Lest this fallacy proliferate amongst the populus, and given the limitations of what I am allowed to defend directly to my friend, I will go into detail surrounding my first c-section here on my own blog, to those who may be curious as to the actual facts of my life.
I was not necessarily knowledgable of the terrible snowball effect that Pitocin often kicks off when I was expecting my second child, and did discuss induction with my OB around 36, 37 weeks. Lots of doctors and patients discuss this.
BUT THE REASON I BROUGHT IT UP was due to the fact that I was suffeing from a severe form of Pubis Symphasis Disorder: (excerpts from pregnancy.com and plus-size-pregnancy.org)
Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating. One woman wrote, "There were days that I didn't think I was going to be able to get out of bed and actually had to roll out of bed and onto the floor to be able to do so!" [See her story below.]
Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful.
Many women also report sciatica (pain that shoots down the buttocks and leg) when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.
Many women with SPD also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPD problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, it probably is associated with the SPD.
Onset of Pain and Duration
Pubic pain often comes on early in pregnancy, even as early as 12 weeks. One mother reports that she had it at 17 weeks. She says:
When I woke up [from my nap] I could hardly move. It took me forever to walk into the next room. Felt like my hips/pelvis were glued together or something. Already this baby feels sooo heavy inside me, like lots of pressure. I've gained 4 lbs. so far, what's the deal? At night when I wake up to go to the bathroom, sometimes I can't move my legs/hips at all, and sometimes things have to 'pop' back into place. I think, what if there is a fire and I died 'cuz I'm too slow!...I thought this problem in my 1st pregnancy was from gaining so much/swelling and it got worse and worse and stayed till over 3 months postpartum."
Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged. This is called Diastasis Symphysis Pubis (diastasis means gap or separation).
To summarize, SPD is the mild form of this problem. Its symptoms often include one or more of the following:
pubic tenderness to the touch; having the fundal height measured may be uncomfortable
lower back pain, especially in the sacro-iliac area
difficulty/pain rolling over in bed
difficulty/pain with stairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.
sciatica (pain in buttocks and down the leg)
"clicking" in the pelvis when walking
difficulty getting started walking, especially after sleep
feeling like hip is out of place or has to pop into place before walking
bladder dysfunction (temporary incontinence at change in position)
knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems
some chiropractors feel that round ligament pain (sharp tearing or pulling sensations in the abdomen) can be related to SPD
No one knows why SPD occurs for sure, or why it happens in some women and not in others. Some ethnic groups report a high incidence, especially Scandinavian women and perhaps Black women. Other risk factors may include having lots of kids, having had large babies, pre-existing problems with this joint, past pelvic or back pain, or past trauma (car accident, obstetric trauma, etc.) that may have damaged the pelvic girdle area. It also seems logical that women who have broken or injured their pelvis in the past would probably be prone to this problem.
Some sources view SPD simply as a result of pregnancy hormones. As noted, the pregnancy hormones relaxin and progesterone tend to loosen the ligaments of the body in preparation for birth. One theory is that some women have high levels of hormones before pregnancy, and then additional pregnancy hormones cause excessive relaxation of ligaments, especially in the pelvis.
Another theory is that some women manufacture excessive levels of relaxin during pregnancy, causing pelvic laxity. However, although still popular, this theory seems to have been disproven by recent research. Another theory is that women whose joints are especially flexible before pregnancy may be more susceptible to the effect of hormones, or that some women's bodies are just more affected by hormones than others. Traditional medical sources tend to view the problem of pelvic/pubic pain (when they acknowledge it at all) as simply a hormone problem.
A different theory holds that the problem is structural instead, and usually results from a misalignment of the pelvis. In this view, if the pelvis gets out of alignment, the bones don't line up correctly in front, and this puts a lot of extra pressure on that pubic symphysis cartilage. If the two sides are not aligned, it restricts full range of motion, pulling on the connecting pubic symphysis, and making it quite painful. The more out of alignment it is, the more painful this area becomes. It also tends to affect the back, especially in the sacroiliac area, since the pelvis and back are interconnected and work as a unit. And since many areas are affected by back problems, pain can also extend to other areas too.
Needless to say, caring for my 2 year old was becoming increasingly difficult, babysitting was non existent, even though both sets of grandmothers worked only until mid afternoon and obviously had weekends off, the prevailing attitude of "you wanted to get pregnant" still prevailed as an undertone when discomforts and difficulties arose for me. The biggest problem with the disorder for me was walking on stairs or bending or rising or turning. Living in an upper flat and going pee every 1/2 hour had me in tears from about 7 months on. We purchased an airmattress so I could sleep on the floor and we watched alot of TV, Greta and I.
I did talk to my OB about induction, and was told that they do not do it until 39 weeks and to "get some help around the house--dont you have any family or friends in town?" Sigh.
So where does the eventual c-section come in? I'll tell you now:
It was June 12th, and time for a prenatal appointment. I took Greta with me as I always had to, and she had just turned 3 years old. There was a particularily long wait in the waiting room that day, and the handful of dirty bristle blocks that was the "play area" in the waiting room had topped being intriguing months ago. I was really really getting hungry and weak, and Greta was uncharacteristically whiney. She said she had to go potty about 4 times, which involved a big walk out to the main lobby, paranoia that I would miss being called, bending, walking, cajoling, and her saying she actually didnt have to go pee after all. Ten minutes of handwashing toddler bullshit ensued, etc. Each time I would go back to my seat, I was more and more angry and hungry and sitting in the chair was absolutely KILLING my crotchbone.
They finally called me in, and then left me to sit on the little waiting table with my fat legs dangling. Greta was climbing onto the one chair that was in there, and trying to take the painting off the wall. She wanted a cotton ball, she wanted to go pee again, she wanted a napkin, she was hungry. I stopped even answering her, i was starting to feel as if I was going to throw up out of heat and anger and starvation. Nobody came, and now I had to pee. So off me and Greta go to the bathroom again. Greta was crying now because she "had to poo" and never had done that without her little potty chair. i was not a very nice mommy, i was snapping at her and telling her she wouldnt fall in the toilet and i was trying to bend over and hold her up and she was crying, and somehow finally did not poo. We waddle back to the room. i could scarcely breathe and was having hot flashes.
When the nurse came and checked my blood pressure, it was "up"--- 138 over 90. i tried to tell her all about how it was June, how long i had been waiting, how hot and hungry i was, how impossible my toddler was, and she said she would be "right back".
When she returned, i was told that "given my history" (of pre-eclampsia with 1st pregnancy, a disorder which is very misunderstood by the medical community at large, but which one of the many signs and symptoms of which is elevated blood pressure) I needed an ultrasound.
So that was fun with the three year old....more waiting, she wouldnt sit in the chair in the ultrasound room, at one point she toddled out of the room and i was up on the table being ultrasounded and the lady didnt even go get her, even though the doors around the corner led right out to a major street.
The ultrasound, which was to see how big the baby was, said he weighed 10 pounds, 9 ounces. As some of you already know, it turns outhe weighed 8 pounds, 11 ounces. Heres some information about the accuracy of ultrasound in determining fetal weight in the third trimester. I could just do a hyperlink but I doubt everyone will take the time to click. If you would like to do your own search, try googling "Accuracy of ultrasound fetal weight"
Ultrasound for Estimating Fetal Weight
Many OBs are fixated on the supposed "dangers" of a big baby (officially known as macrosomia). Definitions of what constitutes a "big" baby differ, but most research chooses one of the following three cutoffs: 4000 g (just under 9 lbs.), 4500 g (9 lbs. 14 oz.), or 5000 g (about 11 lbs.). The average size for babies is somewhere around 7 and a half pounds, but babies vary widely around that and are still born just fine. Although most research considers babies above 4000g to be macrosomic, the American College of Obstetricians and Gynecologists considers 4500g to be a better cutoff for macrosomia.
Although the risks for shoulder dystocia (baby getting stuck at the shoulders) and birth injuries are increased somewhat among big babies, in actuality MOST big babies are born vaginally without any problems. But because a few big babies have problems, and because doctors tend to get sued over these types of cases often, they fixate on whether the baby is big or not, in hopes of preventing shoulder dystocia and birth trauma.
This worry leads to one of the most dubious uses of ultrasound----an ultrasound for estimating fetal weight. This practice is very controversial. Research clearly shows that ultrasounds for estimating fetal weight are often quite inaccurate, and especially so at the extremes of size (extra-small or extra-large). Doing ultrasounds for estimating fetal weight is a very questionable policy, but many providers routinely do it anyhow.
The accuracy of ultrasound for detecting macrosomia seems to run generally from 50% to 65% or so, very low accuracy to be the basis for so much intervention. For example, Pollack et al. (1992) found that only 64% of the babies estimated to be macrosomic (big) actually were. Levine et al. (1992) found that HALF of the ultrasound predictions of fetal weight were incorrect. Delpapa and Mueller-Heubach (1991) found that 77% of ultrasound fetal weight predictions exceeded actual birthweight and only 48% were even within 500g (about one pound) of the actual birth weight. Furthermore, 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren't macrosomic at all.
Notice that predicting macrosomia through estimated fetal weight is as accurate or only slightly more accurate than tossing a coin! It is not very good science. Yet doctors routinely continue to order ultrasounds to estimate fetal size, particularly in large women. And these incorrect predictions continue to result in huge amounts of intervention, which have major health implications.
For example, when the baby is predicted to be 'big,' the doctors often induce labor early in the mistaken belief that this will be more likely to result in vaginal birth and to avoid birth injuries. Or they strongly pressure women (especially big women) to have an elective cesarean, which brings its own set of substantial risks, both for this pregnancy and any future pregnancy the woman may have. Unfortunately, research shows that early induction and/or elective cesarean for macrosomia are NOT justified in non-diabetic women, and may be questionable in some diabetic women too.
In many cases, induction strongly raises the chance of a cesarean (instead of lowering it), and may increase the risk for birth trauma as well. Levine (1992) found that inducing for macrosomia increased the cesarean rate from 32% to 53%, and Weeks (1995) found that inducing increased cesarean rates from 30% to 52%. Leaphart (1997) found that inducing for macrosomia increased the cesarean rate from 17% to 36% in a facility with a generally low cesarean rate, and Combs (1993) found that inducing for macrosomia increased the cesarean rate from 31% to 57%!
Even when inducing early did not increase the cesarean rate (Gonen 1997), it did not improve fetal outcome or lower the rate of shoulder dystocia. In fact, in some studies, inducing early actually increased the rate of shoulder dystocia (Combs 1993, Jazayeri 1999, Nesbitt 1998). So although most OBs have been taught that early induction for macrosomia will decrease the chances for cesarean and lower the risks for birth injuries, research actually shows that the opposite is true.
Even simply the PREDICTION of macrosomia by estimated fetal weight significantly changes the way the doctor perceives and handles the labor, and strongly increases the rate of induction and/or cesarean. Weeks (1995) studied the effect of the label of predicted macrosomia. Those women who had been predicted to have big babies had a 42% induction rate, and a 52% cesarean rate! Yet the big babies in the study who were NOT predicted to be big had only a 27% induction rate and a 30% cesarean rate. There was no difference in size between groups; the only difference between groups was the PREDICTION of a big baby. The authors concluded, " Ultrasonography and labor induction for patients at risk for fetal macrosomia should be discouraged."
Parry (2000) also found that the mere prediction of macrosomia raised the cesarean rate. In this study, the cesarean rate for average-sized babies that were predicted to be big was 42%, whereas the cesarean rate for average-sized babies who were predicted to be average was only 24%. Again, the babies were the same size, but the prediction of macrosomia was enough to nearly double the cesarean rate. In fact, in this study, just doing the ultrasound to estimate fetal size increased the cesarean rate, which was 20% in the overall population but increased to 40% overall in the women scanned for estimation of fetal size.
Another study, Levine et al. (1992), analyzed the management of labor based on prediction of macrosomia. Women predicted to have a big baby were diagnosed by their doctors as having more labor abnormalities (30% vs. 19%), had more epidurals (74% vs. 57%), and more cesarean deliveries (53% vs. 32%). The authors finished by stating, "We observed an association between sonographic estimation of fetal weight at term and the management of labor and delivery. Whether a true cause and effect relationship exists cannot be determined from this study, but, based on our findings, we urge caution in the use of sonographic estimations of fetal weight to guide obstetric decisions concerning labor and delivery."
Obviously, the mere prediction of macrosomia strongly increases the labor induction rate, and in most studies, the cesarean rate. In most studies, there were no significant differences in shoulder dystocia or birth trauma between groups (or the rate was increased in the intervention group), so the strong interventions did NOT improve outcome at all! Yet this is still common practice among most OBs, and especially so in large women.
Sacks and Chen, 2000, reviewed the evidence in the medical literature from 1980-1999 and concluded:
Sonographic estimates are no more accurate than clinical estimates of fetal weight. Regardless of the method used, the higher the actual birth weight, the less accurate the birth weight prediction…To date, no management algorithm involving selective interventions based on estimates of fetal weight has demonstrated efficacy in reducing the incidence of either shoulder dystocia or brachial plexus injury…For all these reasons, incorporating estimates of fetal weights in the care of nondiabetic pregnant women deemed at risk for macrosomic neonates seems to be unsupported…Available evidence suggests that planned interventions based on estimates of fetal weight do not reduce the incidence of shoulder dystocia and do not decrease adverse outcomes attributable to fetal macrosomia. [Emphasis Kmom]
Henci Goer, author of The Thinking Woman's Guide to a Better Birth, sums it up when she states, "Studies [on macrosomia] comparing induced women with women allowed to begin labor on their own all show that induced women have more cesareans and equal numbers of shoulder dystocias...Shoulder dystocia isn't very tightly tied to weight, and while it's a dangerous situation, handled properly it rarely results in permanent injury."
Numerous studies have concluded that the best plan is not to induce labor or to have an elective cesarean, but to prepare and train so that IF a shoulder dystocia occurs, the provider can handle it with the least risk for birth injuries. It's the handling that often causes the birth injuries, and proper training can reduce that risk significantly.
Doing an ultrasound to estimate fetal weight near term is a very common practice, one still employed by many OBs, especially with large mothers (see the FAQ on Large Women and Ultrasounds). However, research clearly shows that this is a very questionable practice. The accuracy rate is very low, many women are pressured into interventions that do more harm than good, and even the mere PREDICTION of macrosomia alters the way physicians perceive and treat labor.
A number of studies have questioned the use of ultrasound for estimated fetal weight. Given its inaccuracy and resulting interventions, this does NOT seem to be a justifiable use of the technology unless co-existing conditions like diabetes are present (even then, some research questions it use). However, it does remain common despite the research against it.
Excerpted from Plus-size-pregnancy.org
So, after the ultrasound, and more waiting around, one of the many actual doctors came in and said "We're goona get you goin' today. How's that sound, Mom? "
I was really caught off guard. I said why, and they said well you got a big baby in there, and we dont wantcha to get preeclampsia, with that blood pressure up like that, theres really no reason not to getcha goin'.
oh fateful rueful day why o why o why o why did'nt i know that i didn't have to do this to my body or my baby or my future?
But instead of doing anything whatsoever like I should have done, I instead waddled out to the waiting room, used the doctor's phone to call my husband at work and drove to what I knew was to be my last food for who knew how long.
I went to the hospital, my perfectly non pre eclamptic self and my fetus and my husband and I, and got into my tiny blue gown in my tiny blue bed. (I thought myself quite the modern day rebel by refusing to take off my bra, as nothing feels quite as disgusting or gross as having 9 month pregnant breasts rolling around in a tiny blue gown for no reason other than to humiliate and infantilize you with nudity.)
They plug an IV into my arm.
They plug pitocin into my arm.
They strap a blood pressure cuff around my arm.
They strap a contraction monitor around my belly.
They strap a fetal heart monito around my belly.
We talk and watch TV.
They come in and break my amniotic sac.
The contractions start hard.
They stick a catheter up my pee hole without anesthesia.
They screw a metal heat rate monitor up through my birth canal, through the cervix, and into Mickey's skull.
They tell me I can have an epidural if only I will give them more blood.
They are so sorry but they need more blood.
They are so so SO sorry but they need more blood.
They cant even express how sorry they are, but the blood keeps clotting and they need more blood.
They hate to even tell me this but they need more blood before anesthesia can come in.
Would I like a little something in the meantime to take the edge off?
A little something makes me vomit and wretch and the auditory hallucinations begin.
I request Phenergan and receive. Vomiting stops, but nausea remains.
I have vomited out my catheter. Naughty. Jab jab jab twist jam.
Anesthesia is here.
Epidural doesnt work on the left side of my body.
They are so sorry.
Would you like alittle something more to help you rest?
I sleep for 30 years. A monster truck has parked on me and I cannot breathe. I am in a sea of vomit but there is no air. The truck rolls back and forth and is getting hot. The epidural has seized my right lung and no can hear me scream under the vomit-sea.
Honey its time to push, now. honey. honey. honey wake up honey. A sea of vomit with honey on the top, keeping me from surfacing, sticking the truck to me harder.
2 Women and a doctor I have seen once months ago are looking down down down at me from the bottom of the vomithoney sea I can see them, but barely...honey...honey..youre gonna need to give us a lot better push if you wanna see this baby....what baby?
Honey you need to push harder than that, lets getcher legs up, lets getcher legs up, Dad, lets get her legs up...ok honey 1 2 3 4 5 6 7 8 9 10....can you keep yer legs back? Honey?
There is a sword now, a valiant, gleaming silver sword. It has come down from the sky, through the roof of the hospital, down through the skin of my lower right side, through my ovary, through the table, down through the lower floors of the hospital, down into the core of the Earth. Such pain i have never even thought existed, never dared to imagine, akin to being electrocuted, such was the jolting, jarring flame from the sword from the sky when I try to move one muscle on the left side of my body. I try to tell them to not not not not touch my left leg but instead a far away moan escapes my lips..."Nooooooo....my leg....."
(I was experiencing a "window" where the epidural does not spread out properly throughout the lower half of the body, but, rather, concentrates and disseminates nerve pain elsewhere. This can be an error on the part of the technician who placed the epidural into the spinal space or due to Maternal immobility. When laying supine, and occasionally during uprght labor, the baby can come down and trigger nerve pain which is felt as leg pain. In a mobile normal labor, the mother would simply move positions and the pain will usually subside, as in a foot that has fallen asleep, etc)
Honey you gotta push, right down in your bottom, honey.
Doctor holds hand held device up to his mouth and says in a voice that doesnt even have the decency to be a hushed tone, and I quote: "Probably a section"
Honey you seem so bushed, honey, this baby aint comin out. (To Steve) She really gave it a good try, but thats a big baby in there, and I think she's just bushed, huh Dad? What do you think, Mom, you wanna give it one more try, Mom? Can you lift your leg, Mom, at all? Can we roll you onto your side, Mom?
Steve is being handed little blue folded clothes and a mask.
The contractions are gone and my bed is being pushed down hallways. They strip me down completely naked and bright lights are beaming down onto my naked body. I am chastised for having my bra on and it is removed over my head without unlatching it. I am convinced that my head is lower than my body, much lower, and the effect is dizzying and terrifying. the blue sheet goes up and I know i have seen this on a Baby Story a zillion times. Where is Steve. Where is Steve. All of a sudden he is there, little eyes under the mask looking unfamiliar and so so so scared. I try to reassure him ( ! ) and my voice catches in my throat. They ask me Miss Leach Miss Leach can you feel this? Can you feel this? I say no.
Then I cannot breathe. I cannot take in a breath. Cannot. I start to cry, the tears rolling up my head, confirming that I am indeed upside down. I tell Steve I cant breathe I cant breathe and they tell HIM "its from the spinal. it goes right up to the diaphragm. its normal. its normal"
CRUSHING SMASHING CRUSHING PRESSURE on top of me.
A coneheaded baby is lifted up over the blue screen for .00001 seconds. Steve looks at me and says "its a boy." We knew it.
Then I start vomiting. Hard. But I cant move and cant project it out of my mouth. im gonna die like Hendrix. I am drowning. Steve lifts my head. I vomit and vomit and vomit and vomit, crying and making horrendous horrendous sounds. the doctor is SUPER PISSED OFF and says "Give her something, Jesus Christ" to someone. they do, and I fall asleep.
I am woken up by hard hard shakes, a physiological reaction to birth and anesthesia. I feel like I will shake too much and they wont stich me right, if indeed I am being stitched at that time. The blue screen seems 100 feet tall and I do not know if anyone is in the room. A nurse comes over to my upside down head and says "Dad and baby are together, hes a gorgeous baby, you did great! Whats his name?"
i just look at her
then I say "Mickey Holland."
"not Michael? just Mickey?"
"I LOVE IT!"
(thank you lady.)
I could contunue with this story as there were many more amazing times to be had in that hospital and the 6 days I was there.
But as this blog entry is in response to my old friend saying that I had the section because I--what was it again? Begged for it? I will stop here.
now why is it again that we wanted a homebirth for our next baby?....oh I remember now! To be kooky!