Shooting Up

Last week, I met with my Perinatologist (a doctor specializing in high risk pregnancies) to discuss our plan of attack to help prevent another preemie. Because I had a preterm premature rupture of membranes (pProm) with Bennett, there is a 31% chance that it will happen again. Now, that 31% figure comes from a study that looked at all moms with a history of pProm - which included known and unknown reasons and risk factors. We don't know why I ruptured so early with Bennett. It could have been a total fluke! Or, there could have been something going on that they could never find that caused it. But, its maddening because without knowning the cause, its very difficult to assess my true risk for a repeat pProm AND to take appropriate precautions to prevent it.

That said, even with known causes, its pretty diffficult to prevent pProm. The Perinatologist recommended weekly 17 p (hydroxyprogesterone) shots, bi-weekly ultrasounds of my cervix (because a common cause is "funneling" at the top of the cevix, leaving the amniotic sac unsupported), lifting no more than 10 lbs, and restricting exercise to light walking. I am also Group B Strep positive, and will be monitored for that and possible spread of infection throughout my pregnancy.

So, the next day, I go to my regular OB check up and report these recommendations to my doctor, who should be the one to prescribe and administer the shots for me. Despite my Perinatologist's recommendation for the shots, my OB was very resistant to it and was trying very hard to convince me that I did not need them.

The 17p shots were designed to help prevent preterm labor. They work by keeping the uterus calm, hoping to keep you from having any contractions. Since I was not having contractions when I came into the hospital after my "full" rupture, my OB said he doesn't think that was the cause of my rupture and therefore the shots won't help me.

That would make sense EXCEPT for the fact that I have a very irritable uterus in general. I have already been having contractions here and there with this pregnancy, and I'm still a few days away from 15 weeks! Furthermore, I actually started leaking fluid at 21 weeks - three weeks before I was admitted to the hospital. Who knows if I was contracting then or not! And the day that I ruptured, I was having contractions on and off the whole day. They weren't regular contractions, so I assumed they were Braxton Hicks - but WHO KNOWS!? The point is, we don't know. But if there is a chance these shots could help me prevent putting another baby through hell, I'm going to do it!

Then my OB had the nerve to say - "Yes, but you realize that this is an added cost [the co-pays] and pain and inconvenience for you?" Does the man not realize that I would hang from the ceiling by my ankles for the rest of my pregnancy if I thought it would keep this baby in? Does he think I care that it will hurt or cost $10 a week? He has obviously never had to sit at his child's bedside daily for nine weeks watching him struggle to breathe. I would do ANYTHING to keep that from happening to this baby.

I was already looking for a new provider before this happened, but now, I feel all the moreso that I need to do just that...

So, starting at 18 weeks, I get to have a shot in the bum every week. Fun, fun, fun! Now, all I need are volunteers to administer them....

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.