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What ARE the Risks of Cesareans?

This was a recent question in my Navelgazing Midwife Facebook Page. You’d think anyone reading anything on a more natural-oriented site would already know the answer to that, but I was really glad to see someone ask. It gave the readers a change to answer in a way no textbook can describe. 

A: Having the incision tear further when they pull the baby out - causing hemorrhage and complicated repair and possibly eliminating the possibility of a VBAC - this happened to me. Two hours to repair the extension. (I was able to VBAC though, but have talked to other women who were not able to.)

J: Risk of cutting the baby, nicking nerves, increased likelihood of adhesions in the abdominal cavity, increased risk for uterine rupture with future pregnancies, increased risk of placenta accreta with future pregnancies.

N: Nicking the bladder or intestines causing infection and all the complications that come along with that.

R: Post operative infection.

J: Increased likelihood of prematurity and associated morbidities, increased likelihood of blood loss and clotting problems.

M: Hematoma and uterine wall infection which are currently being experienced by a client of mine-landing her back in the hospital.

J: Increased risk of complications from anesthesia, and the risk of surgical complications is higher in obese moms.

C: Hemorrhage, infection, as you noted compartment syndrome, increased maternal mortality with each c-section, decreased fertility, increased pregnancy complications such as placenta accreta, nerve loss, bladder damage (accidents happen even with a catheter in place and an empty bladder), sleepy babies that nurse poorly if at all, late milk coming in, pain (a lot) and pain that stays for many months after delivery, poor incision healing, blood clots... It sort of becomes endless.

S: Significantly increased risk of death for mother.

S: So scary to read these in list form like this.

J:  Your eyes opened to shit you never ever wanted to know or feel, for months and years. Also, disfigurement.

A: In addition to the overall risks of major surgery (infection, reaction to anesthesia, etc), there are the risks to future pregnancies, particularly placental abnormalities like previa and accreta/increta/percreta. And then there are the potential problems (not insurmountable, but notable) of separating mom and babe in the early hours and the impact that can have on establishing breastfeeding. Plus due to not passing through the vagina, babe is not colonized with normal flora, increased respiratory difficulties . . . Where to stop?

L:  Death.

D: Excess fluid in lungs for newborn.

C: My son and I both carry scars from that operation. He was sunny side up, and they wheeled me in pushing. He now has a small scar on his cheek that, as he is getting older and bigger, is becoming more prominent. BTW, informed consent is a joke when your doc has a dinner party to get to on New Year’s Eve. Further risk? Maternal or fetal death. Increased placental placement risks. Fertility risks. Bowel, internal organ healing risks. If I knew then, what I know now....

M: Disgusting, oozing, adhesive burn from the dressing over my incision.

NgM: It's imperative to remember the Risk/Benefit Ratio. One of the things about cesareans is they are proof positive that a mother will lay down her life for her child; she forever has the scar(s) to prove it.

A: I read a lot of medical issues here, but not so much on the emotional issues. I remember feeling "broken" for a while.

R: Emotionally, issues bonding with baby, increased risk of postpartum depression/post traumatic stress disorder/postpartum psychosis.

L: Actual complications in my case, cut hip to hip, hemorrhage, cervical laceration, massive surgical infection that took 8 painful (not to mention shockingly expensive) months to heal. Additional surgery and medical advice to carry no additional children. Between the risk of another preemie, the scar tissue and the extent of tearing of my uterus including the cervical laceration, several docs have strongly advised against further pregnancy.

L: Repeat sections with increasing probability of placenta accreta is the one that scares me most. Freaks me out when this starts with a teen primip (first time mom). High-risk category forever. Bad news if you hoped for more than 2 kids ever.

W: Can we have this same thread with vaginal births, as that isn't a risk-free walk in the park either. Just because this needs to be said, just because it is a risk, doesn't mean it will happen to you. There is a risk of most offbeat things every time you get into the car (even the emotional things) but 99% of us still ride in cars.

NgM: No, it isn’t a “risk-free walk in the park,” but it is true that cesareans carry far more risks for mom and baby than a vaginal birth does. Acknowledging them is fine, but seeing them as equal is flat out wrong.


Did ACOG (finally!) Take Their Meds?

If you haven’t already heard the screaming in the streets, let me be one of the first (thousand!) to let you know that this afternoon, the American Congress of Obstetricians & Gynecologists released guidelines that aim to lower the repeat cesarean rate as well as saying that women having a VBAC after 2 cesareans or who are carrying twins or women with an undocumented previous incision ALL should be permitted/encouraged to TOLAC (trial of labor after cesarean).

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 [sic] 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. “ (emphasis mine)

Am I dreaming?! Could ACOG have actually said something that aligns itself with facts? Beyond stunning.

Also, “Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. (!!!!!!!!!) A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).”

When the old guidelines were put into place in 2004, a monumental shift occurred that forced hundreds of thousands of women to endure, by force even, a repeat cesarean. The two criteria quoted here, whipped the insurance and hospital admin industry into an apoplectic frenzy.

“…a physician (must be) immediately available throughout active labor who is capable of monitoring labor and performing an emergency cesarean delivery; and the availability of anesthesia and personnel for emergency cesarean delivery.”

Because of these few words, an entire mindshift occurred regarding VBACs and the last six years have been HELL for far too many women.

In March 2010, the National Institutes of Health had a symposium to explore the VBAC “problem” and to try and find solutions. For two-and-a-half days, expert after expert, from OBs to mothers, shared data… scientific data… proving the appropriateness of offering VBAC. I wrote a post, What I Learned Watching the NIH Conference, if you’re interested in reading another perspective of the symposium. I know I am not alone in thinking the words of that conference were inside soap bubbles and would drift away and pop over the ocean somewhere, drowning out any of the positive ideas that were presented.

But, apparently, somebody was listening!

ACOG says, “Women and their physicians may still make a plan for a TOLAC in situations where there may not be ‘immediately available’ staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. ‘It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance,’ said Dr. Grobman. And those hospitals that lack ‘immediately available’ staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added." 

One of the most heinous aspects of the VBAC Wars has been when women have been forced, by law and/or physical force to have a repeat cesarean. Women have been cut open even as they screamed “I refuse consent!” One of my own clients had a baby at +2 station, shoved back up so she “could” have a cesarean. I tell the story in “Forced Cesarean.” I still get sick to my stomach remembering the experience; nothing like what the mom feels, I’m sure. Addressing this issue, ACOG says:

“The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.”

Or a MIDWIFE. I’ll take her.

Even as the print was barely dry, commentaries around the Net had begun. The International Cesarean Awareness Network (ICAN) says:

However, more than a revision of the VBAC Practice Bulletin is required to reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates.  ICAN challenges ACOG to take an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans.” 

The LA Times says:

“The National Institutes of Health report combined with ACOG's new guidelines have the potential to usher in a new era of childbirth in the United States, returning it to a more natural, less-invasive event. Women's health experts nationwide have long agreed that one-third of all births by surgery is unnecessarily high. But, no matter what the medical evidence says, whether the attitudes of doctors and women will change to favor a less-invasive and medicalized — as well as slower and less convenient — approach to childbirth remains to be seen.

I know many more commentaries will be born in the next couple of days.

I am absolutely shocked to read the new guidelines. I know many women don’t believe one word ACOG says, but I can’t help but pray/dream that this statement might actually cause a seismic shift in maternity care.

I’m crossing my fingers, but not holding my breath.


A mama after her successful VBAC.








So, What's the Deal with Dr. Wonderful?

If you wander the Net, mostly Facebook, especially with me, you’ve been following the saga of Dr. Robert Biter’s expulsion from San Diego’s Scripps Encinitas hospital. His obstetric privileges were removed on Friday, May 7, 2010. No one, not the hospital nor Dr. Biter has said why he was suspended. The hospital states confidentiality; Dr. Biter has been silent.

But, I have some ideas, have alluded to them, have spoken to the press about them and wanted to share them here. Rumors are a’flyin’ and it’s time they stopped. I do understand nothing will quash all the rumors except the truth, but I’m not sure when/if that’s going to come out anytime soon.

Therefore, in the meantime, you get to see/hear what the press is saying, sound bites from various acolytes and my thoughts on the whole thing.

I’ve written about Dr. Biter since June 2007 after attending the Garden Labor (where I first coined the moniker “Dr. Wonderful”). The posts continued with A Birth Unfolds in Photos and Words, one of the most viewed pieces I’ve ever done. One more, VBAC (with a whiff of pit), was also photographed and its story told. Those pieces demonstrate the wonders of natural birth in the hospital, that it can be done –with the right care provider and supportive nurses. That how the way he practices is so odd; it speaks volumes about his style. Over the last three years, women have disclosed other doctors around the country who seem to practice in much the same way. I’m thrilled to know there are more! However, there aren’t that many.

On May 14, 2010, there was a huge turn-out in front of Scripps Encinitas Hospital that included Ricki Lake and Anna Getty. There was a rally on Mother’s Day; My Best Birth gave an overview of the situation, families rotated through the week and then this big rally was the culmination of a loud outcry of his being fired. Some of the pre-rally media included this piece from CBS, the San Diego News Network, the formation of Bring Biter Back and the creation of this Petition to demand Dr. Biter’s re-instatement. Last Friday, we saw plenty of press. ABC, CBS, the Union-Tribune-SignOnSanDiego and the North County Times hung out with us for awhile, even talking to the one nurse from L&D who dared come outside to protest.

Plenty of love is given to Dr. Biter. His reputation is stellar. Or is it?

You can find a couple of so-so reviews on Yelp!, and there are dissenting views out in the community, but most hinge on the, sometimes, interminable time it can take to see him in the office. Once he is actually in front of you, you have his attention 100%. It’s the getting there that can be challenging.

Yelp! has removed other negative comments that I’ve read over the past couple of years. A common one was that he was too chummy, too huggy. His physical kindness is a hallmark in Dr. Biter’s care and is welcomed by those that adore him. I’d almost forgotten the snarky things people had to say about how he hugged them too much until a Biter Rally attendant ran into a couple of RNs that alluded to the reason behind his expulsion was because he was too “friendly” with his patients and their families. When she mentioned it on-line, the topic quickly blossomed into “I noticed his affection for his clients in the photos you took,” and “At first I was taken aback by how he touched the women in the pictures.” Upon examination, we were able to see the sexism in the equation, that if he were a female OB, it wouldn’t seem out-of-place at all. I countered that I don’t often see female OBs hugging their patients, either. But, I suggested we exchange his male OB-ness for a midwife and the “ah-ha!”s had the picture. It isn’t inappropriate for a care provider to hug a client, it’s just crazy bizarre to see an OB doing it!

In the photo spreads I’ve done, I noticed that I took the pictures because Dr. Biter was doing something so unusual, so beautifully different than every other obstetrician –and many of the midwives- I’ve worked with in my life. I went over the photos again and smiled at the love that man has for life. I look and remember every moment of the births with him. Dr. Biter is so present with his clients. No matter how tired he is, no matter how much he still has to get done, he is there with whomever is in front of him. And women/clients/families feel that kind of adoration. It is returned to him a million-fold.

I’d heard about this man, this Dr. Biter, before I went to a birth with him. I swear angels and twinkling hearts live around his name as it is said out loud. When I finally got to the birth with him, I know a part of me stood in the corner with my jaw hanging open. Who is this person? He went to medical school? He stayed with the client, he encouraged her, he breathed with her –he helped her through the rough parts until she eventually birthed her baby into her own hands.

Was this a fluke?

The next and the next and the next births were the same. Well, not the same same, but similar in their tenderness and respect. I had a mom who transferred in during a complication and Dr. Biter happened to be the Doc-in-the-Box. This mama needed a cesarean and it was clear she did, but it wasn’t a fly-down-the-hall-in-hysterics kind of cesarean. Dr. Biter was gentle with her, talked to her about what was going on, brought her a photograph of what the baby looked like inside and then we all talked about what the cesarean would entail. When the time came to go to the operating room, Dr. Biter said I phrase I have heard repeated with a couple more women –and heard he had said to other women as they were wheeled in on the gurney: “We’re not just having a cesarean, we’re going to have a birth.” I swear I swooned.

Dr. Biter welcomed me into the OR on three occasions. The anesthesiologist also said it was fine. Who refused my entry was the “circulating nurse” –the nurse responsible for the patient’s safety during the surgery. Interesting how she came to be in charge. In every other hospital for over two decades, it is the OB and the anesthesiologist who decide who goes in. Suddenly, the rules changed.

So, with all the great things this doctor seems to be doing (and has done), why would Scripps Encinitas Hospital want to push him out of their system? Wouldn’t you think other doctors would want to mimic his style so they, too, could be busy to overflowing? Wouldn’t you expect doctors to see what women are asking for and strive to fill it? Initially, it seems baffling. But, if we look at this from another angle, the point of view of the hospital and other OBs, it becomes clearer. And let’s not forget the lawyers, shall we?

From this vantage point, we see a doctor in a lone practice… a lone busy-as-all-get-out practice. The doctor does all of his own prenatals, GYN surgeries and sits with his “patients” during much of their labors. If they are VBACs, he is required to stay the entire time (per ACOG) in the hospital. How can one man possibly do all of this and be safe?

Keep looking through the angle of the medico-legal world.

Dr. Biter is known to take wide berths with, what is professionally called, Friedman’s Curve. In a nutshell, once women are in active labor (3-4 centimeters dilated), she should (red flag word right there… “should”) dilate one centimeter an hour. She should only push for two hours if this is her first baby, one hour if it is her second or subsequent. When the mass-utilization of the epidural came into effect, second stage (pushing) was extended to three hours for a first time mom and two hours for a second (plus) mom.

In the one week period during the protests, I heard woman after woman talk about how Dr. Biter never gave up on her, never having a time limit on how long she could labor/push, how triumphant they were because they knew if they’d had a different doctor, they would have had pitocin or a cesarean. That Dr. Biter believed they could birth, even if it took time, meant the world to these women. Besides the immense joy, the financial cost was greatly minimized by the births they had. The physical cost was infinitely less than a cesarean would have cost. The time healing, the time away from the family… even the time spent processing a cesarean… is miniscule compared to a surgical delivery.

But, doctors who are ingrained in the Friedman’s Curve (even though other docs have insisted it isn’t accurate) –and those that believe the Curve should be even faster with pitocin- probably see what Dr. Biter does as renegade. If he steps out of bounds with something as basic as the Friedman’s Curve, what else is he rocking the boat with?

Dr. Biter is meticulous with monitoring. Intermittent monitoring (although, with my VBAC clients, they have had continuous monitoring, as per ACOG protocols), either being listened to with a doppler or getting a strip every hour or so, has been shown, over and over again, to be just as effective as continuous monitoring and continuous monitoring restrains a woman much more than doing it intermittently. So, if the woman is being listened to periodically, that means she probably isn’t in the bed; she’s “wandering around” – a phrase I have heard many nurses use over the years. It is much easier to keep track of a woman in bed on monitors that worry about her “wandering around” the hospital (or even just her room). If mom isn’t in bed and wandering around, that means she most likely doesn’t have an IV pole being dragged behind her. She, most likely, has a saline lock, but not necessarily. (Are you counting the red flags most OBs would be seeing about now?)

By bucking convention, other doctors must be spinning in their office chairs and their hands on their heads screaming, “Horrors!” You see, to them, these things are risky (at best) and dangerous (at worst).

Cutting out all the crap, Dr. Biter surely looks like a lawsuit waiting to happen to them. I can pretty much bet they are scared witless that they will be sued should something untoward occur and they don’t have the “proof” that “everything that could have been done was done.”

Defensive medicine. At its worst.

After the NIH VBAC Conference a couple of months ago, it finally sunk in that many/most doctors do not make decisions based on what is best for mothers and babies, but what is best for themselves and their lawyers. To me, this is an abhorrent way to treat women and practice medicine. Sadly, it is the reality of our obstetric world today.

But, for those of us who believe decisions should be made based on a woman’s and baby’s unique set of circumstances, this defensive medicine mess needs to be tossed into the dung heap. It is time to stop cutting women because all the doctor can visualize is standing in a courtroom defending himself/herself.

Doctors are going to be sued; whether it is because they did something or because they didn’t do something. As was mentioned during the NIH Conference (and beyond), it is the mindset of luck, responsibility and fate that needs to be changed. Our court system needs to be changed. Tort reform must occur. Something else has to be done instead of cutting women out of fear of being sued.

Scripps Encinitas’ cesarean rate is 28.9%. That 28.9% sounds low is astonishing to me and the others who are now so used to numbers that high we almost yawn hearing them. But, 28.9% is twice as high as it should be! While I don’t know Dr. Biter’s specific statistics, I have heard rumors that it is 5-7%. Of course, I would love validation of that, plus know what his VBAC rate is; I wish California gave out the doc’s stats like some other states, do.

I’ve often called Dr. Biter a midwife in OB’s clothing. I can imagine this very description has been said as an epithet amongst other OBs. Obstetricians hold a special disdain for many midwives, especially homebirth midwives. That we have a great working relationship with him as we doula our clients or if we happen to get him during a transfer when he’s on-call is another twist in their knickers. I expect he gets a great deal of flack for even acknowledging our presence, much less interacting with us. I will be very, very sad if he is ever required to eliminate us from his professional life.

If we now pull back, far enough to cram the whole picture into a large frame, you can see how different this man is, how unconventional… even non-conforming… he is and how that, most certainly, makes other OBs (and lawyers!) squirm.

I hope that with all the love and prayer and power we are sending Dr. Biter, he is bolstering his resolve to remain one of the most progressive (in his old-fashioned way!) obstetricians in the country. We need him now more than ever.

This is why we are out there marching ever single day asking for his reinstatement. He is worth every ounce of energy.

Dr. Robert Biter with Alisa while she labors, monitored, in the garden. She VBAC'd a couple of hours later.



Cesarean Punishment

Insurance companies have begun refusing coverage to post-cesarean moms unless they have been sterilized during their cesarean.

The International Cesarean Awareness Network - ICAN - reports:

"Peggy Robertson of Colorado. When she applied for health insurance coverage with Golden Rule, her husband and her children were accepted, but her application was denied. After multiple inquiries directed to the insurance company, she was finally told that she was denied because she had delivered one of her children by cesarean. 'It was shocking. I assumed that as a woman in good health I would be readily accepted,' said Robertson. 'When I finally found someone who would explain why my application was denied, they had the audacity to ask me if I had been sterilized, stating that this was the only way I could get insurance coverage with them.'"

The New York Times article says:

"She was turned down because she had given birth by caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."

Also, "Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

'Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,' Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

'“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,' Ms. Pisano said."

As an FYI, Golden Rule insurance company is owned by United Healthcare.

"Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized."

While I hadn't heard of this, it doesn't completely surprise me. I am individually un-insurable because of the gastric bypass. I used to be un-insurable because of diabetes and morbid obesity. Even though the gastric bypass put both diabetes and obesity to in the background, the fact of the surgery alone is cause enough to never be able to buy my own insurance.

I seriously wonder what will happen to the cesarean rate if ALL women had to pay for the surgery out of their own pockets. Scheduling a cesarean will come with a whole new set of issues besides the uterine scar, the secondary infertility, the placental difficulties, the higher risk of dying and having a premature baby as well as post-op pain and a much longer recovery. I wonder if finances will have any impact at all.

A part of me applauds the possible ramifications of their discrimination. Not the actual denials, but the possibilities it affords women who've had cesareans previously. Will VBAC once again be the preferred subsequent delivery?

This is certainly an interesting (and sad) development; we will all have to watch unfold.


The Best Response to ACOG Statement Yet

I've kept away from ACOG's Statement Against Homebirth because so many other people have done just fine responding to it.

However, I just came across a piece that is, to me, by far, the best response I have read. On
The Education of Genevieve's blog, she re-posts A Parody of the Recent ACOG Statement by a writer named Tienchinho. I've tried to find the author, but haven't been able to.

Assuming the author would love others to read her work, I re-publish it in its entirety.


A Parody of the Recent ACOG Statement


As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes.

I acknowledge ACOG’s right not to support programs that advocate for, or individuals who provide, home births, but I do not support a system that denies families the essential information to make informed decisions regarding maternal care. Nor do I support a system that lacks the resources to make VBAC a viable option for all women and ensure the quality of the mother-child dyad immediately after birth.

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk.

Advocates cite the lack of rigorous scientific studies as one justification for promoting hospital births. Consistent dismissal of existing Level I evidence defining the risks of unnecessary interventions such as episiotomy, epidural anesthesia, and amniotomy has concerned proponents of natural childbirth for the past several decades and we remain committed to changing this. Birth advocates throughout the world use childbirth education, grassroots childbirth networks, and recently, the media to provide mothers and caregivers with the evidence.

Multiple factors are responsible for the persistent exceptions to evidence-based medicine in maternal care, but emerging contributors include a fear-based climate that skews mothers’ decision-making abilities and forces caregivers to follow “standards of care” that ignore the scientific evidence. The availability of a birth attendant to provide continuous labor support and of a midwife to provide expertise and intervention may be life-saving for the mother or newborn and lower the likelihood of a bad outcome.

I believe that the safest setting for labor, childbirth, and the immediate postpartum period is one that respects and trusts the birthing process, that meets the Baby-Friendly and Mother-Friendly standards jointly outlined by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Coalition for Improving Maternity Services(CIMS) and is supported by birth advocacy groups.

It should be emphasized that childbirth comes with inherent risks. Implying otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures.

They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as “dystocia” and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby.

I encourage all pregnant women to get prenatal care and to make a birth plan.
Safeguarding the process of giving birth promotes a healthy and safe outcome for
both mother and baby. Every woman should seek balanced information to guide her
decisions throughout pregnancy, childbirth and parenting. For women who despair in the lack of choices, they should look for hope in mothers who have navigated this climate of fear successfully. We are here.

(end post)



VBAC Study Worth Seeing

Effect of Hospital Volume on Maternal Outcomes in Women with Prior Cesarean Delivery Undergoing Trial of Labor states in part:

The authors did not find evidence of an association between hospital VBAC volume and the likelihood of adverse outcomes in VBAC after adjustment for patient mix. Other risk factors consistent with prior research were identified, including induction of labor, 2+ prior cesarean deliveries, preeclampsia, diabetes mellitus, and high birth weight. Prior vaginal delivery was protective against adverse VBAC outcomes. The risk of an adverse VBAC outcome in low-volume hospitals was comparable to that in high-volume hospitals.

(end quote)

I wonder why they did a study about hospital volume in the first place? Was there a belief that hospitals that had a large number of patients also had worse outcomes of VBACs? I'm actually quite shocked that anyone even did a study on VBAC success!

I think the risk factors are really important for women wanting a VBAC. You don't fall into those categories? That bodes very well for your upcoming birth.

I also believe that women who are meticulous with their diets (including my earlier recommendations for organic beef and dairy, no dairy products the last 6 weeks of pregnancy and no juices) can go far to curb or eliminate the GDM and large babies. A great diet can also help avoid PIH/pre-eclampsia, as well. There are never guarantees, but every bit helps.


Montage World!

Dear Pamela (Sage Femme) put up a beautiful montage that is making the rounds. Go see it here!

Quick to follow something good (great!), I have already done one montage myself and would love to share it with y'all. Regular readers have already seen several of the pictures, but I did add more to complete the visual story.

Click below - let me know what you think!

Look forward to more montages - and soon - videos on YouTube since I just got myself a little Flip (a black one). It's the coolest! A mere $120 at Costco (regularly $180!).

('Cuz I don't have enough to do! laugh)



While many of us profess to not be influenced by society or our friends or even our partners when it comes to what we do with our bodies. The reality is, many of us are. I see it every day.

“Let me check with my husband.”

“My friends all swear by fill-in-the-blank book.”

“My boyfriend won’t let me do that.”

“The doctor said I can’t.”

Our friends become a gauge for our actions… are we nursing long enough? Do we do Elimination Communication with them? Or do we use cloth diapers? If I use disposables, will I be ostracized? What if I can’t nurse? What if I don’t go to the hospital they all use, have an epidural like they do, use the same doctor?

Many women struggle with these issues. If a woman uses her mind, she is often punished, even shamed into submission. Or at least, they attempt to shame her into submission. If the woman is strong enough, she plows on and often, in the process, she loses those friends and finds a new circle of friends that support her in her new hopes, dreams and desires. Not enough women have the option of finding support outside their circle of friends, but with the Net, at least it’s a little better, but you can’t always depend on cyber-friends to bolster you when real-life people are smacking you in the face.

But, what if it’s your partner that’s using psychological warfare? How do you work through the issues of circumcision, extended breastfeeding, VBAC, the family bed and homebirth if your husband is adamantly against what you so strongly believe in?

What if your partner says your breasts will droop and be saggy if you nurse past six weeks? What do you know? You’ve never nursed, you don’t know anyone else who’s ever nursed; all you know is what you’ve read on-line and in books and that issue isn’t addressed head on. Is he right? Is he telling you he won’t want your breasts/you anymore if you nurse after six weeks postpartum? Is it a threat? Do you even bother nursing at all?

I hear similar stories all the time. Partners can be the mom’s biggest allies, but they can also be the biggest antagonists.

- Mom is nursing a few-month old child and goes to the baby, who sleeps in another room, once or twice in the night, to soothe her with a pacifier or, sometimes, a short nursing. The dad, who barely awakens at night, rages during the day about mom losing sleep, howling that she immediately throw out the pacifier and quit going to the baby in the night. He brings home “How to Sleep” books and videos constantly and tells mom how to mother the infant. Mom swears she never complains about being tired and has no problem at all with waking with the child, two or ten times a night. The marriage is suffering.

- Mom realized during the pregnancy that she would never circumcise her son if she had one. Her husband, Jewish, but not Observant, insists that circumcision is required in their family and that’s it. When the baby is born, it is, indeed, a boy and the issue turns into an immediate fireball when in-laws, the family’s Rabbi and literature all descend on the newly postpartum mom, who still refuses to allow “her” son to be circumcised, using all the heated language she can – making the topic more and more inflamed. When I met mom, the baby was intact and she was in the middle of a divorce.

Who’s right? Is mom always right? Does she always have the Right of Veto? In the Pro-Choice world, she does. In the Fundamentalist Christian world, she does not. Somewhere, is there a middle ground? In such heated and black & white issues, is there such a thing as middle ground?

In perhaps the most vile, sad and disgusting episode of manipulating shame I’ve ever heard, comes that of a woman’s “friends” who decided to try and talk her out of a VBAC.

This mom, who was creating the most amazing VBAC scenario of her life, was approached by friends and questioned about her sanity. Why would she want a VBAC at all? Why wouldn’t she want to just schedule her surgery? Wouldn’t it be so much easier? The woman defended her choice eloquently by explaining the sadness in her last birth, a cesarean… her desires for empowerment for this birth and how hard she was working to make the stars align for her idea of a perfect birth. Instead of supporting her and applauding her amazing bravery for facing the VBAC naysayers in the medical field, they stepped up the derogatory reasons for why she shouldn’t have a baby come through her vagina.

Beef Curtains.

A horrid term that can actually be Googled. Also known as Roast Beef Curtains. Beef Curtains is a term used to describe a woman’s vulva in repulsive terms, well, let’s make that a REAL woman’s vulva – one that has folds and creases – not a pre-pubescent vulva that has yet to unfold from inside itself. Those “perfect” ones that are copied in operating rooms across the country when women have plastic surgery to “pretty-up” their pussy parts.

This woman’s friends tsk’d tsk’d her insistence on her VBAC by telling her that men just don’t want their women to have beef curtains or, another delightful vulvular term, Romaine Lettuce.

How can women be so cruel to another woman? How can women be so cruel to another woman working so, so hard to empower herself as a woman? How can women feel that the natural folds of a vulva can be so ugly and how can they participate in their denigration so thoroughly? How can women, in less than one generation, buy into the Hustler airbrushing un-reality of a woman’s body? What power do men have over women that they (women) acquiesce everything, even their most beautiful body part – the (proverbial) flower that opens to allow a lover’s touch, a partner’s semen, her own fingers and toys… and then, to allow the babies – the BABIES! – the babies to come through.

The babies come through from uterus through vagina and wear the vulva like a petal’d hat just before reaching the earth and inhaling our air and letting go of mom’s side of the umbilical cord.

Why would someone want to remove the petals from a woman’s body? How could a man not want to fluff with a woman’s labial folds? (Could there be a lesbian somewhere that would also insist on labiaplasty?) How can a woman find her own body disgusting unless someone told her it was? How come it’s always a woman’s body that’s defective? (Not that I think men’s bodies are, but for god’s sake, couldn’t there be some balanced see-saw somewhere?)

When, postpartum, this successful VBAC woman cried because she was worried she would need reconstructive surgery, her friends’ words reverberating in her head.

(And I know now this is one of the reasons women must be choosing primary cesareans, yes? Isn't this horrible?)

I say we all come up with prepared lines for friends like this. Ready?

1. Well, my days as a Hustler pussy model were just about over anyway, so I think a VBAC is worth the risk.

2. Well, you know all those times we sat on the dining room table and showed our coochies to each other at cocktail parties? Those days just might be over.

3. Since when are you so concerned about the issues between my snatch and my lover? Isn’t that between me and s/he?

4. Isn’t that a tad private?

5. My, you sure are bold talking about things you don’t know about in my relationship.

6. How do you know what my vulva’s gonna look like afterwards anyway?

7. How do you know what my man likes?

8. Not everyone's vulva is affected by birth... how do you know mine will be?

9. Well, actually, if the curtains aren’t big enough, I’m having surgery to make them into full-on draperies.

10. Are we going to show each other our stuff now?

11. My wo/man likes my cunt to look like a grown-up’s, not a child’s. A woman’s vulva has “curtains.” So will mine. A child’s has no folds. Is your man into pedophilia?

I think it’s time we stop shaming each other. It’s revolting.

I think we need to turn the tables and laugh the hell out of the women (and men) who try to shame us into thinking our bodies are wrong/fat/less than/ugly. We should all come up with a billion lines to use, put them on tee shirts, business cards, hats, bracelets, necklaces, tote bags, on the big butts of our jeans, across the flat chests - or saggy boobs - of our blouses and memorize them so they spew forth at any given moment that someone tries to make us feel less than we are.

Don't men and women know that beef curtains (let's de-sensitize the name, shall we?) happen in puberty or pregnancy, not just in birth? Just like saggy breasts happen with the hormones of pregnancy, not with breastfeeding? This is what we get for not living in a naked, non-tribal community... not seeing real live tits and ass.

A former topless dancer friend of mine told me she loved seeing the variations on a theme of women's bodies when she started out dancing. She saw women's labia that hung down several inches and was fascinated there was such a thing! She saw inner labia much longer than outer labia, inner and outer labia of all different sizes, shapes, colors and textures. She loved seeing it all and looked closely and often.

I remember seeing the vulva of a new woman who had a few weeks earlier been a man. It was incredible! I asked her to stand over me, showing me every nook and cranny, opening the folds, letting me see her clitoris, her hood, the labia, seeing how the hair grew... it was just so cool! But, now that I think about it, it looked so... un-used? Young? Small? Perhaps that's what women are wanting for their men, but that seems creepy to me. Anyone else?

It’s those that try to shame us that feel shitty about themselves. They are trying to feel better about their own cunts, so they are shaming women about theirs. They don’t want women to have VBACs and feel empowered because if they (the VBAC women) become strong, then that means they (the cesarean choice women) aren’t strong. (Of course, it doesn’t mean that, but in the psychological world, if someone is right, that means someone is wrong.) If the woman has a VBAC and still has great sex afterwards, then perhaps they will be left mute as for the reasons their own sexless, post-cesarean relationship is failing.

The circular thinking needs to stop. It’s useless, pointless and stupid. Let’s everyone leave everyone’s down-below alone, eh? There’s enough shame that comes from our parents, for goodness’ sake! We don’t need it from someone who calls themselves our friend.

Be a friend. Love my cunt the way it is. I promise to love yours the way yours is, too.


VBAC Success!

Story to come...

BUT, this will be one of the most amazing and glorious stories EVER that I have told.


- Mom labored, walking outside in a garden with continuous monitoring almost the entire labor.

- Dr. Wonderful stayed with us and talked and laughed and told stories almost the entire time.

- The cesarean doctor said the mom's pelvis would never be able to "tolerate" a baby coming through it. She birthed a posterior baby this time (Direct OP delivery).

- Mom had a Saline Lock - that's it.

- We had a nurse to ourselves who was so wonderful - except for one time when she was infuriating - and I'll tell you about that, too. (How come we had to have that one time when she was infuriating? She was glorious the rest of the time!!)

- Mom did not have any pitocin shot into her postpartum.

- I got to take care of the baby on mom's belly immediately postpartum, ensuring the baby was treated gently and respectfully.

- The doctor wanted the family to be able to use their iPod in the room so went and bought an iPod docking station.

- I was able to discuss things with the doctor when the family was having alone time in the garden that will make my practice infinitely easier, safer and more incredible for myself and my clients. I am floating today about the VBAC and my experience with the birth and my discussions with the doctor!

Who knew birth could be like this in the hospital?!?