Obstetrician on C-secions in MA

I read this article only moments ago.  I'm still processing it.  I immediately posted it on my Facebook page.  I read this blog commenting on it.  I, too, am angry at what was written.  I also find it very informative. 
It wasn't too long ago that I was a doula for a birth that just about mirrored the birth described in the article.  Except these parents were not thrilled with the outcome.  They are indeed very much in love with their little love, but not with the experience. 
It simply amazes me that doctors, many who are parents themselves, can look at birth as they do...like a blind robot.  It's not as if they necessarily ignore what is front of them...they simply don't see it, process it, like the mother might be.  It's simply mechanical with a means to an end.  And that is all that matters. 

At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium went up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter.

I'd like to believe that someone would endure eight-plus years of schooling, long hours and sleepless nights to be able to help people.  These obstetricians who simply don't care aren't doing their job.  Sure, they care about the mother and baby coming out of the hospital safely...who doesn't?  However, "safely" is subjective, I suppose.

Is it safe to subject your patient, the mother, to depression or symptoms of PTSD?  In a study done
in Sweden, "76% of the moms in the study had experienced their delivery by emergency cesarean section as a traumatic event."
Additionally, in a study comparing the psychological effects of an emergency cesarean, planned cesarean, instrumental and normal vaginal deliveries.  Surprise, surprise - the psychological effects of an emergency cesarean and instrumental vaginal delivery "should be regarded as a pointer with respect to possible post-traumatic stress."
When inflicting this sort of trauma on a woman, why is it then okay to send her home with a newborn?  That same woman, who feels robbed, violated, hurt, angry, disillusioned, depressed, anxious, alone, unworthy, lacking and/or just plain wrong, is expected to be happy about her experience.  I'm probably crossing a line here, but it seems like obstetric rape. 

I birthed three babies vaginally.  I had pitocin and epidurals.  I did not feel like something was taken away from me because I didn't go into it with the thought that I had a right to anything else. 
With what I know now, I read articles like Dr. Wolfberg's and think, "gross."  It's just gross.  It makes me want to put on clean clothes.  It makes me want to yell at people.  It makes me cry for those it adversely affects.  It makes me hug my children tighter. 

I'm fortunate to have this information.  Thank you, Dr. Wolfberg.  I now have another article in my arsenal to present to mamas who want a natural childbirth experience, and steer them away from sterile, uncaring hospitals, and into the caring, colorful, loving arms of a homebirth circle, where she might stand a chance.
 
If you've time to read more, here's an article about a mother who was charged with child abuse for refusing a cesarean.  She and her baby were apart for three years while this case was being held in court. Never mind that the baby was birthed vaginally and was perfectly healthy...

Doula-ing...it sucks not being a super hero

Okay, so I love my job.  I love helping moms achieve the kind of birth they want.  I love seeing the look in their eyes as their baby is being born.  I love hearing a newborn cry.  I love watching a woman labor down, utilizing the tricks of the trade.  I love hearing a woman say, "I did it!" and "Hi baby.  It's your momma.  I love you."
Then there are days like this.  Days where a beautiful first time momma heads to the hospital intending to birth naturally and without complications...but ends up with every intervention known to man.  Broken-hearted and beaten-down she looks to you for answers, but all you can do is give her information to make her own choice.  Don't get me wrong, information is a very powerful thing.  Letting the momma make a decision with all the information on the choices available at hand is such an empowering gift.  But, when she and her husband are looking at you, not knowing what choice to make, my job sucks.  I want to tell her to get up and walk out and go find a midwife and have a home birth right now.  I want to tell her to keep on trucking because she can do this, she IS doing it.  And I do tell her that.  But she is defeated.  She's tired.  She's hungry.  She's tethered and hep locked.  She's on pit and has an epi.  Her legs are numb and her belly aches.  And then all you can do is watch as they wheel her down the hall, prepped for surgery. 
Then you remember that you're there for support.  And you've done that.  You've provided her with information to make educated choices.  That is your job.  You've applied counter-pressure.  You've massaged. You've listened and validated.  You've supported her decisions.  You've cried in your car on the drive home.

Importance of Birth Preferences

I can't stress enough how important it is to have in mind your birth preferences and to relay them to your midwife, OB or whatever other birth attendants you plan to have.  Additionally, it is important to find out the rules and regulations at the hospital or birthing center you'll be birthing at, if you so choose to birth at one. 

Recently, I read a very disturbing article.  A laboring woman in New Jersey walked into a hospital, with a 50% cesarean section rate, and refused to sign the consent form many hospitals present their laboring mamas with.  The consent gives the hospital a right to perform any interventions necessary, including intravenous drip, antibiotics, fetal monitoring and a cesarean section.  I remember signing this consent at all three hospitals I gave birth at, without a second thought.  I've watched mamas do it.  This woman denied these interventions and refused to consent.  However, she was not opposed to signing the consent if the time came where she would need to.  She wanted to be able to assess the situation at hand and then decide.  Sure, why not?  After she gave birth, the hospital and child protective services took her baby.  That was three years ago.  She and her husband still have not seen their baby.  They have been battling it out in courts during this time.  Read the above-mentioned article and this one for more information.  Here is the site for the National Advocates for Pregnant Women. 

I honestly couldn't believe what I was reading while I was reading it.  I could see doctor's freaking out and calling social services in.  But I can't really understand why this became a three-year battle.  I can't understand why it was even an issue.  If hospitals are going to take your children away from you if you don't sign the consent, then why have a consent form?  Shouldn't it just be law that they can do whatever they want and you have no right to your own body?  (that was sarcasm, if you couldn't tell)  I have a hard time swallowing that social services came in and thought it was a good idea to take this newborn baby away from the parents because they exercised their personal rights. 

After absorbing all this information, I felt it absolutely necessary to remind mamas to make sure that they know their rights and to express them to their birth attendants, as often as you deem necessary. 

Happy birthing!

Withholding food in the media!

Hospital policy of withholding food during childbirth coming under scrutiny

Published: Tuesday, August 10, 2010, 6:00 AM Updated: Tuesday, August 10, 2010, 7:45 AM
Angela Townsend, The Plain Dealer

CLEVELAND, Ohio -- The last thing on April Baer's mind while awaiting the birth of her first child was where her next meal was coming from.

A good thing, since she wouldn't have gotten anything to eat even if she had asked.

Like most women who deliver in a hospital, Baer -- who gave birth to baby Stella in early June -- didn't get a morsel of food to munch during her six-hour labor.
"It wasn't really an issue for me," says Baer, a former WCPN FM/90.3 reporter/producer who now works at Oregon Public Broadcasting in Portland.
"Frankly, I was so consumed by the experience -- and by the 'experience,' I mean pain -- I wasn't really thinking about food," she says.
But for some women, especially those who don't eat a substantial meal before heading to the hospital, that absence of food can be irritating.

Earlier this year, the Cochrane Library, a publication of the Cochrane Collaboration, which evaluates medical research, published an article from an international team of three researchers calling for physicians to revisit the long-held notion that food during labor is bad.
It's hard to find a hospital policy -- informal or written -- that doesn't restrict laboring women to clear liquids and ice chips, or the occasional Popsicle or Jell-O. The Cleveland Clinic, University Hospitals, MetroHealth Medical Center and their affiliates are in lock-step with hospitals across the country on this issue.
Women have the American Journal of Obstetrics and Gynecology to thank for those restrictions.

In 1946, the journal published a report by a physician who warned of the risk of a woman aspirating -- accidentally throwing up food or fluids from the stomach and breathing it into the lungs while unconscious -- while under general anesthesia during birth.

That condition -- a risk for anyone who is unconscious from anesthesia, while drunk or during a seizure -- is called aspiration pneumonitis, or Mendelson's Syndrome, named after the physician. The condition can be deadly.

Today, with the advent of spinal and epidural anesthesia, a woman who delivers by C-section almost never goes under general anesthesia unless it's an emergency with little time to administer a more local anesthesia.

"I don't remember the last time I saw general anesthesia in labor and delivery," says Dr. Marjorie Greenfield, an OB-GYN at University Hospitals MacDonald Women's Hospital. "It could have been a year ago. It's just really rare, unless there is a dire emergency [to get the baby out quickly]."
As rare as it is, the mere possibility of needing general anesthesia means taking every precaution, including withholding food.
Based on an analysis of five previously published studies involving 3,130 women who had given birth, the researchers concluded in the journal article published in January that "since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in [labor] for women at low risk of complications."
As well regarded as the Cochrane Library is viewed by physicians, no one is quite ready to ditch decades-old practices just yet.
"The fear of aspiration, that's driven everything," Greenfield says. "For the thousand women, or 100,000 women that we don't feed, we're maybe preventing one case of aspiration."
Adds Dr. Edward Ferris, an OB-GYN who is director of the OB-GYN residency program at Summa Health System in Akron: "Labor is a dynamic process, and things can change at a moment's notice."

Even given some flaws in the data, many studies that say it's OK to give women food during labor look promising, Ferris says.
"But quite honestly, in the medical legal age we live in, a lot of people don't want to take that risk," he says. "Everything we do, we do with the best interest of the baby and mother in mind."

Although labor in a low-risk patient can seemingly go along fine, most OB-GYNs and anesthesiologists "prefer patients to have very little in their stomach," Ferris says.

But if a woman's labor is induced, and delivery seems to be far off, she may be allowed to eat a small meal, Ferris says.
"Most people don't want to eat in the middle of contractions," he says. "That's the furthest thing from their mind."
To help eliminate the chance of becoming dehydrated, women get liquid nutrients intravenously, with enough sugar to prevent hypoglycemia. Diabetics might also get an insulin drip to keep the blood sugar in normal range.
For early labor (which can last for a few hours or a few days, until the cervix dilates to 3 centimeters), it's OK to eat things that are digested quickly, such as carbohydrates and liquids.
But once a woman goes into active labor (as with early labor, the duration varies but is typically six to 12 hours, until the cervix dilates to 7 centimeters), food and liquids aren't digested as quickly.

Over the years, thanks in part to the anesthesiology community, the amount of liquids that physicians are comfortable giving women in active labor has increased. At UH, for example, a woman's birth plan can specify certain clear liquids. If her physician feels that she is in no danger, she'll get it.
' Physicians haven't budged, however, on the stance to forbid food.

In July, Lamaze International, based in Washington, D.C., issued a news release condemning the no-food policy.
"Women should be allowed to eat or drink while undertaking one of the body's most physically demanding tasks," stated Sharon Dalrymple, president of Lamaze International.

View full sizeTina Fineberg, APHospital officials say that most mothers are "laser-focused" on their baby and not thinking about eating in any case.

"Marathon runners keep themselves well hydrated by drinking fluids during their races and so should most laboring women," she said. "Every system in a woman's body is taxed during labor, and all that effort takes fuel. When women are deprived of food and drink, it's no surprise when those systems don't work as intended."

While the group does not have policies regarding specific protocols, members of the National Association of Certified Professional Midwives also support natural childbirth and generally encourage food and drink in labor, group president Mary Lawlor said in an e-mail.

After delivery, most new mothers are laser-focused on their new baby and little else. But not always.
"Sometimes the food demands come at a furious clip," Ferris says.
After natural deliveries, women often can eat right away. C-sections, however, require waiting several hours before eating because, as with any major surgery, one's intestinal functions must first recover from the effects of anesthesia.
"I've pretty much heard it all," says Ferris. "I've had patients demand McDonald's, pizza, a Pepsi. Sometimes they can't wait to have their first beer."

Ice Chips or a Turkey on Rye?

It is almost always understood that once you put on that hospital gown that is it for food until your baby is born.  It's ice chips, ginger ale, apple juice and Popsicles for you, miss.  I know that is what I'd give someone running a marathon or competing in a triathlon.  That's what birth is, right, a strenuous activity that asks the body to perform unusual and extreme measures?  So, why keep nourishment away from someone who is obviously going to need energy to labor for who knows how long and for how hard? 

You can thank Dr. Curtis Mendelson who in 1946 wrote an article entitled "The aspiration of stomach contents into the lungs during obstetric anaesthesia" in the American Journal of Obstetrics and Gynaecology.  When this article was published, however, it was, again, 1946.  Modern medicine has come a long way, baby!  General anesthesia is not generally used for a caesarean section - an epidural or regional anesthesia is.  Precautionary measures are also taken to make sure that aspiration of stomach contents into the lungs does not happen.  This article does not mention withholding food from a pregnant woman, however it does say "local policies should be followed." 

A recent study published in January 2010 entitled Restricting Oral Fluid and Food Intake During Labor shows that in women with low risk for anesthesia, there was no benefit or harm in restricting fluid or food intake during labor.  "In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity."

When speaking to your OB or the staff at the hospital you're birthing at, feel free to mention that Mendelson published his findings in 1946 and that you hope that medicine has advanced since then.  Then think about eating your turkey sandwich. 

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2.

Where are the Hospitals?

No matter your choice of hospital, I would encourage you to tour the hospital and attend a birth class there.  When I was pregnant I was told by friends that their experience with Lamaze classes really didn't help - the pain took over and they requested an epidural, so the classes were not necessary.  I took their advice and steered clear of any class.  I wish I had just attended the darn thing!  I didn't know that not breathing deeply and focusing would ultimately cause me to vomit - before the epidural.  *Some say that epidurals can cause vomiting.  Additionally, while you may not use the techniques because you intend to have an epidural, you will at least be familiar with what will and could happen during labor and delivery. 

If you are living in the Blackstone Valley you might be delivering at one of the local hospitals:

• Milford Regional Medical Center - http://www.milfordregional.org/site/slideshow/index.cfm           508-473-1190
• Landmark Medical Center - http://www.landmarkmedical.org/                                                    (401) 769-4100
• Metrowest Medical Center - http://www.mwmc.com/home.aspx                                                      508-650-7000
• Saint Vincent Hosptial - http://www.stvincenthospital.com/Home.aspx                                           508-363-5000
  
• UMASS Memorial Medical Center - http://www.umassmemorial.org/MedicalCenterIP.cfm?id=2790        508-334-1000

When choosing a hospital, you might want to find out their policy on birth attendants, that is, how many people you can have present at the birth.  I know that Milford Regional will allow 3.  Other hospitals do not limit the amount.  If you would like your mother, sister, partner and doula at the birth, you might have some thinking ahead of you.