The Business of Being Born

Last night, I hosted a viewing party for the documentary The Business of Being Born, produced by Ricki Lake. A group of wonderful, intelligent women gathered in my home to discuss the state of obstetrical care in America over appetizers and wine (for those of us not knocked up!).

While my shrimp appetizer didn't come out quite as planned (read: you had to have jaws of steel to chew it, but the lemon aioli was to die for!), I felt like the rest of the night went off perfectly! Seven women from all different backgrounds and experiences gathered together to discuss a topic that affects nearly every woman at some point in her life.

The mission of the film was to address this question - "Should most births be viewed as a natural life process, or should every delivery be treated as as a potential medical emergency?"

The film did an amazing job of highlighting what, unfortunately, has become birthing status quo in America - a healthy woman comes into the hospital for what should be a completely normal delivery, but is pushed into undergoing a series of interventions, that lead to more interventions, that ultimately lead to cesarean section for one out of every three births, and other unfortunate results. The snowball effect.

I've posted my birth story with Carter before on here, but I am the poster child for the snow ball effect. Because of that experience, I have become passionate on the issue of child birth, and believe that every woman should strive to keep the process as natural as possible! I definitely believe in modern medicine, and know that there are times when interventions are necessary (i.e. my cesarean with Bennett), but for the vast majority of women, all they need to do is let their bodies do what they are programmed to do!

As the film highlights, "In America, midwives attend less than 8% of all births and less than 1% of those occur outside a hospital. At the same time, the US has the second worst newborn death rate in the developed world." Wow. "The five countries with the lowest infant mortality rates in the March of Dimes report -- Japan, Singapore, Sweden, Finland and Norway – midwives were used as their main source of care for 70 percent of the birthing mothers." Interesting.

What pains me is that birth interventions have become so common place in our country, that most women don't even question it anymore. By way of example, let's talk about the use of Pitocin - a synthetic form of the hormone oxytocin used to cause contractions. A survey done in 1998 showed that approximately 81% of women are given Pitocin to either induce or augment labor. However, the studies consistently show that Pitocin only helps in 3-5% of labors! Overkill much? So, what is the big deal, you ask? Pitocin has been shown to cause harder, longer, more painful contractions, that over the course of labor puts more and more stress on the baby, which in turns often causes drops in the fetal heart rate. Pitocin requires continual electronic fetal monitoring, which restricts a woman's ability to move during labor, and consequently, her ability to cope with pain. Pitocin also increases the risk of cesarean delivery. Half of all first time mothers induced with Pitocin will end up with a cesarean. I've also recently read some academic papers that are questioning a link between the use of Pitocin and the increase in the rate of Autism, but no major studies have been done yet on this issue, to my knowledge.

If you get Pitocin, you pretty much are stuck with getting an Epidural. (I tried to go without an Epidural for 13 hours while in labor on Pitocin, and let me tell you - it ain't pretty). Over 60% of women in labor in this country get an Epidural anyway (and in most metropolitan areas, that rate is as high as 95%). An Epidural may seem heavenly at the time, because yeah, labor hurts. But let me tell you why its not a great idea - if you have an epidural, you are numb from the waist down; which means you are very limited in your ability to move and get into optimal positioning for birth (i.e. NOT on your back!). Epidurals have also been shown to lengthen and stall labor, and is the single most common factor shown to cause "failure to progress" because it slows the release of oxytocin (which means you'll probably get Pitocin, if you haven't already). And what really sucks is that in 20% of cases where an epidural is given, it either fails completely or partially! Plus, the medical risks are nothing to laugh at: fetal heart decelerations, maternal hypotension (low blood pressure), increase rate of forcep or vacuum assisted delivery, chronic pain at the injection site (mine lasted 6 months after Bennett!), prolonged epidural headache, increased risk of pulmonary embolism, and more. Yet, how many doctors give you a run down of these potential risks before agreeing to administer an epidural? I doubt very many.

The plain truth is, MOST woman (93-95% depending on which study you look at) can have a completely natural, uncomplicated birth. The fact is that we ourselves complicate our own births. We are causing the increased rate of fetal and maternal death, and other poor consequences associated with these interventions.

It makes me so very sad.

No Pit Please!!

I just read a fascinating article regarding the use of Pitocin in labor and the correlation with emergency cesarean sections! Pitocin is a synthetic form of the hormone oxytocin, which is administered to either induce labor or to augment labor if the physician feels that the contracts aren't strong or organized enough.

A hospital in Chicago did a 3-year study where in they implemented a policy to infuse the Pitocin at a much slower rate (1 by 1 every 30 minutes v. 2 by 2 every 20 minutes, as done previously), and also decreased the use of Pitocin from 93.3% of laboring patients to 78.9% of patients. As a result, they saw the incidence of emergency cesarean delivery drop from 10.9% to 5.7%!!! There was also a significant decline in the number of vacuum and forcep deliveries, and a sharp reduction in neonatal ICU team mobilization for signs of fetal distres, as well! Oddly, the overall cesarean birth rate remained the same.

Hard to argue with the results! If you need Pitocin, ask your doctor about infusing at a slower rate!

Going Under the Knife

I bet you didn't know that April is in fact Cesarean Awareness Month, now did you?? Well, it is. So, I'm going to take this opportunity to shed a little more light on what - in my humble opinion - is a deplorable increase in cesarean births in the United States. Approximately 1/3 of all babies born today in this country are born via cesarean. And that number continues to grow.

I've had two cesareans, and to be quite frank, I'm rather pissed about it. Neither of my birth experiences came even remotely close to what I had wanted or dreamed of for so long.

I was a month shy of 24 when I gave birth to Carter. I was still rather young and meek and submissive, particularly to doctors, at that point. I thought, surely, if a doctor says you should do something, that means you really should, right? So, when my obstetrician told me she thought I should be induced two weeks before my due date because baby boy has a big noggin, and since a definitive end date was sounding pretty good at that point...I readily agreed to it. My doctor failed, however, to give me some pretty important details. Namely, that over 50% of first time mothers who are induced end up with a cesarean. And that induction in the vast majority of cases leads to other interventions that could otherwise be avoided. Nope, not a bit of that was mentioned.

So, I went to the hospital at 6 a.m. on March 11th, thinking they would just break my water (as we had agreed) and see what happened since I was already 2.5 cm dilated and almost completely effaced (meaning my body was on the brink of going into labor on its own anyway for those who don't know labor-speak). Rather than breaking my water, they hooked me up to a IV with pitocin - a.k.a the Devil's Spit. I should have protested, but I didn't. I was nervous and scared and really just wanted to have this baby already! The contractions came on hard and fast. An hour into it, my doctor showed up (how nice of her) and broke my water. HOLY MOLY OUCH. My pain level instantly tripled. Turns out, Master Carter was occiput posterior - facing up rather than down like he should be. And that my dear friends made the hardest part of his head press into my spine with every contraction - back labor. I had these delusions that I would have a med-free natural birth, but after 12 or 13 hours (who's counting at that point...) of laboring on pitocin with no pain meds, and without making much progress, my doctor gave me the option of an epidural or a cesarean. That was an easy choice. So I got the damn epi, and it worked for a whopping hour then wore off, but not before making me vomit and shake uncontrollably. Like you need MORE discomfort on top of discomfort. But I did in fact finish dilating. So, I started to push, and I got him down to the point where we could see his little head starting to come through, but every time I would push, his heartrate would drop. So, they had me wait and see if my body would bring him down naturally. Nope. I tried pushing again, and his heartrate kept plummeting to scary lows. So my doctor said (with sleep lines all over her face because it was after all 3 a.m.) I'm off to a c-section. NO!!!!!!!!!!!! This is not how it was supposed to happen!!! This was my nightmare!

So, Carter was born via cesarean. They cut me open, took out my baby, then took him to a warmer to clean him off, look him over and bundle him up. I got to lay eyes on my firstborn child for the first time as they were wheeling me out of the operating room and into the recovery room. I tried to hold him, but my arms couldn't support him from being numbed from the anesthesia. Within an hour after the delivery, I got very ill and they had to take him away because I was useless to him at the moment. I got to see him again 5 hours later. This is definitely NOT what I had envisioned giving birth to be like.

But my doctor assured me that I could try for a vbac (vaginal birth after cesarean) for my second child. So, I held onto that, made peace with my cesarean, and looked forward to giving birth the "right" way one day.

When I got pregnant with Bennett, I did all the right things to prepare for my vbac. I did all the research and was lining up interviews with doulas (special birth partners). Then, my water broke at 24 weeks. And of course, Bennett was breech. So there went my hope for a vaginal delivery. This time, my cesarean was even worse. I had uncontrolled bleeding during the surgery and it took them a good while and a lot of force to get the bleeding to stop. My recovery was extremely long and painful. Nearly a year later, I still have pain on one side of my incision where they nicked a muscle closing me up. Definitely not the birth I had envisioned.

So, I can hold on to hope for a vba2c, right??? Probably not. I will be lucky to find a doctor in Maryland who will attend a vbac after 2 cesareans. I'll save the argument for why THAT sucks for another day, as the risks of having something go wrong is still very slim. But the point remains, my dreams of giving birth to my child, of having them lay him on my chest while Ace and I stare down at him, of having those crucial bonding moments together - those dreams have been sliced to pieces with a very sharp scalpel.

Now, I realize that not all women feel so strongly againt cesareans. And not all women have bad experiences with them. But the facts are clear that cesareans generally are not a good thing, and should be avoided a much as possible.

* It is MAJOR abdominal surgery with huge risks to the mother of infection, blood loss and hemorrhage, hysterectomy, transfusions, bladder and bowel injury, incisional endometriosis, heart and lung complications, blood clots in the legs, anesthesia complications, and rehospitalization due to surgical complications, rate of establishment and ongoing breastfeeding is reduced, and psychological well-being compromised and increased rate emotional trauma. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sex. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions.

* Half of all women who have a cesarean encounter some complication from it. The death rate from cesarean is between 2 to 4 times greater than that from vaginal births. 180 women in the U.S. die from elective repeat cesareans every year.

* Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies. Both of these complications pose life-threatening risks to mother and baby. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancy in subsequent pregnancies.

* There are risks to the baby too - respiratory distress syndrome (RDS), prematurity (when surgery is performed because of an error in determining the due date), persistent pulmonary hypertension (PPH), and surgery-related fetal injuries such as lacerations. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications. Far from doing better, even premature and at risk babies born by cesarean fare worse than those born vaginally. Just today, I read a study that showed that being born via cesarean increases a child's odds of developing asthma by 80%!!!!!

* Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding, and the establishment of family bonds.

Unfortunately, it seems that the common-place occurrence of cesareans in this country has distracted us from the stark reality that it is a dangerous procedure for both mother and child. There are numerous reasons why the cesarean rate continues to rise, and I will definitely do a blog on that another day (in the meantime, you should try to watch Ricki Lake's documentary called "The Business of Being Born" - its fascinating!!). Suffice to say that something needs to be done. This is unacceptable and unnecessary. According to the World Health Organization, only approximately 10-15% of deliveries should be cesareans. As the nurses used to "joke" with me while I was on bedrest - it seems that the doctors all got a shiny new scalpel to try out.

(Disclaimer - I am fully aware that not all, and probably very few, doctors perform cesareans for any reason less than full belief that it is medically necessary, and yes, there are situations in which a cesarean is medically indicated).