Tuesday, November 20, 2007

BBBB: part four: Being "on the Panel" and having folks back to the house

After the movie, Rixa, Kelley, Jen, Judit and I all went to the front of the auditorium and sat upon the edge of the stage. We had 2 microphones, and gave brief introductions of ourselves. I said that my name was Joy, and that I have had 3 hospital births, two of them by Cesarean, and one Homebirth VBAC, and that the experiences didn't even compare, with the homebirth being one of the most amazing and transformative experiences of my life, and the other births being difficult, lonely and damaging times to my body and spirit, with long term negative repercussions for my entire family. My waver-y voice got a bit steadier as I saw heads nodding along in agreement, understanding, sympathy, empathy. Wow. No-one was rolling their eyes at me, no one was getting ready to tell me at least I had a healthy baby. No one thought it was "good" that I had suffered needlessly. I moved from noticing nodding heads to noticing eyes-- eyes of mothers, some of them so so young and hopeful, looking at me, on a stage, like I was somebody. Somebody who might know something, might have something for them, somebody who might be able to finally help them-- but what? What did they want, what could they get, what did they need from me? Did I have it for them, or did I belong in the audience rather than on the stage? Didn't we all belong together?

The audience started in with questions immediately, which was great. It would be impossible for me to go over everything that came up, but I will tell you that the first and foremost issue for these people, these inspired and hopeful people who had just watched a movie whose theme was overwhelmingly "Have your baby at home", was HOW DO I FIND A HOMEBIRTH MIDWIFE IN THIS STATE?

Yikes. Not having studied up on the political climate of homebirth in their state, I felt panicked and unprepared for this, yet somehow wholly responsible for helping them. One mom who looked SO young, and SO intense, said she had had 2 sections and was expecting her 3rd baby, and didn't know what to do. How could I just sit up on some stage and carry on about my awesome homebirth? What could this movie do for her but infuriate and frustrate and hurt her, with the birth scenes and all? Could she come home with me in my orange racecar, and meet my midwife? I took the microphone. I told her that it can be difficult to find a midwife, because the ones that are practicing often have more than enough clients as it is, and they might be hesitant to "Advertise", due to fear of prosecution or simply being as busy as they can be already. She looked annoyed and disappointed.

I offered to the entire audience that there are websites: http://www.birthpartners.com/, http://www.midwife.org/ , http://www.mana.org/ , and just to Google the words "Find A Midwife" and start making the phone calls. you might not get someone right away, but you might get connected, get other phone numbers, leads, ideas. I saw alot of people looking at me like that wasn't enough, and I felt very impotent and lame.

How did I find my own midwife? Through a ridiculously improbable chance conversation at a birthday party with one of her former clients. So I know. Its hard---and it isn't nearly as difficult here in Michigan as it appeared to be in their state-- goodness gracious, I just had no idea. Being an hour away from crunchy Ann Arbor, anyone could find a midwife, doula, massage therapist, herbalist, naturopath, hypnotist, you name it in the way of natural healer and health care provider. I assumed it would be the same most places and I was wrong.

As the audience began sharing stories more than asking us questions, the vibe of the room was one big birth talk, which was great. There were alot of the same difficult stories, tales of the unnecessary episiotomies and the pain and disruption that this procedure had caused these young mothers, tales of breech babies and the overwhelming consensus by obstetricians as well as nurse-midwives and some lay midwives to not "let" these babies be born vaginally, despite it being a normal variation of birth, but the big topic which Rixa lead us into and which we stayed upon for the remainder of the meeting, was VBAC.

VBAC stands for Vaginal Birth After Cesarean, and until verrry recently, as in the last 4 or 5 years, it was strongly encouraged by the hospital world. But boy o boy, hot topic numero uno, especially in the state in which this meeting took place, VBAC was being BANNED in hospital after hospital. Banned. As in "we are not allowed to let your baby come out of your vagina in this building, Ma'am."


Leaving aside all of my personal experiences and opinions for a moment, and trying very hard not to over-simplify, here goes:

When a woman has a cesarean birth, there is more than just an incision. there are layers of tissue being cut, the skin of the abdomen, the fat layers, the muscle layers, and the uterus itself. When they take out the baby, they then sew up the uterus, the muscles, I don't know about the fat, but then the skin of the abdomen. They suture you up just like any other surgery. Open heart surgery, leg surgery, plastic surgery, foot surgery, dental surgery. They suture you up and your body heals. You have every right to expect this to be a normal surgery, and for the job they did to "Hold".

As in all surgeries, the post-operative pain and healing rates will vary greatly from person to person. Please bear with me as I try to stay within my own knowledge levels not as a doctor but definitely as someone who is very well versed in this subject matter through years of study and interview and research and reading and having undergone the procedure twice myself. If you can rest and eat healthy foods and be taken care of post-operatively, you will most likely not suffer any infections or debilitating pain. I had both infection and long term pain, phantom numbness, itching, swelling, oozing, tearing sensations, lasting for years, fading with time, but I know plenty of women who did not go through this.

So. Lets say you have had a c-section and you are now pregnant again. Your uterus has a scar on it, yes. But like I mentioned before, we do not expect our other surgeries to be so shoddily performed as to rip open, fly apart, or "not hold up", so what gives with the whole VBAC controversy? There is a fear of Uterine Rupture.

What is Uterine Rutpure, and what is the deal with VBAC moms and Uterine Rupture?

Uterine Rupture is when the uterus ruptures during labor. It can happen to moms with their first baby. It can happen to moms with no previous cesareans. It is very rare, but very serious. now here is the catch, ripe with irony, as are so many of today's obstetrical protocols:

The MAJOR, major attributing factor in cases of Uterine Rupture, both in VBAC moms and unscarred uteri, is the use of induction drugs. Pitocin and Cytotec. The very drugs that in some states, over NINETY PERCENT of women are being subjected to during labor in the hospitals.

When you start talking about "90 percent", you are talking about a vast, vast majority, correct? when you start talking about "90 percent", you start seeing "Birth" as a women hooked up to induction drugs as a matter of course. When you introduce these drugs into a woman's body, the cavalcade of other interventions increases exponentially. Because these drugs make the uterus contract very, VERY strongly. And there is no way of telling exactly how one woman's body will react to these drugs versus another woman's body, so so many things can get really out of control when you use these drugs. Super hard contractions. Super long contractions. Decels in heartrate, drops in blood pressure, raising of blood pressure. Extreme pain. Fetal distress. But the one that we need to be most concerned with to stay on topic here are the Super Hard Contractions. Contractions so hard that they can cause a uterus, especially one that has a scar on it, to rupture.

So. What do we have. We have a nation of women who are getting nearly all of their births augmented with oxytocic drugs, leading to higher and higher rates of primary cesareans. then we have "statistics" coming out that VBAC mothers have a higher rate of uterine rupture than vaginal birthing women, and so, boom! Lets simply ban VBACS. We cut ya once and now you are a section-lady for life. We dont trust you to birth and you shouldn't trust our sutures to hold up. You're gonna BREAK and DIE. Lovely.

Wow. So what about some initiatives into reducing primary c-section rates? What about some sound advice as to how to keep the VBAC moms away from the Pitocin (total ban on all induction/augmentation for VBAC moms) banning the deadly Cytotec (more on Cytotec) (still more on Cytotec) (a good study of why Cytotec is way bad for VBAC moms) altogether, and getting some real statistics into the hands of the allmighty ACOG?

What has changed since 2001 that has sent all these hospitals scrambling to simply ban VBAC rather than persue these other channels of prevention and fact? Did that many women really rupture? What is the real increased risk of rupture for ALL women, and what role does Pitocin and Cytotec play? what about the role of restricting movement of hospital birthing women, of restricting their access to quiet or privacy or nourishment or positional changes? What about the role of the other common birth interventions such as AROM (breaking your water with a amnio-hook) lying on your back, forced purple-pushing (holding your breath while they scream 1-2-3-4-5-6-7-8-9-10 at you, despite your own bodily urges to push or rest....what roles do these practices play in putting the uterus in danger of rupturing? Does anyone care? Don't the hospitals get about $19,000 for a straight-forward cesarean, versus about $4000 for a vaginal delivery? And to ban VBAC in a climate where primary cesarean is on the rise in nearly every state guarantee more repeat clients at that $19,000 level?

Hmmm. Sick yet? Angry yet? Feeling defeated, or inspired? Or both? Marsden Wagner was more right on than anything else is saying that birthing women need to first and foremost get the hell out of the hospital, huh?

Its alot, this whole VBAC thing right now. And that's where we stayed with our audience that afternoon. Managed birth after managed birth "ending up in" a primary c-section, and now the women feel that they can't find a midwife for their homebirths they so desperately need and want, and they don't even have a chance to VBAC in their own hospitals. Where is the hope? What can seeing this movie mean for these people? For their friends? For their daughters and daughters-in-law, their granddaughters, their sisters?

Many women go to a midwife for their first VBAC. They didn't know about homebirth, or they were "Afraid" of the idea of it, and now they have a scar and now they wanna know. I did this, I had a VBAC at home, an HBAC they call it in the abbreviation-world. But guess what else I was the most disappointed to find out that day? Some midwives are joining the band wagon now, especially the nurse-midwives, the ones who work in the hospitals, the fancy birth centers, but even more sadly, some of the lay midwives. Because of politics. Fear of lawsuit. THIS IS NOT evidence-based care, people, not even close.

Where else we went with this as a group discussion was a united urgency in helping mothers to avoid that first section much more aggressively, with "stay the hell out of the hospital" as the first and most obvious call to action for primips (1st time mothers).

We needed to get out of the auditorium, so Rixa invited any and everyone to come back to her house. I was skeptical, but they came! Just from memory, I would say that a dozen or more women took up the offer to continue the discussion at her home, a very high turn out, judging just from my own past experience in attempting to have a political event at the house, a dozen is a HUGE turnout. Very very inspiring. We got to chat much more intimately outside of the auditorium setting, of course, and I made a few personal contacts with a few very wonderful people-- a doctor, a doula, and the young mom who had the episiotomy and went on to have a homebirth with her second child. We exchanged emails and blog names, and it was just so important, so validating, so real, to have these flesh and blood people who felt the way I felt and who were fighting for things that I was fighting for,and who were asking me questions, all sorts of questions about my state, my own stories, wanting advice, wanting input. It was amazing. I will never forget the feeling in that room that evening, ever.


Maria said...

Joy, I was so pleased to see you talking about VBAC and homebirth in a positive light and encouraging the women in the audience at the movie. You should check out ICAN www.ican-online.net and pass it on to anyone who you think might need it. ICAN is a non-profit organization that focuses on maternal-child healthcare by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting VBAC.

Kelley said...

Thank you so much for being so passionate about this. You make a difference with what you write. I've heard you say some of this, and yet reading it in your words makes a very powerful impression.

Trish said...

Wow - what a discussion! I know you had to be so frustrated to not have more to give to those ladies. But - I have to think that you are an inspiration to them. You're so passionate and you've lived a HBAC.

Okay - this is the sickest thing I've heard lately (about hospitals banning VBACs)! I am now SO convinced that the VERY worst thing a pregnant woman can do is trust her body and her unborn baby to a hospital/doctor (not that I wasn't convinced already). I felt ill just reading this. So so sad and something MUST be done about it!

Maria said...

So I read your blog, I enjoy it a lot. Usually I don't comment, but I did want to disagree with one thing you wrote (I know, isn't it terrible the one time I comment is when I want to say something negative). But you said you wanted to ban inductions of VBACs. If that were the case I never would have gotten one. My first daughter I had a c/s for severe pre-eclampsia, essentially my kidneys and liver had shut down by the time the docs figured out what was happening. I didn't go into labor at all, it was not what I expected at all and it was not a pleasant experience.

Second time around I knew a lot more about pre-eclampsia. When any sign of it showed up, I demanded tests for it. They looked at me like I was crazy, saying I probably didn't have it, but I said run the tests anyways. Turns out I was pre-eclamptic again, but mild this time. I was able to be induced and have a VBAC. My daughter needed to come out and with your suggestion I would have had a repeat c/s instead of a VBAC. Anyways, I just wanted to say there was reasons for inductions, even in VBAC mommas.

I'm glad you enjoyed your trip, it sounded like a lot of fun, I'd love to see the movie, but doubt it's coming to me.

Joy said...

Thank you for sharing your story, Maria!

I am sure there are many many instances like yours. I am not in a position to ban anything, I am not a doctor or midwife, so I guess I think I can say stuff like that because I feel like it. But youre right-- hopefully they would go realllly easy with the pit-- or perhaps try some herbs or other ways to initiate labor on a VBAC attempting Mama. I'll watch what I propose :)

Michelle said...

Cool to read about the panel discussion! I usually just read your Hearth and Home blog but checked this out from my friend Jen B's blog. What a great report of the whole affair you gave. I was lucky enough to see the flick here in Phoenix and take a 7month pregnant friend with her first. If we could only reach EVERY woman and get the resources and education to them..
I enjoyed all of the "parts" of the story.

Angi said...

Good for you! I'm so glad you got to have this great experience. I know Kell had a "fabulous" time.

kris said...

so glad you shared all this w/ us. and my heart aches, i had a could be vbac client who i talked to last night and is "so happy" w/ her ob, who is pro-vbac, but told her that b/c she has such large babies that he will only let her go to 39-40 weeks b4 he takes baby c/s. i was mortified, but could only say so much. i did encourage her that there are lots of things to do to encourage natural induction *wink*wink*

also, i have a great link to an article by ina may about the horrors of cytotec if you want it let me know...