Dirt Worshipping Tree Hugger

Sharing the daily life of Sunsong with interested parties.

Friday: The kettle is boiling over August 15, 2009

I must’ve lost my damn mind this week. I don’t know what prompted me to watch that train wreck “Deliver Me”, but I watched it, and after about ten minutes I was screaming at the TV and my kids were looking at me funny.

Let me throw out and define some terms for you.

  • ACOG stands for American College of Obstetricians and Gynecologists; essentially, ACOG tells your OB what is and is not an appropriate standard of care. The “Ruling Body” of Obstetrics, if you will.
  • Macrosomia is a fetus weighing more than 4000 grams (8 lbs 13.1 oz) and sometimes defined as 4500 grams (9 lbs 14.7 oz). Keep in mind my children were 9 lbs 2 oz (4139 grams) and 10 lbs 4 oz  (4650 grams) each and both delivered vaginally, the larger with shoulder dystocia which resolved itself without intervention.
  • Suspected fetal macrosomia is when the OB guesses (usually with the aid of ultrasound) the weight of the fetus and predicts it to be over one of the two previously outlined weights.

Before I get into my little rant here just read this: ACOG Practice Bulletin No. 22

Since I don’t expect any of you to be able to read that and remember the parts which are about to become relevant to my case here, I’ll just recap what ACOG has to say about macrosomia, induction and c-sections:

First of all: Macrosomia (all emphasis is my own):

“The term fetal macrosomia implies fetal growth beyond a specific weight, usually 4,000 g (8 lb, 13 oz) or 4,500 g (9 lb, 4 oz), regardless of the fetal gestational age. Results from large cohort studies support the use of 4,500 g as the weight at which a fetus should be considered macrosomic.”

Just to prove to you that I do know the definition of macrosomia. Anyway continuing:

“Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise”

What’s that you say? The doctor does NOT have a magic crystal ball that magically tells him/her the weight of the baby before it is born? You mean the only way to actually KNOW how big it is, is to weigh it AFTER it is born?! I guess that’s why there is never a prenatal diagnosis of  macrosomia, only of  suspected fetal macrosomia. Hmmm… At this point let’s just cut to the chase here and I’ll copy their
“Summary of recommendations” at the bottom. AHEM:

  • Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.
  • Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes.

Got all that? Just becuase the OB thinks the baby might be big is no reason to dose the woman up with labor drugs, cut her open, or threaten to do either of the above.

So here’s what gets me about this show then. (Season 1 Episode 3 “Size Matters”)  A lesbian couple is seeing these doctors when the ultrasound indicates that the baby might be approaching 8 lbs, (Possibly nine, I’m not entirely sure.) So the OB starts talking about induction and/or c-section. The pregnant lady in question really wants a natural labor and indicates that her mother had four natural, vaginal births. Eventually the lady lands in the hospital with an induction for macrosomia. The woman is laboring on her back the entire time. I believe she is given cervidil then pitocin and eventually asks for an epidural. Keep in mind, also, what was said by Dr. Jacques Moritz, who was in the documentary “The Business of Being Born”. He is quoted here from Pushed be Jennifer Block (which I will comment on later.): “These are bad-ass contractions. I personally think it’s cruel and unusual punishment to give somebody pitocin without an epidural.” So essentially this woman is induced by her doctor who KNOWS that the woman wants a natural birth, and yet goes against ACOG standards of care for macrosomia and all but ensures that the woman cannot have a drug-free labor. In addition, twice I counted during labor the OB is speaking to the woman and telling her all kinds of stuff that she’s not progressing enough and that “Maybe the baby isn’t going to fit.” or “Maybe it is that you just can’t dialate.” Way to go, doc; completely undermine the first-time mothers’ confidence in herself. First you pit her until she begs for an epidural and then start plating seeds that she can’t do it anyway and might “need” a c-section. Are you @#$%^! kidding me?! And the worst part of the whole thing is ACOGS expectations are very easy to see, anyone can look them up. HOW IS THIS WOMAN PRACTICING MEDICINE ON NATIONAL TV AND GETTING AWAY WITH THIS?! She is quite clearly not following guidelines designated by the ruling body of obstetrics or practicing evidence based care, failing to do so on a national television program, and yet is not being stopped. WTF?

Ok, rant over. Just another show that is total and utter garbage. Unfortunately what pisses me off the most is, it is also probably a very realistic picture of American obstetrical care. UGH! /vomit /wrist /wrist /wrist!

About Pushed. I checked this book out from the library and ATE IT. I read it in less than 24 hours and will probably read it a couple more times before I give it back and then buy a copy of it. Every woman, no, every person in America should read this book, (along with a half-dozen other eye openers.)

The book brings up some things to think about for me, as a training doula. On the one hand I’m incredibly depressed by some of it. But then there is a passage in the book about how the primary job of a doula is to help the mother have a positive perception of the birth, even if it all went horribly wrong in ways that could have been prevented, or never should have happened. I used to hold with this same philosophy, especially when it came to women who would not experience birth again. I always told myself, why bother to tell them how their labors could have been better? But the more I thought about it, the more it didn’t sit right with me and my current philosophy is that women need to know what is happening to them. They need to get angry about it. Nothing is ever going to change if we keep convincing them that everything is ok, or refusing to tell them that the horrible things that happened to them could have been prevented. How can we fix it if we’re not telling anyone that it’s broke? Once I get to know some of these doctors, I WILL tell a woman if the OB she has chosen has a high rate of  episiotomy. If I know a doctor likes to pull the rug out from under naturally laboring women or VBACS, I’m not going to “be a good doula” and keep quiet about it. I’m sorry but I believe in an informed decision and I believe it’s more important to a good, safe birth than faith (especially misplaced faith) in ones’ practitioner. Maybe that makes me a bad doula, I dunno.

Well, this is getting a wee bit long-winded and I haven’t even talked about half the things I’ve had on my mind this week, like trying to figure out this very strange man I live with. More on that next time, maybe. I also want to do some polls, really a survey. Too often when I hear a woman make a comment about her birth, I have questions. If you think women who go without epidurals are nuts based on your experience with natural labor, what position were you laboring in? were you eating and drinking? using EFM or an IV? I’m genuinely curious. Did you have pitocin? What pain-control methods did you try before you tried the epidural? If your c-section was necessary because you were pushing for hours and the baby just wasn’t coming, what positions did you push in? did you have an epidural? how long did you push? were you eating and drinking or did you have an IV? Did you push with the urge, did your body push involuntarily, or did you push when told to while someone counted to ten? What station was the baby when you started pushing? I need to make a really good survery and method for obtaining results, my interest is piqued beyond containment.

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7 Responses to “Friday: The kettle is boiling over”

  1. Suzanne Says:

    yeah I tried to watch one of those shows once at the gym… I figured I’d better switch channels before everyone in the gym wondered why I was shouting at the t.v. on my treadmill.

    On the one I watched someone had a baby on the side of the road and the helpful cop HURRIEDLY cut the cord with his pocket knife.. since that’s what you are *supposed* to do you know.. And the baby got a life threatening infection from the non-sterile blade. However.. there were NO words in the show about how you do NOT need to cut the cord quickly and that it’s actually MUCH better and safer to NOT cut the cord.

  2. Kurt Says:

    (Not qualified to answer poll for obvious reasons.)

    First of all, this is about control. I can tell from the language you’re using that this is an effort to make birth a institutionally controlled process. Secondly, while I am not familiar with all of the terms (reading your rants is very educational for me, Sunsong). I have enough sense to know that before there were hospitals, anesthetics or doctors, babies were born. This means that all those things came along later, and may or may not be helpful (or at times, useful.) This is getting as bad as insurance and real estate, if you ladies will pardon the somewhat pedestrian comparison. I’m getting tired of this “We know more than you do, we should run you” line. It’s starting to get on my nerves.

    So they cut it? I thought it just dropped off by itself – you just had to wait a few. (You”ll have to forgive me – all my birth experiences have fur and hooves attached to them.) Most detail on human birth I’ve seen is in your slide show, Sunsong.

    Oh, well. Hope I didn’t bother anyone with my blathering.
    Kurt

  3. Trisha Says:

    I’m not going to answer your poll because I know it will just get you even more mad judging by reading your blogs and the way things were handled when I had Dana. lol However I am going to wish you a happy birthday just in case you don’t check your myspace anytime soon.

    • Sunsong Braun Says:

      Thank you for the birthday wishes, Trisha! Sorry about the Myspace thing, I don’t think I’ve been near it since Christmas. I guess I’ll go check it out. I didn’t think about anyone on there remembering my birthday.
      Honestly, I’m very curious about your birth experience with Dana. I’m angry when I see it on TV, because you also see it, along with plenty of other American women who think that it is normal (I guess in America it is normal, but they also think it is OK or acceptable, which it is not.) Personal experiences related to me by people I know are more likely to inspire feelings other than anger. My curiosity overwhelms me. Mostly because I hear so many women saying that women who think they can go without an epidural are stupid. I wonder what caused them to come to that conclusion? I wonder what happened to them during their own labors to make them think that? They blame it on labor, not on what might have been done to them during labor. I just don’t get it, so I want to know more. I’d be pleased if you would share your experience with me, but I understand if you don’t want to, and that’s OK. Mostly I just realise that women like Suzanne and I are unusual in the American birth climate, and I’d like to get to know a few women whos’ experiences are more typical. The truth is, aside from anecdotes and stories I’ve read which are probably (I hope) NOT typical of what the average woman experiences, I don’t have a reliable view of the average hospital birth. I think the best way to get a look at it is to experience more births, and hear the birth stories of women around me, not just the ones who had births like mine.

  4. Sunsong Braun Says:

    I also wanted to add that this particular post didn’t really come out the way I had it planned. I’m not particularly good at making a coherent point when I’m angry. Last night I started doing some research on Obstetrical malpractice suits and I plan on sharing my findings in a post over the next few days.
    I’ll tell you right now that I believe, based on the limited information I can gather from verdict reports that I’ve found, I don’t believe the OBs are entirely to blame for the current state of obstetrical care. I hate saying it but my opinion is that a large about of the blame rests with women who are not very well informed about risks, and hire a doctor expecting a perfect baby as a result. To clarify, I think they they assume every intervention that is offered by the OB (or recommended by friends) is completely without risk, and fail to recognise the problems that may or may not have been preventable as a result of it. The vast majority of cases I’ve been able to find are suits brought about by fetal distress and shoulder dystocia. Let me get my thoughts together and I’ll make an attempt to get it out in a readable way later.

    • Kurt Says:

      I understand now. Between the machine and ignorance, there’s a lot going wrong.

      Happy Birthday, Sunsong!
      EvilDM sends his greetings as well.
      (Cleaning of whiskers ensues.)

      • Sunsong Braun Says:

        /Cleans whiskers
        Thank you, Kurt. Tell our other gerbil buddy and his family that I say “Hello” as always. 🙂

        That’s a nice simple way to put it, though, yes there is a lot going wrong. I really need to revamp my other blog and get started on writing articles every week. The more I think about it, the more information I need to cover. Where is my post about the embarrassing American maternal mortality and neonatal death rates? The post about those verdict reports has become a monster. I could break it up into 500 word chunks and still be able to post something every day this week, and I don’t even consider it to be finished yet. I had to leave it off in the middle of explaining shoulder dystocia. So I think it’s about time that I really took off with my other blog, since I really don’t want my family blog covered in all this. Once you start writing about the American birth culture, it’s only a matter of time before someone comes out and says something horrible. I’ll probably make regular posts here announcing where there is an update there.


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