expect the transfers to not be normal births anymore...if they weren't complicated, then they'd never be seen at the hospital in the first place! I have to assume that you've never actually met a midwife or a woman who's chosen homebirth because you seem to have a very odd notion of what we are like. I'm certainly not hippy and I'm definitely well-educated (I'm also a doctor, though a Doctor of Veterinary Medicine, with a Master's of Science as well. I am currently licensed to practice and actually do practice in Emergency Medicine/Critical Care) . I'm not a religious fanatic, nor am I likely to follow some trendy craze blindly and most people I know plan hospital births. I could care less what some celebrity is doing, and rarely know what they *are* doing. Heck, I thought homebirth was something crazy women did until I started meeting real women who planned them. Turned out they weren't anything like I assumed. I wouldn't have had that much dreaded primary cesarean if I hadn't been persuaded that it was the safest choice to make for my babies because all of my planning for my births was based on the safest choice for myself, my baby and my family. I definitely didn't plan homebirths for some nebulous selfish experience. I haven't yet met a midwife who is desperate for more clients, so I know there isn't some grand push to "steal" patients from the OBs. The midwives I know would love to have a truly collaborative relationship with an OB, because it would allow them to provide even better care for their clients. I know I'd be furious if someone told me my professional standards of practice were going to be determined by some group other than my profession, and I'm going to assume that you'd feel the same way, if you were practicing. Why in the world then would it make any sense at all to not expect midwives to determine their standards of practice? AFtger all, no one knows better what a midwife is and isn't capable of than a midwife. Sure, there are fringe fanatics in the "homebirth" world...just like there are obstetricians who think a 50+% cesarean rate is ideal. I'd consider them to be pretty fringe fanatic too. But most people understand that a fanatic is just that -- and certainly doesn't accurately represent the group. Same can be said about "bad" midwives -- sure, they exist. So do "bad" obstetricians. Doesn't mean the whole group is incompetent or negligent. Maybe you are right and the maternal mortality rate in the U.S. isn't really going up, the increase really is just a product of better reporting. The problem is, even if you're right, it doesn't explain why our maternal mortality rate is so much higher than other developed countries (and a number of developing countries). That can't really be explained by a change in reporting, since its been a consistent finding for decades. Maybe it doesn't have much to do with the fact that the countries with the lowest rates of maternal mortality use a lot more midwives and have a lot more planned homebirths, but you've got to admit, it sure looks like there's a correlation there. No one has come up with a different explanation. I've yet to hear a homebirther say that planning a homebirth should be mandatory for all women, or even for all low-risk women. We all know that homebirth isn't going to be for every woman or even a significant number of them. Honestly, the vast majority of women I know who plan homebirths just want the choice to be one that is accepted and understood, and to not find themselves faced with increasingly onerous obstacles to something that really isn't anyone's business but theirs. So I don't know, Dr. Amy, you just don't make much sense to me. Which leads me to believe that perhaps, you just don't have much sense, not when it comes to birth choices. And that's a sad thing.

New Website for the International Cesarean Awareness Network

Contact: Laureen Hudson
Publications@ican-online.org
(707) 237-5253

Melissa Collins
Melissa@ican-online.org
(951) 973-1028

For Immediate Release

Advocacy Group Unveils New Web site
Site features easy navigation, community resources

REDONDO BEACH, CA, February 7, 2008 – The International Cesarean Awareness Network launches a new, user-friendly Web site today in an effort to further the group’s outreach efforts.

“The new Web site will make an impact in the battle against the growing cesarean statistics by providing information to moms, challenging them to take responsibility for their births and providing a safe community for moms to heal” ICAN President Pam Udy said. “This will give women the tools they need to make educated decisions about their births – because this isn’t about statistics. It’s about every mom and every baby getting the safest birth possible.”

Easy navigation is a key feature of this Web site, which has been in the works since July when ICAN Board Members recognized the need for a more user-friendly Web site. (The Web site can be found at http://www.ican-online.org/) Site viewers will find information separated into five categories: Pregnancy, Recovery, VBAC, Advocacy and Community.

“In our daily advocacy work, we saw a clear mandate for a site that was simple to navigate, simple to understand and full of easy-to-access information for the woman avoiding a cesarean, recovering from a cesarean or on her journey to VBAC (vaginal birth after cesarean),” Laureen Hudson, ICAN Publications Director said. “ICAN interacts with women on very different journeys -- the messages a pregnant woman needs to hear to avoid a cesarean are not the same messages a woman on the journey to VBAC needs to hear. We like to think that this site addresses those two complimentary, yet divergent, needs.”

The Web site lets women research the VBAC policies of hospitals near them; learn how to correct problems (such as malposition or pre-eclampsia) that commonly lead to cesareans; get quick physical recovery tips to help after a cesarean; and stay up-to-date on medical research on pregnancy and birth. New community features include user birth blogs, videos and images; and the capability for users to create their own homepage on the ICAN site to share with friends and family. ICAN leadership also can connect more easily via the Web site with the women ICAN serves. Further, the Web site features a new logo – the logo, and all of the Web work, were completed entirely by volunteers.

“We wanted our site to be easy for the average woman recovering from surgery and caring for a newborn to find the info they needed quickly and easily,” Webmaster Melissa Collins said. “One of my favorite features is the online social community that is safe for moms planning a VBAC or just wanting to avoid. I’m really excited to watch this new community grow.”

This new Web site comes after research in 2007 by the National Center for Health Statistics showed the cesarean rate reaching a record high of 31.1 percent. Further, a CDC report indicated the maternal death rate rose for the first time in decades and Consumer Reports includes a cesarean in its list of “10 overused tests and treatments.” Other research from 2007 cites a VBAC continues to be a reasonably safe birthing choice for mothers. And while studies indicate a VBAC is a viable option, women often have difficulty finding a health care provider who encourages a VBAC – which is where one of the site’s new features comes into play.

“The most useful tool for women is probably the Hospital VBAC Ban information,” Collins said. “Women can look up the hospitals near them and find out their VBAC policy and if any doctors are actually available to attend them. It is getting difficult for so many women to find a VBAC supportive provider and this is one way to make that a little easier for them.”

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

Cesareans and Private Insurance

I'd started to work on this project but then life happened and it got put on the back burner. But then it happened to a good friend. So its not on the back burner anymore.

Turns out, if you are looking to get private insurance (you know, the kind that isn't provided by your employer, or the govt., the kind that some politicos want to give you tax breaks or special savings plans to buy) you might well be denied coverage if you've had a cesarean within the past 5 years. Why? Well, because there are too many complications in that time, after that surgery. Interesting. But its just another way, a better way, to have a baby. Even better, if you do agree to surgical sterilization, they'll go ahead and cover you. (So basically, I think the complications they are worried about are future pregnancies and the repeat cesarean that they know you'll likely have, whether you need one or not). Because its so politically risky, insurance companies are not allowed to mandate a TOL (trial of labor) or VBAC, and understandably, they don't want to pay for a bunch of expensive repeat surgeries that aren't necessary most of the time. So, because this is a market economy at times, they just don't provide their service to women with previous cesareans. I don't blame them.

But I have to wonder if anyone is warning women about this unforseen longterm complication of having a cesarean? Oh, it doesn't really matter if you don't have to have private insurance. But depending on the outcome of the current bickering about health care, that might be just exactly what a lot of people have to get. Except a pretty good number of them won't qualify....unless they are willing to undergo surgical sterilization, of course. Is that offensive to anyone other than me?

The great part is, I'm not just ranting about this. I already have one very motivated woman who is really pissed off about this. I need a few more. Who would be willing to talk to the media. It is distinctly possible that this could become a national story...if we find at least 3 women, with good documentation of the insurance policies and the refusal, who are willing to talk about it. And if its spun well, it'll really highlight what a disaster the 30+% cesarean rate really is, in ways that most people haven't even contemplated. So, if you are one of these women, please contact me. Ask around, see if you know anyone who's had this happen, who'd talk to me. Email me, please!

From the Horse's Mouth

A story, a really true story.

I was talking to a good friend of mine this morning, we've known each other for about 17 years now (yikes!). Her sister is pregnant for the first time. Her sister is a recovering anorectic (this pertains to one of the horses in this story). So my friend, we'll call her A (we'll call her sister L) says to me "L has decided that she's unhappy with her OB group. She knows there's no guarentee that she'll even know the OB who's on when she goes into labor and she's trying to not let that bother her but it really does. L really really really doesn't want a cesarean and she's afraid she's going to end up with one. I told her that if she was unhappy, she'd better switch because she needed to listen to her instincts." (A has listened to me rant over the years, plus she's experienced a couple of pretty different births herself). I asked "so what happened?" I'll give the horses some credit for being honest....

L was VERY up front with the OB group she was seeing about the fact that she was a recovering anorectic. She told them "do not make comments about my weight, do not say anything about my weight, this is difficult but I'm committed to being healthy, etc etc etc". So, at her 5 month appt, the OB (a mare) says "oh, you've gained too much weight". I'm going to assume that she didn't bother to read the record, not that she's that callous and stupid to boot.

At her 6 month appointment, she sees the senior partner, a stallion, who she really doesn't like at all. She says to him "when can I see the CNM?" (turns out there's a CNM attached to this practice). He says "You don't want to see the CNM, she's really not into delivering babies." HUH? Certified Nurse MIDWIFE isn't into catching babies? Or not allowed to....anyway, he continues: "Actually, none of us are interested in delivering babies. We don't want to get up at 2 am and come in while you have your baby."

::jaw drops::

Like I said, I'll give 'em credit for being honest. Honest horses' asses. Who no doubt belong to the American College of OBSTETRICIANS and Gynecologists, good old ACOG.

Merriam Webster has the following definition:
ob·stet·rics
Pronunciation:
\əb-ˈste-triks, äb-\
Function:
noun plural but singular or plural in construction
Date: circa 1819
: a branch of medical science that deals with birth and with its antecedents and sequels

Oh, wait, but not at 2 am.

At 7 mos, L is interviewing an independent CNM practice, with 4 midwives. I'm sure she's going to be shocked at the difference in her care. I also recommended a doula and I hope she does find one she clicks with. Here's hoping.

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?

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?

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 blah...it 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.

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 honestly....how 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 hospital....no, 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 now....it seems like its the same old thing over and over and over....I want to have a VBAC but...my hospital banned them....my OB won't do them....my husband doesn't want me to....there are no midwives in my area....we can't afford a homebirth....or....I planned a VBAC but....my 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 old....my 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.

My Video

Ok, I'm gonna try to do this...my 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.

Gretchen

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 then...cool. 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.

Gretchen