Monday, May 18, 2009

Further thoughts on unassisted childbirth

After thinking heftily about my posts regarding UC, and formulating her own comments, my friend Dana posted this excellent response. She is a friend, fellow natural childbirth advocate, and childbirth educator who helped me to find many of the resources I needed to have an empowering, informed birth last summer. This girl knows her stuff.
p.s. she calls me Mona. Long story.

I just HAVE to quote Dana here, even though this paragraph is in the link above:

"The more I learn about childbirth, the stronger my feelings that God has designed us women beautifully for birthing our babies. Given education, support and safe environment, I believe that the majority of women have the capacity to safely give birth vaginally, joyfully, and to come away feeling strong and empowered. It grieves me that so many women are left believing that their bodies are broken. That some have outright traumatic experiences. Unnecessarily."

I absolutely agree.
For example: myself. When I was pregnant with Ayden I [wasn't ready] didn't do much research. I [was in denial] pretty much didn't do anything regarding pregnancy health for the first four months, not even taking prenatal vitamins, because I couldn't handle the fact that I was pregnant. I pretty much trusted my doctor implicitly to inform me of anything I might need to know. And I ignored [until late in the game] the fact that I was going to have to push this baby OUT.
My doctor is a good one, but, like the vast majority of general physicians in Canada, had approximately 6 weeks of obstetrical training in medical school, focusing solely on obstetrical pathology (what can go wrong). Also like the vast majority of general physicians in Canada, she limits her ongoing medical education mainly to pharmaceutical reps and conferences sponsored by pharmaceutical companies. Pharmaceutical companies are not evil, but they DO have a vested interest in physicians prescribing their drugs, and in physicians educating their patients towards their products (the brand of formula a patient uses usually coincides with the brand that provided a free can or bottle in the hospital, or the brand a physician recommends based on the formula company's representative educating that physician on its benefits). Anyways, my doctor, though she watched me gain weight like a balloon being filled with cement, knew there was some gestational diabetes in my family, and knew that I had several other risk factors for GD, and knew that gestational diabetes testing is available, did not inform me of the existance of Gestational Diabetes testing nor recommend I get it. I didn't know the test existed until I was pregnant with Riley. When I was 36 weeks pregnant with Ayden I had some bleeding so I went to the hospital and the doctor there, after palpating my abdomen, told me two things. (1) I had too much amniotic fluid, and (2) my baby was breech.
In my reading since Riley was born I have discovered that (a) an overabundance of amniotic fluid (polyhydramnia) is associated with Gestational Diabetes. And, (b) polyhydramnia is associated with fetal malpresentation (breech babies).
Later that week I went in for my regular prenatal appointment with my doctor and she ordered an ultrasound to confirm Ayden's breech presentation, and then referred me to an obstetrician. That OB booked me at the hospital for an external version, where they try to turn the baby so it can be delivered head first, the safest presentation (especially for a first time mom who is ridiculously out of shape and who has a big baby in her uterus). The EV didn't work, and so we scheduled a cesarean for the following week. Largely based on a then recently published large research study of best fetal outcomes in vaginal vs. cesarean births, the fact that it was my first baby, the fact that he was large (which is not a disqualifier on its own; we have an obsessive fear of large babies that is unfounded, in my opinion, but in conjunction with the other factors was something I considered), and the fact that I was in really poor physical shape.
Later, in my OB's office, she asked me if I remembered one last big somersault when I was pregnant with Ayden? And I did. I had been leaning back in my chair at a work related class, 3/4 reclined, when it suddenly felt like there was an earthquake in my abdomen. I slammed my chair down and yelped, which made all my male coworkers freak out. I later learned that 3/4 reclined is actually not a recommended position for women to be in during the last stage of pregnancy, as it ecourages fetal malpresentation (as well as compressing maternal veins and reducing oxygen supply to mom and baby).
Based on the fact that I very likely HAD Gestational Diabetes with Ayden's pregnancy but wasn't tested, diagnosed, or treated, and based on the fact that I was not informed that 3/4 reclined is not an optimal position to sit in and therefore sat in, I wound up with a baby in a non optimal birthing position.

In this case, *education* was the key missing component. Like Dana says, "Given education, support and safe environment, I believe that the majority of women have the capacity to safely give birth vaginally, joyfully, and to come away feeling strong and empowered." I didn't know about GD or its management, so I ate horribly, didn't exercise at all, and snarfed down bags and bags of candy. And, near the end, I didn't know about positions which encourage optimal positioning of baby, so I hung out in the 3/4 reclined position a lot. Could I have done more to educate myself, instead of relying on my doctor? Absolutely. I think my lack of readiness for the pregnancy actually was the greatest factor in my ignorance. But with a little more support and proactiveness on my doctor's part and a little more seeking out on my part, I could have avoided a surgical birth with Ayden by controlling my GD and thus the polyhydramnia, and being mindful of my body's posture and position during the last months of my pregnancy.
But it is what it is, and now I know more, and that is how I have been able to have a more empowering experience in a later pregnancy.

I believe very strongly that pregnancy and birth have been circumvented by our culture and turned into "dangerous medical conditions," when in actual fact pregnancy and birth are normal, natural, physiological events. Rather than dangerous medical events, they are necessary bodily functions. Many of us who have had cesarean births are given the impression by the medical staff that we were 'saved,' or our babies were 'saved,' when in reality a cesarean was recommended as less risky. I don't think Ayden would certainly or even likely have died if I had given birth to him vaginally; rather I think that a vaginal breech birth in my particular situation would have carried a higher risk of complications, including a small risk of death. See the difference? Risk does not equate certain death, nor salvation on the part of the medical community. But I was definitely given the impression that a cesarean was 'saving' my baby. It's a cultural thing.

Of course, some cesareans DO save babies who are in trouble! Or some moms who are in trouble. Of course this is true. But I think it important to point out our culture's belief regarding birth as a dangerous event that women are often incapable of doing, and that many womens' bodies are broken or incompetent. And it is important to speak the opposite, whenever possible.
It IS possible to have a positive, empowering birth experience. It is possible to give birth naturally and have that be safe. And even for those of us for whom that is not true once, it can be true the next time.

So powerful.
So necessary!
So good to help us move forward in time, evaluating our past experiences knowing we made the best decisions we knew to make at the time, and feeling a measure of peace about that.
I also think it is paramount that, as Dana touches on, we not allow guilt any place in this equation. We do the best we can. And tomorrow, if we learn more, we do better. Such is life.


Asheya said...

I've been wanting to comment on this whole train of posts, but haven't had the time. Now I am sick, so I really don't feel up to it, so I will just say for the time being that I appreciate you posting about this topic.

Ok, nausea taking over, must go lie down.

Look for my two cents another time :)

Colleen said...
This comment has been removed by the author.
jenna said...

I am impressed with your thoughts but I'm more curious about how you find the time to think in such depths. I haven't experienced that in about 8 years!
And, I deleted Colleen's comment because I am not Colleen but I published it with her name accidentally.

Dana said...

Get well soon, Asheya! I for one am looking forward to hearing your thoughts.