Time Warp

Tomorrow is my youngest daughter's fourth birthday. My VBAC baby :)

I have been thinking a lot about her birth. It's hard to think about her birth without thinking about my oldest daughter's birth. The emotions are not as raw anymore, but they are still there. Word for word, I would likely describe the experience the same way:

WEDNESDAY, DECEMBER 08, 2004

Beginning the Journey
I was an innocent woman who was pregnant. I didn't expect to be cut open and gutted like a fish to get my daughter out of my body. I trusted my doctor, that he would do everything in my best interests and it never once occurred to me that he might act in his own best interests first. Silly, naive me. As I laid on the table with my organs visible to the world, I knew I didn't like it. I didn't know how deeply my daughter's birth would effect me though. It never occurred to me that a cesarean section might carry more emotional scars with it than physical ones. I didn't know it could hurt so much. It is now just over 19 months since that OB wielded his knife and took my child out of my body. My Beloved and I have decided that this is the time to think about adding one more branch to our family tree. My LMP just ended this week, so it's possible that sometime within the next few weeks, I could be carrying a brand new little life again. Such an exciting possibility! I loved being pregnant with BabyGirl. It was a time filled with joy, anticipation, delight... it was amazing and beautiful. Unfortunately, I fear this next time of being pregnant, should we be so blessed, will be riddled with the fears, the stigmas, the labels of being "a VBAC" woman. [VBAC = vaginal birth after cesarean] I resent needing the label. As though the scar on my belly is not enough.

In the end, I got my VBAC, and it was good. Not great, but good. I still have lingering questions, and am only now beginning to process some of my feelings from that time - feelings that had no space to breathe under the emotions of my first daughter was born. There is some guilt there, but it is what it is, and if it could be any other way, it would be.

Her VBAC was the second-hardest thing for me to do, ever, still. The first hardest was to survive my first daughter's birth. I had to have that experience to get here in life, and I'm grateful for that gift even though I'd never want to open a present like that again.

Happy birthday, baby bug. I can't believe you're four already. Thank you for working as hard as you did so we could both have what we needed. Nobody could love you more than I do.

The Witch Hunt for Cara Muhlhahn

Remember Cara Mulhahn, the midwife prominently featured in The Business of Being Born?

Recently, a family was shown on the Today Show in a segment titled “The Perils of Home Birth” where they spoke of how they hired her, and she labored a long time, and then her baby was born still. That family is now suing.

You bet your bippy that the media is having a field day with this. Take a look at Celebrity Midwife Cara Muhlhahn Sued for Negligence Resulting in Stillbirth
Other articles are out there too, if you google her name.

Perhaps she made a mistake. I understand she let the mother labor for days before going to the hospital – although I know many women who have labored for days and done just fine (I am one of those women.) But maybe she missed something. Or, maybe it just happened – as these things often do. If it happened in the hospital, we wouldn’t even hear about it. We would assume that everything possible was done and that it was meant to be.

Something’s got to give. Every time one side pushes, the other side pushes back. Those of us who are in favor of midwifery care and ensuring that women have access to the safest care in the style of their choosing cannot back down – we need to get stronger until our voices are heard. We can’t let all midwives get lynched for something that may have simply be an act of God.

Would I have wanted to know?

I've decided to get personal today.

At this time seven years ago, I was about four months pregnant with my first daughter. My OB/GYN was a charming man whom I had chosen on the recommendation of a trusted friend because my husband and I thought we might struggle with fertility, and heard he was very aggressive in helping couples conceive. I had waited all my life to be a mother and wasn't taking any chances or wasting any time. If there was going to be a problem, I wanted it addressed and dealt with as quickly as possible.

Turned out, fertility was not a problem. Seemed like we only had to think it was a good idea, and it happened. We were elated. At the time, I had one friend who was pregnant four months ahead of me, one who was two months ahead of me, and one who would be pregnant soon after. All but one of us were first-timers. We shared stories, looked to each other for advice, complained, laughed... I remember that time fondly.

As each of us had our babies, there were certain presumptions. We presumed that if we didn't have our baby by a certain date, we would be induced. In fact, we presumed we would have some kind of intervention - whether it was induction, or pain meds, or having our water broken, or a cesarean . Most of us took "the class" at the hospital which gave a pretty thorough rundown about procedures and protocols, and read books like What to Expect While You're Expecting, which told us what to expect but gave us no indication of what to question. We planned to breastfeed. We talked about our birth plans. We oohed and ahh'd over each other's baby registries. We anticipated.

The first mom went in for her induction. She was given a sleep aid with the expectation that things would take a while. They didn't. Within a short amount of time, her labor was strong and she had an epidural. Soon after, all the while fighting off the sleep medication, she managed to push her baby out with some help and a lot of tearing. Breastfeeding was written off almost immediately because it wasn't working. It was a horrible experience for her, but nothing seemed odd about it to me. It's just how it was.

The second mom was having her second baby. She planned a cesarean since she had some kind of "failure" the first time. Her doctors were very supportive of this idea and I don't know if she ever gave much consideration to having a VBAC. When her son was born, she said, "My doctor said my uterus was so thin she was glad I didn't try for a VBAC because she was sure I would have ruptured." I was relieved for her.

Then came me. I had some amount of hope that things would be natural, but little expectation. I saw my friends, and others, before me. Nobody was doing it natural. It was a "nice idea" but I knew not to count on it, so I hoped for the best and tried to prepare for the worst and figured like everyone else, I'd land in the middle somewhere.

So, when I had a cesarean, it wasn't exactly a shock. I knew the odds... I didn't think I would be that woman, but I knew it could happen. Still, the whole thing was so surreal. What I did not expect was how I felt afterward. I hated myself for how it had happened. I didn't think I deserved her. I thought I was being irrational and stupid, which only led to me being harder on myself. So, down I spiraled.

Somewhere in there, a lightbulb switched on and I realized I had to get myself out of there. I started searching. I found ICAN, and other resources. One brazen night I just put my story out there, expecting people to tell me I was being dumb but having no other option; and they responded in droves, telling me they understood and explaining things to me like nobody ever had before.

That's when I started reading. I learned there were other books. I learned there were other websites. I learned many factors that had likely contributed to having a cesarean, and it made me mad. I felt used and betrayed by my OB and the system. I blamed myself.

But you can only know what you can see.

I remember knowing about midwives, but I made an assumption that they did not exist around here. But if I'd known, would it have made a difference? I didn't know anyone who used a midwife. I didn't really understand midwives. I might have listened to a woman who told me about what it meant with a "that's great for you, but I really do love my OB" kind of way. I might have secretly judged her for being too earthy. I never would have believed my OB would harm me, intentionally or otherwise.

I would have said a doula was too expensive. Even now, I probably wouldn't use one - though I promote the idea to other women - mostly because I would rather hide from people than have that.

I knew that the increase in cesareans was of concern, and that my own OB, by his admission, had a higher rate of c-sections than others in the area. I knew this, but I was sure I would not be a statistic. The rules of the rest of the world did not apply to me.

I would have like to know though, that I could change OB's, that someone out there would have taken me at 37 weeks when mine turned on me. I'm not sure that I would have though. You know how it is, you spend your time getting to know and trust someone, and when there seems to be more good than bad, you want to give it a fair chance. You blame your "erratic pregnancy hormones". You doubt your instincts.

If I had known then what I know now, I wouldn't be who I am - a woman who is much stronger, and a better mother for it. I know now that I would not have listened - I would have just stayed in my comfortable, ignorant bliss. What I wanted then, and what I got, was to follow the road more traveled, because it seemed to be the obvious choice. In the end though, I got burned, but I survived.

TIME is On Our Side

Check out the article in Time Magazine!
... and be sure to read the "story behind the story" at The Huffington Post

Does this effect women in WNY? Yes it does!

According to the New York State Department of Health, as well as a survey taken by ICAN volunteers says that women in Niagara and OrleansCounties show that three out of the four hospitals with maternity units do NOT offer VBAC as an option for their mothers. These three hospitals are Niagara Falls Memorial, Medina Memorial and Inter-Community Hospital in Newfane. One other hospital, Mount St. Mary's in Lewiston does claim to offer VBAC as an option, but only 3.4% of women who've had a previous c-section are having them there. These hospitals only handled a total of 1,000 births in 2007, but of that, but it means around 160 women may have been sectioned unnecessarily, subjecting them to unnecessary risk.

What about the women of Erie County? While there are no bans at Women and Children's hospital, Millard Fillmore Suburban, Sisters or Mercy hospital, the rates of women who are having VBACs is on the decline from an overall percentage of 12% in 2006 to 9% in 2007. The most disturbing is Mercy, who is according to the DOH site has a 5.6% VBAC rate, but none of our hospitals are performing up to par.

Cesarean rates at all of these hospitals are high, though this year some have shown minor declines. Overall in Erie county, about 34% percent of women will have the surgery that Consumer Reports has listed as one of the top surgeries you're better off without, and this is up from 33.4% from 2006.

Is this because women are asking for cesareans? Or, could it be that women aren't being well-informed of their choices? Women don't want to talk about the risks because it is too "scary", but we need to start facing what the real possibilities are before making such important decisions.

Journey to Breech VBA2C

Here is one of our ICAN mama's journeys to having a breech VBAC after two cesareans:

Photo and video editing at www.OneTrueMedia.com

ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth

Redondo Beach, CA, February 7, 2008: The International Cesarean Awareness Network (www.ican-online.org) would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements* this week that limit not only women’s choices in birth but imply that birth is a fashion trend rather than a safety concern.

Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective repeat cesarean before making a choice. This decision should not include weighing the choices of your doctor’s malpractice payments but only be a concern of the mother, her baby and their health and safety.

Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG’s demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective cesarean should serve as informed consent.



ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.
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* AABC statement: http://www.birthcenters.org/files/file.php?id=2&file=file&file_type=file_type

ACOG statement: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm

ICAN of Buffalo in Tonawanda News

A story about ICAN of Buffalo! Click here.

Most of my friends and family assume that, since I had a C-section when Cameran was born, I already have a repeat Cesarean scheduled for Little Wahler No. 2’s impending birth.

Sure, it seems convenient. Go in at 7 a.m., start the meds, have the operation, and be back in the mother-baby unit before “The Today Show” is over. I could pick the day even: Do I want a St. Patrick’s Day baby? A first-day-of-Spring baby? Don’t pick March 15 — you know, the whole “Ides of March” thing can’t bode well for babies born on that day.

Am I crazy for thinking that takes the fun out of the whole experience?