Pseudo-live Blogging - Maternal morbidity elevator speech

What is the one thing I'd say to a woman on an elevator about her risks from cesarean delivery?

"Try really hard not to have a cesarean.  It can be very dangerous to your health."

A longer version - I'm really impressed with the data that are available about the risks of adverse outcomes for women after their first cesarean.  It is also shocking how much strong evidence there is about how dangerous the 2nd and 3rd and upward cesareans are.

Given what we know from these data, it seems clear that the lack of VBAC availability is not driven by concern for women's health outcomes.

A lot of the reasearch for this conference was compiled by OHSU's evidence-based practice center.  Go Oregon!

On with the webcast...

Pseudo-live Blogging - Cringe

I remember at the last NIH conference how hard it was for me to listen to my non-scientific birthing community colleagues rail at the deaf (or at least hard of hearing) ears of the researchers who had planned and were running the conference.  I'm cringing again while I watch the first participant comment opportunity.

It isn't that the researchers are bad guys (there that is again) it is just that they are dealing with the issues of VBAC in such a different way from the birthing community that they barely speak the same language, are barely talking about the same subject.

I wish there were more public health doulas & folks like my friend Judith (she was on the VBAC conference planning committee) who could advocate for women's rights in ways the researchers and scientists can understand.

Maybe after my kids go to college, I'll take that one on too.

Pseudo-live Blogging - VBAC conference

I've decided that during my kids' spring break I'm trying to watch the entire NIH Consensus Development Conference on VBACthat happened in Bethesda, MD March 8-10.  This conference is one of those important policy influencing events in which doctors, midwives, epidemiologists, lay birth professionals and consumers get togther and lay out personal experience, scientific research and policy decisions that influence important health outcomes.  Several years ago, while still living in Maryland I had the chance to attend a "State of the Science" conference put on by the same office.

What came after the conference, as came after this one, was a draft position statement that sounded rather benign and exploratory but was in fact quite controversial.  If I hadn't been in the room with the people directing the conference, it would have been hard for me to understand just how rigged the whole game had been.  So, I decided that even though I can read the draft statement for the VBAC conference quite easily, I would be missing something crucial not to watch as much of the actual event as possible.  Fortunately the whole thing is webcast and archived at the link above so if you were so inspired, you could watch too.

I am also finding the whole thing a thrilling challenge to my public health professional's brain - I am surprised at how much I am enjoying the talk about developing models to predict individual women's odds of VBAC success.  The whole thing is biostats and taking population-based knowns and translating them into something that will impact individually-based unknowns.

I have heard that there are many tear-jerking stories from women and providers about VBACs denied and I imagine it will evoke some of my own professional memory.  I have seen women bullied into primary cesareans, tricked out of VBACs and mis-managed all the way to the OR.  I don't have a good-guys V bad guys mentality, and I do honestly think that the nurses and doctors who's views on birth are so divergent from my own still have their patient's best interests at heart.  But I have seen flawed people act badly toward innocent women and even though I acknowledge that that doesn't make them bad guys, it is still hurtful to remember.

Transitions

Spring is my favorite season.  The year unfolds before us in the Spring, trees slowly bud, flower and then leaf.  The dreary landscape livens with a vague green fuzz on branches until suddenly the city is even greener than it was before.  I enjoy watching these changes regularly throughout our busy days and weeks.

One of the tings I especially love about Spring is the longer days.  I’m not a morning person by nature so getting up in the dark is sometimes(strikethrough) always a painful process for me (I’m so thankful for my little little blue light  that helps me wake my brain up before noon!).  As the world is waking from the Winter, I enjoy waking a bit more every morning.

Until the second Sunday of March, when my naturally unfolding awakening is jarred by the reality of Daylight Saving Time.  The “springing forward” of time is arbitrary and annoying and it undoes my body’s trust in the lengthening day.  It usually takes me at least a week to recover from the shock and never again does my mind feel as in tune with the lengthening days and the earlier sunshine. 

This shock to my system reminds me a lot of the way women’s bodies react to disruption during labor.  They may be able to see a change coming, they may adapt to the change eventually, but the shock to her system is real, the impact on her psyche, her body and her labor is real.

Successful transitions are meant to be smooth and gentle.  We don’t wake up one morning and find our bodies hugely pregnant, they grow, slowly over time.  Most women don’t go straight to hard, fast labor, but ease into it slowly, with contractions building in duration, intensity and frequency.  Our bodies give us the gradual pace so that we can wrap our minds around what is happening. So that we can successfully cope.

Most women’s labor will be interrupted from this natural unfolding by a myriad of transitions.  Whether it is something as simple as driving to the hospital or something as important as the administration of epidural anesthesia, the jarring change in environment or physiology causes changes in labor.

As a doula, I’ve seen women navigate these transitions – building up a labor that has slowed down from the car ride and transition to the hospital, agreeing to pitocin to stimulate contractions that dwindled after receiving an epidural, changing coping strategies as labor naturally unfolds from early to active to transition to pushing – and I’m regularly impressed with the grace and willingness they have to do what is necessary for themselves and their babies during labor. 

There are those who would uphold the extreme position to abandon all distraction that most women in labor in industrial nations experience.  I agree that one of the most impressive and wonderful things to witness in labor is a woman’s instinctive and natural coping.  And I think we all, hospitals, doctors, nurses, midwives and even doulas and partners, are inclined to do things that take away from a woman’s instincts.  I’ve found over the years that instead of pulling tricks out of my labor bag, I watch and hold space and worry less about what I should be doing. Instead I watch women to plug into their natural instincts and then follow their lead.

But most women are not going to give birth in a secluded room in their homes.  Most women give birth in hospitals and as such, are subjected to many interruptions to the natural flow of their labor.  Does that mean they can’t have instinctive, low-intervention birth experiences?  Absolutely not.  What it means is that they need a little extra help staying connected to their instincts, their natural ability to cope and their vision for how they want to be in labor.

Just like Daylight Saving Time interrupts our observation of Spring, interruptions in labor are inevitable (except in Arizona? Okay, probably not a perfect analogy).  But with trust, planning, coping and a little blue light, women can make it through.