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There is a global c-section epidemic. Both mothers and babies are suffering trauma and health risks. New research is emerging indicating that the health of society at large is being compromised as a result.

While the reasons for the epidemic are varied and complex, awareness is growing (thanks in large part to mothers, birth workers, and advocates using social media). Earlier this year, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, jointly-issued the Obstetric Care Consensus, stating that allowing most women with low-risk pregnancies to spend more time in the first stage of labor may avoid unnecessary cesareans [1] (long understood in the world of midwifery). 

Despite the growing awareness, US C-section rates (approximately 1/3 of all births) remain far in excess of the WHO standard: “The estimated proportion of births by caesarean in the population is not less than 5% or more than 15%.”[2]  (Note that 15% is not the rate it “should be,” but the very high end of what could be expected.) 

Of course there are some hospitals and OBs with decreasing C-section rates, but the fact remains that, based on the WHO guideline, 55-85% of the C-sections performed in the US are in excess of what should be required.

Alarmingly, maternal mortality rate is higher in the US than in China[3] despite the fact that China has a dramatically higher C-section rate (47%).[4]  Worse, Abigail Higgins reports: “Eugene Declercq, of Boston University's School of Public Health, produced a short film named Birth by the Numbers discussing maternal mortality in the US. In a 2013 follow-up report, he noted that mortality rates in other industrialized nations had declined - while in the US, it increased by 30 percent in the first decade of the new millennium,”[5] partially due to C-sections. [6]

Not only are c-section rates climbing, but surgery is being forced on women against their will.  In April this year, a woman was “kidnapped” from her home by authorities in Brazil to make her comply with her doctor’s demand that she have a c-section.[7]

And just last week in what the Inquisitor said could be termed a violation of the most basic of feminine, or even human, rights, a woman in Staten Island was forced, against her will, to undergo a cesarean section.[8]

Are We Culpable in the C-Section Epidemic?

As the friends, family, and caretakers of the victims of C-section abuse, we are unwitting accomplices to the tolerance and acceptance as “normal” of C-section rates of 33% (US hospitals), and even of 90% (private hospital rates in Brazil) when, by contrast, the rate at The Farm from 1970-2000 was 1.4%[9] (lower than would be expected in any medical facility, but the statistic and their work (www.thefarmmidwives.org) merit consideration. See footnotes*)

 With one sentence—“At least you had a healthy baby”—we unconsciously endorse the system that has created the phenomenon of the “emergency birth,” and the perception that birth is dangerous enough to frequently require surgical intervention to “save” mom and/or baby.

There are dozens of reasons never to utter those words to a new mother after her C-section (all actually nuances of the single problem that it makes us accomplices). Here are the top seven. 

1.    No mother wants “the least” for herself or her newborn.

Though it may be defined differently by each of us, we all want something wonderful—the best possible.  It is never comforting to hear we got “the least.” 

2.    It implies that the baby is healthy because the mother underwent surgery.

There is tremendous and mounting evidence that the opposite is true.  Bypassing the natural birth process (in anything other than a truly life-threatening situation) compromises the mother and baby’s health in numerous known ways (emotionally and physically). Overtime we will undoubtedly discover many more ways in which the compromise to our mind/body compromises society as a whole.  

A new film called Microbirth produced by One World Birth and scheduled for release September 2014 will address this subject with grave and fascinating new evidence.

I contacted Toni Harman, Director and Producer of Microbirth, to ask about her film and the discoveries they’ve made in their research.  This is what she had to share:

     "Microbirth is a feature-length documentary that looks at how the way babies are born could have consequences for long-term health. Over the past eighteen months, we’ve been filming scientists working across many different fields who are starting to link C-section with increased risk of children developing certain chronic diseases later in life. These diseases include asthma, allergies, obesity, diabetes, auto-immune conditions, cardiovascular diseases, mental disorders and even some cancers.

The scientists are hypothesizing that this could be connected to the baby’s microbiome (its bacterial ecosystem) not being seeded properly with the mother’s own   bacteria at birth. With vaginal birth, the mother’s bacteria transfers to the baby inside the birth canal, then more is transferred via immediate skin-to-skin with the mother and breastfeeding. This bacteria innoculates the baby and helps train the baby’s immune system, helping it distinguish what is “friend” and what is “foe”.  This helps protect a baby from developing one of more chronic diseases later in life."[10]

She added that a baby’s microbiome is still seeded during c-Section, unfortunately by the operating theatre. 

3.    It assumes that something was “wrong” with mom and baby in the first place.  

We know statistically that, when we allow birth to happen at its natural pace in a peaceful, uninterrupted, supported environment, the vast majority of mothers without pre-existing conditions can successfully birth their babies without medical intervention. We also know without question that—far too often— the procedures in the hospital are actually creating the “emergency” situations that lead to C-sections. In an article called “The Cascade of Interventions,” Theresa** puts it this way:

     “We are lucky to live in the time of modern medicine, however medical interventions such as labour induction, pain relief, and cesareans—measures that have saved many lives—have been overused. In a hospital setting where your care providers are actively managing your labour, once you have one intervention it makes more interventions more likely to be needed in order to remedy the effects of the previous ones.”[11]

What was “wrong” with mom and baby is that they weren’t given the circumstances in which birth has a decent chance of occurring without surgery. 

4.    It minimizes what the mother lost in the experience.

Even when baby is healthier or saved by a C-section (again, in a small percentage of cases this is accurate), “at least you had a healthy baby” disregards the emotional and physical loss and trauma the mother experienced.  She had a dream for her birth . . .and that dream was taken away (excluding cases of elective surgery). She is experiencing loss, and is in recovery. She has the right to mourn and work through her valid emotions without having them discounted or ignored.

I contacted Lindsay Lipton Gerszt, a documentary filmmaker whose latest work is a film on postpartum depression called When the Bough Breaks, to discuss this aspect of the issue.  She said:

     “According to the National Center for Health Statistics, the C-section rate has climbed more than 50% since 1996.  Whether the C-section was medically necessary or a personal choice, many women who have had it experience postpartum depression. Although the reasons may be many and varied, one reason why women feel depressed after having a C-section may be due to the stigma surrounding it. Many are made to feel guilty for not giving birth naturally.”[12]

In a Catch-22 scenario, by not wanting to contribute to the pain these mothers are experiencing, we try to minimize it with the infamous line, “At least you had a healthy baby.”  I conducted an informal poll online with mothers of C-section, asking how they felt when hearing that statement.  One woman’s response clearly shows the complexity of the emotions mothers of C-section experience:

     "There was such a flurry of emotion. I felt angry because I knew I would have had a healthy baby without the section. I felt guilty because I knew many women who pray for the opportunity to simply have a baby . . .any way. I felt like a failure for not doing a better job of standing up for my rights and my baby's. I felt hurt from the insensitivity of that statement."

Indeed, women of C-section are not to be made to feel as if they failed or guilty for having had a C-section. Either it was truly medically indicated or they’re victims. In either instance, the mother should be supported. There is a better way to support them than pretending (in the cases where it could have been avoided) that their child was “healthier” or “saved” by the surgery. 

I believe we unwittingly perpetuate the problem and dishonor mothers and babies when we try to gloss over the serious risk and pain they endured with what we believe is the kind thing to say, but is—in fact—a benevolent, yet pernicious untruth.

I asked Theresa Morris, PhD, author of Cut It Out: The C-Section Epidemic, for her thoughts. She said,

     “Normative structures of mothering are strong, and when a woman gives birth to a healthy baby by C-section, it becomes difficult for her to question whether the C-section was necessary. Yet, we should always ask, “Would the baby and the mom have been just as healthy (or healthier) if the baby had been born vaginally?” The answer to this question, according to the World Health Organization, is yes for all but about 15 percent of women who give birth in any country in a given year.”[13]

5.    It minimizes what the baby lost in the experience.

The baby. The co-birther. This aware participant who is too often treated—at best—as an incapable, unaware “patient,” and at worst as “an object to be removed.”

Ask any birth worker who has witnessed hundreds of births, natural and surgical, “What are babies like after each kind of birth? How does their behavior differ after the different types of birth?” They will tell you that babies born naturally are generally calm and alert, while babies born of surgery—because they are drugged and shocked—are often disoriented and even difficult to rouse.

We must not allow ourselves to skirt the subject of how babies are traumatized by surgical birth in the name of protecting the feelings of new-mothers-of-c-section. It is for them and because of their experience that we must speak about this subject honestly, and protect other mothers and babies from c-section abuse.

Babies of surgical birth are traumatized. All they are programmed by nature to expect, to be ready for and capable of, is voided in birth by c-section. 

6.    It implies that the doctor has done something that was necessary—was a “savior.”  

There is enormous research indicating that a great percentage of mothers who birthed by C-section felt “pressured” to do so because they were “failing to progress” (meaning in many cases, just “taking too long” for hospital efficiency standards) and would not have chosen surgery otherwise.

In instances of multiple births and breech, many OBs simply won’t consider varying factors, “forcing” the mother to accept C-section as her only option. One mother said:

     "I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her."[14]

7.    It encourages other mothers (and society at large) to believe that surgery is safe and often necessary to save their baby, when for the majority it’s a dangerous option involving more risk and suffering. 

     "There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so," said Dr. Lalonde.[15]

Then What Can We Do and What Can We Say? 

What can we do about this C-section epidemic?  In an article published in The Atlantic titled “Once a C-Section, Always a C-Section?,” Whitney Pinger, Director of Midwifery Services at George Washington University, said of the situation:

     "You can’t pin it on one thing. There’s no one thing to blame, there’s no one person to blame . . .we’re all in this together; we got ourselves into it as a society."[16]

Yep, we did. And it’s high time to get ourselves out of it.  Starting with the very simple first step of never saying, “At least you had a healthy baby.”

What then do we say to mothers recovering from c-section?

We want to support all mothers after birth—and mothers who experienced any kind of trauma need particular care emotionally and physically. Again I went to a group of thousands of mothers online and asked them what they wanted to hear.  Kayla Dar, founder of Baby’s Breastie and mother of four, provided what is the simplest yet likely the perfect response: 

     "After listening to what she has to say about her birth, ask the mother:  

     How are you? How can I help?"

 

_______________________________________________

Note about C-section statistics quoted in this article and in general: In my research I found varying numbers for C-section rates by State (in the US) and by country. For example, rates in Brazil in general appear between 40-50% while there are statistics indicating that 90% of births in Brazil private hospitals are by C-section.  Further, even WHO documents and reports explain their range (generally quoted of 5-15%) differently. In one report, a nuance of the minimum range was explained this way:

“The recommended minimum necessary c-section rate at population level to avoid death and severe morbidity in the mother lies between 1-5%[17]

To further complicate matters for those wanting precise numbers, consider this nuance explained by Right Diagnosis:

“The word 'prevalence' of Caesarian Section usually means the estimated population of people who are managing Caesarian Section at any given time (i.e. people with Caesarian Section). The term 'incidence' of Caesarian Section means the annual diagnosis rate, or the number of new cases of Caesarian Section diagnosed each year (i.e. getting Caesarian Section). Hence, these two statistics types can differ.”[18] 

For purposes of this article, I’d like to suggest that the precise numbers, whether 31% or 33% or 35% for the US for example, is not of primary importance. The fact that we know close approximations—that are far too high—is the point.

[1] http://www.acog.org/About_ACOG/News_Room/News_Releases/2014/Nations_Ob-Gyns_Take_Aim_at_Preventing_Cesareans?IsMobileSet=false February 19, 2014

[2] http://www.scienceandsensibility.org/?p=483 Oct 30, 2009

[3] http://www.vox.com/2014/5/5/5680964/americans-are-likelier-to-die-in-childbirth-than-russians-or-chinese  May 5, 2014 

[4] http://usa.chinadaily.com.cn/epaper/2013-09/04/content_16943528.htm Sept 4, 2013

[5] http://m.aljazeera.com/story/201438161633539780

[6] Ibid.

[7] http://www.telegraph.co.uk/women/mother-tongue/10767161/Kidnapped-by-the-authorities-meet-the-woman-forced-to-have-a-caesarean.html  April 17, 2014

[8] http://www.inquisitr.com/1250257/mother-forced-to-have-cesarean-section-and-now-shes-suing/#UXXEWJoTczECB1Ls. 

[9] http://www.naturalbirthandbabycare.com/farm-statistics/ 

*The Farm does not serve women with preexisting conditions that make them high risk and has had varying policies over the decades about working with women with breech presentation and other situations or variations of normal.  However, the enormous difference in their statistics compared to the national average—especially given the duration of the performance—demands the comparison.

[10] Email exchange with Toni Harman, April 30 and May 14, 2014  http://oneworldbirth.net/microbirth

[11] http://thebirthingsite.com/labour/item/612-the-cascade-of-interventions.html Feb 9, 2013

[12] Email exchange with Lindsay Lipton Gerszt  April 21 and April 25, 2014.

[13] Email exchange with Theresa Morris, April 15 and April 21, 2014

[14] http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile  IL

[15]http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile  IL

[16] http://www.theatlantic.com/health/archive/2014/05/once-a-c-section-always-a-c-section/362088/ May 20, 2014

[17] http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf

[18] http://www.rightdiagnosis.com/c/caesarian_section/stats-country.htm#extrapwarning  April 18, 2014

**author’s full name as posted in the article

Wednesday, 16 April 2014 10:04

A Healing C-Section

Can a C-section be healing? I believe so. Not because I have to believe, but because I experienced one just about two short months ago. Would you like to hear the tale? Let’s begin with the birth of my first child.

Well, it actually has to start about four weeks before he was born. It is September 2011 and I am just about 35 weeks pregnant with my first baby, a very exciting time indeed, when the scariest thing possible happens. I go into preterm labor. Or so I thought. The first thing, of course, that I did was call my provider at the time. I told them I felt cramps that spanned all the way around my abdomen just below my belly button. I was restless and cranky, but had no other signs. They listened to me on the phone and when one 'thingie' as I called it at the time hit, they told me I was having contractions and to come in immediately. So, I did. After spending an hour at the hospital it was concluded that, yes, I was having contractions; but, no, they were not doing anything. My response was SERIOUSLY?! 

I was told I was having prodromal labor (no text can do it justice). Prodromal labor is not, as some would tell you, Braxton Hicks contractions. Having had both, I know. Prodromal labor is all the fun of labor without any progress or baby. It sucks because it comes and goes and is as tiring as actual labor.

For four weeks I went through this. Contracting sometimes for six hours straight at a time and then nothing. Nine days into October I went into labor. I was in labor!! I was dilating and everything. Then we were crushed again. After 18 hours in labor I stalled out. Once again at home I would contract for eight or more hours. I was absolutely exhausted but nobody knew of anything that I could do. I was told to just 'tough it out'. Finally, that Friday I went into labor and stayed there. We went to the hospital and were released about six hours later with the doctor saying there just was not enough progression to warrant admission.

Here is where the story gets infuriating for my birth team with my second child.

When we were sent home, still in labor, our doula said she was going home and not to bug her until we were admitted to the hospital. When I told her the reason we hired her was to be with us during this time, while we were laboring alone, she said she was tired and her daughter had a game the next day she wanted to go to. We were horrified but what can you do? We went home and I labored Saturday and Sunday with the blurry help of my tired husband. Finally, with him facing a Monday of going to work as a zombie he forced me to go to the hospital to take them up on a morphine drip so I could get some rest and he could get to work. When we arrived at the hospital I was checked and was found to be four cms dilated. We called the horrible doula, mainly because my husband desperately needed relief, and progressed from four to seven fairly quickly. Then my body gave out. I did not know what to do so I was not moving or changing position. I was just breathing trying to will more strength into my body while sitting on a birth ball. My doula was checking her Facebook and email. My husband was passed out on the other side of the bed, sitting up, with a death grip on my hand. Never once was it suggested that I switch positions or even lie down in the bed.

Another hour later and I was sleeping through contractions. Yup. That was me. My doula took my exhausted husband aside and suggested I get an epidural to get some rest. By this time I had been laboring naturally for over 69 hours on top of the prodromal labor, I was exhausted. I got the epidural and sent my husband to the 'in-room' couch for a nap. My doula disappeared. I have no idea where she went.

The hospital staff did what they could and my doctor violated hospital policy by letting me labor two extra hours. You see when my waters broke there was meconium in them and this meant I had a 12 hour window in which to give birth. However, my baby was doing so well he let me go two extra hours. Finally, with a body that, on Pitocin, had made it to 9.5 cms, I began to shut down. I was swelling shut. Worst of all my baby was crashing. I was rushed into a C-section where my baby came out with an APGAR of 1.1! Warrior that he was he bounced back four minutes later to have an APGAR of eight.  At 11:30 pm I was wheeled into my maternity room and left alone to ponder what the hell had just happened.

Fast forward to Thanksgiving 2012, about 13 months later, I am staring at a stick not believing the little blue plus sign. I shake the darn thing like it is one of those old time mercury thermometers. The lines do not go away. Though I am not certified, I have taken all my doula training courses, researched, read and most importantly, located good resources outside the hospital. This time I get a midwife and go with an OB who is not only VBAC friendly and highly recommended by every midwife I interview, but is personal friends with my midwife and she has him on speed dial. I get a new doula, who just so happens to be my mother-in-law. I have prodromal labor, but this time am encouraged to take calcium-magnesium daily and Tylenol when it gets bad. With the exception of the stomach flu every month for seven months straight my pregnancy is about as eventful as watching paint dry.

The day before I hit 38 weeks, a Sunday, I am cranky, achy and generally pi**ed off. Hey, it is July and it is hot where I am. Plus, my husband refused to take me to the pool that day. He remarks on how agitated I am and I tell him I have been achy all day, standing up folding a ton of baby laundry and still have to get the nursery together. Did I mention we had not gotten anything ready with the exception of home birthing items, the crib in the correct location (which was already there because my first born was sleeping in it while we were fixing his room) and the co-sleeper ready? Everything else was in pieces. My hubby jokes that it is good that nothing is really happening. Only a man would call what I was going through nothing. Then at 3 am Monday morning I have show. I yell at my husband, take two Tylenol PM to sleep and think nothing of it. With my first I had a show at 36 weeks and he was born only two days before his due date.

Since work is 60 miles away (and my boss had been begging me for weeks to do this) I telecommute that Monday. I get about two hours of work when I just cannot sit still any longer. I walk. I lie down. I take calcium-magnesium. I tell my midwife I am having some bad Braxton-Hicks and ask suggestions. She is skeptical but contractions are about 20 minutes apart and 45 to 50 seconds long. To be fair to her I tell her they have no pattern. See, I have OCD so when people say they have to be consistent I naturally think they ALL have to be 45 seconds long. I labor the rest of the day away. When my husband comes home he immediately calls the midwife. I really do not believe this is labor at all so go to take a shower. When my midwife arrives she comments, as she is checking us, that she could hear me moaning from the front door. I was moaning? I am two cms dilated and not very effaced but definitely in labor and had been so since I saw the show that morning. Everything looks good and she wants us to get some sleep so I take Tylenol PM and she goes home, which is about a mile from my house.

I get no sleep. The contractions, which had been a breeze, suddenly become extremely painful and my hips shoot with pain during each and every one. My husband, bless his soul, holds my hand during each contraction. At 6 am Tuesday morning he calls the midwife to see if she could stay with me while he went to work. By 7 am my first born is at daycare and my midwife has arrived. I am still 2 cms dilated but I have effaced to about 60% and the baby has moved to below my pubic bone. A lot of progress. Then comes the bad news. He has turned so that he is facing my right hip and therefore his shoulders are at a 90 degree angle to where they should be. That means that every contraction has been forcing his shoulders down on my hips and flexing my hips a bit. However, I feel I am in a good place at home so we stay. My husband gets up to get ready for work. The midwife asks what he is doing and when he asks should he go to work she tells him not to if he values his marriage!

We continue to labor at home until about 2 pm. My midwife is concerned. I have not rested. I have not been drinking much nor have I been eating. In fact, the quarter of a sandwich that I ate was hard bargained for by my husband. She is afraid that my body is going to get too tired to push especially since I cannot stop moving about long enough to rest a little. She is calling my OB, my husband is packing us to leave (I told you I was not ready!) and I am screaming at my back-up midwife to put something waterproof on the bed. She is trying to convince me nothing is needed because I am going to the hospital when my water breaks. All over my bed. With no rubber sheet on it. Excited, I am checked again and again found still to be about a 2 cm dilated. The sheets are then tested with some strip that could tell the midwife if it is amniotic fluid. The strip turns dark purple. Not only is it amniotic fluid but there is a good chance there is meconium in it. Now the hospital is not open for debate. We have to go.

At the hospital I try position changes and the fabulous jetted tub. My mother-in-law arrives (we flew her in from Oklahoma) and I labor a little longer without any pain medications. My problem is that I have lost a hold of the contractions and cannot get back on them. It is not the actual contractions or the baby moving up and down, it is the fact my hips were completely destroyed by laboring so long with the baby so low in an unfavorable position. I am, I will admit, screaming for an epidural but am not allowed one until I am six cms. I am a TOLAC (trial of labor after c-section) after all and that is my OB’s orders to maximize my chances of a VBAC. Though I curse his name I am deeply grateful for that edict. I now had a chance to get on top of the pain. Unfortunately, I could not.

When I hit 6 cm I get the epidural. I can still feel and move my feet. I ask the anesthesiologist if this is normal and am told they do not heavily medicate TOLACs; but I do have my joy buzzer if I need more meds. Here is where things go south on rails. The epidural does not hold. (Psst, no one is worried about my slow progress, they are worried about my epidural not holding.) I get the first dose of the epidural again. My blood pressure tanks. It is so low I am starting to pass out lying down. I get medication to boost my blood pressure. The epidural stops working again. I get a new first dose but I think the doctor is just adjusting my joy buzzer. So, at the same time he gives me the first dose I hit my joy buzzer, effectively giving myself a double dose. It is while he is doing this that my nurse registers that I have a fever and subsequent blood work reveals an infection. I fall asleep, though pass out might be better a better term. About an hour after I fall asleep the nurse comes banging in waking everyone up and shakes me. Freaked out we ask if the baby is okay. She is more concerned about me as my oxygen saturation rate is at 65. I should mention here that my baby is a tank. NOTHING WAS EVER WRONG WITH MY BABY. Go figure.

By now my fever is not responding to medication, my blood pressure is staying way too low and my epidural has worn off again. My OB wants me checked in 30 minutes and if no progress has been made I am to be given a C-section or he is afraid I might have an emergency while trying to push. The anesthesiologist is called in again to re-up the epidural. We can hear the disbelief in his voice. The reason? I am on all fours in my bed laboring. With as many times as I had the initial dosing my legs should be jelly. He cannot put in more of the medication because I am having a contraction. It is 3 minutes long with very little, if any, rest in between. My nurse, bless her heart, is sure that this is transition and I will be pushing soon. I think she is more excited than my husband and I. It was a belly drop then when we found out that no, it was not transition but hyper-stimulation of the uterus. Not only that but my vitals took a dive during that contraction. My tank? He was doing just fine.

Once again the anesthesiologist is called in. He pulls out my epidural line and puts in a brand new one for the C-section. Not only is it a hurry to get me open and baby out because my vitals are not great but because we are not sure if the epidural will hold. Baby comes out screaming with a lovely APGAR of eight. The epidural holds until the last few staples are going in. I felt those.

So, how, you ask, is this a healing experience? Some would say it was worse than the first. It is healing because everyone, and I mean EVERYONE, was on my side. My midwife answered every question and helped in every way. She made my pregnancy easy by helping me identify when I needed to take something and being superwoman would do me no good. She helped me keep my Braxton-Hicks/prodromal labor under control and was with me every step of the way. My OB worked with her to maximize the efficacy of my care. He ENCOURAGED the home birth but informed me of his practices surrounding a hospital VBAC should I need to come in. He told me only his VBAC success stories, medicated and non-medicated. That built my confidence that he’d do everything to see my wishes through should I have to come in. The nurses at the hospital left us to our own devices and only came in if absolutely necessary. They hid all the monitors so we could not worry about numbers or lines. They cheered me on through tough contractions, were excited when it looked like I might make it, comforted me when another C-section was ordered and delayed checking me even when directly asked by my doctor. Our night nurse 'forgot' to check on me at the required 30 minute interval because I was doing alright and baby was great. Why mess with what is working? Everyone was working for me, cheering for me and wanting this as bad as I did. The support I had this time around was not given to me my first go around. It did heal me.

What are my OB and I planning? A VBA2C. Well, in a few years. ;)

Published in Birthing Stories

I read this book immediately upon receiving it today. Though I can see its great contribution to these fields, I did not read it from a childbirth provider's, scholar's, or politician's point of view. I read it as a mother who chose home birth at 42 years old---amongst other reasons--to avoid being caught in the "cascade of interventions"--or what I call the "birth template" prepared for us by committees. I read it as someone who writes and advocates for natural childbirth.

Cut It Out, written by Professor Theresa Morris, offers new insight to answer the question: "if most women do not want or choose c-section and most maternity providers claim not to prefer c-section over vaginal birth, why has there been an astronomical increase in the c-section rate in the United States?" It doesn't discuss why there are c-sections, but why there are so many c-sections. The author suggests (and supplies abundant research to back it up) that it's not as simple as the typical list of reasons offered: mothers "to posh to push," or women being overweight, or too "small," or doctors just choosing the easiest or most profitable route. She explains that there is a complex of committees--organizations--in place in which doctors and women are participants, but that "Maternity providers and women are constrained by hospital rules and behavior, even if the expected behaviors do not lead to improved outcomes."

For those wanting natural childbirth, of course home birth is an option, but many women feel safer in a hospital and many need to be there for valid reasons. So what does a woman do who wants natural childbirth in the hospital environment?

Read, learn, know what to expect and how to work with and against the birthing "systems." Cut It Out (a clear picture of the what and WHY in the hospital), and Ina May's Guide to Childbirth (considered a must-read by advocates of natural childbirth) would be two great books to start with for any new mother, knowing she wants the most natural, healthy, and loving childbirth experience possible, but not knowing (yet) how to achieve it.

As with any experience--the more we know about what we're going into, the better we can prepare and the better outcome was can anticipate. If you're going to give birth in the hospital, this is a book to read.


Published in Product Reviews

At 41 weeks pregnant, I woke up late Wednesday evening feeling pains stronger than the "menstrual-like cramps" of Braxton Hicks.  I let my husband sleep as I started to get excited and braced myself for the journey ahead.  Thursday morning, I told him that he could finally stay home today, because it was time to start laboring!  He was so awesome through the whole pregnancy and I knew he was going to shine now, too.  So we started hanging out around the house, doing our pre-labor stuff.   I was feeling strong contractions that were starting to locate in my back, and we thought we would call our midwife to let her know what was up.  She came by a few hours later, and after checking my cervix for dilation, saw that I was 2 cm dilated (where I had been at for a few days now). Bummer.  No progress really then.  She said we should get out of the house and try to lose the labor focus.  So we went to the Lowes down the street to pick up a plant; we wanted to have a living reminder of this labor and something that our baby could see "grow up with her."  We came home; planted the bonsai juniper tree we bought, baked cupcakes, watched a movie, and then settled into bed.

I was still having contractions, but I was able to get some sleep, until around 4:00 am when my water broke!  I heard a pop and felt a surge of warm fluid while sleeping, and woke up to run to the bathroom, yelling, "Erich, wake up! My water broke!"  Thankfully, we had layered the bed with a plastic sheet the previous day in preparation of our home birth. As I sat on the toilet, leaking, my contractions were already getting stronger and closer together, so we called our midwife again to let her know what was going on. About 4 hours later, I was starting to enter labor land, so we timed the rushes again.  They were coming about 5 minutes apart and lasting about a minute each, so our midwife headed over to the house.  Once she was here (around 9:30 am Friday morning) I was really contracting, and the back labor was becoming very intense. With every contraction I would need my husband to push as hard as he could on my lower back until the rush was over.  My midwife seemed to think everyone was doing well, so we pushed on through the day.  We were laboring in and out of the house, walking around the neighborhood, still in good spirits. I was really looking forward to getting into the birthing tub!  However, knowing that it would be best to wait until just the right moment, I did not enter the tub that night. 

So now it is Friday evening, and I had been laboring through the day. The back labor was exhausting, and the rushes were coming close together, but they did not have a strong pattern to them.  We decided to try to get some sleep that night and start again in the morning.  By “we” I suppose I mean my husband and midwife, as they got some sleep; I was still laboring. I was attempting to rest in bed, with a heating pad underneath my back, but every contraction was powerful and I needed the counter pressure to be able to bear it.

In the morning, as tired as we were, we put on our labor hats and plunged deep into the canyon again. My husband and I went for a long walk, and I lunged on the walk. We went up and down the stairs, lunging. We tried every position known and unknown. We bounced on the birth ball, sat on the toilet backwards (I spent a lot of time there, with a pillow to lean into), got on my hands and knees, tried to dance the baby out.  All the while, I was experiencing the worst back pain I could possibly imagine. My husband's hands are probably still sore from the counter pressure. I moaned low and loud, I grunted, I sang, I focused my breath, my energy, I asked the baby to prepare herself. I clung to this process and hoped that the Goddess would deliver us from it. 

Around 5 pm Saturday our midwife checks my dilation again, and sees that I am at 5 cm now, and that our baby is OP, or "sunny side up" meaning her face was pointing towards my pubic bone. This is causing the hard part of her skull to rest on the bony part of my spine. Thus causing my back labor, and making it not ideal for her to come down into the birth canal. On top of that, her head was resting off centered on my cervix.  This was giving her a "top hat" and swelling my cervix without dilating (because she was not putting the right pressure, in the right place).  With this new information, we know I still have a ways to go, and our baby and I need to do some work to get her positioned correctly for the vaginal birth I so craved. When night came, we thought it best to try the "resting" thing again. I took some herbs to help strengthen the contractions, and my midwife and husband tried to lay their heads down.  I paced the house and eventually got in the bath. With each contraction I screamed to my husband to get out of bed and turn on the jets on our garden tub, and then turn them off again. Because my water was broken, we didn't want to chance an infection by leaving them on the whole time, so for three hours I sat in the tub, and my husband tried to sleep in bed, between helping me.  Looking back on it, we both think “Why the heck didn’t Erich try to sleep on the bathroom floor so he was close to the switch for the jets?”  The lack of thought process going on here shows how tired we all were at this point.

Come Sunday morning, I was suffering for lack of nutrition from not eating or drinking, so we started an IV of fluids (still at home.)  We also decided that getting some antibiotics into my system would be best for our baby and lower the infection risk, so we started that too.  Three bags of fluids later I was feeling better and a bit more energized so we started trying EVERYTHING again.  Because, damn it, I was going to have this baby at home!  I cannot express how much I wanted to sit in the birthing tub and push my baby out.  All I wanted was to feel an intense sensation to push, to feel my baby's head in my birth canal, to connect with every woman out there who has done this and will do this; I wanted to feel the energy of the world soaring through my vagina.  So we tried.  We walked again, we bounced, we sang and I moaned. I felt like my back was being split open, like an alien was about to rip its way through my spine!  I was still taking herbs, and homeopathic remedies.  I was visualizing, I was opening to my baby.  I was doing everything they said to do and anything I thought I should do.  

Sunday afternoon, after four days of active labor, our midwife checked my dilation again, (still at 5 cm! What!) and we decided to try to turn the baby to a more favorable position. Our midwife reached in through my cervix, and gently put pressure on our baby’s head to encourage her to move into the birth canal.  She succeeded in turning her a bit, and then the little butter bean moved right back into the same spot she had been in.  We tried again, but alas, she did not want to be in the "right" position.  So as I leaned on the bed, bracing myself through yet another mind bending, back searing, contraction, I saw what I knew to be a bad sign, fall out and onto the chux pad underneath me. 

There was meconium.  My poor baby was stressed (gee...I wonder why?).  I called for our midwife and we assessed the situation.  She listened to her heart tones, and felt they were dropping.  My husband and I were scared, tired, and starting to feel like we needed some help outside the house.  So tearfully, we decided to transport to the hospital.   

When we got to the hospital Sunday evening, I already knew I wanted an epidural.  I was in so much pain, I couldn't stand, couldn't  think, couldn't  see straight. After what felt like hours of questions, I finally got some relief as I slept for the first time in days, numb from the epidural.  We also started pitocin, as my contractions were still not consistent enough to position the baby.  At this point I still had hope for a vaginal birth.  I thought the epidural will relax me, the pitocin will work and I can push this baby out.  Looking back, I feel that my midwife and the doctor were probably thinking differently, and we started the pitocin just to be able to say we tried it.  Which I am thankful for; I know at this point I really did do anything and everything to try to have a natural, then vaginal, birth.  But two hours later, I am still at 5 cm, my cervix is extremely swollen, and there are no signs of things changing.  It's been almost 5 days of labor, and our baby needs to come Earthside.  So with a heavy, scared, and very emotional heart, we know that a Cesarean birth is our only option. I looked to my husband, and he said "this is the right thing," as we prepped for surgery.

I told my husband later how I am sad that I don't fully remember the next few days, and he said "Well, even if you don't remember, you knew how to do it!  As soon as she was out, you were telling me what to do!  Say her name, touch her, stay with her!"  Having the knowledge that she was never out of our sight, at any time, while we were at the hospital, helped to relieve some of the emotions from being there in the first place.  Also, the staff at the hospital understood our wishes, and never fought back on them.  The nurse even asked if I wanted to take my placenta home!

The hardest part of the whole experience came after the procedure, while I was in the recovery room.  Alone, but for the nurse, I had all these emotions and no baby to hold.  I will never forget lying there, feeling as though time had stopped and the agony of having to wait.  Finally she was brought to me, and I put her right to my breast. There she stayed for the next three days as we recovered in the hospital together, as a family. 

The last place I ever wanted to give birth was in a hospital, but if not for one, my baby and I might not be alive today. I learned a lot through this process. It taught me to trust my baby and my body.  Even though I was not able to birth vaginally, my body WAS working in harmony with my baby. If I had been contracting stronger, her little body might have been damaged, her neck might have been broken!  I know I did everything I could to birth my baby... and in the end I DID bring a beautiful, strong, magical being into this world.  Her path here was not mine to decide.  Her path around the Earth will not be either.  I am merely the platform from which she can jump from.  All I can do is accept her, love her, and foster joy every day, from now on.  And whenever I see her sweet face and smile, I know I would do it all over again. 

Published in Birthing Stories
Saturday, 27 July 2013 11:18

Tips before, during and after a c-section

I know that birth is natural and nothing can be compared to that process when you give life to your child (unfortunately I can’t live through it naturally). Moreover, I noticed that c-sections are like foster-children. No one likes to talk about them. But in Hungary (where I live) the rate of c-sections is approximately 35% which means that every third baby is born this way. (“The suggestion of WHO is only 15%!”[1]) When I prepared to write this article I searched for some articles which help me collect and organize the ideas and I was shocked when I realized that very few magazines and books deal with c-sections in more than 10sentences (all of them discusses just the operation, the reasons and effects but just from medical side, none of them gives you tips how to “survive”). Natural birth is dealt through pages but “there is no argument that there are cases when c-section is the only chance to preserve the health of the mother and the child as well.”[2]

During my pregnancy with my son I thought that I will start labor at home, go to the hospital, give life to him and it is not a big thing. Once I heard if birth weren’t a natural thing, people had been extinct. I agree with that statement pretty much. I attended classes before my birth, I learned everything about being in labor, and “all the staff” but nobody was talking about c-sections. Unfortunately I had both my children with c-section. I had genetic, uncontrolled pain weakness.

With my son I was induced as the result of his non-stress test was awful. I was in labor for 6 and a half hours, after it doctors decided to make c-section as my water wasn’t clear and I can’t dilate more than 3cm. I was disappointed but very happy that I have a healthy son. My daughter was born with planned c-section as the result of her non-stress test was not good for a while and doctors knew my birth history so on my due date doctors decided to make the operation. For the second time I know what will happen, how to prepare for it and how to recover from it as soon as possible.

With these tips I’d like to help mothers who have to face this operation.

Tips before a c-section (if you know that it will be):

  • “Don’t forget: during a c-section a baby is born, a mother is born and a new family is born. Giving life is a saint thing, no matter where it happens.”[3]
  • Prepare your bags carefully

Ø  One bag you take to the intensive unit: tissues, glass, straw, mobile phone (fully filled), clean nightdress, clean knickers (disposable one is a good choice), sanitary napkin (the best one is which has “a soft cottony cover top anion sheet”[4])

Ø  Another bag with all the other staff – from it put the most necessary things onto the table next to your bed and onto the one where you will take care of your baby

  • Write a c-section birth plan if you feel that you need it. E.g. if you want to watch how they pull out your baby, whether you want to be informed about every little thing or not, etc. (Unfortunately in Hungary doctors can’t be adaptable as they have to work according to the rules of their hospital)
  • In Hungary you have to tell your baby’s name in advance so prepare with a male and female name as well

Tips during a c-section:

1.  Try to bear in mind:

  • “Birth experience is a unique and wonderful thing. If it is a c-section than it is.”[5]
  • “Everybody else wears masks and strange clothes because of YOU and YOUR baby. They help you. They serve you. The operation theatre is also the place of YOUR baby’s birth, even if it is not so natural.”[6]
  • You will never forget the moment your baby is born. Try to live it through as id it were a moment just for the two of you,
  • Don’t be afraid of asking, it can help you understand what is happening. (During my second c-section I asked a lot of questions and they answered all of it properly)

Tips after a c-section:

          In the intensive unit:

  • Have a rest, sleep. Think about this period as you have already started to recover.
  • If you can, move your legs – it will help when the time comes to stand up
  • When your baby is with you breastfeed and use skin-to-skin contact. “Use this time very intensively, for that little person you are the world, you and your love is much more important for her than the circumstances of her birth.”[7]
  • Do the first getting-up very carefully, don’t let them make you hurry (with my first baby after getting up I felt that all my organs are falling down to my ankle)
  • Walk very slowly

          In your hospital room:

  • Practice getting up – the more you do it the easier it will be
  • Walk – moving is the best therapy
  • Relax when your baby is sleeping. You can co-sleep as well!
  • (of course) Breastfeed as much as you can. Try different positions. With my second child different positions were comfortable then with my first one.

          At home:

  • Write down your birth story. You can write more versions – e.g. just for yourself, for a friend of yours or as if it were a letter to your doctor. Mention everything which is important for you. Try to stress the best and worth thing. It can help you accept the situation.
  • Don’t care about the housework. Write a list about the most necessary things and give it your family members to help.
  • Relax and sleep when you can. When my baby slept, I slept, too.)
  • Wear knickers and trousers which don’t hurt your wound
  • When you wear clothes use bandage on your wound if it makes you more comfortable in the first few days/weeks, but when you just relax at home try to hold your wound on the fresh air.
  • Avoid lifting heavy things – if you have a bigger child try to hold him in your arms just when you are sitting – it can be a golden rule not to lift heavier things than your baby
  • Your wound will heal fully just after 6 months, so don’t hurry yourself![8]

Your birth story is that how you saw, heard and felt it – the miracle is inside it, where you can find it!!!


[1] Szentendrei, J.: Császármetszés a világon (C-sections around the world) Retrieved July 27, 2013 from http://kangaegyesulet.hu/2012/09/04/csaszarmetszes-a-vilagon/

[2] Szentendrei, J.: Császármetszés a világon (C-sections around the world) Retrieved July 27, 2013 from http://kangaegyesulet.hu/2012/09/04/csaszarmetszes-a-vilagon/

[3]Csodálatos császármetszés (Wonderful cesarean). Retrieved July 24, 2013 from http://felicitasz.blog.hu/2010/10/06/csodalatos_csaszarmetszes

[4] On the box of Crystal Anion sanitary pad

[5] Csodálatos császármetszés (Wonderful cesarean). Retrieved July 24, 2013 from http://felicitasz.blog.hu/2010/10/06/csodalatos_csaszarmetszes

[6] Csodálatos császármetszés (Wonderful cesarean). Retrieved July 24, 2013 from http://felicitasz.blog.hu/2010/10/06/csodalatos_csaszarmetszes

[7] Csodálatos császármetszés (Wonderful cesarean). Retrieved July 24, 2013 from http://felicitasz.blog.hu/2010/10/06/csodalatos_csaszarmetszes

[8]Császármetszés utáni lábadozás (Convalescence after a c-section) Retrieved July 24, 2013 from http://www.csaladivilag.hu/cikkek/szules/csaszarmetszes-utani-labadozas/298/

 

Published in Birthing Styles

DARK AGE II: REPORT ON THE RITUALS & BEHAVIORS OF ANCIENT TRIBES LIVING IN NORTH AMERICA FROM 1950-2050.

 

“The philosophies of one age have become the absurdities of the next.”
-Sir William Osler


It is now the year 3013, and in this report we will discuss briefly three rituals and behaviors of the tribes of people living in North America: the tribe of the United States collectively called “Americans,” and the tribe of Canada collectively called “Canadians”—during an era now called “Dark Age II”—1,000 years ago in the period between 1950-2050. As we’ll see in this report, Dark Age II was marked by extraordinary aberrations of nature and a reign of fear, exemplified in these three rituals/behaviors:

 • “Hiding” from the sun for fear of its evil intent to harm and kill
• Cutting off a portion of male infants’ penis at birth, called “circumcision,” to
   “prevent sickness and please the god”
• Ritualistic drugging and cutting in half of women to remove their babies, called
  “Caesarian-section,” to “save the mother and baby,” and the feeding of
   chemical powder rather than mother’s milk to newborns.

 

HIDING FROM THE SUN

Through various forms of testing, scientists have now determined that the plague which struck these North American tribes (called “cancer” at the time) was caused by various activities of the tribe, including but not limited to: the extensive use of toxic chemicals (apparently known by many at the time to be toxic) in farming; processing of water and addition of by-product and waste chemicals like chlorine and fluoride); chemical agents in construction materials, cleaning products, and as by-products of energy generation; the alteration of animal and plant genes (for the purpose of patenting life and assuring ownership of all organisms by a select few); the accelerated growth and alteration of plants and food animals with chemicals with the intent to cause unusually high cravings and consumption by humans; and the complete reliance on medicine men (male and female) to “cure” the resulting ills—through the ingestion of various poisons and surgical removal of “bad organs.”

In a fascinating twist, the tribes were led to believe that the sun—which tribes of all millennia before and since have known to be the source of life on Earth—was the cause of the plague.

To “protect” themselves, chemicals toxic to humans and the general environment were spread or sprayed on the body to allow the tribe members to remain in the sun for periods of time longer than generations long before and since have known to be healthy. They believed that in doing so, they could “hide” from the “death-inflicting” sun.


CIRCUMCISION

Though this cult practice can be traced back a few thousand years before Dark Age II, it is surprising to our medical and anthropological communities today that the practice survived and thrived in the tribes of North America. We’ve traced the practice back to desert-wandering tribes at least 2,000 years earlier that used the practice as proof of commitment to or to appease their god (and could conceivably have roots in practices for hygiene in harsh climates), but continued in North America in religious and non-religious sub-tribes alike on the premise that it was “good hygiene.”

Male (only) newborns were strapped to a board—rendered unable to move or defend themselves. Then, during a dangerous and extremely painful procedure, they had the foreskin of their penis cut off—permanently damaging the penis and diminishing sexual pleasure for the grown man and his partners. Anthropological research shows that—in another shocking twist to this report—the parents of the victims requested and paid for the procedure, and then—most macabre—the medicine men sold the foreskins to factories for use in “skin creams” and other products to sell back to the tribe members.


C-SECTION

What originated in the tribes as a positive advancement and an excellent practice— used only in extreme conditions where a mother and/or baby were at risk of death in childbirth (1-3% of all deliveries)—became a ritual practiced in 30-50% of the members of the North American tribes—and spread to other tribes and nations, reaching rates as high as 90% in some nations.

Where throughout all time and peoples, women gave birth either protected from the elements inside their dwellings or outside in nature (in fields or streams), attended by experienced women (called midwives), free of chemicals, free of machines and devices to contain them or limit their movement, and free of weapons and devices for cutting, the medicine men during Dark Age II persuaded the tribe members that childbirth was an illness. Thus women were transported to factories called “hospitals” (a word that can be traced to the 12th century, meaning “a shelter for the needy” and around the 15th century became known as “institution for sick people”) where every other sort of illness, injury, disease and emergency was treated—and countless, dangerous bacteria, viruses, and other infectious vectors existed and bred.

The women were given various chemicals to speed labor by strengthening contractions beyond normal (we have found evidence linking the term “Pitocin” to this activity), which made labor extremely painful, for which other drugs and painkillers were used—which in turn led to fetal stress and fear in the mother (further disturbing the natural flow of the labor process). The medicine men would then swiftly cut through the woman’s abdominal cavity and uterus to remove the baby.

Due to the intensity of the surgery, the affects on mother and baby of the drugs, and the removal of babies immediately from the mother (for the purpose of administering more chemicals), babies were often disoriented, confused (also referred to at the time with the phrase “drugged out”) and were unable to perform the most natural act in all mammalian offspring—to latch. After a brief period of trouble latching, the medicine men persuaded women that they were unable to provide for their offspring and offered chemical powders to the infants—bypassing the female mammal’s natural inclination and desire to care for her young with nature’s most nourishing and free food.

These discoveries are considered an enormous link in the search for an answer to why so many women during Dark Age II experienced postpartum depression (PPD) and postpartum psychosis (PPP).

Again, in a bizarre twist difficult to conceive now, many female members of the tribe came to believe that this method of “removing the baby” from the body was superior to the natural homo sapiens’ method of childbirth and often requested the expensive and dangerous procedure.


CONCLUSION

As with all bizarre tribal phenomena, it is impossible to know now exactly how these practices found widespread acceptance. We can only assume that the driving force behind them was a desire to build and maintain a powerbase for a select few tribal chiefs and medicine men.

Fortunately, the use of these macabre practices finally subsided—just as the use of the guillotine in the French and some German Tribes from the 17th century through the 20th century; the use of “torture” (which had different legal definitions in the United States Tribe from the definition of the larger tribe called the United Nations); gishiri cutting (the cutting off of female genitalia in many of the African tribes centuries earlier and through Dark Age II); the foot-binding of Chinese tribes beginning with the Song dynasty and ending in the 20th century; breast ironing practiced in Dark Age II by tribes of Cameroon (a practice of beating breast or using heated objects to make them stop growing); sati ceremonies (a practice of a recently widowed woman immolating herself on her husband’s funeral pyre) by various Indian tribes and banned before Dark Age II; and countless other tribal procedures and practices that flourished and faded into the annals of history. †


“Prediction is very hard to do. Especially about the future.”
-Physicist Niels Bohr

 

Photo used with license from istockphoto.com 

 

 

 

*It will not come as a surprise that this is not actually a scientific report written in 3013, and it IS NOT medical advice and should not be used as such.

It’s a creative essay written in 2013--with respect for our individual needs and decisions--and IS NOT to be taken as a statement of fact or opinion of the author, publisher or distributor.

It IS what creative essays are: food for thought. And the process of thinking usually does one of two things: confirms us in our beliefs or challenges us to rethink—either way: a positive!
 

Published in Wives' Tales & Fun

 

On 8 January 2013 the stars collided. Once again, a beautiful baby entered my world to change my life forever. Hamish Joel was born via an emergency caesarean. It was not the entry I had dreamed of but his birth was a powerful and empowering event. The story of Hamish's amazing journey earthside however starts with an outline of his sister's birth 20 months earlier.

Bethany Grace was born via emergency caesarean after 21 hours of labour. An unneccaesarean due to her posterior presentation & Failure to be Patient (FTP) on the part of conservative care providers. Prior to Bethany's birth I thought I was educated. I did the yoga, read the literature, did an active birth workshop, had a student mid-wife, did “shared care” because I didn't get into the birth centre. Heck I wrote an 8 page birth plan. Boy was I wrong!

My pregnancy with Bethany was complicated. After a threatened miscarriage & following lack of support from my workplace I had an emotional breakdown, was diagnosed with perinatal anxiety & depression & placed on medication. Sure I did yoga but I succumbed to emotional eating, put on lots of weight and stopped my regular exercise regime. I experienced a huge disconnect in my care provision at the end of my pregnancy whereby I was given a late diagnosis of GD (Gestational Diabetes) at my 36 week clinic appointment with a dragon of a midwife who announced in no uncertain terms how incompetent she thought my GP was. I was then given the scare tactics of the “big baby” card by a well meaning OB.

Bethany's labour was unproductive. I arrived at hospital to only be 4cms. Rather than go home I stayed certain I would progress quickly due to the timing of the contractions. Not one of my care providers had told me prior to her labour that she was posterior presentation. Not my GP, the midwife who was so horrid, or even the “experienced” OB who I saw after the nightmare diagnosis of GD. She hadn't switched or moved. She had been in the same spot since 25 weeks gestation. Not one of the three midwives who attended me during the labour told me they thought she might be posterior. I firmly believe had I been given this vital piece of information her delivery may have been different. But at the time I didn't know any better & I bought the crap of the OB who delivered her that it was the safest means for her to come into the world as she was “distressed”.

What baby in distress comes out with an APGAR score of 9 though? I asked myself this & many many other questions after her birth. I doubted my ability to birth babies, I felt broken & cheated of the natural vaginal birth I had worked so hard for. I mourned what I didn't get & was determined that next time it would be different! Next time it would be a vaginal birth or if surgery was required it would be for the right reasons. Next time I would see my child enter the world. Next time I would be the first to hold my child & not have them whisked away from me for three hours. Next time it would be different.

My husband & I had always discussed our children being close in age & even before Hamish's conception I had started my VBAC journey. When the pregnancy test came back positive I put the wheels in motion to make my pregnancy the most healthy & to maximise my chances of a VBAC. I had already lost the weight gained in Bethany's pregnancy & post-partum period. I read everything I could get my hands on, birth stories, books. I questioned everyone to find out their experiences with care providers. I continued to exercise doing RPM , weight lifting & vinyasa yoga up to 32 weeks. After this I walked every day & continued my prenatal yoga up to delivery. I watched my diet diligently & whilst I declined the GTT & GTC I monitored my own blood sugar levels. I got myself an awesome doula. I ensured continuity of care by taking the steps I needed to in order to be accepted into a VBAC friendly publicly funded birth centre. I quizzed my midwife, built myself a support team, & advocated for myself at the hospital to decline interventions that protocol would otherwise decree I must have as a VBAC mumma. I refused the routine group & save on admission, canulla & continuous monitoring. I wanted & gained support to be able to labour & deliver in water. I did Spinning Babies inversions daily & hassled my midwife every single visit after 27 weeks about my baby's position.

Most importantly I worked on my head space. I felt that in Bethany's labour I “overthinked” the whole thing. I knew that for me to get my VBAC I needed to let go. I needed to trust my body to do what it was built to do. I needed to relinquish “control” & tap into the primordial part of my brain, the animalistic part that enables us to birth babies. For this I enrolled hubby, doula & myself in a hypnobirthing course. Following on from which I listened to my tape & practiced my relaxation daily. I also discussed my fears openly with my husband, doula, midwife & close friends. In doing this I gained the support I needed to feel safe.  Everyone in my team knew our birth plan. I would stay at home as long as possible, essentially rocking up at hospital to push. If I was 5cms dilated or less on admission I would go home. I was determined to VBAC but not at all costs. I knew there were some real circumstances within which a caesarean would be necessary & worked hard to feel at peace with these circumstances should this be an outcome.

Hamish was LOA/LOT from about 27 weeks gestation. He moved a little from time to time but was essentially in the optimum foetal position leading up to the night before his birth at 39 +3 gestation. On this night lying in bed before going to sleep I joked with my husband about putting towels in the bed & our brand new car should my waters break. Little did I know that only a few hours later, at 1.31am to be precise, my waters would not only break but gush with the force of Niagra Falls in the bed & all over the bedroom floor. My waters were clear & I informed the hospital when I rang them that I intended to go back to bed to rest. I was told to re-contact if anything changed otherwise I would hear from my midwife the following day.

I went back to bed & within 45 minutes felt the twinges often described as period pain-like. Within 2-3 hours these twinges were real surges that I would work through every 8 minutes or so but I laboured peacefully in bed. Listening to my hypnobirthing CD I closed my eyes & whilst I didn't sleep felt quite rested. I used my breath to work through the surges & let them wash over me. My doula Trish & mum arrived at 6.30am. By the time they arrived my surges were 3 minutes apart. I had spoken with my midwife who had told me to let their length build up further as they were only 20-30 seconds in duration. Shortly after Mum & Trish arrived the surges increased in duration & maintained their 3 minute breaks between. In hindsight it was as if my body had permission to let go once I knew my little princess was being looked after & I had the gentle female support that only a doula can provide. I told my husband James to contact my midwife & speak to her. She told him that we could stay at home longer if we wished but it sounded like I was making fantastic progress.

My doula knew otherwise though & said to James that if we wanted to make the journey to hospital (& contend with peak hour traffic) we would need to look at moving shortly. She knew how much I wanted to use water & gently guided me to the shower. Not long after we made the journey to the hospital by car. Trish was an absolute godsend for this 45minute to 1 hour journey. She was my rock & my soft place to fall. Her presence enabled James to focus on the journey & me to focus on staying internal, in my birthy zone.

Trish & I were both in the back seat of the car. I was in a bizzare all fours position. Right hand holding onto the handle above the window, left hand pushed into the back behind the car-seats & feet pushing downwards into the floor of the car. I had my eyes firmly shut the entire time & a cool flannel over my head. Trish supported me if we went around corners or James had to brake suddenly. She flicked the air-vents on if I barked out “HOT”, off if I barked “COLD” & placed her warm hands in the right spots to apply firm counter-pressure for my ever-widening hips. Without her I would have lost it- she was truly amazing.

When we arrived at the hospital a midwife greeted us in the Emergency ramp with a wheel chair that I not so politely declined. The usual protocol was for us to go into the Women's Assessment Service (WAS) a holding pen of sorts to determine if I was far enough progressed to go up into the delivery suite. I worked through several surges on the way to WAS & on entry was told I could be “taken straight up”. Apparently the noises I was making were enough of a give-away that I was well & truly in labour land. On the way up to the 3rd floor I found great relief in hanging of anything I could. Similarly to in the car, as soon as a surge hit I would look for something to hang off & drop into a squat of sorts. Almost like a monkey in a tree hanging from branch to branch. Apparently this got some interesting looks when the lift stopped at every floor, James also assures me that we got some great looks during the car ride in.

When we arrived at the labour ward I was told that the room I had did not have a bath to which I not so politely stated “I want a room with a bath, now”. Some swift moves meant I got a room with a bath & Trish got to work running it as soon as we went into the room. I went into the toilet where I sat on the toilet & hung off the rails during my surges. It was here that I had a conversation with my midwife. She asked me how I was feeling to which I answered “great, this feels so much more different to Bethany's labour, productive, intense but good, I'm feeling pushy”. I told her I could feel my hips widening & the baby dropping down. She praised my efforts & told me that she could see how well I was working with my surges. She told me she was happy to leave me to see how things went or if I wanted I could have an internal.

I elected to have the internal as I wanted to be sure that I should be in the hospital. My midwife did the internal & announced “great news you are 6 cms” then paused “but that's not a head”. She told me that she was going to have to call the doctors in. I instantly knew what this meant, baby was breech, I would have surgery, & I went into shock. Breech vaginal deliveries are a rarity let alone in the hospital environment. Being a VBAC mumma was an added “hindrance” to breech being considered a variation of normal. All of this I knew but I also knew that I was determined to have a breech vaginal birth if that was at all possible.

The first doctor I saw was a young, conservative female. She did an ultrasound to confirm Hamish's breech presentation then touted previous section, previous big baby as reasons to section immediately. I requested a second opinion all whilst shaking from what I thought was just shock. It is at this point I should mention that we arrived at the hospital at roughly 8.30am & Hamish was born at 10.10am. I was transitioning & in shock about the prospects of another surgical birth. On my request for a second opinion the female doctor brought the head consult into the room & reiterated her reasons for cutting me- breech big baby in a VBAC mumma. The consult, who I will hereafter refer to as Dr C, asked her how she knew baby was big. Its no surprise her answer was she didn't know!

Dr. C then assumed the lead role. He looked at baby Hamish on ultrasound & conducted an internal examination. He confirmed that Hamish was in fact breech & told me that not only was the baby breech but a footling breech. With all my prior reading & research I knew this was a highly risky position. There is a 15-30% increased risk of cord prolapse & most scarily a significantly high chance that once the feet & torso are birthed the cervix shuts down on the neck leaving baby trapped. Both of these are very emergent situations & I knew that if anything like this was to occur this would result in me being knocked out under a general anaesthetic. It would also likely lead to my baby going to the neonatal ward.

The female doctor asked me “what was I so afraid of with a section”. Ha! Full abdominal surgery lady! I have a toddler at home to care for- what do you think I am afraid of? Silly woman had no idea! But I was equally afraid of my baby unduly suffering for my zealous quest for a VBAC. I didn't want my baby to have to be recussed. I didn't want my baby going to neonatal. I didn't want my baby to have a fractured pelvis or shoulder. I didn't want to be knocked out. I wanted to be present & available for my baby who I wanted to hold immediately & not be separated from.

I looked to Trish & told her “I have no choice” to which she said “yes hon you have a choice. You can choose when this happens & have some control or you can let things go the way they will”. I pleaded with my husband to make the decision for me. He told me he knew how much the VBAC meant to me & that if we consented he knew I would still regret it. He told me he didn't want to make the final decision & that whilst our baby's health was paramount it was truly up to me. I knew consenting to the section earlier was going to optimise my ability for me to watch the birth & have immediate skin-2-skin contact with my baby.

So I consented but on my terms. I told them I would only sign for the section if I could watch the birth, have baby given straight to me & examined on my chest. The Paediatrician met with me before we went to theatre & assured me that if baby came out ok all of these things would occur. Once I signed the consent & as I was feeling very pushy I asked for some gas. I decided that if I was going in for surgery then I might as well be comfortable now because there was no way I was going to get my bath! The trip down the corridors to theatre was the worst part, I knew where I was going & what was going to happen. I knew that I was going to be cut again & was spontaneously pushing.

When we arrived in theatre Dr C told me he knew how much a VBAC meant to me. He stated that as I had progressed so beautifully, I was now at 10 cms, if the baby tucked their feet up then he wanted me to “push that baby out my vagina”. With my permission he gave me another internal to see if the baby's feet were still dangling, they were & little Hamish had descended significantly down the birth canal. Dr C then called the surgery & within 20 minutes my spinal was in & Hamish was out. The drapes were lowered, James saw everything & even over my belly I was able to see two legs emerge out of my stomach. James announced we were having a boy! Little Hamish cried & pooped all over Dr C whoC used my own language from my birth plan to explain how the baby would come straight to me. After a quick glance without even a single rub down Hamish was placed naked on my chest. True skin-2-skin, no wrapping up in blankets with only his head poking out but instead naked, birthy goop & all! James & I were truly over-joyed! My student midwife took some amazing pictures of Hamish's entrance earthside & helped him latch within 10 minutes. And lets just say since he discovered the breast he's never wanted to leave it

On reflection a few things strike me as truly amazing. My body worked! It went from waters breaking to fully dilated & pushing within 9 hours! I wasn't broken! While I went to a very primal place I was able to be lucid & articulate when I needed to in order to get the best  care available to me. An experienced OB gave me every opportunity in the world to have a safe vaginal delivery & recognised the importance of a VBAC. Heck he even used my own language from my birth plan & told me that he wanted me to push this baby out of my vagina! The power of true support & a birth team plus quality care results in good birth outcomes. Hamish's birth was a surgical birth but it was dramatically different to Bethany's. It was empowered & it was supported by medical evidence. It was necessary. I owned it. I had choices

Yes I could have let nature run its course but I know that nothing on this earth would ever let me forgive myself if something had have happened to Hamish purely out of my “quest” for the redemption I believed a VBAC would bring me. In the haze of newborn sleep deprivation, a prolonged recovery due to a second operation to re-suture, being house-bound & feeling worthless as a mother to my toddler I have questioned Hamish's birth. I've played the “what if I didn't get that internal” card round & round in my head. But as I've physically healed I've returned to a place whereby I am empowered & emotionally healed by Hamish's birth. He entered earthside surgically but safe & for the right reasons. The risks were too high. My body was amazing, did all the right things & I was not separated from my darling little man. I found my redemption & know that I am not broken. I am a birthing warrior.

 

 

 

 

 

 

Published in Birthing Stories

There is a proverb that states: “The axe soon forgets, but the tree always remembers.” The message in this proverb, that one person's actions (soon forgotten) can leave a lifelong scar on the soul of another, is sobering. Applied to the doctor/patient relationship, it is heart-rending. Surgical patients, including mothers having c-sections, have faith in their anesthesiologists and OBs to adequately manage their pain so they can focus on the physical recovery afterward. But for many women undergoing c-sections, recovery includes a psychological recovery from the trauma of feeling their procedures, often compounded by a lack of validation that the trauma even occurred. They are left wondering: Did this really happen? Could this have been prevented? Did the drugs fail, did the doctor fail, or did I fail? I propose the answer is buried in a larger, two-fold problem: first, doctors in general, particularly in the US, create unnecessary trauma because of how they view birth and laboring women, i.e. as a disease needing treatment and objects to be controlled; second, there is a basic misunderstanding of how anesthetic drugs affect different laboring women when they are applied in a universal, one-dose-fits-all approach.

In preparation for this article, I asked mothers to send me their stories if they had felt any or all of their c-sections, including details about the drugs used (if known) and the general location of their experience. There were a variety of drugs involved in the responses I received, and locations ranged from the US to Canada. The one common thread, however, was how the women were treated when it became clear their anesthesia was not working (the following are just two samples of the many stories I received; names have been changed):

I was wheeled into the OR; they gave me a spinal block because the epidural had been turned off...I remember the nurses joking about something while they pinned up the drape and rubbed something cold on my stomach. I asked for my husband, and was told he was on his way. Then I told the anesthesiologist that I could feel the straps across my ankles, thighs, and that there was someone touching my foot. He said, 'Oh, it's normal to think that you feel that.' The next thing I remember, my world was nothing but pain and fire. My voice was choked, I couldn't scream or even utter a sound. I was alone, no husband or mother, no one to speak for me. The nurses were still laughing and joking. My son's head had already been delivered by the time they let my husband into the OR... By this time, I was gasping for air and close to passing out. My husband started yelling at the anesthesiologist, that I was about to pass out. The anesthesiologist looked at my wrist, put what I found out later was Ketamine into a syringe then into my IV. At this point I blacked out. The nurses told me later that I was fighting them and crying over my 'dead baby.' I honestly don't remember. About 4 hours later, I got to see and hold my son. [My doctor] came in later that day to check on me, and I sent him out demanding anyone but him. The next doctor didn't believe me about what had happened. So, I talked myself out of talking about it...” (Chelsey, Virginia, USA)

The doctor made the first incision and I remember it felt very strange, and he asked if I could feel it, or if it just felt like pressure. I did not know what pressure was supposed to feel like. I told the doctor I wasn't sure. He made the second incision and I groaned. At this point, he told my husband that he had gone too far to turn back, and could not give me any pain killers because it would harm the baby. I groaned loudly for the rest of the procedure, which seemed to last forever. One of the nurses came up to me and said, 'I think you're scaring the doctor, please quiet down.' The first thing I said to my husband after my child was born was, 'Did I curse in front of our baby?' I could not remember if I had yelled profanity during surgery. I saw my child with my blurry vision, and they started giving me morphine in my back. I did not get to see my child for 8 ½ hours after that.” (Lisa, North Carolina, USA)

The stories I received, while pointing out a clear failure in adequate anesthesia, also pointed out a complete disregard for the patient and the severity of the trauma being experienced. A clue to why this happens can be found in the description of birth trauma provided by Penny Simkin and Phyllis Klaus in their book, When Survivors Give Birth:

In the language of obstetricians, 'traumatic birth' refers to births that incur serious physical damage to mother or baby. For example, a sudden emergency cesarean perhaps with inadequate anesthesia; shoulder dystocia; severe perineal damage; fetal asphyxia; vacuum extractor or forceps injuries; severe hemorrhage; newborn disabilities or death... Women who undergo such trauma also suffer psychological trauma... The psychological trauma is frequently unacknowledged by the woman's caregivers and sometimes by her loved ones.”1

The medical community openly acknowledges the existence of physical trauma in birth, but disavows the psychological trauma that goes with it. Why the disconnected view of a human being as both physical and psychological? Are doctors unaware that they are causing harm, or do they view “harm” and “trauma” differently than their patients do? Understanding the historical medicalization of birth offers important insight into this current mindset. In Rediscovering Birth, following a description of twilight sleep2, Sheila Kitzinger describes this medicalization of birth as a move from supportive human touch (midwives at home), to restraining, and even punitive human touch (OBs and nurses trying to control a mother under the influence of birthing drugs), to nonhuman (or apparatus) touch:

Delivery tables were designed with handcuffs, ankle cuffs attached to lithotomy stirrups, and shoulder restrainers on either side of the patient's neck to prevent her raising her head and shoulders from the table... In the 1980s, with the electronic revolution in obstetrics, catheters and wires connected to electronic machinery also took the place of human hands, and the use of spinal, caudal and epidural anaesthesia ensured that patients did not toss and turn or move away when an examination or manoeuvre was attempted. The woman was fixed like a laboratory specimen under bright lights, or like an offering on an altar, as gowned and masked professionals conducted the delivery in a shrine-like theatre where the obstetrician served as high priest in the drama of birth.”

Patients go to doctors to be healed, to have a problem fixed. Once a laboring mother becomes a 'patient', birth becomes the problem or illness needing to be healed. The mindset of the doctor is that the patient does not know how to fix the “birth problem” on her own, and may even harm herself (and/or her child) if she tries to. The doctor sees himself or herself as a source of salvation where salvation isn't needed, controlling a chaos that doesn't need to be controlled, and all at the expense of the mother's humanity. Michel Odent describes his experience with this mindset as an OB as follows:

[Early in my practice] I had known little of the world but doctors and patients. I had looked at people from a narrow medical perspective; I had shared the conventional view of childbirth as a 'medical problem' requiring technical 'solutions.' I had grown used to hearing doctors speak of pregnant women as 'patients'”... Today obstetrics still focuses on the role of the doctor and his preoccupation with how best to control and master childbirth. Especially in the United States, this attitude has resulted in the systematic concentration of normal births in environments equipped with advanced technology and routine electronic surveillance. Modern obstetrics knows nothing and cares less about the fact that labor, birth, and early nursing are integral parts of a woman's sexual life.”3

In an environment in which a woman is seen as an objectified patient, and birth is seen as a problematic event in need of medical intervention, is it any wonder that an OB, nurse, or anesthesiologist would ignore the cries from the operating table or dismiss the traumatic experience as normal or “all in her head”? Would a patient undergoing heart surgery be allowed to suggest to his or her surgeon that the doctor wasn't doing his procedure correctly? Doesn't the doctor know best? These are all arguments I have heard from medical professionals addressing a mother contradicting her OB or challenging the anesthesiologist that she could still feel. The problem with this mindset is the basic concept that birth is an illness. Birth is not a broken heart or festering wound. Until we change this basic misconception among medical professionals, we will see many more forests full of scarred trees. But this is only half of the problem.

The other half of the problem leading to the traumatization of women in birth, particularly in c-sections, is a lack of understanding and lack of precision in the use of anesthetic drugs. For c-sections, women are commonly given either a spinal or epidural block; both allow the mother to be awake during surgery so they can see their baby after birth. When a spinal or epidural block are inadequate for surgery (i.e. a woman is able to feel all or part of the procedure), this is referred to as neuraxial block failure. To understand why this happens, it is important to first understand these two types of blocks and the drugs used to achieve them.

A spinal block is an injection of a local anesthetic and narcotic into the intrathecal space (space containing the fluid surrounding the spinal cord); an epidural is a similar injection into the epidural space (a fat-filled space outside of the membranes surrounding the spinal cord and spinal fluid). According to theadequatemother (a Canadian blogger, mother, and anesthesiologist):

"A spinal interrupts nerve transmission in the spinal cord itself, an epidural interrupts nerve transmission in the nerve roots as they exit from the spinal column through the epidural space. A spinal requires less volume of drug because the intrathecal space is smaller. It also has a faster onset compared to an epidural. For an epidural to work for a c-section, many levels of nerve roots need to be frozen. The medication has to spread up and down in the epidural space and enough volume has to be injected for it to reach all the nerve roots that carry sensation to the surgical site. Although the incision for a c-section is usually confined to a small area, the freezing has to work on the entire peritoneum (the membrane lining the abdominal cavity, not the perineum which is the skin and muscle located between your vagina and anus)." 4

The use of one block over another has shifted through the years as new drugs became available, and depending on which one was seen as causing fewer side effects or giving the anesthesiologist more control. The drugs used currently and their doses vary depending on the anesthesiologist, hospital, and even the country in which they are being administered. Bupivacaine is one example of a commonly used drug for both epidurals and spinal blocks. The main difference between epidural and spinal block use of Bupivacaine is the amount of drug given. For obstetric use, 0.5% hyperbaric Bupivacaine is used, given in 10mL increments for epidural injection, but 2mL or less for spinal block. In researching for this article, this spinal block amount was a major point of differentiation between the US and other parts of the world (namely the UK and Nepal). One article out of Manchester, looking at cases of epidural and subsequent spinal block failure in c-sections concluded:

"The ideal dose of this drug [Bupivacaine] for Caesarean section remains uncertain. However, the use of less than 2mL is associated with a substantial risk of inadequate block. The use of 2.5mL has been reported to be satisfactory in several series.”5

Another study6 out of Nepal noted a failure rate of 6.0% for a 2.20mL solution of Bupivacaine in c-sections, meaning 6.0% of women receiving this drug needed additional anesthesia or were put under general anesthesia. In stark contrast a study7 out of New York showed that women receiving lower doses of Bupivacaine had a significantly higher anesthetic failure rate during c-section:

" In our previous study, almost all mothers (19 of 22) given 0.5% hyperbaric Bupivacaine (7.5-10mg [1.5-2.0mL]) for spinal anesthesia in cesarean section required narcotic supplementation because of visceral pain."

The study goes on to show that their current study comparing two dose levels of Bupivacaine showed women given a 25% higher dose had significantly lower failure rates. One study group was given Bupivacaine in a range of 1.5-2.0mL, the other group was given a range of 2.0-2.5mL. In the first group, 70.5% reported moderate to severe pain after delivery associated with peritoneal traction (exteriorization of the uterus and closure of the peritoneum). In the second group, 31.6% reported this. [Note: All mothers reporting moderate to severe pain received additional intravenous medication.]

In short, while Bupivacaine will still fail some women, the rate of failure is significantly reduced simply by using a slightly higher initial dose. Currently in the US, anesthesiologists tend to add a narcotic rather than using a higher initial dose of Bupivacaine. Narcotics have their own list of possible side effects; for example, Ketamine can cause double vision, motor incoordination, delirium, hallucinations, irrational behavior, and temporary elevation of blood pressure and pulse rate.8 For a woman who is already in a state of stress and panic from feeling their surgery, adding these neurological symptoms is literally a nightmare.

What is the solution? I think the best option is one suggested by a thinking, feeling mother/anesthesiologist (quoting again from theadequatemother):

"When I discuss anesthetic options with my patients and we are discussing a spinal or epidural block, I always mention the possibility of block failure as well as methods to address it such as conversion to general anesthesia. When a block fails, there is a human tendency to dismiss it... oh, well, the patient is just nervous, or, well, it's not that bad, right? Clearly she's just feeling tugging, not pain, and tugging is normal. But that doesn’t do either myself or the patient any service. They will get increasingly distressed and I’m just putting off the inevitable. We need to face our failures head on and deal with them and fixing the problem of a neuraxial block that doesn’t provide adequate anesthesia for a c-section requires time – time for a discussion to occur with the patient regarding options and preferences, and time to repeat the injection or set up for and establish a safe general anesthetic. Best to fix the problem as soon as it is identified.”

If OBs and anesthesiologists take it upon themselves to see their birthing mothers as human beings, rather than sources of illness, if they communicate with mothers before surgery about the risks and options, and above all, if they work with mothers as participants in their own births rather than static objects to be controlled and silenced, then we will see real change.

There is a moment toward the end of the movie The Lorax when the main character stands against the socially accepted norm in support of what is right, proclaiming, “I am Ted Wiggins, and I speak for the trees!” Women must feel empowered to speak for themselves, and doctors must be willing to listen and validate. If this does not happen, other women and men must speak for them, until someone listens. The women who have been ignored, shushed, yelled at, and belittled while suffering through a neuraxial block failure will always bear and remember the scars of the axe used against them. Unlike the proverbial trees, however, they do not have to stand in silence waiting for the next axe, and we can add to their voice to make it heard, beginning now. I am Jeanne-Marie Floyd, and I speak for the trees.

 

1Simkin, Penny and Phyllis Klaus. When Survivors Give Birth. Seattle, WA: 2004.

2Twilight sleep refers to the drug Scopolamine. This link provides a good history for this drug.

3Odent, Michel. Birth Reborn. Medford: BirthWorks Press, 1994.

5Beck, G. N. and Griffiths, A. G. Failed extradural anaesthesia for Caesarean section. Complication of subsequent spinal block. Anaesthesia, 1992; 47: 690-2.

6Shrestha, AB, et al. Failure of subarachnoid block in caesarean section. Nepal Med Coll J, 2009; 11(1): 50-1.

7Pedersen, Hilda, et al. Incidence of Visceral Pain during Cesarean Section: The Effect of Varying Doses of Spinal Bupivacaine. Anesth Analg, 1989; 69: 46-9.

8From the MSDS on Ketamine.

 

Published in Birth Voice

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