Sunday, October 21, 2007

My kids are cute, and some rants about overly managed birthing

I love my kids. I love that randomly in the middle of other activities Lacy will say, "Mom, I love you." I love that she plays so well with her sister, and is so protective of her. She is so smart, too (humor me here if these are typical for a 39 month girl, and smile and nod). She can spell her name (sort of, sometimes she says L-A-Y-S instead of L-A-C-Y, and occasionally she starts naming off random letters). She knows her birthday. She knows all the colors in the rainbow, can count to 20, recognizes numbers on paper at least through 6 and counts items well, through 5. She knows many of her letters and always gets the ABC song right, and some of her older friends do not. She can draw recognizable people now if instructed, and can break eggs without causing too much damage (when we're cooking of course).

Rose is also a joy. She says a lot of words and uses many signs now, though the sign for "eat" means a lot of things, as does "all done." She can say Lacy, now, though it comes out more like "eee-see." She is also very proficient with the word "hot" and says it all the time! Probably because I say it all the time to her! She likes to help me cook, you see. Today she went to nursery for about a half hour and she DIDN'T EVEN NOTICE I LEFT. She is SOOOOOO ready! Only 4 more Sundays to endure before she is nursery aged! YEA!!!!

And the birth rant. OK, I am a huge advocate of normal birth. I don't put much trust into the birthing industry in general, though I do trust my midwife (she is a licensed midwife but not a nurse midwife). I do generally trust the medical community, after all my life was saved by a great Uriologist (shout out to Dr. Ellen!). But birth is not a disease. Generally speaking, it should not be managed by surgeons. While I don't dismiss the need for surgery in childbirth (it is very necessary and lifesaving, and I know many, many mothers and babies have been saved by this surgery, including my own husband), I feel it is overused. Currently the rate of cesarean rate is about 30%. The World Health Organizations says that once the rate goes above 15%, it is costing more lives than it is saving. *Disclaimer-- I do support full choice in birth for ALL women, whether it be elective primary cesarean with a tummy tuck or unassisted homebirth in the forest. Mostly I want women to know their options and to be fully informed of all their birth choices, not just the ones their birth attendant gives them with risks glossed over.

OK, there is one situation in particular that I want to address. A woman in Relief Society today excitedly announced the birth of her newest granddaughter, born Wednesday. Baby was stubborn and didn't want to come out (mother was 41 or 42 weeks I think) so they induced the mother at 6 AM. Mother stalled out at 8 cm in the early afternoon. After several hours of being at 8 cm with no cervical changes, the doctor gave her a time of 6PM that she needed give birth by, otherwise she would need a cesarean. OK, to me that seems so suspicious. 6 PM? So he can get home in time for dinner? There is nothing wrong with stalling out at 8 cm, especially for a mom who had previously given birth vaginally, as this mother had at least two other times. I personally stalled out myself for about 4 or 5 hours, in transition the entire time, with no drugs I might add (not that this makes me special in any way shape or form, it's merely a fact to point out how horribly painful this 4 hours was-- I was actually asking for drugs at the end but didn't get them which I am glad for since I've had a bad epidural experience with my kidney surgery in 1997). Nobody said a single word about surgery to me, not once. And I certainly would have been open to it at one point in my labor! It's the 6PM thing that really bugs me. If mother and baby are fine, just not progressing, why have a c-section? Sometimes labor just stalls for no apparent reason and starts back up again after some time. I've always heard 24 hours after your water is broken (which I personally think shouldn't be a hard and fast rule in every situation), and this was only 12 hours, and I'm not even sure her water was broken at the beginning of the induction anyway. The good part of the story is that mother did give birth vaginally at about 10 minutes after 6. YEA!

Another woman in my ward had a grandbaby born this week, too. This one WAS by cesarean and a necessary one at that. Baby was transverse, which makes it impossible to birth vaginally. Mother had a bicornuate uterus (same problem my mother-in-law had) and baby wasn't able to get enough room to turn vertex. In the end, it turns out there probably WAS enough room to turn vertex, but because he was so frequently transverse there was a high risk of cord prolapse. So he was a c-section. While I guess technically because he was born vertex (albeit by cesarean) he could have been born vagnially, he did like to move to that transverse position a lot, and the risk of a prolapsed cord is too high to justify waiting until the onset of labor to decide whether to try for vaginal or not. It seems like many women begin labor with their first with spontaneous rupture of the membranes, so this would have been irresponsible on the physician's part not to recommend a cesarean in this case. And thankfully, this mother got a low transverse scar, which means her risk of uterine rupture is less than half of one percent (0.4%) in future labors, the majority of which are not fatal (3 out of 10,000 perinatal deaths, same perinatal death rate as planned repeat cesarean), so if she chooses to try for a VBAC (assuming her labor is unaugmented which increases the rupture risk, especialy if cytotec is used) her risk of rupture is about equal or lower than the risks of side effects from a cesarean.

OK, that's enough birth talk for now. Can you tell I'm obsessed? I really want to have another baby but I know now is not the right time. I want Rose to be closer to 3 when we have another baby. Which means only 6 months until we can discuss taking out my IUD! I know, TMI. For now, I'll live vicariously through my friend Emily, for whom I am throwing a baby shower on November 1st. It should be fun! We're filling her freezer with all sorts of goodies.

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