Home Birth Story

Click here to read this nice story and commentary.

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A Place of Peace

Several months ago, my husband made plans to go out and visit his father. I was fine with it. In some ways I wanted to go with him, but didn’t have anyone to leave my kids with for a week, and didn’t really want to leave them that long, either; nor did we want to take them, not least of which reason was buying a plane ticket for each of them. So, I was going to pack him off for a week of fun out West, while I spent a lot of time at my mom’s, or with the kids in front of DVDs and me in front of the computer. In some ways, I was even looking forward to it, until…

For no apparent reason, towards the end of the school year (he’s a teacher), I started having morbid thoughts about him, for no apparent reason. He was five minutes late home from school, and I started planning his funeral from a car wreck — that sort of thing. Weird. No logical reason for it. Once he drove a bus after school or had a meeting and was nearly an hour late — either he forgot to call me and tell me, or I didn’t get my voicemail — and by the time he drove up (completely safe and sound), I had not only planned the funeral, but was trying to figure out if I wanted my mother-in-law to move in to help me with the kids or not. Yeah, kinda insane, I know. I tried to say that it was just because of the way my father died (car wreck — one day, he just didn’t come home) — but it seemed more than that, because I couldn’t figure out why on earth I might be having such dark and gloomy thoughts all of a sudden with such great frequency and regularity — sometimes I would even drift into such macabre thoughts in the middle of the day — thinking things like, “I wonder if he made it to school today?” or “I wonder if he will get in a wreck on the way home today?”

I thought it would get better when he was done with school and didn’t have to go anywhere, but it didn’t. If anything, the negative thoughts and feelings intensified. Visions of car wrecks on the way to the airport and plane crashes over Texas filled my head. For no reason.

Then, a few days before he was scheduled to fly out to see his dad, my husband told me that he had been having morbid thoughts as well — thinking things like, “What if this is my last week with my family?” and such. Premonitions that he would die. And it was associated with him going out to visit his dad. I had resisted telling him my fears (complete with planning a funeral, having to call his brother back from a business trip across the country, filing insurance paperwork, not to mention all the plans we had for the summer being completely disrupted — yeah, I have an active imagination), but when he told me his thoughts, I told him the same thing had happened to me, too. It wasn’t too difficult for him to take the complete lack of peace he had with his travel plans and put them on hold. As frugal as I am, I was in complete agreement with him not flying out, even if it meant he would lose the money he had spent on the ticket. With the decision made, we both felt like we were in a place of peace.

Although he wishes he could have gone out to visit his dad (and his favorite brother, who chose to visit his dad at the time when my husband was going to be there — so much for plans!), he simply did not feel right about going. We may never know why he had such a feeling of foreboding — particularly since he loves flying, and even has his private pilot’s license! The flights he would have taken did not crash; we did not hear of any fatal car accidents that he might have been involved in on the way to or from the airport; his dad and his brother are just fine; it’s possible he would have gotten mugged or his car stolen from the airport parking lot had he been away; and although all the feelings of fear from both of us were based on him dying, it is possible that it might have been me or the kids who could have gotten hurt or injured with him gone. Or something else horrible.

We may never know why we both felt like he was going to die if he went out to see his dad. But we did. So he didn’t.

Sometimes when a woman makes a decision about how she gives birth, it may not make sense to her why she feels the way she does. She may have some ill-defined fear or sense of foreboding that is not logical, but is preventing her from choosing a way that she otherwise would. I’ve read numerous birth stories written from women like this — for some, it is choosing a home birth when they ordinarily would have a hospital birth; for others, it’s choosing a hospital birth when they would ordinarily have a home birth. Some women have said, “Thank God we were at home — I would have been given a C-section unnecessarily had we been at the hospital!” Others will say, “Thank God we were at the hospital — my baby would have died in a home birth.” And they both may be right.

It’s normal and logical to have some episodes of fear or misgiving when contemplating birth, regardless of your history and background, particularly if it’s your first birth and this whole thing about birth is a great unknown. But I make a difference between passing qualms or “cold feet” and a complete lack of peace, such as my husband and I felt about his going out to see his dad. If you don’t feel peace with your birth plans, try to figure out why and do what you can to get to a place of peace. If you don’t feel at peace with your choice of care provider (even if your best friend and everybody she knows lives him/her), make a different choice.

A friend of mine told me about someone she knew who was pregnant with twins, and had a real sense of fear for her upcoming C-section. She died on the operating table. Perhaps she should have listened to her intuition. It may be that she did actually need a C-section; but perhaps a different day, a different doctor, there might have been a different outcome. The weird thing about my story above, is that I have no qualms about my husband going out to visit his dad, and have even encouraged him to go out. He had planned on leaving about 10:00 in the morning to make sure he made it to the airport with plenty of time to park his car and check in early and all that; but I figured that he could have left even by about noon and still made it. By noon, I was feeling peaceful, and even suggested that he still go on his trip, though he had already called his dad to tell him he couldn’t make it, but had not yet canceled his ticket. Maybe there was something that would have happened if he had gone at 10, but not at 12. Who knows? But I still think that if he had gone as originally planned, then I would be writing this as a widow. And I don’t have a logical explanation for that.

[Oh, and if you know me in real life or via facebook, please keep this quiet. My husband and I are downplaying to most everybody we know the depth of emotion this seemingly insignificant choice generated. We just said something like, “We had a strong feeling he ought not go.”]

Great post on doulas

Here at Birth at Home in Arizona. Many times women may say, “What do I need a doula for? — my husband will be there.” Sometimes husbands say, “I don’t want a doula there — I want to be there for my wife, not have a doula elbow me out of the way.” This post explores the topic in more detail, so go read it.

While it is possible for men to be such good labor support as to make a doula redundant, or for doulas to make men feel redundant, this is somewhat rare. What is much more typical is for doulas to help the dad help the mom, for example, by suggesting various comfort measures that are just not blatantly obvious to most men. [And if most men are like my husband, it would have to be blatantly obvious! :-)] So, dads and doulas are usually partners in labor support, complementing each other’s skills and abilities (as well as letting each other have periods of rest if need be), combining forces to make a great team to help the laboring woman.

Ina May Gaskin on Maternal Death

Last year, Ina May Gaskin published an article in the Journal of Perinatal Education entitled “Maternal Death in the United States: A Problem Solved or a Problem Ignored?” Very well worth reading.

This stood out most to me:

A recent article in a major obstetrical journal revealed a 93% underreporting rate of maternal death in Massachusetts (Deneux-Tharaux et al., 2005). It is very likely that a similar rate of error could be found in the other 49 states. Not only do we have a comparatively high death rate for women from causes directly related to pregnancy or birth, we are almost certainly failing to gather most of the data. Because of this, we literally have no idea how many U.S. women die from pregnancy- or birth-related causes every year. The CDC’s most recent guess is that they could be missing as much as 2/3 of the maternal deaths (Johnson & Rutledge, 1998). How can we prevent those deaths that are preventable when we don’t really know why all of these women are dying? [emphases mine]

She then goes on to explain how easy it is for maternal deaths to be not reported — most easily if the person in charge of filling out the death certificate does not even know that the woman had been pregnant in the previous year, and/or if the state does not have a check-box for the M.E. or coroner or whoever fills out the death certificate to state whether or not the woman was pregnant in the preceding year.

As an addendum, I recently read this article which was disturbing — apparently an anesthesiologist had meningitis and passed it along to two patients through their spinal/epidurals, killing one. The article said it’s not uncommon for anesthesiologists not to wear a mask. That will probably change. I assume the anesthesiologist did not know he was sick or contagious; and that can happen — remember “Typhoid Mary” of the 1800s? — although she was never sick with typhoid herself, she passed it along to numerous people who died. Many diseases can be carried on or in a person without making the carrier sick. Or the disease can be not yet big enough in his system to make him feel sick even though he is. You can take steps to reduce or prevent infection.

Let’s get something straight, shall we?

In the wake of Dr. George Tiller’s murder in Kansas, I’ve been in some conversations, read other blogs without joining in, and was apprised of conversations other people had had, that discussed the nature of the abortions he performed. One man said that “6,000 women will die every year” because Tiller won’t be able to perform “life-saving abortions” on them. Many other people apparently think that most if not all of post-viability and/or third-trimester abortions Tiller performed were to save the life of the mother. This is not true.

Here is the link to the Kansas Department of Health and Environment’s abortion reports, from 1998-2008. I’ve only looked at a few of them, and as far as I know they don’t mention Tiller by name, but I believe he was the only person in Kansas who regularly performed abortions after fetal viability. The Data Summaries appear to be pretty standard, and starting around page 10 have tables showing abortions performed at 22 weeks or more — where the women were from (Kansas or another state), before or after fetal viability, the reason for the abortion, etc. I looked at the 2001 document (just picked that one at random) and was surprised at several things, which may be of interest to you, regardless of where you fall on the pro-choice/pro-life spectrum.

Let me insert here, that it is a “spectrum”, as polarizing as this debate can get. Few people who call themselves “pro-choice” will literally agree that women should have the right to have an abortion at 39 weeks 6 days for any reason; and few people who call themselves “pro-life” believe that there should be no abortion ever, not even to save the life of the mother in the case of a pre-viable fetus. (I have read a few comments or seen a few polls that way, which is either not consistent with a pro-life stance [sacrificing two lives when one could be saved], or they define “abortion” in such a way that they don’t consider that removing a tubal pregnancy is an actual abortion, because the purpose of the surgery is not to kill the baby, but rather to save the mother’s life, and the death of the baby is an unfortunate and unavoidable end result of saving the mother’s life, since the baby is pre-viable.) Most people are in-between, with lots of shades of variation.

So, there is a wide spectrum, but the abortions I think of when I think of Dr. Tiller are the post-viability and/or third-trimester abortions.  “Viability” is the point after which the fetus could live outside the mother’s womb, and this varies depending on the technology of the country and the particular hospital. In America, it’s generally agreed to be about 24 weeks, which is when 50% of all babies survive, albeit with many babies suffering from defects (including things like cerebral palsy, blindness, mental retardation, etc.) due to being born too soon. [Those of you who work with L&D or the NICU or know first-hand statistics can fill in some of the gaps, or correct any mistakes.] The rate of survival goes up and the risk of defects goes down the longer the baby stays in, so delaying birth if possible is always a good thing from that standpoint; and by the beginning of the third trimester, the baby has a good hope of survival with much lower risk of long-term negative side effects. Obviously, the likelihood the baby will survive if born prior to 24 weeks is low, but the youngest surviving baby I’ve heard of is Amillia Taylor, who was born at 21 weeks 6 days of gestation; she turned two last fall, and is starting to walk and talk. Considering that she had less than half the typical womb-time of most babies, this is miraculous; and adding in the nearly 5 months she ought to have gotten before being born, she would be about 18-19 months old, so not even totally off the developmental charts for a baby born at a normal gestational age.

So, back to the 2001 report, dealing with abortions at 22 weeks or greater (on the edge of viability, or beyond) — 1) 585 abortions were performed on out-of-state women, with only 50 done on Kansas women. 2) 385 post-viability women were from out of state. This makes me wonder just how dangerous the woman’s condition was that she could go off to another state for health care, rather than going to her nearest hospital. To those of you who work L&D and particularly antepartum, trying to keep pregnant women safe and alive who are suffering certain health complications — does it sound even remotely safe for you to pack up these women and transport them from all over the country to Kansas for an out-patient procedure, under the “medical care” of the woman’s family or friends? I’ve read numerous blog posts from you, in which you detail working with patients on magnesium drips — how you have to watch them carefully, taking reflexes every hour, among other things, to make sure that they are being treated properly. Does it sound right to you to send off sick women for an out-patient procedure without medical care? Or does it give you the heebie-jeebies? 3) There were no abortions performed to save the woman’s life; all post-viability abortions were done to “prevent substantial and irreversible impairment of a major bodily function” should the pregnancy continue. In fact, I just looked at all the data summaries, and not one case was done to save the woman’s life. But in many cases, these babies are viable, meaning they have a reasonable chance of living outside the womb, if they were allowed to be born alive by induction or C-section, if the pregnancy did indeed need to be terminated for maternal health reasons. (Since there is no break-down of abortion data, we can’t say from here how many abortions were down at 24 weeks, and how many were done at 30 weeks [when there is at least a 90% viability rate, with a low rate of long-term complications due to prematurity] or beyond. 4) There were no “emergency” abortions — which is a good thing, because the abortion procedure Tiller employed took 3 days to complete, usually starting with an injection of digoxin into the baby’s heart to stop it from beating and thus kill him or her, and inserting laminaria into the woman’s cervix to slowly dilate it, before administering some drug (perhaps Cytotec) to induce labor and the woman would give birth to the dead baby. This blog goes more in depth into the data summaries, adding up all the reasons of all the years.

All pregnancies are terminated at some point. The majority of them end somewhere between 37-42 weeks with the birth of a live baby, either by C-section or vaginal birth. There is no doubt that some pregnancies should be terminated early, but whether this ends in the birth of a dead or live baby is where the point of contention lies. What is the reason to ensure that the baby will not be born alive (which is the point of a post-viability abortion, and the only difference between an abortion and a preterm induction)? Except for having limited medical attention over the course of the dilation, and giving the baby a lethal injection prior to birth, Tiller’s procedure is basically an induction — the mother gives birth vaginally to the baby at whatever stage of gestation she is, whether 22, 24, 27, 30, or 36 weeks. If she can give birth vaginally to the baby at that stage (which she obviously can without damaging her “health” or “major bodily function”… since that is exactly what she did), why kill it first?

I will also take another side-track to define “health” and “major bodily function” the way either the United States or the Kansas Supreme Courts do, and that is to include “mental health” as a “major bodily function” and “finances” as an aspect of her “health.” Of course, most people who use the terms “major bodily function” and “health” do not think that finances are an aspect of health, nor that “mental health” is a “major bodily function.” I have to tread lightly here, because I don’t want to seem like a jerk about mental health. I’m not; but I have a major problem with the way the courts have defined it, and more importantly with the way elective abortions have been shoehorned through that loophole. If you want an actual psychiatrist’s take on Tiller’s “diagnoses” of these women, click here to watch an interview with Dr. McHugh, who reviewed the redacted medical records and noted a paucity of actual clinical diagnostic information, and said, “he had mostly social reasons for thinking that the late term abortions were suitable. That the children … would not thrive. That the woman would have her future re-directed. That they wouldn’t get a good education after they had a child. That they would be always guilty in some way about having that child. That they had been abused already and that this — to have the baby would be another form of abuse. These … are not psychiatric ideas… These were social ideas. …. There was nothing to back these things up in a substantial way.”

In response to one hard-headed abortion advocate I was discussing this issue with, I emailed a group of pro-life Maternal-Fetal Medicine specialists with the following letter:

I’m currently in the middle of a debate on a pro-life blog with an abortion proponent who is insisting that the sort of late-term abortions the late Dr. Tiller did were medically justifiable, although he can come up with no such medical reason, and a L&D nurse I know said she could think of none — saying if the mother’s life or health is in danger, they induce or C-section the mom, thus saving both. I’ve asked if he could give evidence of any OB doing what Tiller did (i.e., kill a baby who could be born alive, particularly leave a woman who supposedly needed an abortion to preserve her life or health in a hotel for 3 days with her friends), rather than at least keep the mom in a hospital. He claims that Tiller’s way must be okay since, “you can’t point to even a single case of his way being condemned by any authority.” So, I guess I’m asking for authoritative voices who have condemned Tiller’s method of terminating the pregnancy in such a way as to kill the baby, rather than preserve his or her life. If you could particularly point me towards sources that authoritatively declare that the proper way to end a pregnancy if a woman’s life or health is on the line does not include out-patient procedures, nor injecting digoxin into the fetal heart, but in trying to preserve both mother and baby.

To which they responded:

Kathy,

1)       Dr. George Tiller was a family practice doctor. He had NO training in high risk pregnancies, fetal or maternal problems.

2)       There is no need after 23-24 weeks to ever perform an abortion in the way that Dr. Tiller did, to save or protect maternal life or health in any way. If life or health is threatened all trained obstetricians and maternal-fetal medicine physicians can and would simply deliver the baby and place the baby in a neonatal intensive care unit. It happens every day, many times, all over the United States .

3)       Sometimes before 23-24 weeks (rarely) a pregnancy has to be delivered because the mother’s life is clearly in danger. In this case, the labor can be induced, the baby delivered and the baby will not survive because of the early gestational age, but this can be done without intent of killing the baby.

4)       The only reason abortions were done by Dr. Tiller was because the mother did not want a LIVING baby born. He induced their labor and delivered the baby, almost always killing the baby first, before inducing the labor, to achieve the real purpose for which woman came to him: they did not want to deliver a living baby.

5)       If a mother’s life or health was really at risk from her pregnancy it would at least border on malpractice, if not be frank malpractice, for a family practice doctor without any special training in high risk obstetrics to induce the labor in such a woman in the outpatient setting. This alone should make it clear to anyone familiar with medical practice that none of the abortions he did were MEDICALLY necessary, at least not with the need to kill the baby before delivery.

You won’t find any “authoritative” voice that will say exactly what you are looking for. It would be like looking for an authoritative source that says if you jump out of an airplane and want to survive you need a parachute. In other words, it is so obvious, and there is no other way it is normally done, that you don’t need an authoritative source to state this in so many words. Any one in medicine who works in obstetrics would have to admit this.

On the other hand, every single text book on obstetrics or maternal-fetal medicine can be scoured and you will not find any description stating that killing a fetus before delivery is necessary to save the life or health of the mother, in any circumstance. This should be evidence enough. . …

Nathan Hoeldtke, MD for the Pro-Life Maternal-Fetal Medicine Group.

For those of you who may still have reservations, thinking there must be some reason for late abortions to be necessary sometimes to save a woman’s life or health, or that ACOG would have some position statement either endorsing or censuring it, let me direct your attention to something. The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) wrote a brief one-paragraph statement about how ACOG arrived at its stance on partial-birth abortion (which is not precisely what was under consideration in the majority of this post — PBA was outlawed in Kansas at some time during Tiller’s career, so he switched from that to digoxin-induction as his method of abortion; but I think it has bearing on the topic). Basically, a select panel met to formulate a policy statement, came to the conclusion that there were no circumstances in which PBA was necessary to save the life or health of the woman… and then the ACOG board unilaterally added the statement that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman. . .” The AAPLOG response to the actual ACOG position statement is here, in which they blast the leadership for issuing such a position without any evidence, saying it “lacks scientific credibility.” If you’re surprised that ACOG would take such a position without evidence… remember their stance on elective C-sections, as well as on home birth.

So if you’re in a conversation about late-term abortion and somebody says that they’re necessary to save a woman’s life or health, or that Dr. Tiller in particular saved women’s lives by performing late-term abortions nobody else would do, ask them, “Where’s the evidence for that?”

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Paying addicts to get long-term birth control

This was the first I’d heard of such a project. Called Project Prevention, it pays women (and men) who are drug addicts to get some long-term birth control — tubal ligation (or vasectomy), Norplant, an IUD or something similar — something they don’t have to use every time (like a condom) or every day (like birth control pills).

If you’ve read this blog for any length of time, you know my objections to forms of birth control that may allow ovulation but prevent implantation of the embryo, because if life starts at conception (which is not even in dispute, medically, gentically, or biologically speaking), then that allows a new life to be created but prevents it from being lived. Since “abortion” and “abortifacient” are defined to refer to actions that take place after implantation, the action of preventing implantation is not technically abortifacient (although ACOG changed the definition in the 70s, so prior to that, it was considered abortifacient), but it is still bothersome for people like me. I wouldn’t take them; and for this and other reasons, I advocate against them; but I’m not going to look down on you if you do it.

But long-term birth control for drug addicts is different. This may be inconsistent at first glance, but I believe it to be actually of a more consistently pro-life stance. I’ve not done too much research into babies born to drug-addicted mothers, but I know enough to know it’s not pretty. There is a higher incidence of miscarriage, preterm birth (which also increases infant mortality by itself, even without drug abuse), stillbirth, and infant mortality among drug addicts; not to mention increased risk of pregnancy complications which further hurt the baby (which may also harm or kill the mother) such as placental abruption, IUGR, low birthweight, etc.; not to mention the neonatal and long-term complications of being a “crack baby” or having been exposed to other drugs before birth. Plus, we have to add in the dangerous and risky behavior of some addicts (such as selling her body for sex) which may increase the likelihood that these women will repeatedly get pregnant and give birth to compromised babies who will be taken from them and put into foster care (assuming they survive at all). The woman who started this program adopted four children from a drug addict (who had eight altogether), so she knows first-hand the complications they face through life, as well as the other sad statistics of pregnancy and birth. This addict had eight children. Eight.  And she couldn’t care for them, because she was a slave to drugs. Other addicts have even more children, with even more pregnancies lost to miscarriage, and more babies being stillborn or dying in the first year of life, due to the maternal drug use.

I don’t know the percentage of pregnancies that are prevented by these long-term methods of birth control, but I suspect that most are prevented due to suppression of ovulation or inhibiting the sperm from reaching the egg. At least, I hope that most women using these forms of birth control “don’t get pregnant” due to preventing an embryo from implanting. I assume (and hope) that the number of babies that die after conception and before implantation due to the hormonal interference of these forms of birth control is less than the number of babies who would die after implantation (an “established pregnancy”), due to maternal drug use — from miscarriage, stillbirth, and infant mortality. Not to mention the greater problems the babies that survive face due to maternal drug use.

There have been some attempts (all unsuccessful, as far as I know) to require long-term birth control or sterilization under certain circumstances (perhaps after the birth of one drug-addicted baby, perhaps after other criteria), but I would assume it would be difficult to pass such legislation, and even if it were passed, that it would somehow be declared unconstitutional. But this is different, because it’s not mandatory; and assuming women are not being coerced into it, they are choosing it of their own free will. Which is one step of responsibility, even if they find themselves unable to kick the habit — and at least, they won’t have any babies born addicted to drugs. And it’s not a “Mississippi Appendectomy” but is her conscious choice. Nor is this racist nor eugenicist (“1,478 clients have been Caucasian, 845 African-American, 385 Hispanic,and 321 of other ethnic backgrounds”), but is strictly based on their actions (taking drugs).

So, what do you think?

Canada to support vaginal breech birth!

Read all about it on Stand and Deliver and The Unnecessarean.

In a nutshell, the Canadian version of ACOG (the SOGC) has reviewed the literature on breech birth and determined that there is insufficient evidence to say that all breeches must be born vaginally. Many vaginal birth and vaginal breech birth advocates have been saying that there were problems with some of the breech trials that seemed to show a problem for years, so it is nice to see that the SOGC seemingly confirms that.

This does not mean that it is 100% safe for all breech babies to be born vaginally — if you do an internet search, I’m sure you’ll find numerous stories in which it did not work out. But I think the worst statistics the pro-C-section people had to offer was 6% of breech babies being serious injured or killed (I don’t remember the study for sure, but it seems like that has been the number bandied about — Pinky, do you have anything more certain on that?). Which means that 94% will do just fine. And trying to figure out which breech babies will be in the “6%” category and which will be in the “94%” category will be the subject of much discussion, I’m sure. There are some definite contraindications, but a whole lot of middle ground to study. [Update — Pinky corrected me to say that it’s 6/1000, so that means it’s 0.6% of breech babies possibly harmed by vaginal birth and 99.4% that will do just fine.]

Apparently, one of the factors in the SOGC’s decision was that some women have chosen out-of-hospital births as an alternative to automatic C-section, since that was their only “choice” in a hospital. Since a lot of U.S. hospitals and/or doctors will no longer allow VBACs, regardless of the reason for the initial C-section, many women have found the “automatic C-section for a breech” to have the unfortunate negative consequences of morphing into “automatic C-sections for all babies.”

Now the question becomes, what will ACOG do?

For more information, check out Science and Sensibility‘s post on this topic.