Posts Tagged ‘OB/GYN’

September 7th, 2010

OB’s Aren’t Listening to ACOG

OB’s aren’t listening to ACOG. While this is a huge shock for some people, it is not surprising for others. But how did I come to this conclusion?  Well, becoming pregnant put me in a position I was not comfortable being in yet. Being a woman looking for a trial of labor after two previous cesarean sections.   One that was not medically necessary at all, and one that saved my youngest son. While I believe if things had been done slightly differently the second could have been avoidable, but it was a catch 22.

In July of this year, ACOG released new VBAC recommendations in response to the growing cesarean rate, complications that are a direct result of that, the falling VBAC numbers, and the lack of access for VBAC that was all brought out in the National Health Institute’s VBAC Consensus back in March.  I was lucky enough to be able to watch the entire conference from home, and take a ton of great information from it. But it also hit ACOG hard because their representatives knew that their guideline changes essentially caused the decline in VBAC access for women Nationally.

On July 21st, ACOG made a new press release detailing some of their new VBAC guidelines, which included a statement on women with two previous cesarean deliveries.

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, “The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,” said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

Ok, so what is the big deal right?  It says right there that ACOG supports and finds a trial of labor acceptable and essentially a safe option for women with two prior cesarean sections.

So what is the hang up? Apparently all the same OB/GYN’s out there that were quick to jump ship on VBAC when the guidelines changed years ago with new guidelines on the readiness of Anesthesia in the hospital, are NOT as quick to jump back ON the VBAC bus despite the clinical information showing it to be a safe choice.

Where does that leave me right now?

Screwed!  I have a hand full of options I am looking into at this point, but I can’t go see the midwives I was with because their backup OB practice won’t take me on… I have an appointment with a high risk Perinatology group who seems to be open to my request, but the two words high risk scare me because I know it is going to limit the availability of a natural birth. Although the positive of it all is a friend of mine, who had two home births, and came down with a horrible blood disorder during her third pregnancy had a 100% natural hands off birth with this same practice. So… I have hope…

We’ll see!

August 3rd, 2010

New VBAC Guidelines

After being so involved in the National Institute of Health’s VBAC consensus earlier in the year, I, as well as so many others were really anticipating the new ACOG VBAC Guidelines. The decline in VBAC began when they changed their guidelines suggesting only certain women, and certain hospitals were candidates for a Trial of Labor after a previous Cesarean delivery.  We saw a peak in the VBAC numbers in 1996, then a drop consistently there after.

ACOG included in their release something new that previously had been unthinkable in the medical community as a valid option for most women, and that is a trail of labor after two previous cesarean sections. Studies show that it is a safe and valid option for women who wish to attempt a VBA2C, which I have been saying all along.  But maybe now because a huge medical organization with MD after their names says it, people will understand it truly is a safe choice for mothers to make.

Also included in these guidelines are women pregnant with twins, with a prior cesarean delivery, and an unknown uterine scar, which in the past have meant automatic repeat cesarean deliveries.

Just some numbers to include into this also.

In 1970, the cesarean delivery rate was 5%, in 2007 it increased to over 31% of all deliveries with very little improvement to maternal and neonatal outcomes. VBAC was at about 5% which increased all the way up to 28% in 1996. Then the decline started, in 2006 the VBAC rate dropped down to a little over 8%.  Which is horrible for our women here in the U.S.

While I stand by women being informed on making their own choices regarding their care, as a mother who has had two cesarean deliveries, researched, learned the numbers, the risks, and everything involved in VBAC vs. ERCD (Elective Repeat Cesarean Delivery) the risks for a repeat c-section are much higher than a trial of labor after a previous cesarean. You are more likely to have long term complications, be re-hospitalized, need a type of blood product, and all the risks that go along with major surgery when opting for a cesarean over a trial of labor.

The risk for a uterine rupture is between 0.6-0.8% with one previous cesarean delivery, and the most recent studies and numbers has not shown a neonatal death from uterine rupture. I am not sure the amount of years it has been, but per the information from the NIH VBAC consensus, it has been at least 10 years since they have documented a case.

Maternal mortality rates are higher with elective repeat cesarean deliveries over VBAC also. When comparing ERCD to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!

I think that these new VBAC guidelines are certainly a step in the right direction, while the change may not take place overnight, we are seeing that it is something now being addressed on a large public forum as the backlash of high cesarean rates are starting to take their toll on our women and babies.

May 23rd, 2010

Was Biter Blackballed?

It certainly seems like it!  For all of you that do not know who Dr. Biter is, or has not been following the story of the California OB/GYN who was suspended with no explanation in recent weeks can read more about it here, thanks to Dou-La-La one of my fav bloggers.

So basically on Friday, we all got the word that Dr. Biter had been re-instated after weeks of daily protests outside of this hospital. The excitement through the birth community that had rallies around him was loud, and quick. Unfortunately it was immediately followed by the announcement that Dr. Biter had “willingly” given up his privileges to practice medicine at this hospital.  Of course at this point there is still no explanation as to why this has taken place, but it is no surprise to most of us really involved in the natural childbirth community.

With no word from the Biter camp, and a brief statement from the hospital, it leaves a lot to the imagination. Certainly tons of speculation, but this is also alarming on several levels. The fact that there are tons of pregnant women who are not left without the provider of their choice is the first and most important issue. These women went to Dr. Biter because of his thoughts on birth, the way he practices, and the fact that he had the lowest cesarean section rate.

This was no small community that was upset. This was lots of mothers, fathers, and even children delivered by the doctor who rallied around him.

The hospital seems to be where all fingers are being pointed here. The other L&D staff, mainly Obstetricians that simply wanted nothing to do with someone who did not practice the way they did, or did not like the way he handled birth. Understandable on some levels because good OB/Gyn’s are certainly hard to come by, especially the ones who really look at birth as something more than a medical procedure, or something they need to do before heading home for their dinner at 5:00pm.

Unfortunately for us, we may never know exactly what happened. But it certainly has shown the natural childbirth community, what happens when a OB/Gyn stands up to “the man” to fight back for something they believe in. My thoughts are with Dr. Biter, and his family, the families of all the babies he has delivered, and the pregnant women who are now left without a provider for their birth.

It is a very sad state of affairs for birth in our country. 

May 20th, 2010

There are good OB’s

A lot of people tend to think I am some kind of man hating, anti-ob/gyn, crunchy nut. Which in reality couldn’t be farther from the truth. With my first pregnancy I had a female OB/GYN, who was tolerable at first, but in the end I jokingly called her The Wicked Witch. As mean as it sounds, it was a pretty accurate depiction on her, as well as her personality. The only thing she was missing was a wort on the end of her pointy nose.

Needless to say, most of you who read here know I had a horrible experience and switched to midwife care for my second child. In the end, I needed a second cesarean section, so I was with the on call OB/GYN and the OB/GYN resident who was on call. Female on call, and male resident.  I have always had a thing about male OB’s… was just kind of off to me. A man, who wants to do that for a living kind of makes me wonder.

But really, back to the point of my post.
Many in the natural childbirth community give off the impression that all OB/GYN’s are evil, Midwives are far superior, and we should set out in an angry mob with pitch forks and torches to run them all out of the country. While there are some OB’s out there like that (coughDramyinsaneinternettrollcough) not all of them are evil, and in the case of some situations, they are fully needed.

Enter Keith. My resident who took amazingly good care of me when I was not only in surgery, but during my 4 day stay at the hospital I gave birth at. I coughed, he offered me a cough suppressant (coughing after a c-section is NO walk in the park), he helped me walk to the bathroom, he was caring, warm, welcoming, informative, helpful, and everything a truly good OB should really be.

I have sang his praises since I was discharged on May 20th, 2009. Well a couple days ago, right before Benjamin’s first birthday, I found Keith on facebook. Just so happens that he is facebook friends with one of my midwives. Haha!  (Who thought that Doctors actually used facebook!  OH! That’s right, they cause internet drama!)  So of course I sent him a random message knowing he would have no idea who I was, what my story involved, or why the heck I would even take the time to message him… I was wrong!

I guess I made such an impression on the L&D staff with my labor, they all remembered me. I thanked him for being an example of what ALL OB’s should be, and we are now super cool facebook friends!

Moral of the story, when there is a time and place for an OB/GYN, there are some great ones out there. We just need to weed out the bad ones.

April 22nd, 2010

Post Cesarean Feelings Survey – Question #6

Continuing to unveil the results of the World Wide Post Cesarean Feelings Survey that I recently worked on with Theresa from Health Baby Network, I wanted to move on to question number 6 which was “Did you feel like you were in control or your care and respected through out the process?”

Like every other question on this survey, we saw complete extremes on each side of the question, and very few moderate or middle of  the road answers. 312 women left a comment with their answer for this question, which left me with 14 pages of information, experiences, and comments that could be a trigger for anyone with any sort of a birth trauma. So I truly caution those same people from reading further.

Our of the 851 women who answered this question :
37.4% or 318 women felt like they were in control of their experience, and respected.
35.3% or 300 women felt like they were somewhat in control of their experience, and/or respected.
31.4% or 267 women felt like they were not in control of their experience, and were not respected.

When I discussed some of the comments these women left, Theresa said to me “Man, some nasty treatment” which is horribly sad for any woman who has been subjected to such treatment. It took me nearly 2 weeks to get through these comments and write this post because of the extreme nature of some of it.

So on to the comments.

“They treated me like a number. Like a ticking clock. They seemed to be prepping the OR behind my back, and every request, from ice to squat bar was ignored and almost sneered at.”

“No one treated me harshly at any time, my requests were carried out without protest, good lactation help”

“No respect, no compassion. At the mention of a c-section I started sobbing and the OB just stared at me stone-faced.”

“Dr. came into the room only a couple times the entire day, told me what was going to be done (never asked) she even laughed when she saw me sitting on the birth ball”

“Doctors are experts. I was OK with them being in control.”

“I am disappointed that no one ever explained the risks of c/s to me, especially to subsequent pregnancies, but I do feel like my OB would have respected my choices/opinions had I known better and refused c/s”

“The doctors were very respectful, explaining every step & making sure I understood why & what was going on.”

“I was constantly told what I needed in an effort to wear me down so that I would agree to their demands. I was forced to have my legs open in front of many strangers. I cried and nobody batted an eyelid. I wasn’t important. Childbirth is supposed to be a sensual, sexual, and most significant event in a woman’s and her child’s life which is certainly not acknowledged by the hospital system. I would say that I was sexually abused while in the hospital bed – another doctor (this time male) came and put his fingers into my vagina and the hospital midwife looked on with a smirk on her face that said ” You’re lucky to have such a good looking doctor like that up you”

“my membranes were ruptured without my consent, the OB did an episiotomy without my consent, the midwife was rude and confrontational, students were invited into the delivery room for the birth without my consent, i was left to hemorrhage until i came close to death, and so many more instances of poor care.”

“I felt in control of everything and I was able to explain my desires/wants”

“My first c-section – No. I felt like scare tactics were used to get me to induce w/o medical reason (“every day past your due date your baby has a higher chance of dying”), and then after 13 hours of labor, progressing nicely, I was told I had to have a c-section because my baby’s heart rate was very concerning. Yet, it took nearly 1.5 hours from decision to incision. Doesn’t seem very emergent to me.
Later, when I requested my records, I found that it listed my c-section as ELECTIVE. I still think I was coerced into a c-section because the doctor felt my labor was taking too long, it was the night before Thanksgiving, and she wanted to go home. After the surgery, they told me I couldn’t be with my baby and she HAD to go to the nursery. I didn’t see her for two hours and no one would call the nursery to find out if she was okay. I laid in a hospital bed, unable to move, terrified for my baby who was FINE (the nursery was understaffed). No one seemed to care how I felt or how upset I was. My second c-section was much better supported – however, I firmly believe that was because I demanded it of my caregivers. I knew everything I could know about VBACs and repeat c-sections
and refused to let myself be treated as poorly as I was the first time.”

I feel as though some of these comments are very telling as to the way maternity care works today, and the way that women view their providers, especially the comment above that a woman was happy her Doctor was in control because they are the professionals show us how much faith and trust women are putting into their providers. Good, bad or middle of the road outcome way too much faith and trust is being placed blindly in providers today.

Women need to build relationships with their provider, and build trust, it is not something that we should just automatically be giving because we picked Dr. X to deliver our baby, or provide us with prenatal care.

March 31st, 2010

The Midwife Difference

With my first pregnancy, like most people I chose the care of an Obstetrician. Misconceptions on pregnancy, birth, and medical treatment surrounding pregnancy is what ultimately brought me to my choice, and looking back I wish I had a clock that could turn back time.

After the half care I received from my first Obstetrician practice, and the negative birth experience that they provided with their misinformation, lack of informed consent, pushed birth, and ultimately my first cut, I know it was something I would never willingly go through again.

I understand that there are some wonderful Obstetricians out there, I am not anti OB and I do not hate them. They simply do not have a place in normal birth or with low risk pregnant women. It is over kill to say the least, and healthy women are experiencing maternity complications at their hands because as trained surgeons they are taught to see pathology where there simply is none.

With my second pregnancy, I oped for midwives after learning more about the midwifery model of care, and had a great desire to have a simple, healthy, and low risk pregnancy with providers who looked at me as a mother, and a human, not just a paycheck or a liability.

But when people use the term Midwifery Model of Care, sometimes it confuses people because they are not familiar with what it actually is. Per the Citizens for Midwifery website, it describes the Midwifery Model of Care as the following :

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

I think that if we had a turn in how Obstetrics is practiced in The United States and started utilizing this model of care, we would see amazing improvements in the lacking care system we see today.  We spend more than any other nations and have the highest maternal and infant death rates of all industrialized nations.  Half of that bill is footed by the tax payers through medicaid programs.

With all the recent reports on the rising cesarean rates, the dangers, and the sky high maternal mortality rates, we really need to take a second look at the way we are handling birth.

But back to my story. With my second child I used midwives. The differences I found?

Ob Care :

• Rushed appointments
• Long waits
• Numbers of tests
• My concerns were never fully listened to
• I was treated like a child, or uneducated fool not a person with feelings

Midwifery Care :

• Long appointments
• Very short wait times
• My questions were actually answered
• My providers believed in me and the choices I made in my own care
• I felt like I was being mothered, cared for, and educated not treated like a fool.
• I made a direct connection to my providers who I am still in contact with on a friendly basis.

Take the time to find a midwife!

March 28th, 2010

Weekly Round Up

I have found that some of my readers really enjoy the weekly round up posts, so I am going to continue them as long as I have things to round up each week! Hahah!

This week there were quite a few things to highlight, but certainly not as much as there has been in the past.
I will start off with highlights from my house this week :

• Everyone got sick. Real highlight huh?  Both boys got croup for the first time.
• Camden went to his first Easter Egg hunt!
• Benjamin is starting to try and pull himself up to stand. (I am done for once that happens)
• I opened my own Online Mark Store!  Come by and see if there is anything you are interested in, their products are awesome!!

On the internet blog circle :

• When Labor & Delivery Staff Behave Badly : I have seen posts about this all over the internet on various blogs, but because I love Gina, and she actually had a picture of the exchange, I decided to feature her post. I love some of the comments on it. Last night my Husband sat down and read it while we were having our Pizza dinner and he stopped eating and told me he was completely disgusted. Not much can make make him stop eating!
• Dou-la-la knocks one out of the park with her Weekly Movie about The Food Revolution that aired on ABC Friday Night. Baby was asleep, DH had the toddler with him at the fire house, and I watched it. I was completely disgusted and astounded that this is such a problem and I really hope this opens the eyes of the American public.  Another great post about Jamie Oliver’s Food Revolution comes from Peaceful Parenting.
• Amnesty International Slam Dunk’s craptastic “Dr” Amy’s post on Maternal Mortality in the United States.  I can say that there are only a hand full of people in life I “hate” because it is such a strong word, but the more I read this bitch write, the more I think she is just an internet troll with no real education.
• Great post in Mothering Magazine which turned out to be a very interesting read : Is Aluminum the New Thimerosal?
• Even though I was taking with local superstar Amy Romano about this a couple weeks ago, I finally had the chance to see it : This 1-Year-Old Happy Meal Has Aged Surprisingly Well.
• The ICAN Blog covers the ACOG Spokesmen talking about the rising cesarean section rates.

I hope you enjoy these highlights as much as I did this past week. If you have any highlights you would like to have included in my weekly round up posts, please e-mail them to me at Danielle.Elwood@gmail.com.
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