Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

A Very Inspirational Update March 30, 2010

This one is for all you VBAC mommas out there!!!

In October of 2009 I posted a letter sent to me by Kelly, a mother who, at 35 weeks of pregnancy, was startled, hurt, confused, angry, and scared to find out that her supposedly VBAC friendly obstetrician was actually leading her on the whole time….

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Dear Nursing Birth,

 

I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)

 

I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!

 

And how does the doc get away with not telling me something important like this until NOW? Unbelievable!!  My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time.  I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!

 

If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.

 

I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!

 

I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time! 

 

Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).

 

Sincerely,

Kelly

 

 

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I replied to Kelly in my post entitled “The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On” with words of encouragment and some information about other scare tactics that some health care providers use to intimidate VBAC planning mommas.  My main message was this:

“You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for.  Your desires for said unmedicated, intervention-free VBAC are well supported by the research.  You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC.  You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE.  You deserve it for THIS birth. “

 

Fast forward 4 months.  I was struggling with the thought of returning back to blogging as NursingBirth.  I was working for a hosptial with a 40% C-section rate.  I was feeling powerless.  Until I saw this in my inbox…..

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Hi Nursing Birth!

Hope you still plan to come back after you settle in from your move- we miss your great posts!

 

Also, just wanted to say thank you -again- for posting about my comment awhile back!  I wanted to update you and tell you that I had a successful VBAC!  Thanks for your suggestions, resources, and support!

 

You can read my story over at my blog:  http://chun-beeks.blogspot.com/2009/12/happy-birthday-john-carl-fischer.html

 

Hugs and best wishes,

Kelly

 

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Needless to say I was touched, proud, empowered, honored, and ESTATIC!!!   There is no doubt in my mind that Kelly’s email was a main factor in my decision to return to blogging as well as take the plunge and start yet another new job!  So thank you Kelly for being just as much of an inspiration to me as I was to you!!!  I am so lucky to be a part of this awesome community we call the “birth blogosphere” 🙂

Congrats again Kelly!!  You rock!!

NursingBirth

 

Hey NursingBirth!!! Where the HECK have you been?!?! March 29, 2010

Filed under: Ramblings — NursingBirth @ 11:57 AM
Tags: , , ,

 

“Hey did you hear what happened to Nursing Birth?  I heard she was struck down by a bolt of lightning when she encouraged one of her patients to push in an upright position instead of on her back in stirrups!  She hasn’t been the same since!!

 

“No, no no…you’ve got the story all wrong!  I heard that the government had to put her into the witness protection program after she suggested to a  room full of obstetrical residents that a woman could indeed deliver a baby WITHOUT pitocin!  And it didn’t help matters when she then told the group that women do not have to have a vaginal exam every two hours while in labor!  That really set them over the edge!!

 

“I heard she was captured by an angry mob of obstetricians after mentioning the possibility of a TOLAC for a woman who showed up on the ward in labor after 5pm at night!  They held her captive on a deserted island where she was forced to listen to lectures touting the “benefits” of elective primary cesarean sections for all pregnant women!!”

 

“You know what I heard?  I heard she had a nervous breakdown after hearing 20 maternity nurses simultaneously utter the phrase “Why don’t you just let us take the baby to the nursery tonight and give him a bottle so that you can get some rest” while at the same time shoving a box of pacifiers into her mouth!

 

“No, you all have it wrong!  I heard that she had to flee the country after a group of anesthesiologists overheard her admit to a patient that indeed epidurals do carry some RISKS to both mothers and babies!  Rumor has it they chased after her screaming “HERETIC!  BLASPHEMY!”

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No you are not seeing things!  It’s really ME!  Your old friend NursingBirth!  I’m sure you all just did a double take when you saw my post pop up on your google reader but it is true, I am back!  However as hard as it is to believe, none of the above scenarios are true! 

Despite the fact of me being back, however, being “better than ever” is unfortunately debatable.  The last 5 months have been a whirlwind of highs and lows, with Christmas time with my family, a newborn nephew, and more than double the amount of sunny days being a few of the “highs” and the selling of my first home, moving TWICE and to a new state, dealing with the bureaucracy of multi-state boards of nursing, a panicked job search, a husband out of work, moving away from my very best friend, and starting a new job as being some of the, well… “lows.” 

When I wrote my last post back at the end of October, (WOW, I haven been “gone” for 5 months.  No wonder why my readers have been getting frantic!!) I truly did think that I would be back in action at the computer in only a few weeks.  But the multiple moves really took a lot out of me especially since we spent one of those months without the internet.  (AAHHH!  NO INTERNET!  Lame I know but I am crippled without it!!  Haha!)  However, the biggest hurdle that I had to overcome in order to return as “NursingBirth” was my “new” job. 

Why was my “new” job a hurdle you ask?  Seems like a new job would bring an endless amount of new material.  And in reality it absolutely has.  However as I stated in my last post, when my husband and I decided to move and hence leave behind my “old” job (which hereby will be referred to as “Big High-Risk Urban Hospital” or BHRUH) I started out on a quest to find and work for a hospital or birth center that was both truly mother-friendly as well as baby friendly in their philosophy, attitudes, actions, and outcomes.  I did not want “more of the same.”

But what happened is that I, NursingBirth, became a victim of the Ol’ Bait and Switch!!!!

What was supposed to be a beautiful beginning to a long career at a nice community hospital turned into a deep depression as day by day I realized more and more that I was in waaaaaaaay over my head.  However, I wasn’t in “over my head” as far as my nursing skills or knowledge was concerned.  In fact, I saw, experienced, and managed  situations at BHRUH daily that the nurses at my new job (which will be henceforth referred to as “Bait and Switch Community Hospital” or B&SCH) experienced monthly or even yearly.  (Not that that is good or bad.  No value judgements here.  I also fully acknowledge that there is still much I have to learn and have yet to experience as a nurse.)  I was in way over my head because the “mother friendly/baby friendly” hospital that I thougth I was working for was actually a:

 

“Don’t under any circumstances rock the boat or the nursing leadership will throw you under the bus–We do things here this way because that is the way we have always done them so don’t confuse me with the facts– If you don’t give me my way I’ll just take my patients to your biggest rival instead– Look at all our big screen TVs and SHINY THINGS while we distract you and seperate your baby from you at every possible opportunity– Your nursing license and the safety of the patients comes second to keeping doctors happy– Give them all an epidural at the door to keep them quiet– My C/S rate goes up when I am in a bad mood– Every admission to the nursery= More money for the hospital–No midwives allowed–You can’t do anything to change things here because nurses are not an equal member of the healthcare team” hospital.

 

   And it wasn’t until I made the very hard decision to leave B&SCH that I have had the motivation and inspiration to start writing again.

But today I also come to you with good news!!!  As of May 3rd I will be starting a yet another NEW job at community hospital #2 which I will from here-on-out be referring to as “Birth Center in Disguise” or BCID!!  Luckily my decision to leave B&SCH coincided with a random, word-of-mouth, unlisted job opportunity at BCID that lead to an interview and job offer last Thursday!!!  I feel revitalized and excited and nervous and joyful as well as so many other emotions that I just had to write about them all!! 

I hope you will all stick with me over the next few posts as I process and debreif the last 5 months of my life.  I feel like there is so much I want to share with you about what I have been going through and I haven’t had anyone else to process all this with!  I also want to appologize for going MIA for so long.  It was so hard for me to come back but I hope that I am back for a long time.  I didn’t realize how much I really got out of blogging and I really missed how much I learned from all of you!

Thanks again for all your words of encouragement and pleas for me to return over the past 5 months.  There is no doubt that without them I would never have returned!  You all rock!!

Sincerely,

NursingBirth

 

The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On October 21, 2009

Submitted on 2009/10/20 at 3:24pm

Comment under: Urgent Message from ICAN! Please Spread the Word!!

Dear Nursing Birth,

 

I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)

 

I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!

 

And how does the doc get away with not telling me something important like this until NOW? Unbelievable!!  My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time.  I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!

 

If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.

 

I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!

 

I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time! 

 

Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).

 

Sincerely,

Kelly

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Dear Kelly,

WOW!  I am so sorry that this is happening to you.  You story deeply saddens, frustrates, and angers me because unfortunately YOU ARE NOT ALONE!  Women all over this country have to fight everyday for their VBACs.  Too many are unsuccessful.

First off I want you to know that your gut is absolutely right; 40 weeks is NOT too late and the research does NOT support your obstetrician’s claims.

Second, if that hospital is actually considering revising their entire VBAC “policy” in response to one mother who, as it sounds to me, shook the boat a little bit by demanding better care as well as exercising her right to informed refusal, they are absolutely outrageous and ridiculous!  I would be skeptical of that story if I hadn’t recently read this about the sign placed at the entrance of the Aspen’s Women Center in Provo, Utah.

Third, sounds to me like you did everything right!  You found what you thought was a VBAC supportive care provider, you researched your options and decided you wanted to stack as many cards in your favor as you could for a successful VBAC by planning a drug-free/intervention-free childbirth, you wrote up a birth planthat you painstakingly went through “line by line” with your physician early on in your pregnancy, you have sought out and taken childbirth preparation classes that are geared towards not only providing knowledge about how to have a successful natural childbirth but also help in preparing mentally and emotionally for such an important journey (and on top of that you took those classes with your husband!), and you even hired a doula.  (Yup!  Just as I suspected…you did everything you could!)  So what happened?!?!…

Unfortunately you are a victim of the ol’ bait and switch.

It happens to women everyday around this country.  And its existence is further proof that our maternity system is broken, in shambles really.  There are some obstetricians, family practice physicians, and yes, even midwives that have become really friggin’ good at this awful game.  Women write in to me all the time with similar frustrations and complaints as yours, Kelly.  And I always find myself helpless and speechless.  I don’t know how to help women avoid it and I struggle everyday in my own professional life with how to fight it and stop it!

The worst part of the ol’ bait and switch is the feeling of betrayal that most women report experiencing after they have been victimized they this outrageous action.  (I want to note that I used the terms “betrayal” and “victimized” on purpose.  I understand that they are very strong words but I feel they are the best to describe this very serious phenomenon).  So why does it happen?  Both from what I have personally experienced as a labor and delivery nurse as well as what I have read (for example: Born in the U.S.A by Marsden Wagner and Pushed by Jennifer Block) there is not one simple answer for why some healthcare providers use this “technique.”  But there is no doubt in my mind that money, greed, fear of litigation, fear of losing patients, competition, superciliousness, willful ignorance, impatience, convenience, blatant disregard for evidenced based medicine, favoritism for the “because we’ve always done it this way” model of practice as well as favoritism for the paternalistic provider-patient model of practice (that is, the care provider only presents information on risks and benefits of a procedure/test etc. that he or she thinks will lead the patient to make the “right” decision (i.e. the provider supported decision) regarding health care) all have something to do with it.  Providers who practice the ol’ bait and switch fall somewhere on the, what I like to call “Asshole to Apathy,” spectrum.   Some may be bigger assholes than others, but in the end, they all fall somewhere on that spectrum in my experience.

[PHEW!  Okay, WOW!  Now I’m all worked up!  Sorry, sorry!  I don’t know where that rant just came from!  But this kind of thing really burns by britches!]

So Kelly, you must be thinking, “Where does this leave me?”  The good news is that Kristen, a philosophical doula blogger friend of mine over at BirthingBeautifulIdeas is author of an amazing series she calls “VBAC Scare Tactics” which I think is a resource that you, and other moms in your situation, might find very helpful.  What you are describing sounds to me like VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

In each post she identifies one particular scare tactic, supplies a list of questions that a mother can ask her care provider in response to this scare tactic, and then provides an analysis and/or summary of the research that either challenges or even debunks the scare tactic and its insinuations.  In the introduction to the series she writes,

 

“Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in this country have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.

 

Sometimes this opposition is blatant.  Sometimes this opposition becomes obvious only at the end of the third trimester. (Many VBAC-ing moms refer to this tactic as a “bait-and-switch” since it involves a supposedly VBAC-supportive care provider rescinding this support once the actual VBAC is imminent.)  Sometimes even a care provider’s “support” of VBAC is instead a conditional, half-hearted, or perhaps sneakily-disguised opposition to VBAC.  These “scare tactics” are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean.  (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)

 

If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way.  And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.”

Things I love about BirthingBeautifulIdeas’ VBAC scare tactic posts include:

#1    Her writing is organized and clear.  (You know how much I love organization and lists!)

#2    She respects research and understands the importance of evidenced based medicine. (In fact, the reason BirthingBeautifulIdeas is aware of much of the research she cites is because she actually used said research studies in weighing her own decision about whether to have an elective repeat cesarean section or instead prepare and plan for a VBAC.)

#3    She has personal experience with this subject.  (In fact she not only experienced a VBAC scare tactic and the “bait-and-switch” with her former OB, but also made the difficult decision to and successfully did transfer her care to a VBAC supportive care provider late in her pregnancy (at 37 weeks to be exact!) as well as experienced a subsequent and successful VBAC hospital water birth.  Check out her story “My very own VBAC waterbirth”.)

#4    She does not provide advice.  As she said herself, she is NOT anti-OB nor is she telling women to do anything.  Instead she provides tools that allow women to make their own decisions and stick up for their own decisions about the birth of their babies hoping that in doing so women come out of their birth experiences feeling positive and empowered, regardless of the outcome.

Kelly, please check out the post VBAC scare tactics (#3): An early eviction dateI was going to write to you about the research and such on the topic but BirthingBeautifulIdeas has already done such a fantastic job herself that it wouldn’t even be worth it to summarize her article.

While I’m at it, here’s the entire VBAC scare tactics series:

VBAC scare tactics (#1): VBAC = uterine rupture = dead baby (aka “Why would you want to risk a VBAC only to have a ruptured uterus and a dead baby?”)

VBAC scare tactics (#2): When bad outcomes in the past affect patient options in the future (aka “I’ve seen a bad VBAC outcome, and it was terrible.  You really don’t want to choose a VBAC over a repeat cesarean.”)

VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

VBAC scare tactics (#4): No pre-labor dilatation = no VBAC (aka “Since you are 39 weeks pregnant and your cervix isn’t dilated or effaced, it looks like you probably won’t go into labor on your own ‘in time.’   We need to schedule a repeat cesarean and forgo a VBAC attempt.”)

VBAC scare tactics (#5): VBACs aren’t as safe as we thought they were (aka “You know, VBACs aren’t as safe as we thought they were.  They are much more dangerous to you and your baby.  A repeat cesarean is the safer route.”)

A VBAC scare tactic interlude (Thoughts and resources on transferring your care to a VBAC supportive care provider, inducing labor when you have a history of a cesarean and weighing the pros and cons of pain medications and interventions if you are planning a VBAC.)

 

VBAC scare tactics (#6): CPD or FTP = no VBAC (aka“Here in your chart, it says that your cesarean was for failure to progress (FTP).  Oh, and there’s also a note here about cephalopelvic disproportion (CPD).  You’re not really an ideal VBAC candidate since your cesarean wasn’t for fetal distress or breech presentation, so we need to schedule a repeat cesarean.”)

 

VBAC scare tactics (#7): Playing the epidural card (aka “An epidural can mask the signs of uterine rupture, so I do not permit my VBAC patients to have an epidural during their labors.” OR “In case of an emergency cesarean, I require all of my VBAC patients to have an epidural in place in early labor.  That way, we will not have to wait for the anesthesiologist to get the epidural in place if a uterine rupture occurs.”)

VBAC Scare Tactics (#8): The MD trump card (aka “Look, I’m the one who has earned the medical degree and I am telling you that you cannot attempt a VBAC.  Your only choice is a repeat cesarean.  Period.”)

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Kelly you wrote, “Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.”  You are right.  You don’t have to do anything they say.  You have the right as a patient to both informed consent as well as informed refusal.  However I want to say a few things.  (Here comes my cyber pep-talk, meant of course to be 100% supportive of whatever you chose and not at all meant to give you advice.  But I don’t think many women get a chance to hear from anyone what I am about to tell you.  To get the full intent of this pep talk just picture me standing behind you vigorously rubbing your shoulders as I squirt water into your mouth from a sports bottle and wipe the sweat off your face.  So here it goes…)

You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for.  Your desires for said unmedicated, intervention-free VBAC are well supported by the research.  You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC.  You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE.  You deserve it for THIS birth.

I know that it is scary to even think about transferring care to a new care provider so late in the game.  But I encourage you to at least think about it.  Even if you think that there are many limitations in your options regarding availability, insurance, distance, etc. etc, it is worth it to you to at least check it out.  I also encourage you to get in touch with your local ICAN chapter (unless, of course, you have already done that.)  Some of the members might be able to give you some suggestions on VBAC friendly care providers that they know actually attend VBACs!  Sometimes even if a VBAC friendly midwife or doctor is booked they will make an exception for a late transfer of care if a doula friend or former patient calls and asks for a favor.  (I’ve seen it happen before with my local ICAN chapter).  Also ICAN’s website has a variety of helpful articlesfor moms planning a VBAC against hospital or provider resistance.

I can tell by your story that you are a very strong woman and my gut tells me that you will indeed fight for your rights even if you stay with your current obstetrician.  You just shouldn’t have to do that and it saddens me that any your energy is going to be dedicated to defending yourself during your birth.  Even one tiny little bit of energy devoted to that is too much!  You deserve more!  You deserve better!  I think you said it perfectly when you wrote, “It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!”

 

I couldn’t agree more!

So Kelly, I wish you the best of luck!  And like many of my readers, I really wish I was going to be your labor and delivery nurse!  CONGRATULATIONS on your pregnancy and on your upcoming birth!  I will keep you in my thoughts and I hope that you will one day come back and tell us how your birth went!  I hope that this post has helped you in some way.  Oh and please apologize to your friends and family for me since you probably will be wasting a lot more time in front of the computer now that I have provided so much reading material!  Haha!

Sincerely,

NursingBirth

 

No Doula in the Name of Privacy? Oh Come On! September 26, 2009

This comment was recently left by a reader named Jessica under one of my older posts.  Since I read every comment that is posted on my blog I happened to stumble upon it this morning.  When I read it I couldn’t help but think “I Hear Ya Sister!!!”and felt that it was so well stated that it needed to be its own post!  I know that there are quite a few doulas out there that read my blog and I just wanted to take this opportunity and give a shout out to them all and say thank you for all you try to do to educate women before they get to me on L&D!  Unfortunately, they don’t all listen but I hope you know that there is at least one L&D nurse out there that appreciates your efforts, both before and during labor!!!

 

For all you expecting moms out there please check out DONA’s website to learn a bit more about what a doula is, how you can find one, the effects a doula can have on your birth outcome and experience, and how a doula can advocate for you!

 

And just for the record, there is NOTHING private about a hospital birth experience.  Even in the most well meaning hospitals with the most well meaning birth attendant and the most well meaning nurse(s).  Albeit some women’s hospital births might be more private than others and I personally have had the priviledge to be a part of a few totally amazing hospital births.  But to not hire a doula for your hospital birth (especially at a university hospital!) because you want a “private” experience is a very VERY naive and misguided idea!  I am not saying that to hurt anyone’s feelings and I am certainly not judging anyone out there who decided not to hire a doula for one reason or another.  I am just telling it like it is.  Some food for thought…

 

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Hi NursingBirth!

I am a certifying doula and have recently had an interview with a perspective client. She is 36wks pregnant with her first. She was strongly considering a doula, but everyone else in her family was on the fence, and pushing a “private” birth experience. However, they are planning a delivery at a university hospital, she has yet to see the same health care provider throughout her prenatal care, she has no idea which one will be at the birth, or if it will even be someone she has met. They are planning a natural birth. She assured me that the hospital she is birthing at offers a multitude of birth options, including water birth, birth ball, position changes, etc… and the childbirth education from the hospital has given them confidence in their ability to get what they want from this birth. After much “deliberation” they decided that they were not going to hire a doula, based solely on their confidence in the hospital to give them what they want, and their desire for privacy. While I can completely respect their privacy request, I fail to see how birthing in a university hospital will give her much if any privacy…AND if she doesn’t even know who will be her health care provider at the birth…how is she confident that the hospital will give her what she needs? I wish there was some way to help open her naive eyes to the reality of birth in hospitals today. Her chances of getting to work with a mother friendly doc that understands and respects natural birth have got to be low! Reading your blog was comforting (because I know there are others who struggle with this) and depressing(because we have to struggle with this). I don’t want to have her hire me for her VBAC next time around. I want her to have the birth she desires now. I realize there isn’t much I can do for her at this point, which is why I am here, leaving my frustration with a bunch of like minded individuals. I am hoping things will go well for her and in the mean time, I’ve let her know that I am and will be available until the baby is born. just in case. Thanks for the space to rant.

  

Sincerely,

Jessica

  

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Jessica, you can rant here anytime!!!  I Hear Ya Sister!  Loud and clear!!

 

And now I leave you with one of my FAVORITE Monty Python skits of all time.  I have seen it a million times but it is still as hilarious (and eerily true) each time I see it.  Notice how the doctor invites in an army of people to watch.  It often feels like that where I work no matter what I do!!!

 

 

Natural VBAC Hospital Birth: One Reader’s Empowering Experience September 3, 2009

Dear NursingBirth,

  

I wanted to share with you my birth story.  I thought since I did an all natural VBAC, it might be something you would want to share.  Thanks for the posts.  YOUR blog helped me get though my second birth! Your stories of inspiration that you have are amazing, and just your general  tone.  The fact that there are nurses out there like you made me have the confidence to trust the nurse with me, but also not be totally trustworthy. It helped me realize that I am the final decision maker.

 

In preparing for my VBAC I read your Injustice in Maternity Care Series and your story “I Needed to Know My Body Could Do It!”: A VBAC Story over and over.  I also read Active Birth by Janet Balaskas which I think helped me a lot, and with our first daughter (my c-section) we took Bradley classes so we both thought we were so prepared.  This time I had my mom, a friend and my husband as my birth team and we took control, which reading about it from your point of view gave me the courage to do so!!!


Thanks for all you do!  I love the blog!

 

Sincerely,

Katie C.

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Dear Katie C.,

 

I would LOVE to reprint it and am honored that you would even send it to me!  Thank you for reading and THANK YOU for being such an awesome and empowered woman and mother!!  It is women like you that are an inspiration to ME!

 

I just love everything about your birth story!!  First off, CONGRATULATIONS on your VBAC and on the birth of your daughter!!  What a wonderful time for you and your family!  It also must be really nice to NOT have to recover from major abdominal surgery and take care of a newborn and 3 year old!  Second, one HUGE pat on the back to you for choosing to go back home during your initial trip to the hospital when you were found to be 2 centimeters.  That took A LOT of courage and trust in your body and your abilities, especially since the on-call doctor was pressuring you to stay.   And I completely agree with you; choosing to labor at home until you were more “active” most definitely had a significant impact on your successful unmedicated VBAC.  Thirdly, KUDOS to you for being an active participant in your birth!!  It no doubt helped your labor progress to be upright and moving during your labor!  I am so proud of you!!  While it’s true that no one can really “plan” their birth, you did everything you absolutely could to stack the cards in your favor!!  Yay!  Yay!  Yay!!!

 

Thank you again for reading and sharing!

 

All My Best,

NursingBirth

 

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Katie C’s VBAC Birth Story

College Station, TX

 

Starting on Friday, May 22, I started having very mild but consistent contractions at 5 minutes apart at lunch time.  The rest of the day they came and went, some getting farther apart but stronger slowly as the day went on.  I also had a lot of brownish and pinkish spotting.  Figured that maybe I was in very early labor.  Did my usually stuff that day and went to bed about 9:00pm, just in case this was it. Saturday morning I woke up about 1:00am with contractions strong enough that I couldn’t sleep.  I got up and ate some peanut butter toast and drank a bunch of water and tried to go back to sleep.  Contractions were about 7 minutes apart but stronger and enough so that I was having a hard time sleeping.  Likely because I was excited.  Got up and took a bath but that didn’t help.  Tried to go back to sleep.  Got up and ate 2 huge bowls of apple cinnamon cheerios.  Finally fell back asleep about 4:30 am.  Woke up at 7am and was just very tired.  Contractions were completely bearable but figured that we were starting (maybe) and so I had Madison go to Jaxson’s (and George and Amie) house for a few hours while my mom and I stayed home to see if anything would progress.

 

Lamaze International's Tips for a Normal Birth #5:  Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.

Lamaze International's Tips for a Normal Birth #5: Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.

 

As the day went on they got stronger but not really closer.  I called L&D and she said 3-5 minutes apart, not able to talk through them, so I just figured I would wait.  Wasn’t ready to go to the hospital yet anyway.  I called Meredith (a friend), who was working about 2 hours away, to let her know that she might have to come back that night. We decided that she would come back that night instead of waiting for a call at 2:00 am and have to drive then.

 

Lamaze International's Tips for a Normal Birth #6: Think carefully about who you want to give you support during labor and birth. Consider hiring a doula or other professional labor support person to give you, your partner, and any other support person who's with you, continuous emotional and physical support.

Lamaze International's Tips for a Normal Birth #6: Think carefully about who you want to give you support during labor and birth. Consider hiring a doula or other professional labor support person to give you, your partner, and any other support person who's with you, continuous emotional and physical support.

 

My back started hurting and I called another friend of mine who does massage. She wanted me to come to her studio, but I really didn’t want to leave the house, so I decided to stay home. Rob called his mom and went to meet her and take Madison to her house so that we wouldn’t have here with us. By the time Rob got back, about 6:30pm, contractions were 5 minutes apart and getting stronger. I could still talk and walk, but it took effort. I called Meredith back and she said she was on her way to my house. At 7:30pm I started to panic.  The contractions seemed very strong to me, I was concentrating on them and they were consistently 5 minutes apart, so we decided to head to the hospital.  I called Meredith and told her to meet us there.  Once I got there, my contractions stopped pretty much, likely due to my nerves.  They got me into a room and set and checked me and I was 2cm and 80% effaced.  I was devastated!  I told them I wanted to go home.  The doctor on call was leery of that since I was a VBAC and they said they would really like me to stay but I refused and we packed up and came home.  (In hind site, this was the reason it all worked out!! Best Decision!!!)

 

 

I went to bed disappointed and tired, since I had been contracting for nearly 30 hours at this point and I just wanted to either be in labor or not.  I ate a snack and went to bed.  At about 3:00am I was woken by very strong contractions, 7 minutes apart, strong enough that I would flip to hands and knees in bed and rock and moan through them. Rob decided I was in labor, though I was still not sure!  LOL!  I started just sleeping in between them.  (Must have been some natural coping mechanism, since I did it until about 6:30 am!)  We started timing for real at 7:00am.  Meredith came over and she helped my mom.  My mom would time the start to start and Meredith would time the duration. They were about 5 minutes apart with about 30 seconds of what I would call pain.  The actual contraction would last about a min or longer.

 

 

As the morning went on, I could no longer do anything during the contractions except hang onto Rob and moan.  Contractions got stronger and longer.  They were 4-5 minutes apart, and lasting (pain) about 70 seconds.  During one contraction while I was hanging on to Rob I had a huge rushing feeling, almost like a pushing sensation (or so I thought) so I just said, “We have to go NOW!” We packed up and went up to the hospital.  I had 4 contractions in the car, which were the hardest ones!  [At that point I preferred to be standing during them, since sitting or lying down was excruciating.] We got back to the hospital and I was moaning and hanging on Rob and everyone in the ER was looking at me funny.  It made me laugh.  They probably all thought I was crazy!  

 

 

I went back up to L&D and they put me in the same room and got me all set up again.  The nurse said, “We were waiting for you!” I was so nervous that I would only be 3 centimeters and they wouldn’t let me go!  She checked me (about 11:00am) and I was 6cm, fully effaced!!!  I cried when she told me, I was so happy!!  Rob, Mom and Meredith clapped!  LOL!  They told me I had to stay.  I said that was fine!  They put me on the monitors and said I would be able to get off of them, but then the Dr. on call said “NO!” so I was worried I would be stuck in bed.  The nurse said, “You can move as much as you want, so long as the cord is long enough,” so I got out of bed and stood next to it for most of the day.  We said I didn’t want to be checked again except by the doctor or if they thought I was complete (i.e. pushing) so when the doctor got there at 1:00pm she checked me and I was a stretch 8!! I was still concerned that it wasn’t going to happen, but everyone else was excited.

 

Lamaze International's Tip #4 for a Normal Birth: Plan to move around freely during labor. You'll be more comfortable, your labor will progress more quickly, and your baby will move through the birth canal more easily if you stay upright and respond to the pain of your labor by changing positions. Try rocking, straddling a chair, lunging, walking and slow dancing.

Lamaze International's Tip #4 for a Normal Birth: Plan to move around freely during labor. You'll be more comfortable, your labor will progress more quickly, and your baby will move through the birth canal more easily if you stay upright and respond to the pain of your labor by changing positions. Try rocking, straddling a chair, lunging, walking and slow dancing.

 

Transition for me was the second hardest thing I have ever done.  I refused pitocin (which they really didn’t push since I was a VBAC) and did not let them break my water. I stayed at a 9 centimeters for almost 3 hours, then at 9 ½ centimeters for a while until I begged them to stretch my cervix!!  LOL!  I was on the bed with the back raised on my hands and knees and suddenly had a contraction that felt better when I kinda of pushed at it. My mom went to get the nurse and she tried to check me like that but said I really needed to lie down.  I said I didn’t want to push lying down and she said, “Sweetie you can push however you want, but I need to make darn sure you are complete so you don’t swell.” I knew that was true so I got down and she checked me and then had the doctor come in and doctor said, “I’d call that complete!” I was so freaking happy! However I was also exhausted and once I was lying down, though I was hurting, I just couldn’t get back up again.  They broke my water sometime in there.  [I think it was earlier when I was at a 9 ½ centimeters but I can’t remember.]

 

 

The first few pushes I really thought I was doing it but I think the contractions were just not strong enough.  I actually asked the doctor how far down Hana had to be to use the vacuum!  I was exhausted!  The doctor said that she wasn’t going to use the vacuum, so I was just going to have to push!  I started pushing about 4:45 pm.  She would come down (once I finally figured out just how freaking hard you have to push!!) and then scoot back in.  They explained to me that a little bit of pitocin would help to bring the contractions a little closer together, so I would be more effective in pushing, since I was having over a minute between them and Hana would just scoot back in.  I finally agreed to it at about 5:45pm.  The started it at about 6pm.  The doctor suggested a pudendal block, in case I needed an episiotomy (which while I wanted a natural tear, I wasn’t against at that point and I never thought I would come through it with no tear or cut).  I even got a mirror to see my progress, and knew right then that something was going to have to give! I made them put the mirror away!

 

 

I started pushing 5-6 times per contraction and the doctor had been with me the whole time.  She had them break the bed and get all the stuff ready and I asked “Is she coming out this way?” and the doctor laughed and said, “I’m not doing a c-section today!” She asked me also if I wanted to feel Hana’s head, but I just couldn’t bear the thought for some reason.  I kept pushing and finally she said, “Ok, this next one you’re going to have your baby!” and so I hauled back and pushed harder than I thought possible and her head popped out and I kept pushing (oops!!) and Hana was born Sunday May 24th at 6:28pm!!!  It was the most amazing thing in my life and no doubt pushing was the hardest thing in the world.

 

Lamaze International's Tips for a Normal Birth #10: Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping the baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

Lamaze International's Tips for a Normal Birth #10: Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping the baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

 

They gave her to me and after a few minutes (she was breathing but a little blue still) they took her over to rub her and clean her up some.  I was shaking so bad at that point that Rob had to hold her. I ended up with a 4th degree tear… not from her head, but her shoulder popped out when I pushed and the doctor wasn’t expecting it, and so that’s that.  But it isn’t so bad!  She stitched me up, and while it is sore, it beats the hell out of a c-section! Right after she was born I said, “I had a baby out of my vagina!” much to the amusement of the nurses and pretty much everyone in the room! But I can’t tell you just how amazing it was for me. I had been waiting 3 years for that.  And now I have it!  Hana was given back to me and she latched on right away and nursed like a champ for 15 minutes on each side (I was STILL being sewn up!) and finally Rob and Hana went off to the nursery.  To our surprise (and the doctor’s too) she was 8lbs 1 oz, 19 inches long.

 

Happy Birthday Hana!!!!

Happy Birthday Hana!!!!

 

 

I am recovering very well and almost feel like new!!

 

For more information on Vaginal Birth After Cesarean (VBAC) check out the International Cesarean Awareness Network's website at http://www.ican-online.org/

For more information on Vaginal Birth After Cesarean (VBAC) check out the International Cesarean Awareness Network's website at http://www.ican-online.org/

 

Women’s First-trimester Working Conditions Impact Infant Birthweight June 22, 2009

Filed under: In The News — NursingBirth @ 10:12 AM
Tags: , , ,

A new study that will be published in the August 2009 edition of the American Journal of Public Health has found that high levels of job strain during early pregnancy are associated with reduced birthweight and an increased risk of delivering a small for gestational age (SGA) baby, especially if mothers work 32 or more hours per week.  The study included questionnaires from and conducted follow-up on 8266 pregnant women participating in the Amsterdam Born Children and Their Development study.

 

I find these findings particularly interesting because many mothers, if they have the luxury of being able to take some time off of work during their pregnancy, typically take the time off during the end of their third trimester.  The results of this study make me, and the authors, wonder if perhaps women who work in high strain jobs and/or work a long work week should consider reducing their hours or workload during the first trimester instead or as well.

 

Remember, the first trimester is the most critical time in a woman’s pregnancy.  Although at the end of the first three months the fetus is only about 4 inches long and weighs less than 1 ounce, that tiny little baby has already begun to form all of its major organs and nervous system, has a heartbeat, and already has formed its arms, fingers, legs, toes, hair, and buds for future teeth.

 

To check out the article’s abstract visit the American Journal of Public Health website.

 

To check out a summary of the article visit Medical News Today.

 

Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth May 27, 2009

Dear NursingBirth,

I’m a huge fan of your blog! Please keep the awesome entries coming! I am learning so much. I am just a novice birth-junkie rather than a birth professional and so am anxious to eat up all the great information you’re giving out here.

Anyhow…. Our state treasurer’s wife (that’s here in Arizona) died today in childbirth, and their baby is said to be in grave condition. They’re not giving causes or reasons. Here’s the link:

http://www.azcentral.com/news/articles/2009/05/26/20090526treasurers-wife0526-ON.html

Can you think of occurrences in hospital-birth that would end up with a dead mother and a baby in really bad condition? I’d love to hear from someone who knows her stuff. The things that came to mind for me were amniotic fluid embolism, severe uterine rupture, and cesarean gone really wrong.

Keep up the amazing work!!!
Diana

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Dear Diana J.,

 

I just read the story you linked to and my heart goes out to that family.  Unfortunately the story you linked to did not go into any details, including the most important detail which is: Did the treasurer’s wife have a vaginal birth or a cesarean section, as the risks are significantly higher with a cesarean section.  I think your question is a good one and since this story has the potential to make national headlines, I think that it is an important enough question to put as its own post on my site.  I hope, however in posting about your question that moms out there who read my blog are not unnecessarily worried or upset that we are talking about maternal death as it is still a relatively RARE occurrence when you think about all the other causes of death in childbearing women. 

 

Let’s put it into perspective.  As the Arizona Central story stated, “In late 2007, the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention, released a report showing that there were 13 maternal deaths per 100,000 live births in 2004 in the United States.” And since in 2004 there were 4.1 million births in the United States, if you do the math that would make about 533 maternal deaths in 2004.  And don’t get me wrong…that’s 533 deaths to many for sure!  However take a look at this chart published by the Center for Disease Control (CDC) entitled: Leading Causes of Death by Age Group, All Females- United States, 2004.  It shows the following:

 

Leading Causes of Death for 15-19 year old Females, 2004:

1)      Unintentional Injury (51.7%), 2) Suicide (8.8%), 3) Homicide (7.5%), 4) Cancer (7.3%), 5) Heart Disease (3.1%), 6) Birth Defects (2.8%), 7) Pregnancy Complications (0.9%)

 

Leading Causes of Death for 20-24 year old Females, 2004:

1) Unintentional Injuries (40.5%), 2) Homicide (8.4%), 3) Cancer (8.0%), 4) Suicide (7.6%), 5) Heart Disease (4.6%), 5) Pregnancy Complications (2.7%), 6) Birth Defects (1.9%), 7) HIV disease/Stroke (1.4%).

 

Leading Causes of Death for 25-34 year old Females, 2004:

1) Unintentional Injuries (25.3%), 2) Cancer (15.1%), 3) Heart Disease (8.2%), 4) Suicide (7.5%), 5) Homicide (5.8%), 6) HIV disease (4.4%), 7) Pregnancy Complications (2.3%).

 

And for women ages 35-44 years old, pregnancy complications don’t even crack the top 10. 

 

Okay so if you are a pregnant mom please know that dying of pregnancy/childbirth related complications is rare and I don’t want to completely freak you out.  But there is something very disturbing about the United States maternal mortality statistics which shocks most people when they hear it….

 

The United States ranks 42nd in the WORLD for maternal mortality rates, with 1 in 4,800 women dying from pregnancy complications in the U.S. in 2007.  That means that 41 countries other countries in the world have BETTER maternal mortality rates than the United States!

 

Many of our practices and current situations in this country, including our obsession with medically unnecessary labor induction, our over-medicalized maternity care system, the practice of defensive as opposed to evidenced-based medicine, the lack of a universal health care system, large differences in health disparities among different racial/socioeconomic groups, the obesity epidemic, and our skyrocketing cesarean section rate greatly contribute to our country’s maternal death rate. 

 

So what exactly is defined as “maternal death.”  According to the World Health Organization, “A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”  Therefore a death of a woman that died from complications arising from a cesarean section a month after she had the baby would be counted in the maternal death statistics where a pregnant woman who died in a car accident or murdered during a domestic violence dispute would not. 

 

Okay, but you are probably thinking Why?  Why are so many women dying in childbirth in an industrialized, developed country like the United States at a much higher rate than other industrialized, developed countries like Japan, many countries in Europe, or Australia? 

 

Ina May Gaskin, midwife and founder of the Safe Motherhood Quilt Project, gives us some insight into the situation in her book Spiritual Midwifery, page 455, written in 2002:

 

“According to the CDC, there has been no improvement in the U.S. death rate (which is nearly twice as high as Canada’s) since 1982.  Sadly, the CDC estimates that the true death rate is as much as three times higher than that which is reported and that half of all the reported deaths could have been prevented through early diagnosis and good care.  Given the situation it makes sense for women to avoid unnecessary surgery while pregnant or in labor.  Women double or triple their risk of dying when they have an unnecessary cesarean.  Medical mistakes do happen, even to people who are well informed about their possibility.”

 

Also Ina May’s Safe Motherhood Quilt Project website also links to a Maternal Mortality in the USA Fact Sheet that is worth checking out!

 

The 2008 documentary Orgasmic Birth (which I highly recommend renting) has a 20- minute movie clip as part of the “special features” section of the DVD that provides some eye opening statistics about maternal and infant mortality rates in the United States as compared to other industrialized countries around the world.  In this short movie clip, entitled Birth By The Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.  It is a MUST WATCH CLIP for anyone who is or cares about a mother.

 

Also, here are some articles from mainstream news sources published in response to the 2007 maternal mortality rankings that provide some insight:

 

1) More U.S. women dying in childbirth: Death rate highest in decades; obesity and C-sections may be the cause  Associated Press, August 24, 2007

2) Maternal Mortality Shames Superpower U.S.  Inter Press Service, October 13, 2007

3) U.S. ranks 41st in maternal mortality  Seattle Post-Intelligencer, October 12, 2007 

 

A flyer published by the medical journal The Lancet in 2006 entitled Causes of Maternal Death: A Systematic Review ranks the top 9 causes of maternal death related to pregnancy/childbirth complications in DEVELOPED countries as the following:

1) Other Direct Causes (21.3%), complication of the pregnancy, delivery, or their management which includes (among other things):

            –Anesthesia Complications* (responsible for about 3% of all maternal deaths by itself and includes:    management of the difficult airway in obstetric patient, aspiration of gastric contents under general anesthesia, local anesthetic toxicity, and high spinal or epidural block which paralyzes the breathing muscles of mother).

2) Hypertensive Disorders (16.1%), includes (among other things):

            –Preeclampsia

            –Eclampsia*

            –HELLP Syndrome*

3) Embolism (14.9%), includes (among other things):

            –Pulmonary Embolism (typically a complication seen post-op surgery)

Deep Vein Thrombosis (DVT) (more likely to develop for women on bed rest or post-op surgery

Amniotic Fluid Embolism (rare and more appropriately known as Anaphylactic Syndrome of Pregnancy)*

4) Other Indirect Causes of Death (14.4%), pregnancy-related death in a patient with a preexisting or newly developed health problem like cardiovascular disease, seizure disorder, respiratory disorder, diabetes, kidney disorder, liver disorder, obesity, etc.

5) Hemorrhage (13.4%), includes (among other things):

  – Obstetrical Hemorrhage (most common causes being uterine atony, trauma, retained placenta, and coagulopathy)

  – Placenta Previa*

            – Placenta Accreta, Increta & Percreta

            – Placental Abruption*

            – True Uterine Rupture*

6) Abortion (8.2%)

7) Ectopic Pregnancy (4.9%)

8.) Unclassified Death (4.8%)

9) Sepsis Infection* (2.1%)  (most likely to occur post-operatively but can occur post-partum or antepartum)

 

*Comes to mind for me as having the potential to cause a critical illness or death for baby as well.

**Please note mothers undergoing cesarean surgery, especially repeat caesarean surgery are MORE at risk for anesthesia complications, pulmonary embolism, obstetrical hemorrhage, placenta previa, placenta accreta, and sepsis/infection than moms undergoing a vaginal birth.**

 

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You are probably thinking, “So what does all of this mean for me?” “How can I reduce my risk?”  Both are GREAT questions.  It is important to remember that I am not claiming that 100% of maternal deaths are preventable or even foreseeable.  No one is.  I also do not want anyone to get the impression that I am blaming mothers or putting unrealistic pressures on mothers to control things that are sometimes just happenings that are an unfortunate and very sad part of life.  For example, who could have predicted a fatal postpartum hemorrhage for a healthy mom after a normal uncomplicated unmedicated singleton vaginal birth?  No one could!  But what about a mom who experienced a fatal postpartum hemorrhage after elective cesarean surgery….well that one doesn’t sit so well with me!   And which do you think is more likely?  If you guessed the latter you are correct…by at least 4 times as much! 

 

So how does a mother reduce her risk of maternal morbidity and mortality related to pregnancy and childbirth complications?  The following is a short list you might want to keep in mind.  (Not surprisingly, many relate back to avoiding unnecessary surgery.)

 

TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth:

1)      Obtain good and thorough prenatal care, keeping all of your appointments, preferably beginning in your first trimester.

 

2)      Make a conscious effort to eat a well balanced diet during conception and pregnancy that includes adequate amounts of fresh fruits and vegetables, healthy fats, and protein.  There are a variety of prenatal nutrition books out there as well as many childbirth books that have a section on prenatal nutrition.  If you don’t have one buy one or borrow one from the library!!

 

3)      If you don’t exercise, start!  Many gyms, community centers, and YMCAs offer low-impact, pregnancy-friendly classes for expectant moms.  Even a 30 minute walk three times a week will do!

 

4)      If you suffer from a chronic disease or illness or are obese, it is important to know that making appointments with health care providers and specialists that can help you to manage your disease and lose weight in a healthy way before and during pregnancy can ultimately help you to reduce your risk of life threatening complications during pregnancy and childbirth.

 

5)      Consider hiring a birth attendant that practices a midwifery model of care.

 

6)      Do NOT agree to a medically unnecessary labor induction.

 

7)      Do NOT agree to a medically unnecessary or elective cesarean section.

 

8)      If you have a history of a cesarean section, seriously consider a vaginal birth after cesarean section (VBAC) if you have no reoccurring or new reasons or medical indications for a repeat cesarean.  If necessary switch to a birth attendant that supports VBAC and has the cesarean statistics to prove it.

 

9)      Seriously consider avoiding interventions in labor that evidenced-based research have shown could increase your risk of a cesarean section, fetal distress, and infection including early amniotomy (breaking of waters), accepting pitocin to stimulate or augment contractions without trying other more natural methods for augmenting labor first, going to the hospital during very early labor, accepting continuous external fetal monitoring as opposed to intermittent auscultation for a normal healthy labor and a normal, reactive, and reassuring fetal heart rate pattern, and requesting an epidural or narcotic pain medication (especially in early labor) before trying all methods of non-pharmacological pain management techniques first.  (Check out my post: Top 8 Ways to Have an Unnecessary Cesarean Section)

 

10)   Empower yourself to make safe, healthy decisions regarding your pregnancy, your labor, your birth, and your baby by doing your own research!!  (Check out my post: Birth Resources EVERY Woman Should Know About).