The Female Problem

I am creating this page as a courtesy to male readers who would prefer to refrain from reading about “va-jay-jay” issues.  More specifically, issues relating to childbirth.  Visiting this page is entirely optional (as is visiting this blog, I suppose).  So enter at your own peril.

I first want to point out that I really don’t care how women want to birth their babies.  If you want an epidural, for example, more power to you.  My beef is that the way I want to birth mine is largely prohibited for ridiculous and unscientific reasons. 

One of the reasons that this topic fascinates me is that I am directly affected by it.  I am currently having babies. It is, quite literally, my butt.  Another reason is that this issue is entirely apolitical.  No political party owns this issue (though some try.)  Hard-core conservatives join with hard-core liberals on this one.  I cannot really think of any other issue about which this may be said.  To me, this speaks volumes. 

Okay, so where do I even start?  What’s my problem?  What’s wrong with the way American women give birth?  

The US has a spectacular health care system, and I would never presume to claim otherwise.  But this excellence is in treating pathologies.  When it comes to high maternal and fetal mortality and morbidity rates, we are at the top of the list as far as developed nations go.  This comes as a surprise to many people. 

The main problem is that childbirth in the US is not thought of as a normal, natural physiological process.  Instead, it is treated like a pathology.  It is not a normal life condition, it is a sickness that must be actively managed.  And this active management is where we run into trouble.  For example, the cesarean rate now stands at 32% of all births.  This is dangerously high.  Anymore, “natural” birth means that a baby was born vaginally.  This is insane.  How did we get to this point? 

One reason is the practitioner’s fear of litigation (a reasonable fear in this day and age.)  No one is going to sue a doctor who performs a C-section, b/c it’s taken in a courtroom as the “last resort” (which of course, it isn’t most of the time.)  So, if for example a labor is taking ”too long” (an entirely arbitrarily set time period), then a c-section is performed because of the “what if I’m sued” factor. 

Another reason is due to convenience for the practitioner (the usual case), as well as for the mother, in the case of an elective cesarean.  The practitioner is going on vacation the week of the due date, so let’s just induce now.  (Being induced largely increases the rate of having a c-section.)

The main reason, though, goes back to the patholgy vs. normal physiological process dichotomy.  There is a fundamental lack of understanding about the way the body is designed to go about having a baby.  Obstetricians are not trained to sit back and let nature take its course.  Due to time constraints, OBs simply do not have time to sit around with a laboring woman.  And more and more nurses are unable to offer effective laboring techniques to women, either because hospital policy does not allow it, or they are too busy themselves.  (Or, in this day and age, they’re just not used to dealing with a woman who is laboring without drugs.  They’ve hardly ever dealt with a natural labor.)  Please don’t think that I’m trying to paint OBs and nurses as the “bad guy.”  The system is just set up wrong. 

To be continued…

I’m going to try to paint a little word picture here.  I read something like this somewhere, but I can’t seem to track it down.  So I’ll try to reproduce it from memory.  (Yes, it is uncouth.) 

If We Treated a Bowel Movement Like We Treat Having a Baby Today, or The Insanity of Treating a Completely Physiological Process Like a Surgical Procedure: 

I think we can all agree that the process of producing a bowel movement is, under normal circumstances, a completely normal physiological process.  But, if it were like having a baby, it would go like this:

Patty would go for a routine visit to her doctor.  The doctor would say, “You know, Patty, this poop is going to come any day now.  And from the looks of it, it’s going to be a big one.  Why don’t you come in tomorrow morning, and we’ll get it going early?” 

“Um, okay.  I guess I would be a little more comfortable if it were gone,” Patty replies. 

So, the next day, Patty and her husband arrive at the hospital.  Patty is asked to change into a hospital gown, and she is given a chemical to “jumpstart” the bowel movement.  Patty is asked to lay down in bed, while an IV is hooked up, as well as a continuous bowel movement monitor.  Patty’s husband and the nurses may look at the printout and note the progress of the poop as it descends lower into her colon. 

Soon, it is determined that the poop isn’t cooperating, and it needs a little more help.  So Patty is given a high dose of the synthetic hormone that causes the colon and intestinal tract to contract.  It does the trick; so much so that the pain is more than Patty can adequately manage on her own.  “It feels so unnatural.  It’s not normal,” Patty gasps.   An anesthesiologist comes in to give Patty an epidural, along with a catheter, as she is now unable to walk to the bathroom to relieve herself.

Patty is comfortable again, but the poop has stopped its progress.  The doctor orders the nurse to up the synthetic hormone once again.  Every so often, a medical student comes by with a nurse to check Patty’s progress.  Patty feels uncomfortable and exposed with a complete strangers hands at her anus, but the nurse tells her that she just needs to ”relax.” 

Soon, the continuous bowel monitor starts acting up.  ”Better hook up an internal monitor, just to be sure,” the doctor orders.  So, an electrode is screwed into one end of the poop.  This way, they can better determine bowel distress. 

After hours and hours of this carefully choreographed routine, the poop is finally down where it’s supposed to be, and the nurses tell Patty that she may begin pushing.  Patty, unable to feel much of anything, and on her back, needs a lot of coaching to know when to push.  She recalls thinking how great it would be to actually be upright, as that way makes the most sense, and uses gravity to advantage, but she is told that the doctor must be able to see the poop as it crowns.

After twenty minutes of everyone screaming at her to “Push!” The doctor states, “I’m going to make a little snip here with the scissors, to faciliate the poop.”  Then, the doctor cuts the opening of Patty’s anus larger, and the poop finally makes its triumphant emergence, where it is immediately rushed off to be weighed and measured and tested.  Patty’s bottom is then sewn up.  The doctor says her conratulations and makes an exit. 

****

Yes, that is how most babies make their entrance into this world.  And I think it’s utter insanity.  It’s so unreasonable, in fact, that it’s laughable.  Except that it isn’t funny.

Thank God that I educated myself enough when I was pregnant to say, “There’s no way in HELL I’m going to let myself be treated this way.”  But I’ll talk about my experiences next time.

To be continued…

Like all first time pregnant women (okay, maybe not all), I got my hands on everything I could read about pregnancy and birth.  It’s comforting to read for sure what is happening as another human being takes over your body.  I felt like a science experiment.  I wanted to know what was going on and why, and as time progressed and I saw this baby getting bigger and BIGGER, I decided I really wanted to know all the ins and, well, outs, of childbirth. 

Most mainstream pregnancy books are very straightforward and come from a very medicalized philosophy.  Birth, in these books, is a medical event, actively managed and directed by the OB. To borrow a phrase, birth is an emergency rather than an emergence.   Oh, yeah, they throw in a courtesy sentence about “natural” or “alternative” births, and throw in something about midwives, but for the most part, it’s get to the hospital, we’ll hook you up to all this cool stuff, you’ll lie in bed for the duration, get your epidural, then we’ll cut an episiotomy (it’s really the best for you), and we’ll deliver the baby. 

Let me tell you something.  No one delivered any of my babies except ME.   

As I continued to read, the turning point really came well into my ninth month–the twelfth hour, you might say.  I like to think of myself as a “thinker,” and with all the reading I had done a lot of thinking.  I had basically decided that I would do this as free from unnecessary intervention as I could.  From what I gathered, unnecessary interventions–like induction, continuous fetal monitoring, pitocin, epidural, episiotomy–they usually serve only to mess with the natural progression of labor.  I happen to place a lot of faith in God’s design of things in general, and in a woman’s body’s capability to bring forth a baby.  Women were designed to be able to do this.  In my reading, I was astonished to discover that the baby itself produces a hormone to start labor once its lungs are matured.  Why would I want to “jump the gun” and be induced?  Obviously, my baby’s lungs weren’t ready.  This, among many other similar things, is why I began to really consider the “norm”, and why it probably wasn’t for me.  Why suddenly turn this amazing physiological process into a series of medically-produced steps?

Okay, so I typed up a birth plan.  I realized that most nurses and OBs look at these things and say, “Oh, great.  One of THOSE.”  But I really didn’t care.  Most are probably chucked into the trash.  It’s all well and good to pay lip service to women “getting involved in their care,” but when push comes to push, no one is in charge these days but your OB.  (There are of course exceptions to everything.  In general, though, this is the case.) 

We had just moved to our permanent home when I was seven months, so I had to switch practitioners.  I was now going to a nurse practitioner who was backed up by a family doctor.  The birth would take place in a small local hospital.  Which meant that “the way things are done” is pretty much set in stone, and I got the idea that they didn’t like newcomers coming in and being presumptuous enough to have something called a birth plan.  (All a birth plan is is a list of preferences.  For instance, ”I’d like to move around during labor,” or “I’d prefer to deliver in whatever position feels the best for me,” or “I’d prefer if people knocked before entering my room,” etc…)  But, a few weeks before the birth, I presented it, and made a copy for the backup doc and had them look it over.  It was the most I could do.

And then, about a week and a half before the birth, I remember doing a lot of reading about episiotomy, and in my research I learned that something like 90% of first time mothers will endure one unnecessarily, when they’re only truly indicated about 5% of the time (or less).  The medical opinion was starting to change on them, and they weren’t being emphasized in medical schools as much as they had been previously.  (Of course, midwives have known this for years, and have very low episiotomy rates.)  But the old doctors would cut you no matter what.  I was really concerned about this, and I took my questions with me to my appointment.  (Weekly, by this time.)

I armed myself with all the research I had found, and trooped (okay, waddled) into the office.  I got the usual, of course we won’t do one if it isn’t absolutely necessary.  Then the backup doctor came in, and proceeded to condescendingly tell me that most first time moms will inevitably need one.  But look at all of this new research, I said, and it mattered not a bit.  Okay, so by this time, I was near hysteria.  I think I’ll take a timeout to explain what an episiotomy is, for those of you who might not know. 

An episiotomy is performed by cutting the opening of the vagina bigger to facilitate the delivery of the baby’s head when it is crowning.  Research has shown that simple techniques, such as applying warm, moist compresses to the perineum at this point, applying counter-pressure, and controlled pushing are all more effective at preventing tears than an episiotomy.  (As is delivering in any position OTHER than on the back, or sitting, with feet in stirrups, also the current routine birthing position.)   In fact, research has shown that episiotomies can actually have the opposite effect, and can make a tear far worse.  Imagine holding a handkerchief in each hand, and trying to tear it apart.  It’s difficult.  Now, put a small snip in the middle and try again.  It rips easily.  Same principle.  

And to read the history of the episiotomy, and why it gained popularity in the early 1900’s, further reveals why it should not be used routinely in obstetrics.  It really even goes further back than that, to the same era that gave us corsets (which probably did more to screw up childbirth than anything) and fainting spells and the idea that females were weak and unable to birth a child without the “help” of routine forceps use and the liberal application of episiotomy.  Beginning in the thirties and continuing into even the fifties, “twilight sleep” was common, where the drug Scopalomine was administered, which made a woman simply forget the horrific labor and birth.  They administered it, then tethered the woman to a bed, then cut an episiotomy and extracted the baby with the help of foceps.  Honestly, I can think of nothing worse than this scenario.   Really.  We treat animals better than this.   

Coincidentally, these practices started being implemented about the same time that birth moved away from home and away from midwives, and into the hospital and into the hands of mostly male doctors. 

Please don’t think I’m getting all feminist-y here, or that I’m going to start male bashing.  I’m merely pointing out facts. 

So, back to my story, I was on the verge of hysteria.  I came home after my appointment and decided to call around and see what the consensus on episiotomy was in other local medical establishments.  Most of the responses were either confused, as in “Why is she even asking this?” to “Of course you’ll get an episiotomy.”  Well, sorry, that wasn’t good enough.  Again, I had the research in my hands, and my faith in the medical establishment was diminishing rapidly. 

Finally, I called a midwife who practices in a larger town about 40 miles away.  I’ll never forget her answer.  I nearly broke down right then.  She said, “It’s YOUR butt!  Of course they’re not necessary.  It sounds like you’ve been doing your research.”  She gave me her personal pager number, and said that if I run into any trouble, to page her and she’d call me.  Why I didn’t switch my care to her right then I don’t know, but you can be sure she caught my daughter the second time around. 

Thank God I had the full support of my husband.  He is a thinker, too, and all it took was a glance at the mountain of research I had collected, hearing the words “increased sexual dysfunction after an episiotomy,” along with my saying, “It would be like me saying to you, ‘It’s just a small scrotal incision,’ ” to convince him.   

To be continued…

Jump ahead:  Eliza’s birth

So, what ende up happening with Linus’s birth?  I labored in a hospital bed without any drugs for twelve hours, tethered to the bed with an IV and continuous fetal monitoring.  There was no freedom of movement, and let’s just say that I think the labor time could have been cut in half had I been able to walk around, change positions, etc…  But, I do have to give it to the doctor:  He gritted his teeth and did a little extra work that afternoon by applying warm washclothes and such instead of just doing an episiotomy.  (No, I did NOT get one, and I was just fine, thank you very much.)  And Linus was by no means small:  8 pounds, 11 ounces.  Take that, “You’ll definitely need an episiotomy” people!

There’s so much I”m not saying, partly because it’s over now, and partly because there’s really no way of describing the act of giving birth.  It truly transcends words. 

Now, as for Eliza:  I went in to see my midwife (the one forty miles away) for my weekly check.  I wasn’t due until the 27th, and this was the 18th, so I went by myself and was planning on doing some Christmas shopping afterwards.  Gail looked at me and said, “You DO realize you’re almost 6 cm dilated, don’t you?”  To which I replied, “There’s no way.  I feel completely fine.”   No, in fact, I was quite effaced and dilated.  “Does that even HAPPEN?”  I asked Gail. To which she replied, “I never used to believe it, but now I do.” 

Yes, I had managed to go from zero to six in a week without feeling a thing.  Awesome.  There are countless stories of women who endure hours of painful contractions to find they’re only two cm dilated. 

So, I had a decision to make.  And one of the many things I love about Gail is that she takes the time to talk to you, and gives you all the options, and lets you make your own decisions.  My choices were to go home and go about my business as usual, with the casual warning that if my water breaks, the birth would probably go so fast I’d have the baby at home.  All right, I thought, I could deal with that, but it sounds messy.  My other option would be to drive home, get David, and come back to see Gail, and she would break my water for me, and the baby would arrive soon after.  This was a very difficult decision for me to make.  On the one hand, I didn’t like the idea of any interference with the way things were going.  On the other hand, I completely trusted Gail, and knew she had a lot of experience .  After stating my concern that she would break my water, and then nothing would happen (which, because of the ridiculous, “hospital policy” 12 hour time clock after one’s water breaks, could result in a C-section due to time contstraints.)  I expressed this fear to her, and she said that she was almost 100% sure that this would not happen. 

So, I drove home with incredibly mixed feelings.  There’s nothing like having someone the relative size and shape of a watermelon in your abdomen to get you simultaneoulsy ecstatic over the thought of getting it out and terrified over that same prospect.  Especially having done it before, and knowing it’s not necessarily a walk in the park.