More Birth Controversy

You've seen the hype about 'The Business of Being Born'. Rachel, Aunt B, and I all went to see it. This is an interesting post about the scientific background. The blogger that wrote it is actually our doulla. In addition to being an extremely sharp labor doulla and child birth educator, she's the mother of 5 kids, including one set of twins. Seems like a good investment to us.

Dos Bambinos Update

Yesterday marks the end of week 34 of The Mrs's pregnancy. In case you don't know, the weeks are counted from a woman's last cycle, and 40 weeks is considered full term. Anything prior to week 36 is considered premature birth, at least for a singleton baby. 36 weeks is actually the average time for twin gestation, and twins do mature slightly faster than a single baby in the womb.

Luke and Leia are looking good. We saw them on the ultrasound and their little four chambered hearts are pumping just right. Everyone is practicing their breathing and has arms and legs in the right places. My secret fear of them being Siamese twins is apparently not going to come true because we saw the membrane between them. Luke is quite a bit bigger than Leia, but not enough to cause worry at the moment.

The doctor told us that we have 'won'. We've dodged the pre-term birth bullet that a lot of twins and their parents have to deal with and our kiddos should be grown enough to survive just fine if they were to be born today. He expects them to be here in about another two weeks, which happens to coincide with their mother's birthday.

The only bad news is how they are facing, and even that is a good news/bad news kind of thing. They've both been breech since very early on. Breech isn't good for vaginal birth, so we've been trying to convince them to turn over for a long time now. Apparently they get regular pep talks during the day while I'm at work and unavailable to ridicule or otherwise interfere. But the two of them are getting pretty big for one uterus so we have been worried that they don't have enough room to turn over and face head down. Yesterday's ultrasound showed that Luke has finally turned over and is facing head down.

Unfortunately, Luke is higher up and in a vaginal birth would be born second. Leia is still in position to be the older, but she is still breech. Occasionally you can find a doctor that will do a breech birth, and the doctor told us that if the first baby was born head down she could clear the path for the second to be born breech. But if the first is breech and the second is head down, there is some potential for a dangerous situation because when they're positioned that way their heads are approximately on level, and as Leia moves down to be born her chin could catch on Luke's chin and they end up locked together and unable to be born.

So the short version of all that is this: Bad news - if Leia doesn't flip over it's a for sure cesarean. Good news - Luke had room to flip over so hopefully she will too.

It was really kind of neat (for me anyway, not so much for The Mrs). Wednesday was a bad day for The Mrs. There were lots of practice contractions and she was very uncomfortable all day. We suspect that may have been caused by Luke getting turned over to his new position. Right now The Mrs. is at the doctor twice a week, so it's pretty easy to pinpoint when he turned over.


It Ain't Easy Being Born

Friday night was an interesting experience for me. I attended a professional conference for a screening of a documentary. I'm not good at this kind of estimating, but there were probably more than 150 women in the room, and maybe 20 men. It was the polar opposite of most professional conferences I've been to. It was actually a conference on high risk obstetrics, and I was there to see a screening of a documentary called 'The Business of Being Born'.

This isn't a new idea for me. I've been over our difficulties trying to find the right pre-natal care for The Mrs and the twins, and the whole dilemma was represented very well in the film. There is a growing group of parents that are disillusioned with the whole idea of giving birth at the hospital. The premise is that doctors tend to meddle in a natural process and by doing so screw things up. Unnecessary and seemingly mild induction or 'encouragement' of a woman's labor (using Pitocin, and fetal monitoring to make contractions go faster) lead to more serious interventions and life threatening complications like cesarean sections, the dreaded episiotomy, or using the forceps on a baby.

Aunt B and Rachel have reviewed the film and made some excellent comments so I'm not going to try and recap the information presented. I am going to meta-comment though.

Aunt B says:
On the ride home, Rachel and I were talking about why childbirth isn't more of a feminist issue. It is a feminist issue, of course.
And Rachel agrees:

The second major strength is that the film clearly locates birth issues inside feminism and choice, noting the power disparities of the traditional hospital birth system
That's pretty interesting to me, because when the film started bringing the feminism issue into the equation I thought they were losing focus on the real problem. Their was a lot of discussion about empowering women and how they felt like after giving birth they could do anything. I get that. Birth is hard, and doing anything hard makes you feel a lot more confident about the lesser things in life. However, and you can blame my Y chromosome for this, I think that empowering women and giving them self-confidence is secondary to what is really going on.

The real issue is health. What's best for the health of the mom, and the health and potential of the baby? The doctor focuses on the worst case scenario and ignores the likely side effects, or the unknown side effects. Never mind that the worst case scenario rarely happens, and the bad side effects often do. So then you have a normal pregnancy ending in cesarean because there was a slight chance the baby was too big to fit out the regular way. Never mind that the mom has to have her intestines rearranged and runs a decent risk of infection. Never mind that autism is on the rise and all these pregnancy drugs and cesareans probably contribute to that.

In my opinion that's the point that should be focused on. Expecting the worst isn't always a good thing because you can do a lot of unnecessary damage fighting it off. We're all born and this should be important to all of us.

As a related issue, the demographics of the audience were pretty interesting. Like I said earlier, there weren't too many men in the audience. The woman that introduced the film was the head of the midwife program at Vanderbilt. At one point she asked if there were any doctors in the room. I noticed one hand. One in a room with over 150 people in it. To make it worse, this was part of a high risk obstetrics conference which I'm sure quite a few doctors attended but only one actually stayed over for the film.

Now I want to talk about the end of the film. I'm going to spoil it. You've been warned, but you have a paragraph or two before I get there.

I knew very little about childbirth before my wife got pregnant. Just the stuff I absorbed at 12 years old when my sister was born, and what Hollywood has taught me. Once I found out, a great deal of research began. My wife steered me toward a lot of the issues that I've been talking about here, and Rachel sent me toward several resources to ponder. This particular movie was pretty typical of those. But the thing you rarely hear is that emergencies really do happen. Casareans and all those other medical interventions are sometimes necessary.

I'm glad The Mrs. is thinking about all these things, but my fear all along has been that she will be so wrapped up in the idea of unnecessary interventions that she might ignore a necessary one. The doctor may come in and recommend a cesarean and she thinks it's about him getting to his golf game on time, but it really is an emergency. That's my biggest worry about the whole labor process. (Or at least the most specific one, if you discount vague worries of death, birth defects, and Siamese twins.) It bothers me enough that we discussed it with our doulla.

During the making of the film, the director, Abby Epstein found out she was pregnant with her first child. Obviously that made the whole project a lot closer to her heart. At the end of the movie they show her birthing story. This is where the spoilers start up, so leave now if you don't want to hear it.

Abby went into pre-mature labor while her baby was breech. They had to go to the hospital and her son was born by cesarean very early and with very low birth weight. They eventually showed Abby and her son eight months later, and it all worked out, but I'm very glad they included that. It had to be pretty wrenching for her to go through with a cesarean and hospital birth after all the research she had been doing on natural home births. All the pleasant, gentle home births they showed in the rest of the movie weren't anything like her own. I'm very glad she was brave enough to include that.

And finally, I present contrasting comments from the discussion at Tiny Cat Pants. Sistasmiff seems to agree with me:

Chemically aided births are sometimes necessary. There are risks with any birth. Even with a midwife or completely natural birth, with the whole family tree watching, bringing forth in a pool, you can still hemorrage and have other complications.
Kwach has a point as well. But I think she dodged a bullet. Though the fact that they could tell the fetus had a low heart rate during a home delivery says a lot about the competence of home birth midwives.
My son's birth was slightly complicated and his heart rate had slowed because his umbilical cord was wrapped around his chest. In a hospital, that would have meant an emergency c-section. In my bedroom, that meant a whole lot of lube on Janet's forearm, some dextrous manipulation in a tight space, and the arrival of a happy, healthy baby forthwith.