Informed choices assumes you’re actually informed…

Ok, first off, I’m not avoiding blogging about our car accident last Thursday. The basic account is on Yoram’s blog, and I’m still processing and not fully sure how to express the experience, or even if I want to.

In the meantime, life – thank God – goes on.

So I have a question for you:

Scenario: you walk into a store to purchase a safety product for your home and in one aisle you are approached by a rep from one of the brands. The rep tells you why his brand is the best brand to buy. He shows you articles that conclude that its much safer than the other products for x, y, and z reasons, and that purchasing any other product will result in almost certain death (you know they do, even if they don’t use those words). There is a rep from a competing brand in the next aisle and she has an equally impressive presentation.
What do you do?
Do you buy the product based on the rep’s information?
Do you buy the one that’s most expensive (this is safety we’re talking about, expense must equal quality)?
Or do you do as much independent research as you can to ensure that you are buying the product that is going to best serve you and your family?
Would you be wary of information from someone with a vested interest in his or her product?

Why don’t we treat our Prenatal and birthing choices this way? Why are we willing to be scared @$#%less by a doctor or midwife that has a vested interest in our choosing to submit to their course of action? I’m not saying it’s always the wrong choice, I’m just saying that we always need to consider the beliefs of the speaker.  
And we need to make choices because we KNOW, not because we’re scared of the alternative.

I have been called upon by a very dear friend to re-enter the world of informed choices in childbirth. I know I’m still passionate about the issues. The pain and frustration I feel when I hear pregnant women tell birthing horror stories that could have been avoided, or handled better, if they had just been given all the facts. If they had just been treated as partners in the birthing process rather than patients who need to be saved from a catastrophic event, if birth professionals could infuse women with trust in birth and belief in their own strength and ability to birth – then we’d be hearing a lot fewer horror stories.

My friend has been told that since her previous birth was complicated by shoulder dystocia, she is at increased risk of that happening again, this is not proven. She was led to believe by her doctor that the fault of this complication lies with the mother’s build. That’s possible in cases of true gestational diabetes, or misshapen pelvis, but not in normal healthy women. Allowing a woman to mistakenly believe that shoulder dystocia is something that “just happens” to some women doesn’t infuse women with trust and understanding of the birth process, it does the exact opposite – which, IMHO, will lead to more complications than any other risk factor. He presented her with all sorts of dire possibilities, but did not mention the possibility that the problem is often bad positioning of the mother and that repositioning the mother can and does relieve the dystocia!

Her doctor’s rough estimate of her baby’s size at her current 38 weeks is around 3000 grams. He told her that he wants her to be induced next week. Can we all remember, for a moment, the > 1000 gram margin of error in birth weight estimates after the first trimester???

I just have to share my findings, because the more visible this information becomes the more likely we are to demand a change in protocols.

So first of all, a brief explanation of shoulder dystocia: It’s defined as a case in which a baby’s head is born and the shoulders take more than 60 seconds to follow. Let me clarify further: Shoulder dystocia is not something your baby “has” it is something that happens to a baby during birth. Baby’s who experience dystocia in birth are often over 4kg (~8.5 lbs) but not always, and not all babies over 4kg get stuck. The risk to the baby of this complication is that (s)he can suffer an injury to the brachial plexus nerve that threads under the clavicle. Damage to the brachial plexus can, lead to permanent nerve damage to the child’s arm. Namely Erb’s Palsy or Klumpke’s Palsy.

All the maneuvers that have been practiced to facilitate birth and attempt to prevent injury assume that the laboring woman is lying flat on her back with her feet up in the air.

Here is a brief account of a study of the Gaskin Maneuver which was brought to the US by Ina May Gaskin. This article is easy to read and very clear.

In the study of 82 cases out of 4452 birth, shoulder dystocia occured and was relieved by the completely non-invasive method of having the laboring women turn onto all fours to deliver the baby. Some of the cases involved women who were under epidural anesthesia and were none-the-less assisted into the all-fours position by birth attendants.

Another well researched article is this one from a UK Homebirth advocate. One thing that she noted, which I feel is important to highlight is that injuries that have been linked to shoulder dystocia are not caused by birth, but by the act of extracting the baby from the mother. (those are commonly known as “iatrogenic injuries” but that term is not being applied to shoulder dystocia. It’s called a “birth complication”. Maybe that’s because a lot of “birth complications” are actually iatrogenic. But don’t get me started.)

At the moment, these seem to be my friend’s choices:
a) induction at 39 weeks for same reason as above (consider risks of induction)
b) elective abdominal surgery (i.e. c/section) for suspicion of high birth weight (consider risks of surgery)
c) go into labor when baby is ready if you fall into the 2% chance that a problem presents itself, get onto your hands and knees. No injuries, no additional recovery time, in most of the studied cases the babies were delivered over an intact perineum!!
I just want her to trust her body and her baby and her strong beautiful body that God gave her.
Many doctors and birth professionals (yes, even midwives – such as the midwife who was present for Yitzchak’s birth) try to attribute terms and rules to pregnancy and birth. Like trying to make a corolation between previous pregnancies and the current one for no other reason than “it happened before.” Even though it is the doctors and midwives who should know best that one woman’s birth cannot be compared to another’s, and that even one woman’s previous births cannot predict any future births. Complications happen when those doctors and midwives attempt to manage a birth based on facts of previous births. Like suggesting an induction or a cesarean based on a previous case of shoulder dystocia. Induction carries it’s own risks to baby and mother. And in fact, in the cases of injuries following shoulder dystocia, one of the factors was pitocim use in labor! (causing stronger, more feequent contractions than mom or baby were created to handle, also by limiting the mother’s movements due to the pitocin drip, etc…) It’s the classic interventions chain that is so clearly illustrated in Henci Goer’s book “The Thinking Woman’s Guide to a Better Birth.”

This has been a long post, and I’ve let a lot of my reactions to the information seep in. So allow me a little ipso facto disclaimer: I am not against medical interventions in childbirth or in any other area of medical care. I believe that the technological advancements in medicine and in childbirth have saved many complicated births that would have ended in tragedy a century ago. I am critical of the medical field of pregnacy and childbirth which dictates protocols based on fear not on evidence. I am wary of following the advice of anyone who directly benefits from that advice – which doesn’t mean I won’t take it. It means I will research it first. And I am critical of a generation of women who are willing to allow things to be done to their bodies and their babies that have not been completely explained to them, and without getting all the information first.

In every are of life, whether it’s birth, parenting, business, relationships, or religion – if you make a decision out of fear, you are making the wrong decision – every single time. I’ve seen it in my own life, learned it from my mentors in every area of study and seen it in practice in the lives of those I love.

Make your choices from a place of knowledge and of trust, and if you don’t have access to the knowledge that you need then find someone who does. Pursue it at all costs, and live you life in joy, in complete faith, and not in fear.

“כל העולם כלו גשר צר מעוד והעיקר לא לפחד כלל” “The world is but a narrow bridge, and the main thing is not to fear at all”

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