God Knows Our Every Desire

I am amazed at the love of God for each of his children, but I am particularly amazed today at His love for me. Amazed He cares enough about my heart to carefully orchestrate the perfect set of circumstances wherein I have a healthy baby and a healing birth; despite the fact that, once again, the baby came into the world via surgery. I hadn't known it was possible to have a healing birth via cesarean but I shouldn't be surprised. All things are possible with God.

Before we decided to have a third child, Husband and I prayed and prayed and prayed. We prayed for a normal birth. We prayed for a healthy baby. We prayed to know when the right time to have a baby would be and then we prayed some more. We both felt that a home birth would be the wisest course. So many people were very worried we'd made a bad choice. They were concerned for my safety and that of our baby. We understood their fears but chose not to let it affect our choices and I am so glad we trusted God to take care of us. Not only did He allow us a healthy baby, but He also allowed me the space and time I needed to heal from my previous experiences.

Emotional wounds don't scab over and heal in 10-14 days like skin. They stay raw-- sometimes for years. Even with the liberal application of therapy, an event or comment or something I read could re-open the slice in my heart. The Physician of my soul understands this and He understood how best to heal it.

My soul was in tatters after the birth of my first daughter. Words can't explain how I checked out from life for the first six months of hers. I have no pictures from that time in her life. My husband had a mighty work ahead of him helping me pick up the pieces and move on. Those six months were the reason it took me so long to talk him into having another child. He didn't want to lose me to that dark place again. He needed the assurance from God that this time would be better.

With Heavenly clearance at every turn, we made our plans. We found a midwife for my peace of mind, even though Husband felt from the start an unassisted birth would be fine. I sought intensive therapy to make sure a mental roadblock from Zsa Zsa's birth wouldn't derail this birth. All along I knew that the birth wouldn't go exactly according to plan, but I didn't know what that bit would be. I thought when the midwife fired me that might be it but when I felt that first little gush of blood, I knew we wouldn't have the baby at home.

I labored off and on for 30 hours. Sometimes I would bleed too much for me to be comfortable with and labor would slow down and so would the bleeding. We checked baby's heart tones often to make sure they were sounding great. The entire time I had a feeling of being watched over but also of expectation. Like the Lord was waiting for me to realize it was time to know I'd done all I could do to attempt delivery. To know in my heart that I'd done my part and now the safety of our baby was more important.

On the afternoon of the 3rd, I went to acupuncture to see if we couldn't get things moving along and over with. I was exhausted. Husband was tired. After my treatment, I stood up and gushed blood. That was when my heart sank and also when I felt peace with the idea of going to the hospital. I knew in the very depths of my soul God was watching and that everything would be OK. I felt as though my mission was over. On the drive home the bleeding seemed to stop, but once we were home, it started up again with a vengeance. I filled a Depends brand disposable undergarment every two contractions. Husband gave me another blessing and the bleeding stopped on our 20 minute drive to the hospital. The whole way there he was having such a hard time coming to grips with our God-approved plan being tossed out the window. I was holding out hope that upon arrival I'd be a complete and they'd let me deliver my baby vaginally but I felt such peace with any outcome the method of delivery was no longer important.

Checking in took forever. ER triage, on to registration, and then OB triage. Time started to drag and I began to feel faint.

Our triage nurse was an angel. I don’t remember exactly what happened or the order of things. I know I lost time because it seems like it wasn’t very long from when we checked in to when our baby was born, but in reality it was hours. They took some blood and did an ultrasound. I remember the contractions got significantly more painful. Because the baby was looking awesome on the monitors and the ultrasound came back clean, our nurse didn’t call the backup doc (Dr V), she waited for the on call doc (Dr A) to come in because she knew we didn’t like the backup doctor. This was yet another miracle. We hadn’t ever met Dr A but I talked to her on the phone before we went to the hospital. She seemed so calm and not the type to jump into the OR just because she liked surgery.  Dr V had made it abundantly clear she thought I was an idiot for even wanting a trial of labor and vaginal birth. She was the reason we’d decided not to go back to the doctor or to the hospital for this delivery. Being cared for by Dr A was just more proof God was in control of the situation. If we’d come in the previous day, Dr V would have been our doctor, regardless.

When Dr A arrived, she was so calm and patient. Her exam produced cups of blood (yes, cups). She listened to our concerns. She explained hers and we agreed to the surgery.  At the time I thought it was the anxiety of the inevitable surgery that caused my pain to increase so dramatically at this point but looking back, I think this is when the placenta really started to separate from the uterus. God had allowed me the space and time I needed to be mentally OK with another surgical birth, and now that I was in a safe place and the decision had been made, the situation devolved rather quickly.

We had enough time to visit with the nursery staff and the anesthesiologist before they took me back to surgery.

In surgery the anesthetist started the spinal. I was so thankful for it because I was really ready to be done with the pain. I was shaking so much at that point I had a very hard time holding still while the spinal was placed.

Husband and a good friend were then let into the room. I’m sure the surgery itself was the same as any cesarean except before Dr A had even gotten to the baby she said, “OK. I know what’s causing the bleeding. You have quite a few clots in here. Your placenta has started to abrupt.” Later on, she said a quarter of the placenta had separated from the uterus and I’d made the right choice to have the surgery.

As soon as Dr A pulled baby out, she held her up and Husband announced we had a GIRL! Oh, were we shocked! All this time I had known it was boy. I just KNEW.

Right away they brought her around and laid her on my chest, per our request. The nursery nurses aren’t used to that, and I could tell one of them in particular was a little put out that I’d made her job deviate from the norm.

Words cannot describe the joy of being the first to meet your own baby. Of course other people touched her on her way to me, but that doesn’t matter. I got to discover the little crinkly fold in her right ear. I got to discover that her eyebrows are different shapes and her hair and eyes are dark. I claimed her from her very first moments and it has made all the difference in our first week together.  

Her newborn assessment was done on my chest while Dr A finished making sure I wasn’t going to bleed to death and put me back together. Baby girl stayed with me on our ride to the recovery room. She stayed with me every minute of my six days in the hospital and every minute was beautiful.

I won’t be going to that dark place that swallowed me after my second surgical birth. There’s no need. I was respected as a person of worth and my daughter was treated as an individual with needs that were also to be respected.  I wish I could explain why that matters so much. Maybe it’s because of the heightened hormonal state that surrounds birth or maybe it’s something else all together. All I know is, being treated like a human being with feelings and a mind of my own was a very nice change.

I am so thankful to my Heavenly Father for creating a situation which resulted in a healthy baby. I am grateful to know He cares for me so much that not only are my physical needs met, but my emotional ones, as well. I am thankful that the right people were in the right place at the right time. And I am thankful for the prayers and fasting offered in my family’s behalf over the last few months. My heart is so full and my cup is certainly running over. 

For the story in pictures, go here. 

For the reason this birth meant so much and was so healing, see this post. 

NOTE: The placental abruption had absolutely nothing to do with the previous cesareans or the fact that I labored at home. It's just a random RARE complication of pregnancy. 

HypnoBirthing

I'm so excited to start a new series on HypnoBirthing and to share what I've learned with you. (yippee!)

Recently I had the chance to attend a HypnoBirth, and I was blown away. You can check out the program's statistics here.
The series will start with the birth story from my point of view, and continue with some of the HypnoBirthing highlights and what I took away from the experience and the book.
The story is written and Mom has already agreed to share her story, but I'm waiting for t's and i's. :)

In case you don't know or forgot, I had two surgical births 20 months apart. Neither were planned or at all what I was looking/hoping for. You may or may not have read my Letter To A Bastard that goes a bit more into detail about the second birth. I don't think anyone doubts my level of obsession when it comes to birth. I've read and seen so much in the four years since that first cesarean, that running across something which moved me on such a visceral plane was shocking. I hope that you'll be equally surprised and blessed.

Stay tuned!

A Letter To A Bastard

NOTE: Toward the end it does get a tad graphic. 

Dr (Name has been removed to protect the not-so-innocent),
I've waited a long time to write this letter. Two years, in fact. At first, I waited until the rush of postpartum hormones had subsided, to make sure I wouldn't be unduly influenced. Then I waited, hoping time and counseling for post traumatic stress would render this letter unnecessary.

But now, on the eve of my daughter's second birthday, I understand you need to know what I have to say, so you can avoid harming other patients in the future.

Two years ago, word on the street was, you were the best provider for TOLAC on the east side. I visited four other offices before deciding my sources were right. I knew that you and I hadn't clicked on a personal level, but that was OK with me, as long as I got my VBAC.
When I presented to the hospital with epigastric pain the day before Thanksgiving, I expected a gallbladder ultrasound and some IV fluids. What I got was a cesarean. Not a medically indicated cesarean, not a voluntary repeat cesarean. A cesarean consented to under duress. A cesarean based on a lie.
It's taken me two years of heavy research and a bio-ethics class to more fully understand what took place that day.
When you came by the hospital to see me the first time that day, you asked if I were ready for my c-section. I said no. We ran blood work. I spent the entire day in a bed doing nothing. The tests came back normal, but you said my pain was probably due to my liver going into failure.  I couldn't believe normal blood work could indicate liver failure, so I asked for, and was refused (according to you, by three different doctors)  a GI consult, you said that you'd consulted with a perinatologist and he'd recommended a section as safest for both me and the baby.  Even though both mine and the baby's vitals had been within the range of normal for nearly the entire visit. (episodes of pain excepted when I did exhibit elevated BP readings but the baby's tracings were normal the entire stay). I did not, at any point during this visit, see or speak with another provider.

When you came back to talk with me that evening, the pain had mostly subsided. It was at this point that you again recommended a repeat cesarean. I asked if my husband and I could think about it over night, since there didn't appear to be any immediate danger. This is the good part. You told me, "If you leave, it will be AMA. Against medical advice, and your insurance company won't pay for anything we've done here today." That verbatim quote is seared into my memory because it was the pivotal statement you made that sent me down the road of a repeat cesarean instead of the VBAC I desperately wanted. It was also a lie. I have no idea if you really believed your statement to be true or if you knew The Hubs and I could never have afforded all those tests and continuous monitoring without insurance. What I do know, now, is that in addition to being completely false, this statement constitutes legal coercion. I did sign the consent form for the surgery, but not willingly. I signed it, because you made it clear signing was my only option.
I knew a second cesarean greatly reduced my chances of a future vaginal birth. You brought that little nugget of knowledge to crystal clear point in the operating room when I asked you to stitch my uterus on two levels, to increase the chance of VBA2C. You said, "not with me, you won't". But that was something I'd already decided.
And then you proceeded to mock me as I lay naked, numb and very cognitively aware on the operating table. With my guts on my chest and your hands in my abdomen, you derided my request and my choices, making perfectly clear your dislike for me as a person and my desire for vaginal delivery; a birth that science has repeatedly shown is safer for both mother and child.

The question I have is this: Was your Thanksgiving meal really so important that you risked my life, my future birthing opportunities and my child? Two years later, do you even remember that day? Because I do. I am fighting an internal battle to be happy it's my daughter's birthday when all I really want to do is curl up and cry because every time you touched me, every incision, every tug, every stitch-- constitutes battery when performed without consent. Dr. Name has been removed. I did not consent.

I hope in future you will treat all your patients, even the one's you don't like, with the respect and regard they deserve. Keep beneficence and non maleficence first in your mind, not a turkey dinner.

note: that's not me. When splayed on a table, I'm MUCH more attractive.

Please read about my healing birth here.

Reducing Unnecessareans

OK, this paper could have been better, but I just didn't have any TIME. So I totally turned in my rough draft. Don't judge me. I have a 98% in this class.

In the United States today, an unborn child has almost a one-in-three chance of coming into the world via surgical birth. The 32%² rate is over twice the upper limit recommended by the World Health Organization. It’s one of the highest rates in the developed world. What’s more, this increase in cesareans hasn’t markedly improved fetal outcomes and has drastically increased the risk of maternal mortality. It is time to address the issue of “unnecessareans”.

            In 2003, The United States fetal mortality rate was over 7% with a cesarean rate at 21.1%. In contrast, during the same time period, The Netherlands had an infant mortality rate of 5% and a cesarean rate of 12.7%. They also had better maternal outcomes.¹ The most current statistics for cesarean in the United States put it at 32%.²

An article in the October 2010 issue of “OB.GYN News” by David Priver, MD goes over some of the reasons the cesarean rate in the United States is so high. They include professional liability, the demise of operative obstetrics, impatience, lack of an analytic approach to VBAC (vaginal birth after cesarean), and no one teaching the skills to do vaginal breech births to today’s obstetricians. (Luckily, midwives are still teaching new midwives this skill set and Canada has recently asked its midwives to teach new OBGYNs these skills.)

The ethical dilemma facing healthcare providers is, how do we provide the best outcome for mothers and infants, while also providing care that is above reproach and therefore, immune to litigation. One part of healthcare that has changed in recent decades is the belief that the fetus is a patient, too. Prior to sonograms, we didn’t care as much if the fetus lived or died, it was much more important that the mother live to birth another day, hence the advent of the crochet hook abortion for fetus’ too large to fit through a malformed pelvis, or for term fetal demise. Abdominal surgery just wasn’t a viable option if you wanted the mother to live.  This changing view occurred simultaneously with a skyrocketing litigious movement, making physicians less likely to practice evidence-based medicine, and more likely to perform what was deemed “best practice” by lawyers, regardless of the personal convictions of the physician, or what research showed to be the best course of action in a certain situation (i.e. breech vaginal delivery over primary c-section for a woman who hasn’t even gone into labor yet).

Medical schools began to train new obstetricians not in the management of normal birth, but in the pathology of abnormal birth. New OB’s looked for, and found, pathology everywhere they looked because that’s what they were trained to see.  This new way of teaching coincided with the introduction of fetal heart-rate monitors; a device strapped to the laboring woman that supposedly gives a realistic readout of fetal distress. Health care workers began to treat “the machine that goes ‘ping’”, not the patient. Studies have shown, and even the American College of Gynecology and Obstetrics agrees, that the use of continuous fetal monitoring doesn’t improve the outcome for most infants, and has quite a marked effect on decreasing outcomes for the mothers, namely in the form of cesareans and their vast and varied complications.⁵

We start to see now that doctors have forgotten their oath to do no harm to the mother, in their haste to prevent perceived harm to the fetus. One can only surmise the foremost thoughts in the mind of the physician are the lawsuits he’s evading by following “best practice”.  The real question is, in whose best interest are decisions being made?

When we approach this dilemma from the viewpoint of an absolutist metaethical theory we can ask ourselves, what known truths are being subverted by the physicians in their push for unnecessary surgical births?  There are several answers: the innate autonomy of the woman to make informed choices about her body and her birth, the duty of the physician toward primum non nocere, and the duty of the physician to ensure informed consent. All of these innate rights are being violated in the push for surgery to “cure” what might be “wrong”, not with the primary patient, but with the fetus.

We can look to other countries for ideas to drastically lower our surgical birth rate while maintaining or improving patient outcomes for both mother and child.

The first thing health care providers could do is to spend more time with patients educating them prior to conception, and throughout pregnancy. This would not only allow time to educate, but also foster trust between the mother and the person she has chosen to see her safely through birth. Currently, mothers receive no prenatal counseling and physicians spend on average four minutes per visit with each mother. This means the average healthy mother spends 22 minutes with her provider between conception and the start of month eight. By the time birth is eminent, a mother will have spent less than an hour total with her doctor. Contrast that to the midwifery model of care that has the patient spending, on average, one hour per visit and that hour is frequently in the mother’s home. In addition, many midwives adopt a model of group prenatal care that allows for additional time spent with a group of women in similar gestation, fostering a community of trust and support between both the provider and other pregnant women. This model has been shown to drastically reduce the fear and pain associated with childbirth.  Obviously most doctors are not in a position to offer this level of care, and most people couldn’t afford for a physician to provide it. An alternative would be to let doctors provide the care for truly high risk patients, and shift to midwifery for healthy women.

Another factor in the high cesarean rate in the United States is an epidemic called “failure to wait”. In our need for instant gratification, we forget that babies are not parcels delivered by UPS. They do not have an “arrive by” date, nor do they expire if not delivered within a prescribed time limit of 39 weeks, 6 days. The latest research surmises labor begins when the baby’s lungs send out a signal saying “we’re ready!” and not a moment before. For prima gravid patients, this is 41 weeks, 3 days! Cervical ripening agents and pitocin not excepted, a baby simply won’t be born before it is ready. Pitocin isn’t even an FDA approved medication for labor induction without medical cause, yet women request it, and doctors prescribe it and health care providers abuse the dosing schedule, increasing the rate too quickly or using a starting dose exceeding the package insert, all to make the baby come before the ball game/vacation/holiday/dinner. There is even a movement called “pit to distress” which basically says we’ll ramp up the pit until the baby can’t handle the intensity and frequency of contractions, at which point we’ll tell the mother her baby is going to die unless we do a cesarean. This isn’t even a lie because at that rate, the baby WOULD die—squeezed to death by the womb.

A third idea for reducing the cesarean rate in the United States would be to not only discuss, but educate and encourage women with previous cesareans to birth vaginally. Set up support groups and classes to make sure mothers make informed decisions about their options. You would be hard-pressed to find a surgeon who discussed all the risks of repeat cesareans with mothers. Just a few are adhesions, baby having to spend time in NICU because the cesarean was performed prior to spontaneous labor so baby has difficulty breathing, and placenta acreta (a disorder where the placenta grows into the scar tissue from the previous incisions and won’t let go when the surgeon determines it’s time; this frequently leads to hemorrhaging and subsequent hysterectomy).

In healthcare today, women need to demand better care from their providers. If our physicians won’t do the job of educating, we must find our education elsewhere. ICAN, the International Cesarean Awareness Network has many good resources and chapter leaders can be found in most parts of the country. Healthcare workers must act as guardians of labor and laboring women, ensuring the proper management of normal labor. Meaningful tort reform MUST pass, to give doctors the freedom to do what is best for patients, not the malpractice insurance agency, and every person must realize birth is a delicate dance between the baby and the mother. Health care providers are there simply to make sure the two of them do what they were designed to do, and nothing more.  

The risk of complications up to and including major abdominal surgery to birthing mothers can be reduced if our society takes a step back and remembers to treat birth as a physiological process to be watched and guided, rather than a pathological condition in need of treatment or management; birth by design, rather than birth as cure. Teaching the nation’s birth attendants the normal processes of labor in its many variations, rather than a set form of numbers that MUST be adhered to, “or else” will go far in reducing unnecessareans.

1.      http://www.nationmaster.com/graph/hea_bir_by_cae_sec-health-births-by-caesarean-section

2.      Ob.Gyn News August 2010, p.1

3.      http://www.theunnecesarean.com/storage/cesarean-rate-by-year-US.jpg

4.      http://infochimps.com/datasets/infant-neonatal-and-maternal-mortality-rates-by-race-1970-to-200

http://www.ourbodiesourblog.org/blog/2009/07/acog-issues-new-practice-bulletin-on-continuous-electronic-fetal-monitoring

I think I'm Missing Something

I just read this article about the recent salmonella outbreak from egg farms in Iowa.
The article calls for stricter state regulation on egg farms but the guy in charge of state agriculture says the Federal Government should impose more strict regulation on all egg farms everywhere.

Those of you who know me, know I'm a strong supporter of state's rights, but you know what I'm an even bigger fan of? Common sense.

People, if you know where your food comes from, if you trust the people who produce it, is it even a state issue? No, it's not.

That being said, not everybody has a farm up the street from which they can get eggs, or room for a couple chickens at their own homes, so the next question I have is why people aren't demanding the egg farms do something about this. Why is it the federal or even the state government's job to keep us safe?

What are we? Five? 

No. Most people who buy eggs are responsible adults who manage to take care of ourselves the majority of the time. What's the real deal, then?

Oh, I know. We've been trained to expect the state/federal government to let the state take care of us. State funded education. State funded welfare, state funded public roads and transportation, state funded healthcare, state funded food and drug regulations and state funded business regulations.

Am I alone in thinking this is a BAD thing?

I Wear Designer Babies

I'm a Babywearer. No, that's not a brand like Jimmie Chu or a weird cannibal version of clothing. I wear Custom Designed Babies specially crafted by God, The Hubs and me (we're a team).
They are wonderful, these Designer Babies.
With The Boy, I had a ring-sling designed by Dr. Sears I wore CONSTANTLY. It was great for mad dashes through airports or getting the vacuuming done before The Hubs got home from work or school. It fell short in the hands-free arena, though.
So with The Baby (who is now nearly two) I use a Wrapsody by Gypsy Mama. It's WONDERFUL.

 Us on a recent hike (it was WINDY!)

 NOTE: I don't have to hold the baby with my arms, this sling is totally hands-free.

But now the government is trying to legislate yet another aspect of our lives and tell us something that is totally normal, totally loving and yes, ancient is in fact harmful to our children. Sound familiar? No? I'll give you a hint: they did it with birth. 

This is some pretty good info on the current legislation along with the people  you can call to make a difference.

So I'm writing this post to tell you that I never feel closer to my children than when I'm wearing them. For me there was a learning curve to baby-wearing, but it wasn't modeled for me and people think it's weird that I wear my children (especially as they get older). I had a grandpa stop me in Costco Saturday asking how it worked. He thought it was a curtain. 

Visit this blog for more information on the government's attempt to dictate how we parent our children. Maybe baby-wearing isn't for every momma or every baby and that's OK, but don't you want your children to have the CHOICE?

Also go here for ways you can help.
And one more awesomely well-written blog on babywearing.