Childbirth rant

The other day, one of the other interns asked me if I was planning on being induced. Like it was a conscious decision I will make early in pregnancy. Last year in my family ward, I was sitting in Relief Society when several pregnant women and a few with new babies were talking induction as well-- the new moms were raving about their inductions and asking the pregnant women if they planned on it. I know most of my friends didn't choose their induction dates (I imagine most of these women were birthing at Utah Valley), but it's actually becoming the norm. That is very scary to me. For multiple reason... one, being that induction isn't without risks and isn't something that should be done just for the sake of it. Pitocin is a serious drug; it makes your contractions harder and longer with very little space between them. Because there are no breaks like in normal labor, the baby does not have time to recover in between, leading to a drop in heart rate and fetal distress. Not to mention, the pain of induced contractions is way more intense, and dedicated women that are trying for a medication-free delivery often can't handle the more intense pain.

I know there are cases when inductions are necessary: when you are two weeks or more past your due date for example or there are complications like pre-eclampsia or gestational diabetes. But inductions for the sake of inductions... and the increasingly common use of pitocin... that is scary stuff.

And while we're on a childbirth rant: epidurals. The more I've been reading about them, the more I don't want one! I think it's weird how people are telling me how brave I am to do it natural, how they could never do it, and so on, but I think you are brave for letting a needle/catheter get that close to your spinal cord without freaking out! A spinal cord is a delicate thing. I like my body functioning just the way it is functioning. Epidurals are not without risks either, but I think they have become so commonplace nowadays that women don't realize the risks. Not only do they have medical risks, they also interfere with your body's normal birthing hormones. The pain of childbirth works with your brain to release a series of hormones that facilitate labor and delivery of a baby. When it's functioning properly, the pain send messages to the brain to release endorphins, a natural pain-killer. Epidurals inhibit the release of these endorphins, yummy feel-good pain-killing hormones, as well as oxytocin, the uterus contractor and love hormone. Epidurals administered early in labor will slow it down or stall it completely because it messes with oxytocin, in which case, then a woman will be given artificial oxytocin (pitocin) to speed it back up. Vicious cycle. Unmedicated birthing women also get a surge of hormones right at the actual moment of birth of their baby, which results in an ecstatic moment that is unmatched by any other moment in the woman's life. Her hormones are higher at that moment and the hour after birth than at any other time in her life. I want that delicious, ecstatic experience! But so many women don't know these things, or don't want to feel the pain, or just listen to their doctors recommendations and aren't empowered to give birth the way Heavenly Father designed our bodies to do it!

For example, my sister just said she figured of course she would get one with her first baby. Her labor was short, her baby was tiny, I have complete faith that she could have prepped herself a little and done it natural, but it was never even a question in her mind that she would have an epidural because everyone was having them. As a result, she couldn't push effectively and had an episiotomy for a 4 lb some oz baby. Oh goodness. Let's not get started on episiotomies (for those who don't know--that's basically when the caregiver cuts from the vagina to the rectum to increase the amount of room for the baby to get out). If for some reason I end up in a hospital during my birth (oh, we think we're doing it at home now, another blogpost for another time), if any doctor gets anywhere close to my vagina with scissors, my husband has been given strict instructions to push him/her away. The WHO has come out with evidence that episiotomies are far more hurtful than they are helpful, and most OB/GYNs will not even routinely cut them anymore due to current recommendations. However, there are some practioners that have 90%-100% episiotomy rates still! How a person can ignore the evidence so blatantly I will not understand.

Which now brings me to VBACs: a few decades ago, VBACs were the norm. Then, in 1995 I believe, the ACOG came out with a statement recommending repeat cesareans and also requiring readied surgical teams in every hospital that allows VBACz. This means that any woman who wants one in a smaller, community hospital will not be able to get one because rarely do these hospitals have the capabilities to have a surgical team ready at all times. This subject can kind of be a touchy one as well: there are risks associated with VBAC and they sound really gruesome. Again with the evidence, but it shows that the risks associated with repeat cesareans are higher than those associated with VBACs because the risk of uterine rupture is incredibly tiny, and the risk that the uterine rupture will harm your baby is even smaller. If the woman has a double-stitched, low-transverse uterine incision for her cesarean, the risk of rupture is even smaller. Some doctors are doing single-stitching now though because it takes less time and uses less material-- if you're having a c-section because of a complication, make sure you demand double-stitching! The risk of uterine rupture also SIGNIFICANTLY increases when the woman is administered pitocin or other labor-stimulating drugs. Since pitocin makes contractions stronger, it puts more pressure on the uterine scar. Oh, and a note about the 1995 decision reversal on VBAC by the ACOG: there were a series of uterine ruptures in like Massachusetts and litigation and ruined doctors... but then they realized that almost every single one had been administered Cytotec, which has been proven to result in rupture. Even with this knowledge, the ACOG stuck with their decision.

End rant. And just a disclaimer before the attacks begin... I recognize that childbirth can be just as health-hazardous as ecstatic and beautiful. There is a lot that can go wrong in pregnancy and childbirth. There is low fluid or fetal growth restriction or huge babies or labor that lasts for days and doesn't progress. I'm not saying that modern medicine is not wonderful in preventing maternal mortality. OB/GYNs are awesome. But they are surgeons. They are trained to find complications and treat them. And 90% of pregnancies and births are uncomplicated. Yet these women are still being treated by the surgeons trained to find something wrong so they can fix it. I would love to see more support for midwives and more faith in their care in our country. Because in addition to the toll our system is taking on women's bodies as well as women's experiences with how they feel about their bodies, it's also taking a huge toll on our healthcare system. I believe that birth is the highest grossing medical procedure in our system... it makes the most money for hospitals. There are SO many vested interests at play here, be it the for-profit businesses of doctors and hospitals or the insurance companies. If more midwives were attending normal, healthy pregnancies and births and less unnecessary interventions were being used, millions if not billions of dollars would be saved by individuals as well as by the government from programs like Medicaid. And I'm not saying we should skimp to save money on such an important thing as maternal health. What I am saying, is we could saving money and improving outcomes. The WHO recommends an optimal c-section rate of 10-15%. Ours is upwards of 30%. It's ironic that a majority of c-sections are "emergencies" but take place right before dinnertime. But doctors are people too... and the idea of 15-minute surgery and being home for dinner with your family (as well as the decreased chance of being sued for malpractice) is appealing I'm sure. We put so much faith and trust in doctors that we rarely question them. Heck, I let a stupid resident in the ER give me a completely unnecessary x-ray a few weeks ago because I was too stupid to actually speak up because I just wanted them to fix me. I think it's time though, that women reclaim birth from doctors. We need to trust our bodies! Do a little research, read a few books, look at the evidence and research especially. You'd be really surprised at what you find.

And if you support the idea that women should be able to choose where they birth (be it hospital or birthing center or home) and their caregiver, join the campaign! This is specifically for government-funded programs, allowing women on Medicaid to be able to choose out-of-hospital births. With the healthcare reform on the horizon (God help us), we want Medicaid to provide reimbursement for CPMs as well as CNMs and MDs. Right now, Medicaid will not pay for most birth centers or home births... but if they did, and women chose them, it would save lots and lots of money as I mentioned earlier.