VBAC Mamas, Unite!

I'm a proud VBAC mom. My first birth was a cesarean. Luckily, my next birth took place during the VBAC renaissance, and even though they were whispering in the corner about a repeat cesarean, it didn't happen. I had my first vaginal birth accompanied by a giant episiotomy. That didn't stop me, though. My next VBAC had no episiotomy. The VBAC after that, the doctor almost didn't make it in the room to catch in time. By that time, I'd had enough. My next four VBACs were at home with midwives. Seven successful VBACs.

Women today rarely get the opportunity to even try a VBAC. Hospitals ban them. Doctors trick women into thinking they can have one and then pull the rug out from under them late in their pregnancies. Yet the evidence shows that VBAC is still a safer route to go than repeat cesareans.

This week, the National Institute of Health (NIH) has had a panel meeting to discuss this very issue. I haven't had the opportunity to listen for myself yet, but I've been reading the comments posted by others, outlining the "Hurray!" moments and the "I can't believe they still ignore us" moments.

On the WebMD site, David DeNoon reports, "Hospitals and professional societies should end bans that that keep many women who've had a C-section from opting for a natural birth in later pregnancies, an NIH advisory panel today urged." This is definitely a welcome beginning.

Kenneth Lin, a family practice physician from Washington DC, writes about the obstetrical tendency to see zebras instead of horses. He writes, "If an Ob/Gyn is feeling uncertain about how well a patient's labor is progressing and has an inflated estimate of the probability that something might go wrong (the zebra), it's very hard to resist the temptation to eliminate the uncertainty by delivering the baby surgically, then and there." He ends his article positively with "a trial of VBAC is successful more than 75 percent of the time. It's a real shame that women in the U.S. are discouraged from attempting them more often."

All this sounds great. Maybe women will get more opportunities to have their own VBACs. Maybe the cesarean rate will go down. Maybe... but then we see the extra caution thrown in. "Only qualified candidates" and "eligible patients" are the phrases that begin to crop up. Isn't that part of the problem now? Obstetricians are removing almost every woman from being qualified or eligible. Let's just schedule that cesarean... what do you say? You can pick a convenient time (for the doctor!) and we'll have your baby out in no time!

Kind of defeats the whole purpose, doesn't it? The real result is shown clearly by Courtroom Mama on Jill's Unnecesarean blog. Apparently, on day one, two members of the panel, Dr. Anne Lyerly and Dr. Howard Minkoff stated without hesitation that a woman could not be operated on against her will. The next day, when Susan Jenkins, the attorney for the Big Push for Midwives campaign, asked questions about this, the panelists ended up skirting the issue.

Here is a portion of Courtroom Mama's transcript from her post. Read the full article at the link above to the Unnecesarean blog. SJ is Susan Jenkins. LM is Larry McCullough, the ethicist on the panel.

"SJ: Dr. McCullough, just one quick follow up question, if I may, on that. The conclusions that are reached in the draft, at least the draft opinion that we saw this morning, indicate that the position of the committee is that only where it is considered “medically reasonable”—whatever that means—would the woman have a right to refuse. And the definition of medically reasonable…well, there is no definition of medically reasonable.

LM: Well, actually, there is, and the concept is when the alternatives are roughly medically equivalent. What we said is that shared decision-making should be followed, where the physician refrains from making a recommendation and really helps the woman make a decision that reflects her values and preferences, which is the goal of the informed consent—

SJ: Right, and what if her values and preference is to say “no” at the end of all this?"

Ms. Jenkins was then reminded of the long queue of people wanting to ask questions. Just what is "medically reasonable"? According to who? Apparently not according to the mom in question. Informed consent seems to have just been dumped into the trash. Pregnant women obviously don't have the same rights to equality as other medical patients. 

While we all joke about "pregnancy brain" it isn't something that should remove our rights to bodily integrity and decision making once we check into the hospital or accept a doctor's care. All the talk the panel made earlier of "the doctor and woman should be making these decisions together" seems to have been to placate the masses of women hoping to have a vaginal birth. "Making decisions together" is just another euphemism for the doctor saying "Don't worry your pretty little head about it... we'll just cut that baby right out. You won't need to even break a sweat."

I think this panel brought up some great points. It has gotten articles about VBAC in major papers like the LA Times. But we can't stand idly by and let it turn into the same old line. VBAC mamas, unite! Let your voices ring out. Demand the right to birth your babies the way nature intended. Every baby deserves the best birth possible. Every mom deserves to give birth.

Docs Banning Doulas & Birth Plans... What's Next?

When I saw this I just hated to see that this is happening. This arrived on my Facebook page the same day as a notice about a woman who received a letter from her OB giving her HIS birth plan for HER birth. It was very similar in tone. When I first became a doula fifteen years ago, it was sometimes awkward to try and do your job around the OBs and hospital staff. Doulas were a new concept then for most hospitals, and none of us really knew where we stood.

As the years have gone by, doulas made their own niche, serving women who needed extra support. I never did understand the whole advocacy thing... if we spoke up, we ran the risk of being kicked out and then our client would be without the support they paid for.

I am no longer a doula. As much as I loved helping families welcome their new babies, it wasn't feasible to be gone at any hour on short notice with my own growing family. Once I had my homebirths, the hospital environment was very difficult for me to endure. I know that women in the hospitals need the help of doulas more than ever... and I admire those women who can see women being forced into the situations the sign above insinuates and still do their best for their clients. It takes a lot of grit and determination.

Birth plans have always been ignored... if you had an OB who not only read your birth plan but tried to abide by it... you are one lucky woman! While we all diligently wrote out our birth plans, fully believing they would be honored, one by one we have all become cynical as our plans were derailed, one by one.

We have fought long and hard to bring the ability for women to choose their birth experience and to bring their babies gently into the world if they so choose. Now the docs are fighting back by banning things like opting not to have an episiotomy or to have another support person in the room. Some hospitals are taking the chance with the CDC's recommendation of as few people as possible in the maternity ward during this H1N1 flu panic to ban doulas as well.

We need to step up and keep fighting. They are eroding our choices. No VBACs, no doulas, no birth plans. I say we keep fighting to have the births we want without interference. Why should we care about their time schedule? Babies come when they are ready and take as long as they need during labor. We owe it to ourselves, our babies and our daughters who will be birthing some day to make birth all it can be... as Harriette Hartigan so elegantly put it, "Birth is as Safe as Life Gets."

ICAN Needs Cases of Insurance Discrimination

Last Thursday, Peggy Robertson of Colorado testified before the Senate Health, Education, Labor and Pensions (HELP) Committee about being discriminated against by her insurance company. Her story can be found at the ICAN website: http://ican-online.org/users/ican-blog/blog/ican-mother-testifies-capitol-hill.

According to the ICAN press release, Mrs. Robertson was not only rejected for coverage because she had previously had a cesarean section, she was told in a letter that the only way they would give her coverage was if she consented to sterilization.

With the percentage of pregnant women who give birth via cesarean section rising to almost 33%, using a cesarean as a "pre-existing" condition is setting up a third of American women to be uninsured in the future. More and more hospitals are not offering VBAC (vaginal birth after cesarean) as a choice to women. Page Hospital in AZ was the most recent one in the news that threatened a VBAC mother with a court ordered cesarean if she did not consent, even though she had had a successful VBAC for her last birth. This mother has decided to travel hundreds of miles in order to get her VBAC. This shouldn't happen, either.

If you have stories of insurance discrimination based on previous cesarean, send them to ICAN. The Senate committee wants to investigate this issue.

High Risk

Hi. I'm high risk. If I walked into an OB's office today to get prenatal care, I would be pushed to the high risk category faster than I could say "homebirth." Why? Well, let me count the ways.

Age

At age 44, I am definitely an elderly candidate for motherhood. Somehow when I hit the magical age of 35 I transformed from a healthy young woman to an elderly mother who needs constant surveillance and testing.

Parity

I have eight children. That makes me not only a multip, but a GRAND multip. Everyone knows that our uteruses can only handle a couple of kids, so when you get one as experienced as mine is, it is time to pull out all the stops, because when that baby comes out, my uterus will be so old and tired that it won't clamp down and I'll bleed to death.

VBAC

Once upon a time, way back in the early 1990s, I had a cesarean. Never mind about those seven vaginal births I've had since then.... I've just been lucky.

Large Babies

OMG! I have a history of large babies! Let's see... out of 8 children, half have been over 9 lbs! In fact, the largest was 10 lbs 11 oz! Well, that should have been a cesarean... if I'd come into the hospital like a good little patient, I'm sure they would have taken better care of me and sliced me open right then and there. I must have had Gestational Diabetes to grow such large babies...

Hmmph.

I don't see what my age has to do with anything. If I'm young enough to still conceive, then I'm young enough to grow and birth my babies. I'm healthy and I take care of myself. As for being a grand multip... I'm darn proud of my kids! They are responsible, courteous and bright individuals. I know the symptoms to watch out for regarding hemorrhage and I know how to stop the bleeding. As for VBAC... shouldn't seven vaginal births prove my uterus can not only handle pregnancy and birth, but it is darn good at it! And as for large babies... none have had any problems associated with gestational diabetes or anything else due to their size. Oh, and I did get tested for GD in most of my pregnancies... nada. Zip. No sign of GD. So there.

Pregnant women should be treated as individuals, not lumped into categories for the simplistic reasons of age, parity, baby size and uterine surgery. Every one of us is different. While one person may need extra precautions, the next person of the same age doesn't necessarily need the same precautions.

Likewise, hospital births are not the perfect solution for all of us. We survived as a species this long... but since there are so many reasons to classify us as high risk, how much longer will we last?