Overall, there's good news

Oy! No posts since December? I'm hiding my head in shame.

My excuse is that I've been overwhelmed with the 2011 shit storm of misogynistic politics and can't handle writing about it all. For example: South Dakota and Nebraska thought it would be fun to legalize the murdering of abortion providers, while Utah thinks it's a gas to prosecute women as murderers for having miscarriages.

You see? I can't even comment. It's just too much to handle. Ok, one comment about Utah: Whether or not you agree with abortion, whether or not it is legal and safe, it is a truth of human experience that women will find a find a way, any way, to terminate unwanted pregnancy. But if women had access to safe abortion, they wouldn't be so tragically desperate as to subject themselves to intentional violence. This bill says a great deal about how much these politicians value women's lives.

But recently, there has been very, very good news! Planned Parenthood's budget was NOT cut last week! Ina May came to town! Doctors defended homebirth! And I've attended some truly beautiful births this year.

I witnessed a vaginal twin delivery in which baby B was footling breech. Baby A slipped out like butter, and before the doctor could try a manual version (to turn Baby B), it's teeny little foot poked out. Then its cute tush! It was magical.

I spent all night long with a mother, rocking her baby down. As the sun rose and the snow fell, she felt her baby coming, and whispered, "He's coming, he's coming." Magical.

Ina May came to town to promote her new book, Birth Matters: A Midwife's Manifesto. She bestowed upon us some true gems of hilarity, common sense, and wisdom, including this little query, directed toward anyone skeptical of the normalcy of vaginal birth: "Why do we all think that only men's thingies can get really big and then really small again? Ours can, too."

She also shared this video of an elephant giving birth, complete with elephant CPR. It's intense and graphic (as Ina May said, a two year pregnancy requires a LOT of amniotic fluid), but incredibly beautiful and life-affirming.

Ina May also told us to blog more. Yes, Ina May, I will. I will blog more. I will blog the good word! Such as news like this: a year or so ago, some American doctors published a study in the American Journal of Obstetrics and Gynecology (AJOG) that claimed that neonatal mortality rates were higher among planned homebirths than hospital births. Earlier this month, some other doctors took another look at that study and realized it was completely flawed. And by the way, these other doctors happen to be Canadian and Dutch, hailing from two nations where homebirth rates are higher, c-section rates are lower, and infant and maternal mortality rates are lower than ours. So I'm more likely to believe the doctors whose patients are dying less. Here are their conclusions in Medscape and AJOG.

Finally, I got to spend an hour talking about myself with a fellow rad Barnard chick a few weeks ago, and now the fruits of that conversation are forever imprinted on the scrolls of the internet. More specifically, in an article in Yale's feminist blog, Broad Recognition, about how doula work takes feminism in a pretty different direction than we've seen before. It's going to later be part of an exhibit at Concrete Utopia called "i am not a good enough feminist" (I effing love that title).

I think that's enough information and links to satisfy your birth brains for now. Don't fret, there will be more soon!

The 5 births in 15 days

There is so much to write about. I have plans for so many posts, so here is a list. Maybe I'll get to them someday:

• The closing of St. Vincents/my GREAT birth experience there
• My thoughts on the relationship between pain management (medical or not) and birth outcomes
• A post that I already started, sitting in my drafts folder, about the NY Times article on Freda Rosenfeld, the lactation consultant
• Not birth related, but relevant to early parenting: the debate about babywearing, the safety of "slings", and where Metro Minis, my place of regular employment, fits in!
• The really groundbreaking Amnesty International report on maternal mortality in the US (I'm very proud because I helped work on it as an intern last spring)
• The recent NIH conference on VBAC (Vaginal Birth After Cesarean)
  

It's been a while, but for good reason. I attended my first birth since late November (had to take a break for health reasons) on Febuary 16th. Then another February 20th, five days later. Another February 26th, 6 days later. Another March 2nd, four days later. Another March 3rd, one day later. That is 5 births in 15 days.

FIVE births in FIFTEEN days. I'm birth-exhausted. Both of clients with due dates in March have given birth, so I'm just waiting on my April clients and I feel lucky to have this break (although I am on call for two of those April clients right now). I have five clients lined up for April, and I'm just praying, praying, praying, that they won't all give birth in 15 days. 30 days would be great. Could you do that for me, ladies?

I like giving stats on births, so let's recap the 5 in 15. All in-hospital. One had a midwife, four had doctors. One was induced (for low-fluids). All had epidurals. Three were c-sections: one was for "failure to progress", one was for "non-reassuring signs" in baby's heart rate, and one was scheduled in advance for breech presentation. Shortest (meaning my time spent at the labor, not the length of the labor itself) (and not counting the scheduled c-section, because that's about 40 minutes): 10 hours. Longest: 30 hours. Two tied at 30 hours.

But the most exciting birth by far, was one I was unfortunately unable to attend. On March 11th, one of my clients woke up to some mild contractions. Listening to both my advice and that of her childbirth educator, she went back to sleep, thinking her first-time labor would be a long one. She woke up two hours later, contractions still mild, and turned on a movie. She called me after the movie and told me, with great poise and lucidity, that she was in labor. Gauging her stage of labor by her voice, I thought "she's still in early labor" and said my usual "Great! Call me when anything changes or gets more intense" (among other things, I'm not that boring of a doula). I get a call from her husband one hour later and he says "We're going to the hospital, she can feel the baby coming out." I thought, "Yeah right. I spoke to her an hour ago and she sounded no where near this stage. She didn't even sound like she was in active labor. She probably just feels some premature pushing pressure." But, I leave for the hospital, and by the time I get above ground, I get a message from her husband:

"We didn't make it to the hospital, because she had the baby in the taxi! It's a boy!"

I learned a very important lesson. When a mom says, "I feel the baby coming out", ask "Do you feel like you have to push, or do you feel the baby's head literally coming out of your vagina?" Because later, she told me she felt the baby's head literally coming out of her vagina.

Full story here.

First, too many births at once, then a missed birth? Can't a doula get a break?

Unnecesareans

The WHO recently released results of a survey in which they found that nearly half of all births in China are surgical. China's c-section rate is 46%. I hate to get over-dramatic, but this is appalling. Not because I'm so ideologically attached to vaginal birth, but because this is actually really, really dangerous. The WHO recommends that a nation's cesarean rate should be no higher than 10-15%. Above 15%, the risks of cesarean surgery outweigh the advantages to moms' and babies' health. Looking at it from another perspective, that means that, under ideal maternity care conditions, only 10-15% of labors will truly necessitate surgical intervention in the form of a c-section, and 85-90% of labors will progress normally and safely.

So, to explain why, when the cesarean rate is above 15%, the risks of c-section surgery outweigh the benefits to mom and baby. These risks exist with any c-section, but when the life of the mom or the baby depends on immediate delivery, these benefits of saving the lives of the mom and her baby outweigh the risks of the surgery alone.

But when a c-section is done on woman whose labor falls into the 85-90% that are normal and healthy, mom and baby are exposed to these pretty scary risks completely unnecessarily. Immediate risks to the mom include: infection, surgical injury, blood clots and stroke, emergency hysterectomy, less early contact with baby, depression and psychological trauma . Long term risks to the mom include: chronic pelvic pain, difficulty passing bowel movements, increased likelihood to be injured during future surgeries, future infertility, depression and psychological trauma, and maternal death. Short and long-term effects on the baby include: surgical cuts, breathing problems, difficulty breastfeeding, and asthma throughout childhood and beyond. And if the mom wants (and is able, despite the risk of fertility problems) to become pregnant and deliver again, here are the risks to both her and her baby: ectopic pregnancy, placenta previa, placenta accreta, placental absorption, uterine rupture, stillbirth or death shortly after birth, low birth weight, preterm birth, fetal malformation, and central nervous system injury to the baby. (all above found here)

Now, China's rate is pretty scary, but how does our country fare? In 2007 (most recent data available, from Choices in Childbirth's New York Guide to a Healthy Birth), 31.8% of births were done by c-section. In New York state, it was 33.7%. Rates in the New York city metro area vary, but no hospital has a rate below 15%. The lowest is 18.5% at North Central Bronx Hospital (whose maternity ward is staffed entirely by midwives, by the way). The highest is 52.7% at Lawrence Hospital-Bronxville in Westchester.

It was not always this high. Let's compare cesarean rates to maternal mortality, if we want to see a quick correlation between c-section and maternal health. In 1987, the year many of my peers were born, the US c-section rate was 24.4% and the mortality rate was 7.2 deaths per 100,000. We have to use 2003 now for the most recent data. In 2003, our c-section rate was higher, 27.6%. Guess what was also higher? Our maternal mortality rate: 12.1 deaths per 100,000. I'm not saying that this absolutely means that c-sections cause more maternal deaths, because that is beyond my powers of statistics to prove. I am saying that the conventional wisdom of c-sections allowing birth to be safer is completely false, and that most people hold this conventional wisdom is very dangerous for women's and babies' lives.

Why why why why why why why why??????????

Reasons are hard to quantify. This one is a myth though: that women are choosing c-sections as a matter of convenience. When women say they chose the c-section, they also say that they didn't get to that decision on their own, but from pressure from their doctors about time and convenience, and inadequate and biased information given about the risks. Other reasons include a general lack of faith in vaginal birth and "low priority of enhancing women's abilities to give birth," "side effects of common interventions" (a common cascade: epidural, epidural slows labor, pitocin to speed labor, pitocin stresses the uterus and the baby, baby is stressed and uterus isn't working right, c-section), casual attitudes about surgery and c-section in particular, limited access to information and awareness of the risks, and again, providers fear of malpractice claims and lawsuits (a bit plagiarized from Childbirth Connection- they just say it so good!)

I'm sick of talking and thinking about this. My solution: midwives. They specialize in protecting safe, vaginal births. Obstetricians are great surgeons and indispensable for the 10-15% of births that require c-section. But for the 85-90% of births that don't, let's save women's and babies' lives by letting midwives take care of them. A funny parallel is this: OBs are SUVs that you only need in conditions you'll find yourself in 10-15% time. Midwives are regular cars that do the trick the rest of the time, quite well.

On that note, I'm out. With my phone attached to me at the hip for when one of my clients needs some doula love.

PS: I didn't come up with the awesome title of this post, it comes from the title of a really good blog, http://www.theunnecesarean.com/blog/).