Posts Tagged unnecessarean

Sushi, por favor. Prego!

Long ago in a hospital ward someone noticed a woman’s breathing changes with her labor.  He/she noticed that as the work of labor became more intense she breathed more deeply, deliberately.  Most likely it was also noted that during second stage her breathing may appear to stop, like a temporary holding of the breath.

As is usual with a single purpose track, one thing is noticed but how it occurred or what else is happening is disregarded.  All that was seen was someone breathing differently.

In the 1950s ‘prepared’ birth classes began in hospitals.  I wish I had been a fly on the wall when the introduction of birth classes in a hospital setting came about.  Today there are hospital based birth educators who will tell you they do ‘talk about’ natural birth in their classes.  I’m sure they do ‘talk about’ natural labor.  Let me tell you about one such woman who ‘talked about’ natural childbirth in her hospital birth classes.

The scene:  We are a group of women preparing for a presentation of Birth – The Play aka Birth On Labor Day (BOLD).  We meet twice a week for a couple of weeks leading up to the play date.  Of course during this time we are all sharing birth experiences and experiences with birthing women.  Among our cast is a woman who has never given birth but she is the most enthusiastic of us all.  She is excited just thinking about giving birth some day.  Among our cast is also a woman who gives childbirth classes at CCOG, a local hospital.  In our discussions about birth we do eventually get around to various birth videos.  Obviously one such video clip we bring in for everyone to see is the hospital birth clip from Monty Python’s Meaning of Life, Miracle of Birth as it is a part of the play itself, the machine that goes “ping.”  I love Monty Python.  They can send a real zinger of a message in the funny lines, classic, expert comedy relief.  Then the discussion comes around to a recent birth video, Psalm & Zoya: The Unassisted Birth of Our Twins.  In this film you see a woman experiencing the hormones of labor as she sounds her way through transition into pushing for each baby’s birth.  We are discussing this film because one of the Birth characters must also produce vocals for labor.  That actress is the hospital birth educator.

I cringe still today as I recall her dramatically re-enacting labor vocals.  She is dramatic, not simply “into” the role.  Dramatic.  Flamboyant.  An actress through and through.  She decides to share her experience with a woman sounding her way through labor.  She recalls a first time mother who ‘called out’ Jesus’ name during labor.  She recalled how everyone was out in the hallway giggling to themselves and cracking jokes about praying in labor.  What she didn’t know was that the young mother was one of my birth clients.  She is Christian and her faith is the center of her world.  Very lovely mother.  In fact she had shared her birth story with me and how powerful she felt with each growing contraction and how she’d chanted her way through with the name of her Savior being the perfect punctuation and pitch to her sounds.  She had loved her birth experience and couldn’t wait to share it with others.

Two very different views of the same labor.  Really, the one that matters is mother’s.  The one though that would cause the greatest harm is that of the birth educator, also a woman, who was present.  Hers is a tale of dramatic, made-for-tv drama labor and, I’m sure, jokes about ‘real’ childbirth.  

Two years later I came across a woman who’d had a c-section at CCOG.  Her first birth.  She told me about her childbirth classes and we both identified her birth educator as this woman who had been in the play with me.  She told me just how funny this woman was and how she showed some crazy waterbirth video.  This mother also told me how she’d eaten poorly during her pregnancy, worked extended hours and extended travel during her pregnancy, been induced for labor, had a catheter and so on and so on.

Yes, I’m certain hospital-based birth classes ‘talk about’ natural childbirth.  That’s all they do, talk.

I scoff at journals who write prepared childbirth classes have no effect on birth outcomes.  Of course they don’t when the main thesis is the breathing.  As my husband and I humorously recall the scene in A Christmas Story where the family is seeking bread in a Chinese restaurant I think the same of hospital birth classes.  Many a colleague of mine has remarked the same on some variation of that scene, basically you don’t order Chinese food in an Italian restaurant, sushi in a Mexican restaurant, etc.

Nine months to grow a baby who can breathe and pump blood through their own bodies on their own.  A two-hour hospital class on how to complete admission papers, the dogma of the smallest possibility of a spinal headache (right) from an epidural, how long your baby will be away from you and how soon you can go home.  All this as though you’ve never even considered otherwise.  Learn about real birth.  Period.

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VBAC: The Impact of the Informed Woman

This weekend I supported a VBAC mother through both in-home visits leading up to her due date and during labor.  Her previous c/s was for failure to progess when in fact she had a persistent posterior presenting baby boy and her labor was augmented with pitocin (a drug dripped intravenously in the hopes the drug will speed up labor) after just 12 hours of laboring naturally on her own and following her own instincts to labor on her hands and knees.  This labor began spontaneously with her water breaking.  She proceeded to labor on her own until Dad called to say mom would like to have me there now.  Mother labored with me providing answers to her questions about what she was experiencing and Dad providing her with answers to how well she was doing, how beautiful she is.  We arrived at the hospital with Mom fully dilated and initially beautiful fetal heart tones.  Expectations were that she would begin pushing when she felt like it.  This was just after midnight.  She was never on her back but rather tried pushing by hanging over the back of the hospital bed, side lying and ultimately squatting.  The parents listened to the request from the supervising OB for an internal fetal monitor due to a slow heart rate and a need for consistent fetal heart tone documentation.  Changing positions to squatting provided a happier baby and supportive evidence for mother’s informed decision to try positional changes before continuing discussions on the baby’s well-being.  Upon baby’s birth the OB supervising for the midwife who now supposedly had a birth to see to proceeded to immediately clamp only to have parents tell him to remove the clamp.  There was much pressure to change mom’s mind about a natural delivery of the placenta.  There was a commentary from the doctor that perineal tearing always accompanies natural childbirth.  FACT:  Natural childbirth proponents do not claim no woman will ever tear.  Rather, normal birth experience shows women are less likely to tear in such a way as to need a repair or are not likely to tear at all when they are encouraged to push only to the point of comfort, push only if they feel they need to be proactive in pushing, and when pushing in any position that feels best to them.

One year ago I supported a VBAC mother through both a natural childbirth series of classes and as her labor support.  Her labor began spontaneously at 41 weeks.  She called to let me know she was in labor so that I could make arrangements for my family’s care.  Around 3pm that afternoon Dad called to say she would like me there now.  I arrived to her moaning through contractions yet speaking to me in between.  She let me know how she was feeling, what she was feeling, what she’d been doing to cope and how being on her hands and knees felt so good right now.  Her biggest concern?  That she would dirty the brand new slate flooring!  Around 8:00 p.m. she decided she was ready to go to the hospital.  We left a clean home and we arrived at the hospital with her bearing down.  The midwife on call wanted mom on her back for an exam.  Mom went to her side, midwife propped one of mom’s leg’s up, saw the baby’s head and decided there was a dystocia.  Dad stated mom did not want an episiotomy, midwife said she’d let mom have one more push.  After the next push contraction the midwife cut an episiotomy and proceeded to ‘guide’ the little baby girl (just under 8 pounds) out.  We were all subjected to a lecture on how mother’s previous C/S was due to ‘failure to progress’ and she probably had pelvic issues.  FACT:  This mom’s ‘failure to progress’ was in actuality a posterior presenting baby whose birth had been augmented with pitocin and the back-up OB for this subsequent VBAC birth was on his/her way in to the hospital.

Two years ago I provided labor support for a VBAC mother whose labor began very slowly at 40 weeks.  Her first birth was a scheduled cesarean without labor for twins with Baby A presenting breech.   At the 12 hour mark with mother wanting nothing more than to just hang out at home Dad became fearful…both family and friends were calling to tell him he was crazy not getting her to the hospital right now.  We arrrived at the hospital shortly thereafter and mother proceeded to labor at the hospital for 48+ hours.  Again, the labor was never intense.  She did not experience the classic, intense transition.  More than once cesarean was brought up, not by the doctor.  Rather a second cesarean was ’offered’ by her husband and sister who was now also present for the labor.  The doctor did however bring up time.  Mom went through two doctors’ shifts and two other women’s deliveries by c/s for failure to progress.  Mom’s sister’s c/s had also been for failure to progress as she had ‘made it’ to second stage (with an epidural) and after almost two hours of pushing had made no progress.  Fortunately for mom, Dr. Carolyn Zelop of the Boston study on VBACs (and co-author of the most recent ACOG VBAC practice guidelines) was on and in the hospital (she is not affiliated with the primary careprovider) for this labor.  Dr. Zelop smiled at mom and stated the best care for VBAC is to allow for the labor to progress gently and naturally.  Were it not for two women secure in their knowledge of the birth process this mom would have been coaxed into a second cesarean.  FACT:  This mother was experiencing labor for the first time.  She labored spontaneously, naturally and consistently slowly as is typical of most first labors.  The coping mother did wasn’t easy to see because the physical aspect was not the main influence.  In other words, mother’s mind was not reflecting on pain, but rather that it was truly laboring, something she didn’t ‘know’ her body would do and did not believe her body was doing until the final release of her son into her arms.abor is physiological and nowhere is the power of the mother’s frame of mind stronger and a greater aspect to appreciate than that of the VBAC mother.  Patience and respect for the mother’s sense of security in her body are crucial to the positive VBAC experience.

Women reading this post are likely to be aware for the first time of two pieces of birth consumerisms: posterior labor knowledge is scarce among the medical birth trained practitioners and that natural, spontaneous labor is a good thing for VBACs and are likely to lead to healthy outcomes.  Families and friends reading this post are mulling over their fears over some aspects of the births and probably empathizing with the father and sister in the second birth.  Practitioners are thinking one thing and one thing only:  these mothers labored without any hands on medical observation or protocols which equates with ‘not under their control’ and therefore, must be stopped.

Have these births had an impact on VBAC care?  Yessss, in a way.  The midwifery group mentioned in the first and second births continues to support their client’s informed choice but their back-up OB group is now pushing (no pun intended) to have VBAC birth plans submitted for their review/scrutiny and approval/counterfire.  The practice mentioned in the third birth no longer takes VBAC mothers. 

The VBAC mother continues to confound the medical birth world.  She is in the precarious predicament of representing evidence of and liability for the obstetrician’s or his/her colleague’s previous actions.

More birth consumer’isms’ – VBAC mothers require mental and emotional support on a greater level than the physical coping with labor.  Medically trained birth practitioners offer little by way of mental and emotional support for laboring women as that is not in their scope of care admittedly.   A medically trained birth practitioner as the primary careprovider is NOT the best choice for VBAC labors.   It is difficult for a mother to find a VBAC pracitioner at all let alone one who has the vision to see that the midwifery model of care can provide the support VBAC mothers need and can fill the void in hospital-focused birth advocate’s call for improving maternity health care.

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