Pushed

Lately I've been doing a lot of reading about fertility and naturally that topic lends itself to the topic of childbirth. Most people who know me know that I'm not an advocate of unnecessary medical intervention. If you're in dire need of medical care or it's an emergency, then yes, absolutely, use medical advances to your benefit.

Personally, I rarely take pain meds or medications unless I absolutely need them. Currently I take the minimal amount of HRT meds to balance the hormonal issues caused by my craptastic reproductive system. I'm eligible for meds to treat hirsutism, hot flashes, etc, but I declined them. I'm not pumping my body full of medications to treat vanity issues.

As far as pain meds are concerned, I had five teeth removed (four wisdom and one tooth damaged by a wisdom tooth) and other than the conscious sedation used in the actual removal and one vicodin as I left the dentist's office, I took absolutely nothing else during my recovery. I also had a bulging disk once and took only one Skelaxin (muscle relaxer) but then trashed them because they made me feel out of control. I chose physical therapy instead and I had immediate pain relief.

Anywho. Off topic. Back on track.

A lot of the women in my infertility support group have suggested that I read Pushed by Jennifer Block and watch the documentary The Business of Being Born. Well, I did, and holy shit am I disgusted. Last summer I read a World Health Organization report ranking developed countries and maternal/fetal death rates. Quite frankly, we suck at providing women proper medical care. We have the 2nd highest rate of fetal death in the developed world but spend twice as much money on prenatal care and birth. WTF? Our rates of maternal death are among the worst as well.

It's really eye-opening when you read the research on developed nations and maternal care. Across Europe and Japan 70-80% of all births are attended by midwives; in the US only 8% are attended by midwives. Most developed nations reserve OB care for women in high risk pregnancies. C-Section rates in these countries are in the single digits (6-8%) but in the US 1/3 of all births are C-section births. Some hospitals in metropolitan areas that allow so-called "designer births" (when the woman chooses her due date) have C-section rates of 46-50%. Digest that. It's insane.

The most sobering facts presented in the documentary occurred during the interviews with prestigious OB's who freely admit that c-section rates are so high because there's less chance of litigation and it's just easier for the doctor. One doctor talks about the recent studies showing that c-sections spike at 4 pm and 10 pm. Uh-huh. He explains the obvious: some doctors just want to go home. While I applaud this OB for being honest, I thought he was a fucking prick for saying that women who champion the cause of natural birth are, and I quote, "Feminist Masochists."

Feminist Masochist. For what? Trusting that her body is capable of giving birth? For refusing unnecessary intervention?

Another well-documented point in all of the childbirth literature and research I've read is the fact that the modern medical approach to labor and delivery applies time constraints to a natural process. Rather than allowing women to progress at their own pace, hospitals have time frames for each stage of labor. You have to dilate and deliver in a certain amount of time. This is a PUSHED BIRTH.

It goes like this. You check in. Your contractions are close but you're not dilating fast enough so they push Pitocin. Because you didn't get to ease into more powerful contractions, the pain is often too much so you opt for an epidural. The epidural impedes the progression of labor so they give you more Pitocin. Pitocin contractions are stronger and longer than contractions caused by natural oxytocin so the baby experiences longer decreases in blood and oxygen caused by the contracting uterus. This can lead to fetal distress which then causes the doctor to perform an emergency c-section.

I've just desribed the birthing experiences of two very close friends (related to me in excruciating detail) and what I suspect may have happened to a third. Oh, and Pitocin usage requires constant fetal monitoring and usually the insertion of an intrauterine pressue tube monitor thing. Once you're hooked up to all of these tubes and machines you're confined to the bed.

That flat on your back and push business has perplexed me since I was a kid. When my mom was pregnant with Tricia, I was old enough to understand all that baby business and I couldn't for the life of me understand how horizontal was better than vertical for pushing an object out of a tight tunnel. Seriously, folks, I put a tennis ball in a pipe to test my theory. When it was flat, the ball was stuck. If I shifted the pipe, the ball fell out. Hmmmm. Gravity. Interesting.

The Lithotomy position (ladies, we all know this one: legs in stirrups) seems counterproductive. We know that it causes the pelvis to narrow and that it basically causes the baby to be born at an upward angle. It also encourages the use of episiotomy (OUCH!), forceps, and vacuuming. What gives?

You know, one of the best segments in the documentary is when this one OB encourages his patient to use a midwife. He offers to be the back-up physician should any need arise. (As it happens, he is needed. The midwife is so calm and professional. She assesses her patient, notes that she's 4 cm dilated, and that the baby is breech. Based on that information, she makes the decision to go straight to the hospital rather than risk the baby.)

From the moment Dave and I discussed having children, he wanted to attempt a home birth. He's also of the belief that pregnancy isn't an illness and shouldn't be treated like one. I was so relieved. I've always liked the idea of birthing at home but usually when I admit that to friends/family I get these patronizing pats or tirades on the danger, because, you know, I'm not intelligent enough to have educated myself.

Obviously if we're high risk (which is a real probability) then we're using our current OB/GYN/Fertility Specialist. If we manage to conceive and I don't have high blood pressure, gestational diabetes, or god forbid, a litter, then we'll probably use one of the midwives serving our area. Texas licenses midwives the same way they do medics and other health professionals so I'm assured of getting quality care. And, of course, I absolutely trust Dave's judgment as to the health and welfare of myself and any child we might have. I know that at the first hint of a complication, he would call an ambulance. We're less than five minutes from CSMED which has a NICU so thankfully that's not an issue.

So. That's that. Those are my thoughts on the issue. Please, no flames.

I leave you with Dr. Marsden Wagner's (Former Director of Women & Children's Health for the World Health Organization for 15 years) quote: If you really want a humanized birth, the best thing to do is get the hell out of the hospital.