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How do babies happen?
Well, when a man and a woman love each other very much...
They go see the obstetrician, along with the community midwife, and discuss birth.
We met my community midwife first. She's been looking into vaginal delivery after third and fourth degree tears, and spoken to a midwife with lots of experience, and they suggest a homebirth. If I have a homebirth, I can avoid pressure to escalate the level of intervention. I can choose to transfer to hospital for a section at any time, based on a feeling that things aren't going right or on the advice of my midwives, and I can refuse epidural, augmentation of labour with syntocinon, et cetera. I quite like the sound of this - I can have a go at a vaginal delivery and if it's not working I can have a section and they can all say "I told you so" and be happy.
Then we all went to see the obstetrician, and tried to find out precisely why I am being advised to have a section (we didn't mention homebirth to the obstetrician) and we got very, very vague answers. The only definite answer was "Well, if I were in your position I'd want a section." That's not what I call sound medical reasoning, so I choose to ignore it for the purposes of informed decision-making.
The baby is growing on its curve, is a fairly normal size, and is beautifully positioned - and so is the placenta. If it weren't for my torn up genitals et cetera, I'd be on schedule for an easy birth.
If I have a planned section, it will be on 15th August, a Tuesday, and it will be performed by a woman I'll meet in the next few weeks (I must update my calendars). I'll be able to discuss my c-section birth plan with her, as outlined and revised here, and find out what she's like. I will also quite likely be able to meet the anaesthetist, though that is lower priority because in my experience anaesthetists are lovely people.
Then we went to book my various appointments and I passed the obstetrician who delivered Linnea, and had only a small lurch to my stomach. He walked close to me again later, and I heard his voice, and again I felt a clenching of my stomach - but not more. No urge to run, no urge to vomit, no shaking, no crying, no incoherence. So now I know what he looks like - I can remember it, from seeing it today without trauma, on a conscious level. It's all very interesting (at least to me) and I feel pleased and somehow proud.
Then we had a cup of tea with the midwife and she talked to us about things. She is going to try to find me an independent midwife in my area with experience of delivering babies to women who have previously had third or fourth degree tears. She is also going to try to find actual statistics on maternal injury rates in women who have vaginal deliveries after severe tears or other complications. She's happy to be on call for me and attend the birth of my baby whether it's a planned section or an unplannable vaginal delivery in my own home. The expert she consulted recommends that I do perineal massage, not necessarily to stretch the tissue (as that may not be possible due to scarring) but to accustom me to the sensation of pressure on it, as that might be upsetting and it's best to get that over with before birth itself. I'll buy some sweet almond oil tomorrow, I suppose.
My own midwife reckons that because I have once managed to dilate to 10cm, and because all my tissues are well-stretched ahead of time, and because I have no intention of allowing myself to be trapped on my back again, I have a good chance of a vaginal delivery. But she wants more information for me to make a decision with first.
So we have two plans running concurrently, which is the way I prefer to manage things anyway. I believe in backups.
They go see the obstetrician, along with the community midwife, and discuss birth.
We met my community midwife first. She's been looking into vaginal delivery after third and fourth degree tears, and spoken to a midwife with lots of experience, and they suggest a homebirth. If I have a homebirth, I can avoid pressure to escalate the level of intervention. I can choose to transfer to hospital for a section at any time, based on a feeling that things aren't going right or on the advice of my midwives, and I can refuse epidural, augmentation of labour with syntocinon, et cetera. I quite like the sound of this - I can have a go at a vaginal delivery and if it's not working I can have a section and they can all say "I told you so" and be happy.
Then we all went to see the obstetrician, and tried to find out precisely why I am being advised to have a section (we didn't mention homebirth to the obstetrician) and we got very, very vague answers. The only definite answer was "Well, if I were in your position I'd want a section." That's not what I call sound medical reasoning, so I choose to ignore it for the purposes of informed decision-making.
The baby is growing on its curve, is a fairly normal size, and is beautifully positioned - and so is the placenta. If it weren't for my torn up genitals et cetera, I'd be on schedule for an easy birth.
If I have a planned section, it will be on 15th August, a Tuesday, and it will be performed by a woman I'll meet in the next few weeks (I must update my calendars). I'll be able to discuss my c-section birth plan with her, as outlined and revised here, and find out what she's like. I will also quite likely be able to meet the anaesthetist, though that is lower priority because in my experience anaesthetists are lovely people.
Then we went to book my various appointments and I passed the obstetrician who delivered Linnea, and had only a small lurch to my stomach. He walked close to me again later, and I heard his voice, and again I felt a clenching of my stomach - but not more. No urge to run, no urge to vomit, no shaking, no crying, no incoherence. So now I know what he looks like - I can remember it, from seeing it today without trauma, on a conscious level. It's all very interesting (at least to me) and I feel pleased and somehow proud.
Then we had a cup of tea with the midwife and she talked to us about things. She is going to try to find me an independent midwife in my area with experience of delivering babies to women who have previously had third or fourth degree tears. She is also going to try to find actual statistics on maternal injury rates in women who have vaginal deliveries after severe tears or other complications. She's happy to be on call for me and attend the birth of my baby whether it's a planned section or an unplannable vaginal delivery in my own home. The expert she consulted recommends that I do perineal massage, not necessarily to stretch the tissue (as that may not be possible due to scarring) but to accustom me to the sensation of pressure on it, as that might be upsetting and it's best to get that over with before birth itself. I'll buy some sweet almond oil tomorrow, I suppose.
My own midwife reckons that because I have once managed to dilate to 10cm, and because all my tissues are well-stretched ahead of time, and because I have no intention of allowing myself to be trapped on my back again, I have a good chance of a vaginal delivery. But she wants more information for me to make a decision with first.
So we have two plans running concurrently, which is the way I prefer to manage things anyway. I believe in backups.
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The obstetrician's inability to give you a sound reason why you were being advised to have a section reminds me of what happened when I questioned H. St's no-eating-in-labour policy. Vague handwaving and incomprehension that the Word of a Doctor wasn't enough. Also "you won't feel like eating, you know" - not unlike "in your position I'd want a section". *raspberry* to them. Yah.
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Yes, certainly, it makes sense in the abstract to minimise the risk of aspirating vomited stomach contents while under general anaesthesia. But from my perspective, this risk was far less than the risk of my being inordinately distressed during labour by being denied nutrition. In my opinion, the policy is inappropriate in the context of labour - and more: it's yet another decision imposed on women by a male-dominated medical establishment. Preventing a labouring woman from eating ignores, or at least glosses over, the sheer physical effort required to give birth to a child.
I did a lot of reading up in August 2004, just before I had my son, and I'm fairly sure that I understand the reasons for the policy as well as a non-medic can. The basis for it, worldwide, seems to be a study in anaesthetics done in the 1950s. Since then, it has been deemed safest to require fasting before general anaesthesia - a policy that has probably saved many thousands of lives over the years. But as I say, I believe an exception should be made for labour, given the unique circumstances - and my reading in 2004 suggested that best practice in several countries has moved in this direction. I requested (and got) an exemption from the hospital's policy for personal reasons, and if I have another hospital birth I will do so again.
You might be interested in this post describing my personal experience.
(But what I was commenting to Ailbhe about was the attitude I encountered - everyone just seemed totally gobsmacked that I went on questioning the policy until I had a solution I was satisfied with. Which, argh.)
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I still want that "Feminists: We Whine" tshirt, pls, when you do a run of 'em. Or you could send me a graphic and I'll add it to my Cafepress collection.
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So, it *can* be bad for you.
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(Anonymous) 2006-07-01 08:35 pm (UTC)(link)Yes, of course it can! Forgive my bluntness, but I think you're missing my point. I never said it couldn't be bad for you.
To clarify, I'm happy to accept that an operation under general anaesthetic is ideally undergone on an empty stomach. That seems well established. But I believe that labour and birth are not really "about" the possibility of general anaesthetic, and in my opinion (for reasons I've already outlined), denying nutrition to labouring women is inappropriate.
In my own case, as I said in the post I linked to above, I would far rather accept the risk that I might have an adverse reaction to a general anaesthetic (which I believe is administered in 1-2% of cases in the hospital where I gave birth) than submit to a prohibition that is CERTAIN to cause me distress just when I need it least. This is a known issue with me: if I can't eat, I panic. Therefore, I secured an exemption from the hospital's policy, which allowed me to take in calories, at least (specifically, isotonic drinks) - and I was very glad of it on the day.
As I said in my first response to you, though, my comment to Ailbhe was more about the reaction of the medics to my request than about the substance of it.
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Damn LJ!
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