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Posts Tagged ‘c section’

There are many dichotomies in this world and  they can make our lives an interesting fruit bowl of options. Generally I like them. Coming of age in the 60’s I was keenly appreciative of the depth and power and beauty of nature and although never a pure naturalist and no longer even a romantic naturalist a la Burns and Shelly and Keats, I still see that nature is a thing of genius, not to be ” mastered” as much as recognized and understood. I wish the birth industry was not having such a hard time with this. The modern medical birth has become dominant it our hospitals and is, surprisingly to the medical world, not resulting in the healthy happy moms and infants they assume their way would produce.

We have developed a dichotomy of a  ” medical model” and a “midwifery model”, of childbirth, one that attempts to control birth with the use of drugs and one that relies on the body to accomplish birth without medical interventions, insofar as wise.  Sometimes they cooperate, often they do not. It has become necessary and not a little challenging for parents-to-be to learn about the choices they will be making about their birth and baby either consciously or unconsciously. A doula needs patience and an ability to present the many options with simplicity because it can be overwhelming to consider in aggregate. If we start with acknowledging birth as at the very least a natural thing that the body is prepared to do, sharing information with new moms-to-be can unwind from there.

There is a lot of unlearning to be done for the mothers who are really interested in having a birth of their own choosing. There is so much misinformation floating about the culture, one can begin to understand why some advocates for natural birth and breastfeeding and home based living and homeschooling and attachment parenting  : ) can get a little wacky in their mission statements and blog stands, so I want to focus this year on the dichotomy between natural life and modern culture… I’ll be exploring many practices and habits of action and thought around birth and nursing and I look forward to anyone who wants to comment, and may I say thank you to everyone from whom I will poach quotes and pictures and articles…( credited of course ).

To start us off, I poached this article from my Facebook page, thanks to Blooming Miracle Doula!   The article tackles the difficulty women face trying to rethink the issue of breastfeeding today.

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This is from an OB-GYN, 27 years experience.  Pay attention if you want a natural,or at least vaginal birth… Here what he says to watch out for:

Top Ten Signs Your Doctor Is Planning To Perform an Unnecessary Cesarean Section on You

1. Arrives to L&D immediately after office hours and says, “I just don’t think this baby is going to fit.”

2. Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a C/S”– Did you know?  ACOG has very specific guidelines for when it is appropriate to offer a patient an elective C/S for MACROSOMIA (fancy word for large baby).  ‘Prophylactic (elective) cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights greater than 5,000 gms (11 pounds) in women without diabetes and greater than 4,500 gms (9.9 pounds) in women with diabetes.

3. “We should induce at 39 weeks because your baby is getting too big” – Did you know that, according to ACOG:

‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn morbidity(complications).  Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.’

4. Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2 pounds off?  Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.

5. “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty much standard of care now.  It prevents outbreaks and allows for a normal vaginal delivery.

6. “Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)?  It really does work.

7. “You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are probably not pushing effectively; this is evident on exam because the baby’s head is still perfectly round, but you do not need to know that) “It’s just not going to come out”

8. “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not dilated when you start the induction).  At least 80% of my VBAC patients were induced the previous pregnancy.  For whose convenience was the induction?

9. First Visit (7 weeks), “Congratulations you are having twins.  I will go ahead and schedule your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on what to do when the second baby is coming, plus it pays more to cut you open.  Oh yeah, I don’t have that great a rapport with you because I only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next time’) with you each visit, so I am afraid I will be sued for trying to do the right thing.”

10. First Pelvic Exam in Office (7 weeks), “Hmm, your pelvis is pretty narrow”.

Bonus Tip:

11. 38-week visit, “Your blood pressure is a little high today. You are probably developing preeclampsia or toxemia.  That can cause you to have a SEIZURE!  The treatment is to deliver the baby.  You need a Cesarean Section, as this is the quickest way to resolve it.  Let’s get you up to L&D NOW!” Translation – Preeclampsia or Pregnancy Induced High Blood Pressure is a pain in the butt.  If I induce you, it could take 24 hours or more and then I would have to manage your blood pressure, and put you on Magnesium.  This is way too inconvenient.  Do not worry you can try to have the baby vaginally next time.  Yeah right!

 

Well, I hope you future moms find use for these tidbits of info.  If anyone wants to add anything, please feel free.  Your experience may help other women in the future. Remember, there are only a few emergent reasons for a C/S such as fetal distress, unexplained heavy vaginal bleeding, etc.  It is okay to ask your doctor questions.  We are not supposed to bite.

 

Jonathan Weinstein, MD, FACOG

Obstetrician/Gynecologist

Husband to a Labor and Delivery Nurse with 27-years’ experience

Father to two beautiful children, Zoe and Ashton

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