All About Babies, Part III Some Things I Learned

After my son's mostly wonderful birth followed closely by my daughter's not so great birth, I started reading more about the whole process. I am in a unique position to be able to compare the two and it's hard not to.

I haven't mentioned it anywhere else on this blog, but I'm a librarian. Already a slut for information, working as a librarian has just made me feel professionally obligated to seek it out and gleefully sort through it. Like a kid in a candy store! Except with facts and studies and....well, okay, I'm a really boring person.

I think that seeking out information about birth, labor, and how obstetrician's practice these days was/is a way for me to process my experiences and understand them. So this post is hopefully going to summarize some of the things I learned that made a difference to me and shaped what I want for myself in subsequent pregnancies, if we are blessed with them. I tried really hard to reference everything so you can see that I'm not a lunatic and research for yourself.

I also know that birth is really personal. However it might seem to you, I do not know your circumstances or the choices that you or your doctors made. What I believe is that we need to inform ourselves. We need to understand what is happening in pregnancy, labor, and delivery and we need to know what questions to ask to avoid unnecessary surgery. We need to be confident and less fearful of birth. 


Without further ado, here are the things I have learned:

• Sometimes c-sections are being done because they're the best thing for everyone. 

Sometimes everything goes wrong, even after the best efforts, and surgery is the only way out. I feel like it's important that you readers make the distinction with me between EMERGENCY situations and situations where everyone kind of gives up (or doesn't even attempt) vaginal birth. But how many Cesareans are actually necessary? That is the question.

For example, here is an article about a home birth family, in which the baby ultimately suffered because mom and dad a) had been previously traumatized by a c-section and b) refused all medical interventions upon arriving at a hospital. I think if the baby's heart rate is decelerating, it might be a good reason for a Cesarean.

• Sometimes c-sections are being done because it's the best thing for everyone else, i.e. your schedule, the hospital's bottom line, the OB's busy life...

When I was pregnant for the first time, I went to the first OB's office I found. My first appointment with her was nice. And then I started hearing all sorts of stories about how she was c-section happy. One woman was told her baby's heart rate was worrisome and rushed into surgery at 38 weeks. Her doula objected faintly that her strip (the strip of paper printing out baby's heart rate from the fetal monitor) was perfectly fine. Later she found out that the OB was going to go on vacation the following week. I switched to a practice that wasn't so OR-friendly.

But that's not okay. I think moms and doctors need to take a step back from putting our own schedules ahead of a physiological process, because it sure seems like circumventing that process hasn't done us any favors.

Ricki Lake's documentary The Business of Being Born talks about the 'conveyer belt' mentality in hospitals. You go to the hospital. You might be induced. If the induction doesn't work, then you get Pitocin. Because Pitocin is certifiably exhausting, you get an epidural. If the Pitocin doesn't kick-start things, you end up with a c-section because everyone is tired and eventually mom and baby start to show signs of duress. It doesn't take a genius to figure out that sometimes your body isn't ready to labor and then you're 'failing to progress'.

Some doctors are inducing women who are not physiologically ready to give birth so that they can get home on time, which is just plain bad medicine. Here's an article about cutting for convenience. In Pushed, doctors and nurses admitted that patients were induced all in one day just so the doctor on-call could try to get everything done in one day.

A woman I really admire, The Feminist Breeder, almost missed her VBAC because the hospital staff was tired of waiting for her to labor. The Doctor gave her the 'dead baby speech', but in this instance everything was actually fine and dandy. Feminist Breeder's husband was getting scared. He took the doc aside in the hallway and finally got the truth. The Doc admitted the baby's heart rate and the mom's heart rate/bp were fine and agreed to back off. THIS SHOULDN'T HAPPEN. If there's no concrete reason for surgery, it shouldn't be done. You should click on that particular link. I love that story. Anyway, the reason she got her VBAC is because she knew what was what. If baby had really been in distress, things might have ended differently.

• Some OBs use fear and crap reasoning to coerce women into getting c-sections. 

This article is about this very phenomenon. Some call this the 'dead baby card'. That's ultimately how I felt before my section. "Restricted growth! Low amniotic fluid! Breech baby!" In the end, I have good sources who tell me it was more about my OB not wanted to wait around for me to labor than any risk factors. I have heard lots of women say they got c-sections because their pelvis was too small, their baby was too big, or because they weren't progressing 'fast enough', Failure To Progress. From what I've read, it doesn't seem like these are always good reasons, they're more like excuses.

The link for 'small pelvis' includes a video full of women who were told that very thing and then proceeded to have babies out their 'too small' pelvis. Here's a link about what anti-intervention people call "Failure to Be Patient".

Then there are the out-and-out lies, like in the Feminist Breeder's VBAC story: “They kept trying to tell me that Julsies’ heartbeat was becoming [too fast]. Well, I knew what that was and I could see the fetal monitor and it wasn’t,” Crosley-Corcoran said. “To me, the most inappropriate behavior was the scare tactics.”


I have friends who have labored for hours and did discover they had a weirdo birth canal and had to have a c-section. By the same token, I have read story after story about women who were told their pelvis was small or their babies were big and would never have a baby vaginally but then went on to have their babies vaginally. What does that mean? You don't know if X, Y, or Z is the really and truly the case until you've labored.

• Speaking of fear, we need to be less fearful of childbirth.

We are scaring ourselves out of a positive birth experience. The End. Seriously, there is physiological evidence that the more anxious and fearful you get in labor, the more labor is inhibited. Then you get drugs and then maybe a c-section. The current medical climate isn't solely to blame for the insane rise in c-sections.

• Some OBs are terrified (with good reason) of being sued. 

The reason for all these c-sections? Doctors and hospitals get sued if they don't do c-sections fast enough these days. It looks like they've done 'everything' they could if they do a c-section. Here is an article about how there are actually fewer OBs because less people are willing to deal with the lawsuits and malpractice insurance, etc. etc. Dr. Amy Tuteur (a stanch opponent of home birth) posted about a lawsuit (Homebirth Ends Brain Damage, Parents Win 55 Million...From the Hospital) in which, after a failed homebirth, the hospital who tried to save the baby was successfully sued. WTF?

• Most OBs are less skilled at delivering babies and are more skilled at cutting.

Breech vaginal deliveries, twin deliveries, and all sorts of non-vertex positioned babies are routinely scheduled for c-sections. Part of the reason is because (besides being terrified of lawsuits) doctors don't know how to deliver these types of babies anymore. There are only two doctors in my town that will attend a vaginal breech delivery.

PubMed has an article entitled To Rescue A Vanishing Obstetric Skill--Vaginal Breech Delivery that explains this phenomenon. Another blogger at The Obstetrician's Lament has a post about this as well. A similar article, Vaginal Delivery of Vertex-Nonvertex Twins, discusses how nowadays instead of even attempting a twin birth, twin pregnancies are automatic c-sections.

Yes, some deliveries are higher risk. But I think that when we hear the phrase 'high-risk' we assume that 60% of vaginal breech babies WILL DIE, for example. Breech babies "Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity, and intrauterine fetal demise." So breech babies are at a higher risk for having something wrong with them already, regardless of the mode of delivery.

In Pregnancy Outcomes by Mode of Delivery Among Breech Births, the authors write that between women who had a vaginal breech birth and a c-section: "Neonatal complications did not differ between the group of women with term babies" and that "Vaginal delivery of 1,000-1,500 g babies presenting as breech is associated with the increased neonatal mortality compared with cesarean delivery. [Um, because they already have something wrong with them...] Cesarean delivery is associated with maternal morbidity compared with the vaginal delivery." 


Did you catch that? Cesarean is riskier for the mom. Huh, I thought they were just sunshine and roses.

This is the End of Part I. It's getting super long. See my next post for the continuation.