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.