Guest Post at Mothers of Change

I'd like to thank the great team at Mothers of Change for hosting my guest post on updating cesarean protocols. Please have a read and feel free to comment here, or there, especially if you have any suggestions for bettering the cesarean experiences

http://www.mothersofchange.com/2011/12/changing-cesarean-births.html

This post was not only a great oportunity to share information, it got me writing again, something I have been wanting to do for a while now!

"Natural Cesarean" Why the Controversy?

This tissue has been brewing for me for the last year.

The issue is this; in most hospitals cesarean protocol is antiquated in a number of ways. Routine separation of mother and baby is the norm. Often baby is sent to the nursery, or at best is sent with dad(or partner) to wait for the mama to come out of recovery.

Even at the hospital I birthed at that allowed skin to skin in the OR, and babies in recovery, my perfectly healthy newborn was not shown to me for around ten minutes while he was weighed and measured and tagged, and a medical student practiced a newborn exam on him.

The atmosphere in the OR was "business as usual", cold impersonal, lacking in any "warm fuzzy" feeling at all. I was told my son had been born by having one of the docs declare "1:25" loudly at my face. When I didn't respond he clarified "That's the time of birth". The doctors talked to each other as if I wasn't there, discussing my "bladder dissection" as a example of how to avoid nicking a bladder. The operating doctor didn't say anything to me in the OR at all, in fact I didn't even know who had operated on me until three weeks later.

This was on top of numerous experiences in the lead up to the surgery that led me to file a formal complaint. And to suffer p.t.s.d. I still struggle to deal with symptoms.

As part of my healing process I started researching better cesarean techniques. I was sure that there had to be a way cesareans could be done in a more holistic and psychologically sound manner. I was thrilled to find this article:

The natural caesarean: a woman-centred technique

J Smith,^a F Plaat,^b and NM Fisk^ac

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

It describes a more holistic cesarean experience, keeping the focus on the family, early contact with mother and baby, allowing the parents to watch the birth and more. The result is much happier mothers. Less trauma more satisfaction.

I was so happy. A team of wise care providers had pioneered the exact type of technique I was thinking about.

And then I started talking about it on the "natural birth" type forums I was frequenting. Instead of embracing this "woman centred" cesarean the idea was attacked. And I was attacked for championing the idea. I was accused of promoting elective cesareans, being complacent to the cesarean epidemic, and told I lacked integrity. Let me tell you it was a shock, especially as a new cesarean mother suffering greatly due to the non woman centred protocols I endured.

Two concepts seem to really offend. First, the term "natural cesarean" that just gets so many folks nickers in a twist. "Cesarean aren't natural" they proclaim. One blogger says

Natural caesarean section? CODSWALLOP!

The other is that the article describes a technique for elective cesarean surgery. Apparently this is an evil that haunts many birth advocates. The fact that the article clearly states that these techniques can be modified for the emergency situation. Obviously a emergency section mother is not going to tour the OR before hand, but they could still have the screen lowered to view their babies birth. Makes sense to me.

When I saw this post at Lamaze's Science and Sensibility by Kimmelin Hull got me all bothered all over again. I would summarize the authors stance as this: Doing cesareans in a more woman centred way is too risky as it might further increase an all ready unhealthy cesarean rate. The author quotes a doctor as calling gentle cesarean techniques "window dressing".

Are you freaking kidding me!

These are harm reduction techniques not fluffy inconsequential stuff.

I wrote the following response:

I believe that ALL cesarean should be done in a better, more human way. To imply that making them more “natural” will result in more women picking them I think is not giving women enough credit. As you point out no matter how humanly a cesarean is done it is still major surgery with potentially life long implications.

I also believe that one of the reasons that woman choose repeat sections is that their first section was not the experience the wanted and they believe, and are often told, that a planned section is much better then a emergent one. Perhaps if the initial sections were not so trauma inducing women would be emotionally more ready to choose a vaginal birth next time.

It seems wrong to not do what ever we can to promote emotional health of the mothers and babies, and I firmly believe that every care provider should be striving for the most holistic birth possible, even if that ends up being a “natural cesarean”. Emotional health is a part of birth that is often an after thought,but it shouldn't be. I believe doing woman friendly cesarean can help avoid the increasing cases of p.t.s.d., a debilitation and potentially long term health issue.

One of the saving graces of my sons emergency c.s. is that he was placed skin to skin in the OR with me. It a moment that I use to help balance the rest of my experience which was very non “natural cesarean”.

Many other woman agreed with these sentiments and many adding their our outrage. Still the author didn't back down defending her position by referring to a fictitious woman who is exhausted and not progressing, who given more support and time could have had a vaginal delivery but is convinced by a doctor to let them do the c.s. by promising low lighting and music.

Sorry but I think this is total B.S. Woman are convinced by doctors to have cesareans because they are told their babies could be in danger. I haven't met one unplanned cesarean mother who wasn't told some version of "it's better for the baby" to have surgery.

I followed up with this post:

@Jane “Failing to fully get behind efforts to make c-sections less traumatizing and unpleasant for mothers and babies is just disappointing and wrong” I totally agree! Thank you for your post.

If this topic were a way to make cesareans physically safer there would be no debate.

A technique to prevent maternal deaths from cesareans would be embraced. I really can’t see how can any birth advocate justify denying “gentle” or “natural” cesarean techniques . I recently read that p.p.d. and p.s.t.d. can result in suicide. It is also reported that cesarean mothers are at greater risk for these disorders. I feel it’s not too far fetched to infer that:

protocols that lessen the trauma experienced during a cesarean is life or death matter.

I think it’s terribly harmful to try to prevent the dissemination of good information in suppressing “natural cesarean” techniques simply because of fear and a misguided attempt to influence the cesarean epidemic this way.

To me the natural, woman friendly, family centred, or gentle cesarean is a topic that should be addressed outside of the debate as to how to reverse the tide of the dramatic overuse of cesarean sections in the developed world.

Empowered women make good choices, not women living in fear of outdated protocols.

Think of how ridiculous it would seem if home birth advocates were calling for routine separation of mothers and babies in hospital to try to convince woman to home birth.

It is misguided to defend leaving cesarean protocols as they are as woman are being harmed.

I’m ashamed to hear otherwise wise birth advocates(both here and in other forums) bowing to fear and trying to prevent harm reduction techniques

I didn't get a direct response from the author to either of my posts, but feel so glad to see the number of women who also stood up for this very necessary dissemination of information.

Okay, I feel a little less bothered now. I guess that's what's really great about blogging is you get to say your piece.

Here's hoping that we can come together to better the treatment of families during cesareans.

One year later...

Cesarean awareness month has come to an end and I am curious to see that it has been a year since I posted about my skin to skin experience in the O.R. SEE HERE

This post by far gets the most hits of any post on my blog, with dozens of people from all over the globe viewing it daily.

Of all the hard things about my little son's birth, (which is in a couple of days!) I am grateful that there are good things too. It makes me feel a sense of purpose to have a way to positively influence births. I hope that by letting the world view us in our first meeting we will help other mothers and babies meet each other sooner.

I have hear that the first two years after a traumatic birth are the hardest. So I'm almost there. Please wish me luck.

Total Support Pillows

I totally love this idea.

Cesarean Support Pillows

From the ICAN blog http://blog.ican-online.org/2011/04/09/new-ican-support-pillows/

"ICAN debuted our newest support offering at our 2011 Conference in St. Louis. Designed by talented ICANer Mallory Brock from a concept by Education Director Krista Cornish Scott, this fabric can be ordered by the yard directly from www.spoonflower.com with a portion of the sales going to ICAN. One yard of fabric makes three support pillows. A caring and thoughtful gift for a mom recovering from a cesarean, it has both practical advice and emotional support that is the hallmark of ICAN."

I'm ordering two yards right now to make up pillows for cesarean moms in my community.

The words of the back are particularly wonderful... the one that is sticking in my mind is something like: It's normal to have more then one emotion about a single event"

How true, my littlest son's birth was both a amazing magical moment and a source of deep trauma.

These pillows will support in many ways. I believe that physical and emotional recovery needs to be active and almost violent, the same way an aggressive surgery is.

A wise friend of mine reminded me that

Sometimes you ave to meet the fire with your own heat.

All That Matters is a Healthy Mother?

We have all heard it time and time again the many versions of:
"all that matters is you have a healthy baby".

Often I found this to be in response to people finding out that my newest son had been born by unplanned cesarean section. But I also found that a version of this phrase was tossed out when I talked to birth professionals about the lack of prenatal information about cesarean avoidance and/or preparation.

I once suggested that women should be given more information about their risk versus the unborn baby's risks of cesareans. The response I got was:
"Most mothers would say to do what ever it takes to get the baby out safely".

I felt like I was being chastised for suggesting that I might choose their safety of myself over the safety of my baby. I quickly dropped the subject. But months later I think.
Am I really the only one who would choose me?

Through out my pregnancy my greatest fear was that I would die in childbirth and leave my older son motherless. I no longer do many of the more risky things my pre-mother self did and I felt that I had taken on a risk in being pregnant and giving birth that was unfairly exposing the mother of my son to potential harm.
Apparently this fear is fairly common in second time mothers.

I would look at my 8 year old and imagine the life he would have without me and how much emotional damage would be done to him if I didn't make it though the pregnancy and birth.
I should also note that this fear was greatly enhanced by contracting H1N1 at about 30 weeks.

If I had been asked who's life should be protected first I would have picked my sweet eight year old's mama (me) over the baby in my belly, who is now my beautiful 2 year old son. Yup it might sound terrible to say but it's true.

And I don't say that lightly-but if it had to be one of us, I would take on the pain of loosing a child to protect my other child from the pain of loosing his mom.
And I know it would be awful.
I was there for one of my best friends when she lost her newborn. I grieved along with her and saw the total and horrible sadness that consumed and transformed her. Her life was never the same. She is a very different woman because of the loss of her new baby.

Maybe I am the only one. Maybe I am driven by a subconscious selfishness that I have justified to myself. But I will stand by my assertion that we should be given a choice in who's health is the most important.

Would I give up my newest son to avoid the P.T.S.D. that I endure because of his birth, no way.
But for example...
Should a women with her heart set on a very large family have the right to decline a cesarean for fetal distress knowing it could put future pregnancies at risk?

There are so many different scenarios. So many different risks and wants and beliefs. Should we be informed and be able to choose for ourselves?

Am I crazy to think that many there should be a box to check that says "Protect me first"?

I'm going to end with a phrase we are starting to hear more...

Mother's Matter Too

(Almost) Wordless Wednessday

Along the Journey

I haven't been in the birth community in a while. And I feel so blessed to come back to find a beautiful blog post that made me feel just the type of support I needed.
Healing is hard. Dealing is hard.
Trying to savour these last few days of true babyhood that my 22 month old takes concentration.
Knowing there are many mama's out there getting it done is more inspiring then anything else.
Happy Womens Day All.

Here's the post that felt like a great big hug... thanks Avital

"CESAREAN COURAGE"

http://avital.blogspot.com/2011/01/cesarean-courage.html#axzz1G2HPkQra