Wednesday, February 16, 2011

Birthing a nearly 11lb baby

My midwife warned me that she suspected he was pretty big. But I doubt she suspected he would be quite that big!

After spending several days trying everything short of castor oil to get contractions started on their own, my good friend Kristi came over at 8pm after I got May to bed so David and I could go to the hospital for the induction.

I was pretty bummed about having to be induced again--and also sad to leave May for so long. I was pretty torn up about not being able to see her for a nearly two days.

We got to the hospital and when I walked in to the emergency entrance I said to the triage nurses, "I'll bet you can guess why I'm here!" They laughed. We were sent up to labor and delivery, and I got changed into my nightgown. The nurse put me on the monitor and discovered I was having mild contractions 7min apart. She called the midwife who said to check me and see how effaced and dialated I was. I was dialted to 3cm--was 2cm the day before. So they had me walk around for an hour to see if anythign progressed. I might not need to be induced after all. But after an hour there wasn't a lot of change, so in went the cervadil to ripen the cervix.

I told David to go home and get some sleep since the chances of anything happening for several hours was slim. I also knew he wouldn't get much sleep on the uncomfortable sofa in my room. And I knew I probably wouldn't get much sleep either. Those L&D beds are not so comfy, and I was finding it hard enough to get comfy in my own bed.

Around 4am I started feeling active labor coming on. My favorite midwife who had spent the last two days delivering 4 babies showed up unexpectedly. Another woman was also in labor (further along than I was) so she had to come back to the hospital since she was still on call until 8am. I was pleased to see her, as I didn't think I would. I called David at 5:30am and told him he should come back. The midwife checked me and said I was already dialated nearly to 6cm and suggested I get in the whirlpool tub if I liked. Sounded like a great idea to me, as the bed was very uncomfortable and contractions were getting harder and closer together. The whirlpool was fanstastic--made dealing with the contractions a lot easier. David arrived around 6:15am while I was still in the tub.

I got out and the midwife checked me again. Now I was about 7cm and she broke my water to speed things up. That made me about 8cm. After monitoring the baby for a bit, I got in the shower for awhile. My cousin Julie was scheduled to relieve Kristi at our house at 8am. I called and said she should take May over to the neighbor's house so she could be here for the delivery because things were moving a lot quicker than they did with May, and they thought I'd have the baby by noon. Julie and her almost 10yr old daughter Holly arrived around 9:30am when I was in the whirlpool tub again. Contractions were getting very close at that point, and quite strong (even though I hadn't even had any pitocin). The tub once again was the only thing that gave me any relief, and I was determined not to have an epidural this time around. I figured if I could go 22hrs without one with May (even though I got one in the end when my labor stalled at 9cm for about 6hrs), I could do it again if I had to, and the chances of a second baby taking that long were slim.

By 11am I was still at 8cm and starting to get a bit discouraged. The midwife once again suggested I get in the tub since it seemed to relax me and help me dialate. I was only too happy to follow her advice. After about 45min of being in the tub and dozing in between contractions, I was at 9cm.

At this point I was getting realy crampy as well, and the pain was getting incredibly intense. It was sheer stubborness that prevented me from getting an epidural at that time. After getting back on the monitor for what seemed like agonizing ages, I finally was able to get back in the whirlpool to try to get some relief, with dopplar heart rate checks every 20min or so.

By this time it was around noon and my midwife Sandy had to go and was being replaced by Gail--another midwife in the practice. I was in excruciating pain at that point, and it was taking every ounce of stubborness and determination to not get an epidural. I felt like things were getting realy close and was feeling the urge to push. I told Gail this and got out of the tub so she could check me. I said, "I swear to God if I'm not 10cm now I'm getting the epidural!!" She checked me and informed me that I was complete. "Thank God!" was my reply. I practically got off the bed and started pushing at that point, not caring that no one had told me to start or that I was in any kind of birthing position..lol. I just didn't care. I just wanted that baby OUT. I was in so much pain that primal instict just took over.

It took my cousin, husband, midwife and nurse to get me in position to push. I could barely move I was in so much pain. Finally in position, I screamed like a banshee while I pushed. He was out in two extremely painful pushes--much to my surprise, since I pushed for 3 hours with May.

He was put on my chest while they suctioned out his mouth. Then I started bleeding heavily--not bad enough to call it a hemhorrage, though. A pitocin drip, cytotec and uterine massage got it stopped pretty quickly. Then it was time to stitch up a small tear. That took all of three stitches.

And yeah, he weighed 10lbs 13oz. I still can't believe I did all that vaginally and with no pain medication. I have to admit that I'm feeling a bit like superwoman.

And now we just have to come up with a name for our big boy....

Wednesday, February 2, 2011

Childbirth in America

This is a topic that I feel very passionately about. I think most Americans think that this is probably the best country in the world in which to have a baby. But in actuality, it is nowhere near the safest country in which to give birth. Americans spend more money on childbirth than any other country, but when you look at the statistics below, you will see that we are not getting our money's worth.

According the the World Health Organization, in 2008 Ireland and Greece lead the way in low maternal mortality rates with Ireland having 3 maternal deaths per 100,000 births and Greece with only 2. The United States, on the other hand has 24 deaths per 100,000 births. That is 12 times Greece's rate. Most developed countries have rates between 5 and 10. Here's a list of countries that have lower maternal mortality rates than the United States:
Australia, Austria, Bahrain, Belarus, Belgium, Bosnia and Herzegovina, Brunei, Bulgaria, Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Israel, Ireland, Italy, Japan, Kuwait, Latvia, Lithuania, Luxembourg, Macedonia, Malta, Montenegro, Netherlands, New Zealand, Norway, Oman, Poland, Portugal, Qatar, South Korea, Serbia, Singapore, Slovakia,  Slovenia, Spain, Sweden, Switzerland, United Arab Emirates, and the United Kingdom.

We are tied with Saudi Arabia for 49th place. I find this shocking. When Kuwait has 9 maternal deaths per 100k births and the United States has 24, well, that pisses me off. What makes me even angrier is that our rate has not decreased in the last 25 years, but has increased. In the mid 1980s our rate was only about 12 deaths per 100,000 births. So it has doubled in the last 25years. If that doesn't concern you, it should.

So why is our rate increasing instead of decreasing? And why are 48 other countries kicking our butts in this area? A huge part of it is that most American obstetricians view pregnancy and childbirth as a medical conditon instead of a natural condition. OBs are trained to view childbirth as a very dangerous thing where all sorts of things can go wrong. Due to this, they often rush to intervene when no intervention is necessary. But if women are given proper care and support, and allowed to let nature take its course, interventions are rarely needed.

It is interesting that while our maternal mortality rate has increased over the last 25yrs, so has our c-section rate. Perhaps there's a correlation. The WHO says c-section rates should be between 10-15%. In Europe it is 19%. In the U.S. it is 30%. That means nearly one in three American women will give birth via c-section when only one in 7 women actually needs one. One of the reasons for the high c-section rate is that women who have had a c-section with a previous baby do not have a vaginal birth after caesarean (VBAC) despite 90% of those women being candidates for a VBAC. Reasons for this range from women not being given the opportunity to try for one or being unable to find a physician or midwife willing to attempt a VBAC delivery. Many hospitals do not allow for VBAC deliveries. About 75% of women who do attempt a VBAC are successful, and the risks of a VBAC for the vast majority of women are much lower than the risks of a repeat CS. Still many OBs and hospitals are against VBACs. One has to wonder if money and the convenience of a CS to the OB are some of the factors.

Another reason for America's high CS rates is that OBs tend to be CS happy. They give a woman so many hours to have her baby, and if she hasn't delivered within about 24hrs, off to the OR she goes with "failure to progress" as the reason--even if mother and baby are fine. Births in hospitals with an OB in attendance are also more likely to have interventions such as elective inductions and the use of epidurals. Whenever induction drugs or pain meds are used, it increases the chances of fetal distress and can slow down labor, necessitating the need for a CS.

Many women are scared into a CS because the doctor tells her based on the ultrasound that her baby is too big to pass through the birth canal. Well, ultrasounds are notoriously wrong in their weight estimates. I know several women who were told they were having a huge baby and pressured into a CS without even attempting a vaginal birth. When their babies came out, they were considerably smaller than what the ultrasound indicated. Those women probably could've had a vaginal birth. Often when the baby seems too big, a vaginal birth can be had if the mother changes into a position that works with gravity--squatting or getting on all fours. The traditional position for laboring (on one's back) is the least affective position for birthing. And being stuck in a bed hooked up to IV's, or with an epidural is also counterproductive to getting a baby out.

There are so many more reasons for our high maternal mortality rates, but it would make this blog into a novel. If you really want to look into this further and see how unmedicalized a birth can be, read Ina May Gaskin's "Guide to Childbirth." She is a very well-known and respected midwife around the world. Her birthing center in Tennessee has unbelievable statistics. Her CS rate is 2%. She has never lost a mother in over 2,200 births, and her infant mortality rate is lower than the national average as well. Ina May's theory is that women's bodies were beautifully designed to give birth vaginally. And she is quite sure that a lot of the reasons women fail to progress in hospitals is because of the cold and unsupportive atmosphere women in labor endure. Too many doctors and nurses fail to respect the mother's wishes and have terrible bedside manners, often belittling and scaring women into agreeing to procedures they otherwise wouldn't--and without giving her all the facts. Check out Ina May's website http://www.inamay.com/

 I just re-read her book, and it is so empowering to women. I recommend all pregnant women and women even thinking about having a baby read this book. I know too many women who have had bad experiences in childbirth that probably would've had better outcomes had they read this book. My experience with my first birthing was fairly good--my wishes were always respected by the nurses and my midwife. I did cave after 22hrs of drug-free labor and get an epi because my labor had stalled at 9cm and I was worried I'd need a CS if things didn't start moving again. I was exhausted and the epi took my pain away and helped me get some rest. May was born about 6hrs after I got the epi. My goals for this birth are to not be induced, to pass on the epidural, and to have a shorter labor.

Many people here are wary of using a midwife. But in most of the countries listed above that have better MM rates than we do, nearly all low-risk women use a midwife and not an OB. They also have more home births. Midwives spend more time with their patients during pre-natal visits and during labor. They have much lower rates of CSs and interventions. And despite what many people think, you don't have to give birth at home in order to use a midwife. Mine only does hospital births. But the studies show that a planned home birth with a qualified midwife is just as safe for both mother and baby as a hospital birth with an OB--and you're far less likely to end up with a CS.

If more low-risk women went with midwives," I have no doubt that our quality of care would increase dramatically.

Tuesday, February 1, 2011

All the Way to Timbuktu

Did you know that Timbukto is actually a real place? I always thought it was an imaginary land until my grandmother told me about a decade ago that her older sister was going there on a trip. Aunt Marge was one of the most adventurous women I've know for her generation. I remember as a child looking forward to seeing her at Christmas because she always regaled us with stories from her latest travels. I wanted to be like her when I grew up and travel all over the world. Aunt Marge was in her late 70s or early 80s when she flew to Mali in Africa where the city of Timbuktu is located.

I recently finished reading a travel adventure by Mark Jenkins called To Timbukto. It was quite a fascinating read. Not only does he tell the tale of how he and three friends set out to be the first to navigate the Niger River from source to delta, but he tells of the travails of Western explorers long before him who all set out to find this mythical city that was said to be immensely wealthy. Mark and his friends are beset with all kinds of problems such as harsh climatic elements, tribal wars, theft, etc making things difficult. Add to it that Mark's and one of the other men's wife were both six months pregnant when they left the States to begin their journey.

I won't give away the ending in case anyone wants to read the book. I checked it out from the Rockford library. All I will say is that those four men were far more adventurous than I will ever be! I admire people who have the chutzpuh to embark on travels like that, and love to hear their stories. But I am not brave (or perhaps crazy) enough to do it myself. I do like to travel, but I like my creature comforts. Being crocodile and rhino bait while kayaking down a dangerous river and sleeping on the hard ground in a tent while being attacked by killer bees is not my idea of a good time. Give me a day at the Louvre, dinner al fresco at a Parisian brasserie, and a comfortable bed in a clean hotel anyday!