Taking off our rose-colored glasses

Our closed Facebook group continues to grow and to be an incredible resource and support for more and more women.  I can hardly keep up with it all and am grateful my fellow board members, especially Katie Champ, have been doing an exceptional job at keeping it safe and relevant. 

I have been thinking about fear tactics, and the effect they have on all of us.  Let me remind you that I am speaking as a mom.  I am not a professional.  It seems to me every time I hear a birth professional in the hospital setting talk about VBAC and homebirth, they all seem to have been part of some horror story that involves the loss of the baby.  As the years have gone by, I have become suspicious of how many actually witnessed this, or if it is just stories passed around.  And they never report any horror stories that occur in the hospital, as though everything is just perfect there.  So I built up resentment over it and distrust. 

(start here if coming in from the Newsletter)

But something happened just recently to remind me, to remind many of us, that there are real people out there who do experience loss, and I don’t ever want to be a part of minimizing this.  I wonder what those families would think if they knew they were being used as horror stories to shame other moms for their birth choices.  It doesn’t seem to honor or respect either family, certainly not the baby, and really just seems to use them to suit their own needs and/or fears. 

So I do not presume to speak for all other women preparing to VBAC, but when I did, I learned a lot about what could go wrong, including that I could lose my baby.  I learned statistics, I learned about drugs, methods, risks, and on and on.  I made educated decisions that were best for me at the time.  With my first VBAC, I needed to be in the hospital.  I felt more secure knowing there was a “safety net.”  I don’t know what that safety net was exactly, in my mind, but it was important for me based on where I was in my journey.  With my HBAC, it was the opposite-I was more afraid to be in the hospital and all the risks that are there. That is where I was then in my journey.  Both were OK choices, and both should be made available to all women because we need to birth where we feel safe and are fully supported. 

This is completely opposite from my first birth-I had never heard of placental abruption, cord prolapse, uterine rupture, placenta accreta, nor had I ever heard of side effects from epidural, risks of Cytotec (I was never even told about Cytotec, even though it was used on me), risks of induction, risks of cesarean, etc.  The only thing I was ever told by my OB was that after 42 weeks there is a higher chance of stillbirth.  So there, that was it.  I was led to believe that everything would be just fine as long as we got the baby out before 42 weeks, and I did everything they told me.  “Thank God for modern medicine that saved my baby’s life,” was something I said regularly until I started preparing for my VBAC and the bombshell was dropped on me.  I was completely unprepared for anything bad happening, and if my baby had died I would have been bewildered, as I really didn’t think things went wrong to the baby when you had good prenatal care and did everything your doctor told you to do.

So with my VBAC’s I knew very well  that sometimes things go wrong, that not everything can be controlled, not everything explained, not every baby saved  no matter what you do, no matter who is attending.  I learned about all the things that can go wrong.  But in learning about it all, I wasn’t any more fearful, just realistic.  I learned that birth is as safe as life gets.  I saw this on a bumper sticker of my midwife, and soon understood what it meant.  So with all that knowledge, I made what I believed were the best decisions for both my baby and me and our health and our lives.  Now had I lost a baby, maybe I would feel differently, and I am grateful to not be in that position, but it would be hard to believe I would feel any differently, since I knew all the risks.  I was prepared and empowered, and it was important to my midwives that I knew all these things, as opposed to my OB who never mentioned one statistic, one negative, one drawback to being induced.

But one thing I never, ever want to do is try to guess what other families may be going through after a loss, other than supporting them and honoring their baby.  Because when we talk about loss, there really is a baby, and a mom, and a family, and the story is theirs to tell.  I think a hospital worker spewing out a horror story at a pregnant woman dishonors both families .  Women have the right to make their own decisions, no matter what others think.  And I believe they have a right to not have people spew horror at them.  I do encourage all women to learn about all the risks, and advantages, so they can make their own best decisions, and then please, let them gestate in peace!

Meet Our Board: Jill VanderZiel

Second up in our ICAN Board bios is Jill VanderZiel. Here is her story in her own words.

Jill (and husband Christian) have two children, both born by cesarean. For the birth of our oldest, our son, we took the more traditional path of having a large obgyn group, taking hospital birth classes, and as many others do, doing more research on what stroller we were going to buy than how we were going to bring our first baby into the world! My water broke at 38+6 and I went to the hospital, where I was administered Pitocin immediately. The Pitocin caused fetal distress, and we were scared into agreeing to a cesarean shortly thereafter. I never really labored at all. What had been a very healthy, easy pregnancy had ended in a dramatic, and scary birth. Our son was allowed to get too cold in the OR, which affected his blood sugar, so he was given sugar water, and sent to the special care nursery. 

After we were home, I struggled with what had happened. It never occurred to me that my birth experience would/should matter, and I was upset with myself for being upset, if that makes any sense! I found ICAN several months later when I just wasn’t “getting over it” – I was amazed to find a community of women who felt similarly and had similar experiences and struggles! 

Two years later, we had our second child, our daughter. I planned a hospital vbac with her, and had prepared by hiring a doula, taking HypnoBirthing classes, and in general doing a lot of reading and research. We ended up being induced at 41+1 due to a sudden spike in high blood pressure. This time around though, I fully understood my options, was cognizant of the pros and cons of the available interventions, and made educated decisions in regards to them. Ultimately, I had just about all the interventions you could ever want to avoid  (foley bulb, AROM, Pitocin, pressure catheter, epidural, and finally a cesarean). But my husband, doula, and caring, supportive providers and hospital staff made our daughter’s birth a positive, healing, and healthy experience. Making the call to return to the OR after a long, 27 hour induced labor (only 3 hours of which I had pain relief for), was tough, and admittedly a little heartbreaking, but it was the right decision for us.  

The birth of a child is a monumental, life-altering event in a mother’s life, and too often women’s feelings in regards to their births are belittled and ignored. ICAN provides a valuable service to women in the Twin Cities community. In want ICAN to be a safe place for mothers and mothers-to-be to come and find support, healing, acceptance, encouragement, and education. 

What has ICAN done for me?

Almost 6 years ago I found ICAN via my childbirth educator, in my attempt to have a VBAC. I had no idea I needed ICAN. After all, my cesarean was quite necessary and all I needed THIS time was a midwife who didn’t want me to schedule a second one. It was truly astounding, to think of the pre-ICAN Heather and the post-ICAN Heather.

It took a couple of meetings at most when suddenly my world shifted, titled, spun a little faster, became wobbly and almost rolled away into oblivion. To find out my cesarean was not only probably not necessary (well, the induction anyway), but more likely instead of saving my baby and me really almost killed us was quite a shock, even to a suspicious liberal feminist type like me. I had NO IDEA. No idea. Medical model vs. Midwifery model. Cytotec. Inductions. Unnecessary c-sections. Homebirths. Doulas. I could go on and on.

So much changed. I learned so much. I wanted to shout it from the roof top. I wanted to call the dean of the Women’s Studies department at my women’s college and let her know what was going on! I wanted to tell every woman I knew--OUR BODIES KNOW HOW TO HAVE A BABY, and birth is not a medical emergency waiting to happen, and I am the one doing this, not a doctor, or a midwife, or a nurse or a doula, but me. And I CAN!!! So ICAN, thank you. You made my life better, for me, my children, my husband and countless others around me.

So what can I do for ICAN? Become a subscriber! For the month of April, the rate is only $25 for individuals and $50 for professionals. Please, let us know what ICAN has done for you, and become a subscriber! Help us keep on doing this life changing and lifesaving work!

My Journey to Homebirth

Birth story of Gregory Patrick

HBAC (Home Birth After Cesarean) on 01/13/2011

by Heather Deatrick

How I ended up having a homebirth is truly amazing, as it is nothing I ever would have considered before, before I knew things about birth. Homebirth was something I had never even HEARD of, much less considered. Homebirth was something you had accidentally, when you couldn't get to the hospital in time, because after all, the hospital is THE SAFEST place to have a baby.

So the birth of GP starts with the birth of Earl, in March 2003, who was born by “emergency cesarean section.” A day that changed my life in more ways than I could ever had guessed! When I unexpectedly became pregnant with him, I stayed with the OB I had just seen for the 1st time, thinking he is a fancy Edina OB and I will be in the best of hands. I had absolutely no idea about the birth culture in the US. I had heard of midwives and had always planned on using them, but there was something very seductive about a fancy, busy OB clinic in Edina. Ok, I lost all my common sense. It happens to the best of us!

Even though I had a regular OB, I still wanted a natural birth. I came across Bradley (too late-in my 9th month) and had some ideas about things. I had heard to avoid an induction, but how was I to say no for being overdue? My OB said the baby could die after 42 weeks and there was no choice. It never crossed my mind to look further into it. I was induced at 41.3 weeks (why wait for 42 weeks when my OB is on his rotation at the hospital that day!), with Cytotec the night before (without my knowledge or consent-I was only told it was a cervix ripener), and then after a horrendous night of what I believed to be labor coincidentally starting on its own (and the subsequent epidural that I really didn’t want but I just couldn't handle the labor anymore without), Pitocin at 7am. I went to the OR for the section at 12.45 PM. There was no doubt it was needed at that point as Earl was having pretty major decels with each contraction. I remember so clearly my OB demonstrating how the heart rate went down when the Pit went up, and how he hadn't descended at all and yadda yadda yadda. I was just glad it was almost over and couldn't wait to meet my sweet little boy, provided I survived the surgery. I still remember so well when they took him out, showed him to me (after wrapping him and suctioning etc) and then putting him in the warmer and wheeling him off, with my husband in tow, leaving me to think about things like bleeding to death and my baby not being held. It would be at least two hours until I finally got to hold him, but to be honest I don’t think I could have much earlier.

Fast forward 4 years and husband #2. I knew I wanted a VBAC, and I knew it wouldn't be with my former OB who was not so interested in my baby, my birth or me when I asked about VBAC and he patted my knee condescendingly and said “of course not--you will just have another c-section now,” as though it were a bonus. Not to mention how he never even bothered to meet the baby he delivered that was in the waiting room with my sister. It was sad, but it was enlightening. I knew I had been so stupid then, but I didn't know just how stupid. I still didn’t know it was en entire system, the whole medical model that was failing us, not just an OB here and there.

So this time we went to Bradley classes, and it was there I really started to learn about birth. The instructor was a homebirth midwife and I remember thinking that was CRAZY, but by the end I was starting to feel the effects of the deconstruction and subsequent reconstruction of my knowledge and beliefs about birth (and she directed me to ICAN, so I will be eternally grateful to her for that).

In May, 2007, after 36 hours of labor (only eight of them in the hospital), and no epidural, I triumphantly gave birth vaginally with the assistance of a doula and hospital midwives, and my vigilant and amazing husband. The labor itself was long and hard, but compared to the Cytotec labor it was manageable. I just stayed focused on each contraction individually and knew it would end, and knew an epidural would lead me straight to the operating room. While it was truly so amazing, there were some things I didn't love, like no tub, continuous EFM, the hovering OB, the episiotomy that I wonder about sometimes. But since I never thought I would be so blessed to have this second child, I basked in the glory of this moment, thinking we were done.

Fast forward again three more years (two of those spent trying to conceive), and we are blessed once again with one more child! This time I knew what I wanted-a homebirth. I told my husband this, but that I also really wanted to take this journey with him and that we would both agree on where he was born. He agreed to consider all options and to do his own research and homework. We started with a certain OB in Hudson. I knew that if we were to have another hospital birth, it would only be with him. I assume his reputation is well known, but in a nutshell he believes in birth like no other OB, and has the power to let a VBACer have a water birth that a hospital CNM doesn't usually. My husband really liked him as well and we saw him until halfway through the pregnancy. We also toured one of the birth centers here. It was really nice, but my husband agreed with me--that if we do it there, we may as well do it at home. We then met with the homebirth midwives. I knew I wanted them all along, and when DH met them, he really liked them too. Also, the OB was so supportive and actually told them we were coming to meet them before we had! We are very lucky here in the Twin Cities to have so many options for birth.

So by week 24 we were set on having the baby at home. We did have an ultrasound and found out it would be another sweet little boy. It was a relief to know that there weren't any major abnormalities, but I was conflicted about doing it. I realize now that my journey to homebirth has been one of really understanding that there are no guarantees in birth, and that there can be things wrong with the baby, and I was OK growing a baby in a perfect state and then finding out and accepting whatever may be at the end. I had heard from a fellow ICAN member that maybe people who have homebirths are more accepting of death, not because it is more dangerous, but because we really do know all the real risks with birth. The risks they don’t tell you about with the OB’s (unless you want a VBAC, of course). I totally get now the saying “birth is as safe as life gets.” So we chose homebirth, because to me it was the safest and gentlest thing I could do for my baby and me. I found that I had no fear whatsoever of anything catastrophic happening-I do know it is a rare possibility, but I knew what we would do (we live 5 minutes from a hospital, where my first two were born), and what the odds were with different things. More importantly, we had our more realistic plan of what to do if labor stalls or stops progressing. In that case we would transfer to Hudson. To know that there was an OB and a hospital out there that wouldn't shame us for having a homebirth was a tremendous relief. Most important of them all was the relief I felt knowing that if the baby got stuck or something of that sort, I had the most skilled people I could have at a vaginal birth. There is no one I could trust more to get the baby out safely than my midwives!

With my second child, my VBAC, I went into labor just after 38 weeks. This was a great relief to me since I was “overdue” with my first. So when I hit 38 weeks with this baby (GP), I thought for sure I would go into labor at any time. I had such a feeling of all-knowing, of assurednss, that I should have KNOWN it wouldn't happen like that! Sure enough, week 39 and still no labor. Then week 40! I really started to psyche myself out in anticipation. I had alot of prodromal labor that last week, and each night I would think this would be the night. I really love how labor is so unpredictable and so its own thing. I love that it is bigger than I, than what we all know. That it is its own amazing mysterious thing in perfect harmony with the baby. Too bad the mama was tyring to outsmart it!

Finally, on a cold Tuesday night, I had fairly strong (but very manageable) contractions all night long. I awoke my husband at some point and told him to blow up the pool, but not fill it yet. I figured I was doing the work just to get to a 3cm, like last time, and had a day to go. So we prepared, but made no phone calls. We did keep Earl home from school. The contractions stopped in the morning, but this happened just like this with William so I was not alarmed, I sat on the birth ball all day. I did become alarmed when they didn't come back. AT ALL. I couldn't believe it. I was so confused. Was this another false start? I assumed my labor this time would be about half as long and at least half as intense. I even held out hope for an “orgasmic birth!”

I tucked in the boys and went to sleep. I was now hoping it didn't start again until I had some sleep since I had been up all night before. Once again, my brain messing it all up. But no, no good night sleep when it was time for the baby! At about midnight I was literally thrown out of bed by what was absolutely no doubt a very strong contraction. I had no time to feel tired or crabby as its strength overrode any of that! I stumbled down the stairs and told my husband to fill the pool as this was it! I then headed straight to the big bathtub. Once there I laid on my stomach, sort of on my hands and knees. I remember thinking I must tell my husband not to call anyone yet because we will have a long way to go, as it takes my babies a long time to descend down, and I hadn't even lost my plug or dropped or anything (hah). But instead all I could do was moan loudly through each contraction as he called my doula, the midwives and my mother. Oh well, I thought, they will know what to do and when to come.

Much to my relief, in less than an hour my doula was there. I vomited just as she arrived. This really surprised me because it was still so early and I only vomited last time when in transition! It was only afterward that she told me she thought I must be in transition-I had no idea! The pool was about ready then so we moved there. I wasn't in it very long before the midwives and the apprentice all showed up, and my mother to watch the kids. I was not able to pay too much notice to any of them however, as I really needed my doula and my husband to help me through each contraction. I seemed to be much louder this time, and each moan was very deep. I finally said that maybe I felt like I wanted to push, but it was so early (at this point I had been in labor for about two hours)! The midwives said they thought it sounded like maybe I was already and to do it if I felt I needed to! Wow, I was really caught off guard at this--at their trust in me, in my body knowing what it needed. I asked if they needed to check me and they said only if I wanted them to. I did not and started pushing.

With William I thought I was a pretty good pusher. I pushed him out in about 45 minutes. I assumed, once again wrongly, that this would be the case again. Instead I just couldn't seem to get a good position. I was in the water and couldn't seem to move from the position I was in due to the strength of the contractions. While it was a good position to get through them, it wasn't great for pushing. We tried this for a while-an hour maybe, and it was suggested that maybe I move to the bathroom and sit on the toilet. I did agree (though I did not want to) and we went in there. I did one contraction facing forward that was very very intense, and then another facing the wall. With that one the baby seemed to move to where he needed to be and we decided to head back to the water.

Once back in, I still felt as though I couldn't quite get him out and we talked about my bulging bag of waters. While I loved the idea of birthing him in his bag, I just didn't think I had the strength and I asked them to break it. They agreed but this is just not standard protocol for them, bless their hearts. Once it was broken they noted it was very thick and strong, and that the water was clear. It was at that point that I felt him start to crown. For some, the ring of fire may be scary or painful, but for me I love it-it means the best part is so so so close. I pushed with everything I had left and little by little he made his way down. Finally I felt his head come out and I so wanted to just finish it right there and push his body out, but the midwives told me to wait for the next contraction. Funny how until then they seemed on top of each other, then suddenly I had to wait for what seemed to be minutes!

Finally it came and I pushed him out. I remember trying to savor that moment, there is nothing like it--all that work, the intensity, the preparation and with a big swoosh he is free and there is this moment in time that is just magic. It is almost as though God is there with us, like I have felt the hand of God, of what a miracle life is and how amazing my body is to do this. Indescribable, really. I then heard the midwife tell us to pick him up because she couldn't reach him!! Both my husband and I reached down to pick him up from the bottom of the pool and he was fine of course, not having yet taken his first breath. I held him and he looked at me so calmly. I waited for the midwives to suction him, but they don’t do that! Instead they tickled his foot and helped us rub him and he started to make some sounds. He was so peaceful, even as he picked up steam and let out some good cries. He was perfect and handsome and peaceful. I wanted to just stay in that tub forever and hold him, still attached to me.

But it was time to get out, so we moved to the bed. Birthing the placenta was more painful than I had remembered with William, but I think I just wanted so much to be cozy in my own bed that I had little patience for any more pain. The midwives and doula took such good care of us all, and my oldest son cut the cord. I tore only a tiny bit, which was impressive since I had had a prior episiotomy and this baby was almost a pound bigger. I am sure that is because of the midwives skill. The care and attention I received from them was incredible-so much more than in the hospital. They were so gentle and attentive and made me eat and drink and pee and made sure my mother and husband and kids were all OK too. The midwives and doula did all this. An incredible experience, so unlike the hospital. It made it really easy for me to snuggle and bond with the brand new little baby that just made a really amazing journey. My doula managed to help him latch on within 15 minutes. What a joy, all in my own bed!

My closing thoughts are how natural this all seemed. It is very unfortunate that women don’t feel and are told they can't do this without assistance from modern technology, when in fact the technology just makes it worse, and even more painful in many cases, unless truly needed. Not to mention what a truly successful species we are, thanks to childbirth! I had no idea my body was so amazing and powerful. At one point in the labor I swear I could feel with me all the laboring women over thousands of years, telling me I can do this! Though I will admit It definitely was not orgasmic in any way, and while it was only 5 hours or so in length, it was much more intense than Williams. GP was also a pound bigger (though still just a peanut at 7lbs 6oz compared to so many women I know), so that may account for some of the intensity, not to mention one hour to transition, which maybe didn't give my body quite the time it could have used to prepare... maybe, maybe not. It is amazing how in such short time afterward I think I could do it again! Also, the midwives really hated breaking the water, being such non-interventionists, but I am very glad they did as I really think it moved things right along. It is pretty amazing to watch the video and see his head out, eyes open, mouth moving!

Birth is so primal, so incredible, so powerful, beautiful and scary too. I feel very fortunate to have been able to find out that my body works just fine and that I can even have a baby in my dining room! I wish that more women could experience this, as it truly is the most empowering thing I have ever done in my life, by far. I dream of a day when C-sections are once again only the amazing life-saving procedure they should be, and all women will get to experience their full and natural power, for them and their baby. If only women could be taught that birth is not a disaster waiting to happen while at the same time promising a perfect baby-it is all so unrealistic and wrong. Birth is normal but there are no guarantees, in anything of course. For me, having the baby at home was safest, for me and the baby. And to have my boys there, and even my mother (poor mom), and of course my husband, was a dream. It is really hard to believe that just over four years ago I truly believed my OB had saved my first baby’s life and “thank goodness for modern medicine and hospitals to make it all so safe;” to today when I know the studies and the mortality and morbidity rates for both moms and babies in the US say exactly the opposite.

Today GP is the happiest, calmest, most content child. People ask me if they think it was because of his birth and I say maybe, or maybe it is just being the third boy, or maybe it is just that sperm and egg combination, but I do think the birth has something to with it.

My fabulous labor team-DH and doula

I was a little loud for William

Moments after birth

Amazing midwives!

Earl cutting the cord

A very happy family!

Thank you ICAN and my ICAN sisters Sarah, Kara and Chandra, midwives Emme and Clare, apprentice Janine, doula Veronica, Mom, DH Greg, kids Earl and William, and of course Gregory Patrick.

I am truly blessed.

Your Feedback Requested! Potential New Quality Measures for Maternity Care in MN

We recently received the email below asking for public comment on potential new quality measures for maternity care in Minnesota. Please read and send in your feedback to paul@mncm.org!

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I have been working with a group of physicians and other health care experts to develop clinical quality measures around maternity care.  But I need some feedback from people who are pregnant, who have been pregnant, or know someone who is pregnant!  Will you think about your/her experience and let me know what you would like to know about a doctor or doctor’s office?

We’re considering reporting:

• The percent of a doctor’s office births that are c-sections to low-risk, first time mothers
• The percent of times a doctor’s office induces a pregnant woman (without a medical reason) before 39 weeks
• The number of deliveries per year by a doctor or doctor’s office
• Whether or not a doctor’s office offers vaginal birth after deliveries (or VBAC)

We’re also considering other measures around maternity care for additional reporting.  Would you be interested in:

• Prenatal care topics like education, tobacco cessation, screenings, etc.?
• Postnatal care topics like breastfeeding, postpartum depression, etc.? 
• Other procedures at the time of birth like injuries or tearing?

It really helps to hear about what people would find helpful.  I know what I would consider valuable information, but others might have different ideas.  Please forward this message to your colleagues and friends if you can think of people who are interested in maternity care quality.

I would love feedback before the end of November so I can share your thoughts (anonymous of course) with the doctors and experts on the workgroup.  The topics they end up recommending could become state-wide measures for all of Minnesota.

Thank you!
Brenda


Brenda Paul
State Quality Measurement Program Development Project Manager
MN Community Measurement
3433 Broadway Street NE  # 455
Minneapolis, MN 55413
612.454.4829
paul@mncm.org

Large malpractice settlement following c-section!

I first heard about this as a teaser for the upcoming 10:00 news. They only said ‘large malpractice lawsuit settlement nets 4.6 million after mom dies after giving birth’, or some variation of that. I said to my husband “c-section!” Of course while he is used to the c-section talk and takes it very seriously, he really wanted to know why I was so sure. I said because women in the US don’t die from vaginal births anymore-that is so rare. They die from c-sections-they die from bleeding to death or from a blood clot (my statement wasn’t too scientific, so now that I look up the numbers, I see that hemorrhage is number one, though I can’t find it directly tied to c-sections).


When I watched it on the news they made no mention to the c-section. They only said she bled to death after the birth. I went to find it online and the Strib had a much more in depth article. Honestly, I was so shocked to hear that it was much more than a woman bleeding to death after a c-section. I was so shocked to read that a hospital would actually perform one when they didn’t even think they had blood on hand! In my mind, I immediately assumed it was because they view c-sections as so common and ordinary that they didn’t think they would need it?! I don’t know, I am at a loss. It is bad enough—the risks with having one’s labor induced, the risks of having a c-section, but honestly I never feared personally that there wouldn’t be blood on hand. I thought it was common knowledge that the blood loss from surgery is high, and the potential for blood loss postpartum, whether vaginal or surgical was high as well! Stunning. What a tragedy.


Unfortunately, the culture of c-sections is so accepted that there is no question of being induced at 41 weeks. Now, I am not saying I know everything—maybe she was showing signs of preeclampsia or the baby was stressed and the c-section was necessary, but I was induced at 41 weeks just for “post-dates,” and how many of us are there were induced at 40 or 41 weeks for no reason, or “post-dates?” This is so common that no one bats an eye at it. This woman did not have to die and the hospital certainly was negligent and deserves to pay that settlement, even more. But the fact is, we live in c-section culture and these death will continue to happen until the rate comes down. The fact is, this hospital was not safe to have a baby. How many others out there? Or is the medicalization of birth that is at fault?

I will end with talking about my own birth journey. With my first, I thought having a fancy OB would keep my baby and me safe. It never entered my mind that he has a different list of priorities than I. I was naïve, I know, but I really believed that I was safer with a trained OB and delivering in the biggest private maternity hospital in the state. It just didn’t dawn on me that overused technology is not a good thing in the case of normal, low risk birth. This boggled my brain. When I went to Bradley classes with my VBAC hopes when pregnant with my 2nd, I knew I needed to switch to a midwife (in a hospital setting), but still wasn’t sure about my body. I also was shocked but interested to learn that my instructor “caught babies” at home! Wow—I remember thinking how could this women know what to do in case something goes wrong? At home? This is nuts. Now fast forward to baby #3, and we are having him at home. And you know what? I feel safest there. I know that my midwives are better trained and have higher skills in vaginal birth and all its potentials for problems than most OB’s (who, in my opinion are one trick ponies as skilled surgeons). I know that should something catastrophic happen I am a few minutes from a hospital that can handle an emergency c-section (and I know I could get there in the same time they would prep me in the hospital), and I know that if I stall and just can’t finish at home we are blessed to have an OB here who believes in birth and will let me finish my labor without shame. This is the way it should be. Birth is as safe as life gets and midwives are incredibly skilled. I am so lucky to be able to have a baby where I feel safe, and know that if I need a c-section, it will be truly necessary. When I heard this story about this poor family, I thought, “and they say homebirth isn’t safe!” Hospitals have a whole set of problems that need to be fixed before they can start pointing fingers at homebirth. Finally, I will end with saying women matter! Our birth matters! The end does not justify the means, and often the means is killing us women. This needs to be talked about.


Heather
Mom to two boys-one by c-section due to failed induction and one by hospital VBAC.

Boy #3 due in January, planned homebirth



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From the Star Tribune:
Malpractice lawsuit nets $4.6 million award
A woman bled to death after giving birth at a hospital in Wright County.
By SARAH LEMAGIE, Star Tribune


The family of a woman who bled to death after delivering her first child was awarded $4.6 million Thursday by a Wright County jury in a malpractice and wrongful-death suit brought against the hospital where she gave birth.


Claudia Calcagno of Albertville began hemorrhaging and died hours after her son was born on Jan. 18, 2008, at Monticello-Big Lake Community Hospital, now New River Medical Center. Her doctors were unable to perform surgery that could have saved her life because the hospital failed to provide enough blood for transfusion in time, even though it was "sitting right in their refrigerator," an attorney for Calcagno's family argued.


"Her doctors needed blood to save her life. It was as simple as that," said attorney Kathleen Flynn Peterson.


The jury's award isn't the largest ever seen in a Minnesota malpractice case, but multimillion-dollar verdicts against health-care providers are unusual, said Flynn Peterson.
In a statement issued Friday, the hospital declined to release expert-witness documents supporting its position, saying they contained private medical data. "Our thoughts and sympathy go out to the Calcagno family," the statement said. The hospital is considering an appeal.


Flynn Peterson said the hospital argued in court that Calcagno's doctors were negligent, and should have gone ahead with the surgery. On Friday, the hospital said that "clinical staff members can only act under the direction of a physician, and we believe [hospital] staff members acted according to the orders of the attending physicians."


Two doctors were named in the suit along with the hospital, but Flynn Peterson said it became clear to her before trial that they were not at fault.


The jury found that neither doctor was negligent. The award includes compensation to Claudia Calcagno's family for past and future economic loss, as well as the loss of her companionship.
For Claudia's husband, Bob, "not a day goes by I don't think about her," he said in an e-mail Friday. "To put it simply, I miss my wife."


Claudia was as an executive assistant for Catholic Health Initiatives, Flynn Peterson said. She and Bob met on the job in 1999: He worked for a company that installed furniture for her office. They began dating, and married in 2004.


"The day we found out we were pregnant I cried like a baby," Bob Calcagno said.
As Claudia's pregnancy developed, their excitement grew. She got the house ready for a baby, and "you just knew she was going to knock this whole mothering thing out of the park," he said.
Calcagno, 36, was 41 weeks pregnant when admitted to Monticello-Big Lake Community Hospital on Jan. 17, 2008, to have labor induced. Her labor stretched into the next day, and after she had pushed for two hours, her obstetrician ordered a caesarean section. At 6:50 p.m., she gave birth to a healthy son, Vico.


But mistakes that contributed to her death had already been made, Flynn Peterson argued. Court documents say that a routine order to type and screen Calcagno's blood put in before her C-section wasn't done until hours later. And following its own policy, the hospital did not stock blood of her type -- A negative -- falling short of accepted standards of practice, Flynn Peterson said.
At 8:50 p.m., nurses checking on Calcagno found that she was bleeding heavily. Her doctors were called, and a surgery team was paged.


A doctor who examined Calcagno ordered blood for her. The hospital lab sent the O negative blood, traditionally the universal donor type, it had in stock. A 911 call was also made to get blood from a hospital 12 miles away, but it's unclear when it arrived.
Calcagno could have received A or O positive blood that the hospital had in stock, but her doctors said they were never told it was available, Flynn Peterson said.
She was taken to the operating room for an exam under anesthesia and possible treatment, including surgery to remove her uterus. But her doctors decided against that.
According to documents, they were concerned that, given the hospital's resources, they wouldn't be able to control potential bleeding problems if they went ahead with surgery. They also felt they had stabilized Calcagno. So instead, they decided to transfer her to North Memorial Medical Center in Robbinsdale. As a medical crew from North Memorial wheeled her to a helicopter, two more units of blood arrived and were sent with her.


During the postpartum hemorrhage, Calcagno lost at least 4,000 milliliters of blood. By the time she reached North Memorial, she was in critical condition, with dangerously low blood pressure. Despite treatment, including a blood transfusion, her heart stopped beating shortly after she arrived at the hospital. Doctors started an emergency hysterectomy, but despite efforts to revive her during surgery, she died.


With help from Vico's grandparents, Bob Calcagno is staying at home for his son's early childhood. The couple had planned to have one parent stay home for their son's first five years, and "he wants to keep that pledge to Claudia," Flynn Peterson said.
Bob Calcagno said Friday that no amount of money will bring his wife back, "but I take comfort knowing that our futures, especially Vico's, are financially secured."
Sarah Lemagie • 952-882-9016

Star Tribune Features Low-tech Birth & Midwives in MN

The Star Tribune recently published two stories highlighting one Minnesota woman's journey to VBAC despite many roadblocks and St. Joe's Hospital's extraordinarily low cesarean rate. Both articles are valuable in what they have to say about birth in our area.

The first article by Josephine Marcotty tells Danette Lund's search for a care provider to support her desire for VBAC.

Because she had delivered her first child by Caesarean section, a hospital birth would almost certainly mean surgery again. Home birth? Her midwife refused, saying it was too risky. A birth center outside a hospital? She'd have to shell out $7,000 because her insurance wouldn't cover it.

"I felt like I had no options," said Lund, 36, who lives near Waconia. "I was so frustrated."

Lund and other women have discovered that birth in America is rarely the natural event they long to experience.

The article goes on to highlight the overuse of cesareans, the risks involved, and the barriers that so many of us face to having a safe, healthy birth. Marcotty uses Lund's story to illustrate how, despite what media stories and even doctors sometimes say, women are fighting to avoid unnecessary interventions in childbirth. Lund's story will sound familiar to many of us:

"There is nobody advocating for lower C-section rates," Peaceman said. "It's not insurance companies. Not doctors and not women."

Except, perhaps, for women like Lund.

Last year, when she became pregnant for the second time, she knew she was likely to have a C-section again. The surgery has become standard for women like her because there is a small chance that a prior C-section scar will rupture during contractions....

Lund's hospital, Ridgeview in Waconia, will consider a vaginal birth after a C-section. Many hospitals won't because of stringent national medical guidelines for the procedure...

After weighing her options, Lund asked a midwife to deliver her baby at home, but the midwife said it was too risky. She called a St. Louis Park birthing center run by midwives. Although such centers are common in some states, they are new to Minnesota, and Lund's health plan wouldn't pay.

By that point she was 30 weeks pregnant and out of options, she said.

Lund, an attorney and trained litigator, is the first to admit she is not typical of most pregnant women. She's comfortable with confrontation and decided to take matters into her own hands.

Three months ago her labor started at 1:30 a.m. She and her husband waited. And waited. They counted the minutes between contractions, then waited some more. Finally, when she was far enough, she hoped, that it would be too late for a C-section, she went to the hospital.

As soon as she arrived, her water broke. Her cervix was 9 1/2 centimeters dilated. She was ready to deliver her daughter.

"I said: 'Yay, there is nothing they can do to me now,'" Lund said.

The second article by Chen May Yee profiles St. Joe's Hospital in St. Paul, which boasts an incredibly low cesarean rate of around 12%, far lower than Minnesota's 26% rate and the nation's 32.3% rate.  The story tells of St. Joe's long history of supporting natural childbirth, especially with its emphasis on midwifery care.

Kara Sime, 38, a first-time mother from St. Paul, arrived one recent Thursday morning, her contractions five minutes apart. By Friday morning, her labor still wasn't progressing. Exhausted, Sime asked for an epidural, a powerful painkiller, and got one. She also got Pitocin, a synthetic hormone to induce labor.

But there was a problem. Her baby was facing backward, increasing the diameter of the head going through the pelvis. Such cases usually require a C-section or a vacuum.

Instead, the midwife and nurse helped Sime onto all fours -- no small feat since her legs were numb from the epidural. With Sime's belly hanging down, the baby turned.

Three pushes later, Catherine Julia was born at 6 pounds 10 ounces.

"I don't have surgical skills," said the midwife, Melissa Hasler. "I'm motivated to get the baby out vaginally."

Gail Tully, on her Spinning Babies Blog, also shared her own experience with the care providers at St. Joes:

A long time ago, I was at a posterior birth with Deb Monson in which the mom was working hard but staying at 7 cm for 3 hours. Deb's simple trick of 3 pushes against her fingers as they created a false pelvic floor quickly turned the baby and let the labor proceed. Doctors at St. Joe's (I don't know if the Midwives do this) will also occasionally reach in and manually rotate the posterior baby's head to anterior so the birth can finish vaginally. Not all posterior births need any of these interventions, but some do and I believe these skills are a big part of why St. Joe's has a low rate of cesarean section. Plus, the community midwives and doulas have long referred to St. Joe's for their quiet, kind nurses, and mother-centered birthing practices. 

With such a low cesarean rate and a practice culture that supports non-interventive birth, St. Joe's may be the best hospital in the Twin Cities for women hoping to avoid a cesarean. Sadly, however, St. Joe's is the only hospital in the Twin Cities metro area that does not allow VBACs.

This means that St. Joe's rich tradition and practice culture described by Yee and Gail are not available to women like Danette Lund who, for whatever reason, did not avoid that first cut. In a conversation I once had with a representative from St. Joe's administration, I was told that this is because HealthEast "cannot afford" the medical malpractice insurance fees involved in supporting VBAC. This stands in stark contrast to St. Joe's reputation for supporting evidence-based childbirth. And, unfortunately, it shuts out women seeking VBAC who could perhaps most benefit from the kind of support and quality care that St. Joe's provides.

Many thanks to Marcotty, Yee and the Star Tribune for writing and publishing these stories on a very important topic for birthing women in Minnesota.

"The Real Risks of Cesareans"

I can't take credit for much of this post, but it is too good not to pass along. It was written by Pamela Candelaria over at Natural Birth for Natural Women.

The rest are Pam's words - I love how she breaks things down so understandably:


Over 1.3 million babies in the US were born by c-section in 2008, accounting for 32.3% of all births. The most common reason for cesarean delivery is having had one before, but the reasons for a cesarean can vary widely. Sometimes there are medical reasons for planning a c-section prior to labor, and emergencies during labor make other c-sections truly lifesaving. For a huge number of women, though, the picture is less clear. They are told they have small pelvises, or big babies, or their labors aren’t progressing fast enough. Many women are told cesareans are a safe way to avoid the risks of vaginal birth, and an increasing number of mothers are choosing c-sections with no medical indication at all. Whatever the reason for the c-section, though, one thing they almost always have in common is a lack of truly informed consent. Let’s look at the risks listed on a fairly typical consent form—what isn’t on the form may be surprising:

The consent form says:Infection in the skin incision, usually this is controlled with antibiotics. Sometimes it can require you to be re-admitted to the hospital, but in most cases antibiotics are taken as an out-patient.

In reality, you are twice as likely to be re-hospitalized following a c-section, infection is almost five times more likely to occur, and infection can extend to the uterine incision. Taking antibiotics while breastfeeding contributes to thrush, adding another challenge when breastfeeding is already less likely to succeed following a cesarean.

The consent form says:Development of heavy bleeding at the time of surgery with the possibility of hemorrhage which could require a blood transfusion.

Transfusion is required in up to 6% of cesarean sections. If your c-section goes perfectly, you’ll lose over twice as much blood as you would during a normal vaginal birth- and even that number may be grossly underestimated. It is interesting to note that “normal” blood loss during a c-section would be considered a hemorrhage during a vaginal birth.

The consent form says:Injury to the bladder and/or bowel which could require surgical repair (this occurs in less than 1% of all Cesarean sections)

True- but mild bowel paralysis occurs following up to 20% of cesareans, and some women have bladder injuries that don’t require surgical correction but do require use of a catheter for weeks following delivery. Even if only 1% of women require further surgery to correct these injuries, that is almost 14,000 additional- and largely preventable- surgeries per year being performed on mothers who should be happily caring for their newborns.

The consent form says:Injury to the ureter (a small tube which passes urine from the kidney to the bladder)

While this injury is unusual, occurring in just 0.1% to 0.25% of cesareans, it often goes undiagnosed until the mother returns to her doctor with symptoms including pain and fever. Another surgery is then required.

The consent form says:Developing a blood clot in the leg veins after delivery

This occurs in ½% to 2% of c-sections- somewhere between 6,900 and 27,000 women- and can be fatal; yet many women are never told what symptoms to look for or how to reduce their risk.

The consent form says:
Risks for subsequent pregnancies include: placenta previa (where the placenta lies wholly or partly in the lower part of the uterus)

Shockingly, this consent form fails to list any other risks for future pregnancies. Reproductive consequences of a primary cesarean include a risk of uterine rupture that is 12 times higher than it would be with an unscarred uterus, even if a repeat cesarean is scheduled. A woman also faces increased risk of placenta previa, more severe placenta problems like abruption and accreta, miscarriage and unexplained stillbirth, unexplained secondary infertility, and dramatically increased risk of surgical complications in future c-sections. If that is not enough, the scar tissue and adhesions left by cesarean surgery can cause chronic pelvic pain and sexual dysfunction, and in rare cases can cause intestinal blockage that can be fatal.

The consent form says:Cutting the baby during the incision into the uterus (this occurs rarely).

About 1-2% of babies are cut during c-sections- that could mean over 25,000 babies, every year, receiving anything from a nick to a severe laceration at the hands of the delivering OB. While the consent form ends here, a slippery scalpel is not the only risk babies face when delivered by cesarean. Babies born by elective cesarean are up to seven times more likely to have respiratory problems at birth, and are up to three times as likely to die in their first month of life. C-section babies have lower APGAR scores, higher NICU admission rates, and they are more likely to have ongoing health problems like asthma. It’s important to note, these are low-risk babies, not babies who are delivered by emergency cesarean who may have been affected by complications of labor. No, these babies experience these issues as a direct result of the way they were born.

I’ve talked with hundreds of women about their cesarean births, both online and in real life. There is a pervasive belief that c-sections transfer the inherent risks of birth to the mother, providing babies a safer and lower-risk entrance into the world than they’d have with a vaginal birth. Many OBs perpetuate this myth, but it’s clear they aren’t telling us the whole story. I don’t think I’ve met one woman- not one single mother- who was told up front that in some respects her c-section put her baby at greater risk than vaginal birth would have. Even though many women seem comfortable with the increased maternal risks of c-sections, few are truly aware of exactly what those risks are, how much they are increased, or how they can be reduced. OBs are selling c-sections as a safe and easy way to deliver a baby- and women are buying.

Buyer beware.

Why Is VBAC a Vital Option?

Why is VBAC a vital option? by Heather Deatrick and Jess B.

*This post is the combined thoughts of Heather, ICAN Twin Cities member; and myself, Jess, ICAN Twin Cities member. Written for the ICAN Blog Carnival and for all birthing women out there.

Jess: How do we even start this post? Why is VBAC a vital option – I have reams and reams of information in my head – and I know that there is evidence upon evidence to support why I think and know that VBAC is a vital option. I am a perfectionist and like to wait until things are perfect before I submit them. But, in order for me to meet the deadline for this post – I am afraid that I will not be addressing every issue – besides the fact that I think this would turn into a doctoral thesis if I did!

Heather: To me it is obvious. The c-section rate is climbing. The rate it is going, followed by subsequent c-sections, means women are facing surgical birth as the norm. This defies logic as women have been giving birth for thousands and thousands of years and we have been a very successful species. The most successful actually, and hand washing to prevent disease only started in the last 100 years! To suddenly, in a matter of two decades, have birth become something that women cannot do without the help of a surgeon is arrogant and dangerous.

Jess: Let me start by stating that I had a successful VBAC in 2009. My c-section was in  2006 after an induction for pre-eclampsia at 36w5d. A nurse talked me into an epidural at 3cm (easy to do when the mom is in a fog due to Magnesium Sulfate running through her veins) even though I wasn’t feeling any pain. Shortly thereafter, my bp dropped significantly and my son responded by giving a bunch of whopping late heart decelerations. Hence my “emergency c-section” under general anesthesia. I knew before I even left the hospital that my next birth was going to be a VBAC. I even had nurses telling me, without me even mentioning my desire to VBAC, that I will never be able to have a vaginal birth as there would be too much risk for me and the baby. I must admit that my initial decision to VBAC was highly emotionally driven. I mourned the lack of initial bonding with my baby and the fact that he was given bottles by the nurses right away, thus ruining our breastfeeding relationship. But, hey, in no particular order of one reason being the best or that type of thing, there is reason number one why VBAC is a vital option – for the emotional health of the mother. Honestly – I’m tired of people who brush aside the emotional importance or significance of a vaginal birth – these factors are also important – so let’s start supporting mothers in that quest.


Heather: We know that while childbirth certainly has been dangerous in the past, this did really change with the advent of washing hands, and the ability to stop hemorrhages. Though while it was dangerous, it certainly wasn’t 30%, the way the c-section rate is now. I think it is abundantly clear that the rising c-section rate has to do with other things-technology, fears of litigation, time constraints for the doctors.

So why is VBAC vital? With every c-section comes a woman’s higher chance of death, comes a babies higher chance of breathing problems and asthma and who knows what else. We know that nature does everything for a reason, and vaginal birth is no different. The only way we are going to stop the runaway rising c-section rate is to start making VBAC the norm. When that happens, the provider will start to view vaginal birth as the norm again. It seems to me that vaginal birth is viewed as abnormal and a woman is “lucky” these days to have one.

Jess: I want to point out what some of our resources show. The Mayo Clinic states that the cons to C-section are: Your hospital stay will probably be longer than if you'd had a VBAC, Pain and fatigue linger longer after a C-section, you may wait longer to bond with your baby and begin breast-feeding , A repeat C-section makes it riskier to attempt VBAC for your next baby. C-section poses rare — but real — risks to your baby, such as premature birth and breathing problems. The risk of needing a hysterectomy to stop bleeding after delivery increases with the number of repeat C-sections. A C-section costs more than a successful VBAC does.

I once heard the quote “A C-section is a controlled rupture of the uterus.” I’ve had so many people throw uterine rupture in my face during my VBAC pursuit, a real risk no-doubt, but maybe I should have countered with the controlled rupture line.

Generally, if you have a low-transverse scar on your uterus, your risk of rupture is less than 1%. This article helps put VBAC and uterine rupture in perspective.

Heather: I have a feminist slant too as to why VBAC is vital. To me it seems that this a way to take away the controls from women that used to be 100% ours. Once, women gave birth out of our vaginas and women, midwives, throughout cultures and throughout time, caught them. This was one part of a woman’s life that was sacred and males were not a big part of, but certainly were in awe of. After all, to have a baby is almost god-like—to create and birth life is incredible. My own father told me when I was girl how lucky I was, and what an honor it was. While it is wonderful to have men part of this now, I would never change that, it is no longer a woman who does it. It is a monitor, a fetal scope, a suction, an epidural to sleep, a scalpel, a doctor delivering. It is our body totally controlled by an institution the minute we walk into a hospital. It is the ultimate handing over of our body to another.

To me, a c-section should really be only life saving. A woman today should be able to really say “thank goodness for modern technology that saved my baby and me.” While maybe a lot of women ARE saying that (even I did!), it isn’t the truth and really, modern technology has actually killed many. In this day and age there is no excuse or valid reason for a rising maternal mortality rate. I truly believe that changing the tide on VBACs is the answer.

Being prepared matters

Just over a week ago I got a text message from a friend asking for prayers. His wife was being induced at 35 weeks due to low amniotic fluid.

My first thought?

Oh crap. She's gonna end up with a c-section. Yet another friend to "welcome" into the Sisterhood of the Scar.

Turns out, I was wrong. Even though she was induced at the hospital with the 3rd highest cesarean rate in the Twin Cities (30%), she escaped a surgical birth.

How did this happen?

I bumped into her at church this morning. She told me that she was freaked out when she knew she was headed for induction. She had the same thought I did, that she was probably going to end up with a cesarean. The chances were certainly good - a high risk situation, induction, a preemie on the way...

I think it was her preparation (and no doubt support of her husband and others) that made a huge difference. This was her second birth. Her first had been at the same hospital, but they were well-prepared the first time, too. They had taken Bradley classes and stayed home as long as possible during labor. She had a drug-free birth the first time around. That same mindset and preparation helped her avoid more interventions during her induction this time. She told me, "The only bummer was that I had to be in the bed the whole time [for monitoring, Pitocin, etc]. But I used having to go to the bathroom a lot as my excuse to get up often. So, I got the drug-free birth I wanted. Well, except for the Pitocin...."

My friend was prepared to meet the challenges of an unexpected, stressful birth because she knew from experience as well as from childbirth eduction that sometimes you have to work with what you've got. She knew that moving around is so important in labor. So, she used a little trick to work the system and get up as  much as she could. It wasn't a completely ideal situation, but she worked for the birth she wanted even despite the odds. 

Jamie's Breech Birth Story

On April 1, 2008, I found out that Baby (gender at the time was unknown) was breech.  Approaching 33 weeks pregnant, I was unafraid because I knew there was plenty of time for Baby to turn around.  For curiosity's sake, I posed a question in an online community, asking what typically happens if a woman goes into a hospital in labor with a breech presenting baby.  The answers I received were, to say the very least, shocking, eye-opening and frightening.  I had women point me in the direction of "Pushed" by Jennifer Block in which there is at least one story of a woman forced by court order to have a c-section against her wishes because her doctor thought it best for her particular situation.  The general reply I received from the women in their replies was that to refuse a c-section would be unwise since most all doctors nowadays are not taught the art of breech vaginal delivery.  Many were helpful, offering links to Gail Tully's "Spinning Babies" website, as well as ICAN.  I was told about the various techniques to help coax a breech baby to turn.  To be honest, I didn't follow any of the advice or techniques yet, Baby was once again head-down by April 7, 2008.

I didn't worry about it and, in fact, I went to that same online community and did a little online happy-dance and bragged that Baby had resumed a vertex position.  If I'd only known...Toward the end of my 37th week of pregnancy, May 5, 2008, I went in for my weekly appointment with my midwives at a large hospital in Minneapolis.  She laid hands on me and got a strange look on her face and said something about breech presentation.  She left the room and returned with a portable ultrasound machine.  I held my breath as the midwife spread the lovely goop on my belly.  BAM!  There was a little head pushing into my ribcage where there was supposed to be an ass.  I was not amused.  My midwife was going to schedule an external cephalic version (ECV) but by the time we were finished with my appointment, the scheduling office was closed.  She spent a lot of time with me showing me various positions to get in to to coax Baby to turn and gave me other tips as well; much along the same lines as what can be found on the Spinning Babies website.  She also made an appointment for me to have a moxibustion session later that week.  Moxibustion is a traditional Chinese medical practice that involves the burning of herbs to stimulate acupuncture points.  In pregnancy, the herbs are burned near the pinkie toe on the woman's foot.  When I finally did get in to have a session, it was just for the woman to show me how to do it myself at home.  I went to my mother's house and had her do it for me and it was quite surreal.  It certainly did get Baby moving around a whole lot but all that movement was a whole lot of nothing and Baby still remained breech.  The session did make for a neat video to add to the story!  I swear, it was like something out of the "Aliens" movie!  I wasn't able to get the supplies needed for the moxibustion until what turned out to be 2 days before I gave birth.  The session had been scheduled for the middle of my 38th week of pregnancy but the night before I was supposed to go in, I got a call from my surgeon's office saying a surgery I'd previously been turned down for due to my late stage of pregnancy, was back on.  So the moxibustion was canceled and instead I spent the better part of the day on an operating table getting my right hand sliced open for the second time during my pregnancy in order to repair a tendon injury.  Because of this surgery, I was unable to do the water therapy I'd wanted to try to get Baby to turn.  I did go to the pool on Mother's Day (I even got in for free!) but I had a splint on my hand and could not go underwater so it was all but pointless, at least from the point of view of someone attempting to get a breech baby to turn.

I had 2 versions performed during the last week and a half of my pregnancy.  The first one was at the hospital.  I went in early in the morning and was placed in a triage area of the maternity ward surrounded by other women in various stages of pregnancy.  I laid in the bed hooked up to an IV for fluids and a fetal heart rate monitor for about an hour and a half before they brought me into the ultrasound room with the OB who attempted the version.  The lights were kept low as a technician stood by and checked periodically with the goop-covered transducer to see if any progress was being made on Baby's position.  Let me tell you, if you think having a human kicking its way around in your uterus is a strange feeling, try having someone on the outside attempt to get that tiny human to move in a direction it does NOT want to go.  I walked around for days afterward feeling as though I'd been punched repeatedly in the stomach.  I left that day feeling sad and defeated.

 

That weekend I networked in a way I never had before.  I called my aunt who gave me the number to my other aunt who gave me the number to a home birth midwife that she had met through some group or other.  I called the midwife and left a voicemail, practically in tears, and let her know of my situation.  She called me back the next day and we talked some things over.  She said that she would gladly have me come to her house and she would make another attempt at a version.   It was a Monday morning when my boyfriend and I drove to her home in St. Paul.  I ran into a friend of mine in the lobby of her building and he got a kick out of my story behind being there in his building!  The midwife buzzed us in and when we walked into her apartment, I felt very welcomed.  Her kids were running around playing and were very respectful of the fact that Mommy was with a client.  They just kind of played off to the side while the midwife and her assistant laid hands on me while I was laying on a mat on her carpet.  She was very gentle and despite still feeling bruised from the hospital's attempted ECV, I didn't feel any pain.  The assistant listened with the fetoscope while the midwife worked.  She must have had her hands on me for 10-15 minutes before she finally gave up and let me know that this baby was wasn't going to turn.  She told me she was not going to charge me anything for the attempt, which was a welcomed silver lining amidst a sea of mucky grey.

She then offered to attend my birth at home.  The thought hadn't occurred to me, though I had been told that was about the only way to accomplish a vaginal breech delivery.  If I knew then what I know now, I would have jumped at the chance.  To be honest, that little voice in my head told me to have my birth with her and I really did want to despite knowing virtually nothing about home birth, especially considering my first birth was a stereotypical hospital birth with an epidural and a midwife I'd never before laid eyes on.  But I really knew I could trust this midwife.  However, after discussing it with my boyfriend and my mother (I'd be giving birth at her house if that's the route we took), they were not comfortable with the idea therefore the midwife was not comfortable since they were my support persons.

So there I was, 9 months pregnant and knowing I was going to have a c-section despite the fact that women have been birthing babies who present in all forms of presentations since the dawn of time.  It sounds extreme but it was like a death sentence for me, the c-section, I mean.  I had done everything I could think of to get Baby to turn.  I spent so much time inverted hanging off the end of my couch that upside-down began to look like right-side-up to me.  I talked to Baby so often that I thought for sure it would be born so sick of my voice that it would cry whenever I spoke.  I played music via headphones between my legs while holding a cold pack on baby's head near my rib cage.  I tried a heat pack in place of the head phones.  My best girlfriend had brought me her Ab Lounger that allowed me to get into an even better inverted position than I was able to accomplish on my couch.  I watched a lot of TV upside down with a cold pack on my ribs and a heat pack and headphones down below while I sang little songs to Baby about how it needed to go toward the sound and flip around for Mommy.

  

At 39 weeks exactly, I had my last midwife appointment.  My favorite midwife was there that day and she had no choice but to send in an OB who told me all of the scary stories about why my wanting to have a vaginal delivery could very well kill me and my baby.  She brought in copies of statistics and studies (I know now that this was excerpts from the Hannah Term Breech Trial that has since been proven to be so full of holes that it's almost laughable that a medical professional was showing them to me) and I read through them while listening to her and this little voice in my head was telling me to run very very far away.  But at that point, I didn't have a choice.  I'd called all the area hospitals and no one would accept me for a vaginal breech delivery.  A nurse at one hospital I called went so far as to lay into me about how unwise of a choice I was making by trying to have a vaginal breech delivery.  I think I simply hung up on her.  In general, I got the same tone from every place I called.

 I didn't give up trying to call to find a provider but I had no luck.  Finally I was at a coffee shop near my house writing up a new c-section birth plan when my favorite midwife from my hospital called me.  She said she'd just left a conference and met a perinatologist from a different hospital who wanted to meet me for a consult the following day.  She got his office on the phone via 3 way and I went to the consult the next day.

During the consult, I was told that in the practice of 15 doctors, 12 would be open and welcoming for my vaginal delivery, but that 3 would push strongly for a c-section.  He basically said that, while those 3 would push for the surgery, they were ALL more than trained and competent enough to do a vaginal delivery.  He made sure I knew the risks but made it clear that he felt those risks only really applied to women with larger babies and who had not given birth before.  He didn't warn me in a frightening way that the choice I was making was going to harm me or my baby.  He did say there was a risk, but also said there were many risks to c-sections and said that if there was such a thing, I was a perfect candidate for a breech vaginal delivery.  He did a quick ultrasound which showed Baby was 6 pounds even and he told me what to do when I was in labor.

I laugh now when I think of the conversation I had with him that day.  He said just in case I came in in labor to one of the 3 doctors that would push for surgery, to labor at home as long as possible and to only come in when I felt I was very far into labor.  Overall, he made me feel really calm.  Well, that was the calm before the storm I suppose, but I'll get to that later.

My labor had kind of started that Monday, when I was 39 weeks along.  Contractions were regular but they were 15-19 minutes apart, though slowly getting closer together.  I knew I wasn't going to make it to the end of the week.  I drank a few glasses of wine over the course of those few days before I had my consult with the perinatologist because even though I'd accepted that I had to have surgery, I almost knew I wasn't going to have to; the same little voice that told me a c-section was not the "right" thing for me also told me to have faith.  No sooner did I get home from the consult than my contractions started to pick up.  By 9pm that night they were 7 minutes apart and getting closer.  I got no sleep that night.  I'm not comfortable sharing the story of my labor that night because it's pretty much littered with personal drama, for lack of a better way to put it.  My boyfriend never really saw me in labor with our first daughter, not TRULY in labor.  With her, my water broke, we went to the hospital, got the epidural when contractions started and I pushed her out in 47 minutes, there was no primal woman in labor going on as there was with my breech baby.  With my breech baby, it was a lot more primal, I was listening to my body, I was having contractions to signify I was really in labor and labored at home as opposed to having waters break and immediately going to the hospital.  I was a lot more in touch with myself as a mom, and as a pregnant woman and I think I must have been like a complete stranger to him and he was not there for me in any sense.

By around 2pm the next day, I'd been up all night walking the sidewalk in front of my place.  Mike's mom came over that morning and had spent a good portion of the night talking to me on the phone.  I was living next door to my mom's house so my mom was there as well as my best friend.  Mike was at home right next door but I don't think I saw him until hours later when we were all getting ready to go to the hospital and, to be honest, I didn't care.  I was deliriously in love with being in labor; I can't think of a better way to describe it.  It was beautiful; everything I'd read about in Ina May Gaskin's books.  I felt so empowered and beautiful and I laughed through the (quite painful) contractions as I dropped to my knees to moo like a cow or blow raspberries.  During a late lunch, my mom and Mike's mom realized that my contractions were barely over a minute apart and they convinced me it was time to go to the hospital.  I agreed about half an hour after that; it was around 3 in the afternoon.

I don't remember a whole lot about the ride to the hospital aside from arguing with my mom for going over bumps in the road because it made my contractions unbearable.  Since I'd just switched practices the day before, I didn't have any idea where to go once I got to the hospital.  I tried calling 411 to get the number to the hospital but a woman in active labor strapped behind a seat belt, mooing like a cow and arguing with her mother does not lead to a successful phone call.  We just parked in the ER parking lot and were directed to the maternity ward.  The walk down the hallway and the ride in the elevator is a complete blur to me of leaning against walls and I think I may even have sat on the floor once or twice.  I was still laughing.  I feel like the perinatologist who did my consult really set my mind at ease and despite the fact that I was going to be giving birth in a hospital again, I felt at peace because I knew I was going to get the safe, vaginal breech birth I knew I and my baby deserved.

Of course, I wound up with a doctor who wanted to do a c-section.  I had a huge fight with the doctor and kicked him out of my room and said if he wouldn't do it, to find someone who would.  He left and came back 45 minutes later with what I love to call the "waiver of baby death" and said that while he was uncomfortable doing it, he was probably one of the most trained for breech delivery, having been in practice since the mid 70's when breech delivery was a normal thing.  During that 45 minutes that he was out of the room (and I was in the sterile maternity intake room hooked up to monitors laying flat on my back, of course), my labor all but stopped.  Mike was nowhere to be found because he'd found other more important things to tend to like locking his keys in the car outside the hospital.  My contractions became unbearably painful and according to my mom and Mike's mom, I was losing it completely; hyperventilating, crying, shaking, angry.  While I calmed down after he agreed to "allow" me my vaginal delivery (gee, how generous of him, right?), I never did regain that sense of peace and calm I'd had when laboring at home.  I think that's why I finally broke down at 7pm or so and got the epidural.  It wasn't really for the pain, which I was managing quite well again at that point.  I was more than afraid the doctor would find a "reason" to do the surgery and I did not want to risk there not being enough time and my having to use general anesthesia.

I basically gave up.  I don't blame myself for it, but I know I gave up.  I let him break my waters and I let him administer Pitocin.  I did have a LONG conversation with him about not wanting to have him perform an episiotomy during the pushing stage, that I knew my body could push Baby out without one and that if it came down to it, I'd rather tear along the path of least resistance.  Just shy of 2am, I felt that burning feeling and I knew from my previous birth that I was ready to push.  That's when it got crazy...I was wheeled in to the OR (I already knew I'd be giving birth in there, which was kind of frightening) and there I was, Mike was the only person allowed in the room, covered head to toe in a gown and mask, holding the video camera.  I don't remember exactly how many people were in the room but they had the doctor's surgical team and the NICU team in there with us.  I don't remember exactly how long it took to push her out but I know it had to have been less than 10 minutes because I had her out with the 3rd contraction.  After the 2nd contraction, he asked the nurse for the tool so he could do an episiotomy and I screamed out NOOOOOO.  He told me her heart rate was dropping and that he needed to get her out RIGHT AWAY.  Of course I went with it.  She was born at 2:04am on May 16th 2008.  Six pounds 3 ounces of perfection.  I was able to hold her immediately while he stitched me.

I left after she was 12 hours old, much against medical advice.  I knew I wasn't going to stay as long as they wanted me to but I left so soon because the pediatrician came in when she was around 10 hours old or so and before asking me how I or she was doing, he said he'd taken a look at my chart and saw that I was still nursing my 19 month old and that I should probably stop now that I had the new baby.  I barked at him about how the WHO recommends nursing for 2 years and as long as is mutually desired thereafter and that if I wanted parenting advice from him, I would have asked.  He checked her from head to toe and quickly left the room!

Fast forward to this past February, I got a copy of her medical records and mine as well.  I got her records to be able to get her social security card (she didn't get one in the hospital because she didn't have a name when we left).  I got my records just for curiosity's sake.  In both of our records, there is no mention of her ever having a problem with her heart rate and the only mention with the episiotomy is that tearing was likely.  In her records, it very clearly states that her fetal heart tones were reassuring throughout.  Her heart rate was never a problem, there was no need for the episiotomy, he gained my consent through lying to me before cutting me from my vagina down toward my anus.

All in all, I'm VERY happy that I was able to have my vaginal delivery.  But I very much feel as though my entire birth experience was a form of emotional, and at times, physical rape.  I can't watch a video of a woman giving birth, be it in a hospital or at home, without longing to be in labor with her again, to be able to have a do-over.  I cry a lot when I think about it.  I have a copy of "The Business of Being Born" from Netflix that's been in my possession for several months now that I've not been able to force myself to watch.  I'm afraid of everything flooding back to me again.  My little breechling is now 19 months old.  I wasn't able to begin facing my birth experience with her until about 4 months ago.  Sure, I've been "bragging" about it since I gave birth, but it wasn't until recently that I really allowed myself to feel the emotions.

Mike videotaped the birth.  I watched it for the first time a month or so ago and I was a crying mess just by halfway through it.  I got to the part where he cut the episiotomy and I heard the loud cry I made and it was like being on that hospital bed all over again.  He didn't wait long enough for the numbing medication to set in before he took the tool to me and I FELT my flesh being cut open.  I had blocked that out of my mind.  The time on the video after she was born, I look like someone else.  I don't see myself when I watch the video.  I was shaking from the epidural and perhaps the adrenaline pumping through my body.  I was completely detached from the entire situation.  Mike was off near the table where they'd brought her to weigh her and clean her off and I was listening to all the conversations around me and adding babbling sentences to other people's conversations.  I think the most telling part of the entire video and the entire story is that I didn't cry when she was born.  When they placed her in my arms it was like I was holding A baby but not MY baby.  I had no attachment to her whatsoever.  I continued to feel like that for the first month or so of her life.  I had this baby with her mouth on my nipple and I was changing her diapers and she was like this strange little alien that had just dropped from the sky and I was expected to take care of her.

Around the time she was able to start smiling and became more interactive with others around her, that's when I felt a bond and I *knew* she was mine and I felt that surge of love hormones.  Before that time, I was just going through the motions.  I knew she needed to eat so I offered my breast.  I changed her diapers and her clothes, I bathed her, she slept next to me at night and I did all of the other things a mother does for her child and that I did for my first daughter but for that first period, I didn't feel as though I was doing these things for my own child.  Knowing what I know now, I was in a state of shock after giving birth to her.  I don't see myself in the video or in pictures because the self I've come to know and love after 20-some years on this planet was not really present.  That "me" took a hike the moment the doctor came into the room and barked at me about how he would never take the kind of risk I was taking with his own child and he didn't understand why I would take it with mine.  While I am very much bonded with my daughter now, and have been since she was around 2 months old, I feel as though now that I'm finally facing my birth experience head on, ugliness and all, I'm finally getting to know myself again, the self that ran away and hid when I got to the hospital that day.

In September of 2009, I made a choice to finally go to college, having graduated from high school in 2000.  I think the reason I waited so long to go back to school is that I didn't know what I wanted to be when I grew up.  Now I know I want to be a midwife.  As of January 11, 2010, I will be attending classes to gain the general education credits necessary to enroll in the nursing program.  The next step after becoming a nurse is to complete the training to become a certified nurse midwife.  Through personal experience, I have found that there is a frighteningly MASSIVE amount of incorrect information out there for women who are pregnant, about to give birth, nursing a baby, a toddler and raising children in general. There are blanket statements passed around to women who, through no fault of their own, just don't know any better and believe that doctors (OBs and pediatricians specifically) are infallible. For a long time, I was one of those people. I felt that doctors were bound by their oath to "do no harm" and that if they'd gone to school for so long for their specific field, obviously they must be right.  My experiences over the years have taught me otherwise.  And I am grateful for those experiences and both of my daughters for the parts they have played.