lactic acidosis associated with ftp and subsequent surgical birth

A few days ago, this link made the rounds of the birthy-minded folks on Facebook. Researchers have published a series of studies (here's a better description of it, including references to the researchers involved and their studies) which linked levels of lactic acid in amniotic fluid with long labour and caesarean sections resulting from failure to progress. The conclusion they reached was that pitocin augmentation was ineffective for women in whom their amniotic fluid contained heightened levels of lactic acid. Lactic acid is produced by fatigued muscles, and a researcher was quoted as saying that an already fatigued uterus being supplemented with pitocin was akin to asking a marathon runner to run an extra 10 000 metres after crossing the finish line.

I was a party to a number of discussions on it. Some commenters argued - as do the researchers - that this represents an improvement in maternity and partum care. Now women who are destined for long, painful labours without the likelihood of a successful vaginal birth at the end can avoid the hours of trial and have the inevitable caesarean section sooner, avoiding the exhaustion and trauma of a long labour.

But others saw this differently. Will this publication be used as yet another excuse by injudicious obstetricians to encourage mothers - particularly first time mothers, as noted in the article - into prophylactic caesarean surgery? And will practitioners suspecting lactic acidosis be willing to wait for the spontaneous rupture of membranes in order to check the amniotic fluid for lactic acid levels, or will they more readily turn to amniotomy? We know that amniotomy does not greatly shorten labour, and that it is linked to an increase in the rate of caesarean section, so to even unintentionally encourage the use of amniotomy would serve to only exacerbate matters.

We can go further with this, though. Shouldn't we look at why mothers may be experiencing lactic acidosis and find ways of avoiding it? Could it be that the way labour and birth are approached is leading to uterine fatigue? None of the studies referenced in the article appear to examine any external influence which could be contributing to acidosis. Could immobility and chemical pain management be associated with fatigue to the uterine muscles? Is there evidence that acidosis predates the beginning of labour, in which case, can we be caring for our bodies during late pregnancy in such a way that lactic acid build up may be avoided? And what about the iatrogenic norms in regards to defining labour as "long"? Hospitals are notoriously clock-oriented in their approach to labour, and far more liberal with the application of the diagnosis "failure to progress" than are home-based practitioners. How long did researchers "allow" (I hate using that word!) women to labour before declaring their labour unsuccessful and a caesarean necessary for failure to progress/failure to dilate/labour dystocia?

I'd love to believe that this study will be a good thing for mothers and babies, I really would, but frankly, I just don't see it that way. Too many important and fundamental questions are left unasked and unanswered. The outlook taken by researchers is predictably pathological, looking for what is wrong, rather than looking at what can be made right. I'm all for avoiding unnecessary suffering and trauma, but increasing prophylactic caesarean sections is not going to achieve that.

are you qualified to birth?

A fellow mum I know was given a stroller by her mother-in-law.  Her mother-in-law said "I'm going to get the most expensive stroller I can find, because that will be the best one."  The mum thought this was ridiculous (though was suitably appreciative of her lovely and free-to-her stroller).

I wonder if our consumerist approach to baby gear has extended into health care and maternity care as well.  We buy expensive strollers when many parents would happily just strap their babies to themselves with a piece of cloth.  We feel pressured to buy fancy diapers - disposable or cloth - when many parents are satisfied with simple flat or prefold diapers, or eschewing diapers altogether and using elimination communication.  The floors of many - I'd propose most - North American homes with an infant are littered with bouncy chairs, Bumbos, playards, swings with music players, infant "gyms", play mats and exersaucers.  The very brand names of many of these products encourage us to buy by implying these items will keep our baby safe, educated, entertained, and loved.

Complicated and scientific-sounding infant formulas and baby foods suggest our own milk or homemade food doesn't quite suffice, and may leave our children wanting for space-age nutrients which will grow bigger, better, smarter children.  Cribs are marketed as the safest place for an infant, while articles are published likening concientious bed-sharing families with negligent drunks and junkies who inadvertently kill their infants while high or intoxicated in bed with them.

So much time and money and thought has been put into the research and development of these products, and I truly believe that, in the beginning, it was done with the best of intentions in every case.  We have come to believe in these products so strongly, though, that I believe we have lost sight of their real purpose, and forgotten that we really are capable of surviving without most or all of them most or all of the time.  I would argue that these "parent helpers" have tricked us into believing that our own touch, our own bodies, our own instincts, our own love and attention, fall short of our children's needs.  We aren't qualified to parent.

So, too, with maternity care.  All of the technology, the medical procedures, the instruments and tests, have become so ubiquitous that we believe they are necessary for a successful pregnancy and delivery.  We believe prenatal care is essential to having a healthy baby, when in fact it is a symptom of an environment in which the mother is most likely healthy.  A woman who is able to receive prenatal care generally has sufficient access to clean water, nutritious food, housing,  and is adequately informed to know how to care for her pregnancy.  Listening to a baby's heart tones or taking fetal measurements by ultrasound or palpating a mother's belly doesn't keep the pregnancy healthy, or improve its progress, though it's certainly reassuring to the parents and to the HCP that all is well.  Somehow, though, we as a society have come to see such care as essential to having a healthy baby, rather than trusting the healthy body of a healthy mother to properly grow the infant.

Too often I hear doubt in the voices of mothers as they discuss upcoming or past births, saying they "hope" they can give birth, or that it would "be nice" to have a natural birth, while in the next breath saying that they'll try not to be too disappointed should trouble arise.  We are warned by everyone around us to prepare our minds for a surgical deliver "in case", to give birth with an obstetrician in a hospital "in case", to agree to a few interventions just "in case".  We approach birth without really believing - really and truly believing - that we are physically capable of the act.  It isn't surprising, then, that so few women manage to accomplish the task without some sort of alleged assistance, assistance that, very often, leads to a cascade of interventions culminating in caesarean section.  We aren't qualified to birth.

The United States has an epidural rate of 90%, an induction or augmentation rate of 85%, and a caesarean rate of nearly 32%.  So long as we continue to operate under the premise that we cannot birth, these numbers will not improve.  As with any challenging task, the most elemental factor in determining whether one will succeed is believing that one is capable of accomplishing it.  So long as we do not believe every woman can birth - and not just those extreme, natural birthing mamas; you know, hippies like me! - we will assuredly be correct.

BirthLove - a truly phenomenal online resource

I was linked to a website, BirthLove, through a Facebook friend. It is an absolutely amazing resource. I haven't yet read everything on there because there is, quite simply, WAY too much on this site to be read in one day while also playing with a toddler, feeding a toddler, dealing with meals... It is a very prolific site.  Amongst their contributors are Gloria Lemay - one of Canada's best known and respected birth attendants - and Marsden Wagner - former director of Women's and Children's Health with the WHO - as well as Gretchen Humphries - I've linked to her site in the 'Resources' sidebar - and Sarah Buckley - a mother and writer from New Zealand.

One article recently really jumped out at me from the site.  It's entitled  Rape of the Twentieth Century.   It is a shockingly honest and brutal portrayal of the sadly-common tragedy of unpleasant hospital births.  The author begins with a description of her five hospital births, each one a broken birth, a birth in which her choices and her body were treated with disregard and disrespect.  She describes how her body and her births were used as teaching tools, rather than treated with honour and sanctity, how unnecessary and unwarranted procedures were performed on her and her unborn children "in the name of science".  It is a harrowing tale.

She goes on to discuss the interventions used in medicalized births and many of their untold risks: the use of episiotomy motivates heavy suctioning to clear the infant's lungs, and poses the possibility of cutting the baby, forceps can disfigure women's genitals, caesarean section increases the likelihood of maternal death by a factor of sixteen.  And as the author writes:

In a cesarean section, a private, secret, and sensual event becomes a sterile crucifixion in a room full of slicing, staring strangers. And the ultimate rape is that we are told we need to be cut. The sanctity and power of birth becomes a meek "yes, doctor" and we become spectators to our own violation; we even thank the doctors as they scurry on their way out of the operating room.

Her description of medicalized birth is unforgiving and cuts deeply, but she writes as one who has had more experience with hospital births than is average.  Five hospital births.  Five births which left her alone and weeping.  Five births in which she felt her body a failure, defective and incapable.

She argues strongly in favour of homebirth and midwifery, not purely because it is so pleasant, it is so simple, but because hospital births truly do pose such a grave risk.  It is a risk not only of undesired intervention or surgery, not only of dissatisfaction, but one of deep and abiding sadness at what has been lost, and of avoidable death.

We are living in strange and savage times. This century will be remembered as one of war and genocide; and violent, coercive childbirth. Birth is weeping, and bleeding. We are made to believe we must give birth in sometimes hostile and mostly indifferent hospitals, where interference with a woman's natural birthing rhythms is the norm. Our vaginas can be stared at and cut by strangers, and abnormal emotional and physical behaviors- such as excessive fear, crying, and stress-induced stoppage of labor- have become normal and expected. Babies are routinely harmed; and the perpetrators are exalted as life savers, instead of reviled as child abusers. A birth without unnecessary intervention is now unusual, even though we all have the potential to birth beautifully- if only left alone.

Getting more than you bargained for

If this story doesn't anger and terrify you on multiple levels, I'll be surprised. A woman in Illinois wanted a c-section. She got one, and a sterilization as well. A tubal ligation was never discussed with her ob, never requested, and she certainly never consented to one, but the surgeon sterilized her anyway. I mentioned this story to my husband, and as horrified as he was by it (and he was: as a proponent of personal agency and informed choice, I definitely married the right man!) he suggested that perhaps it was just an error on the surgeon's part. "If he had several sections with tubals scheduled earlier in the day, maybe he just made a mistake." And I agree: it seems entirely possible that this was simply an error on the surgeon's part, possibly the result of becoming so accustomed to all this reproductive surgery that he stopped really thinking about what he was doing. But wouldn't that indicate a more basic problem? Say it with me now: too many unnecessary scheduled ceasareans!! **If you aren't already a fan of The Unnecesarean on Facebook, or have her on your blogroll, I highly suggest you do so: it's just one awesome post after another over there. Shared via AddThis

Something interesting is happening in birth: Part I

Yesterday evening, I attended a performance of the play “Birth” by Karen Brody. The play was staged by Three Sisters, a company of professional actresses in Ottawa, and was staged in order to raise funds and awareness for the Coalition for Breech Birth. The Coalition was founded by consumers, women who had had their births stolen from them by a system which refuses to admit the reality of breech birth, a system which fails to instruct its physicians in catching breech babies, and allows those physicians to coerce mothers into unwanted, unconsented and unnecessary caesarian sections.

The play is beautiful. It tells the story of 10 women's births with their first (and in one case, second, third and fourth) children. There are stories of joy: a woman chanting a mantra as she births squating, supported by her husband and her doula, believing and trusting her body; a woman kneeling in a pool in her home, her three children beside her, cheering her through her labour. But there are many, many stories of sorrow. Women coerced into deviating from their birth plan, into denying the needs of their own body. Women treated with disregard and disrespect while pregnant and while labouring. Women assaulted while birthing: cut, without need or consent, while bringing her child into the world.

It's extremely difficult to watch, even when staged in a minimalist, Vagina Monologues-style format. An actress, mimicking birth, telling the true story of a true woman's birth, screaming, not only in pain but in terror, in sorrow, in rage, at the realization that, just as she reached between her legs to feel her daughter's head being born, her doctor, her practitioner, was slicing through her perineum. Watching it, it was not just unethical, and not just assault: it was rape.
 
This is happening. This happens far more often than we'd like – and than any physician would ever dare – to admit. This is one of the realities of birth in North America. Women experiencing the trauma of rape during their births.

What do we do? Me: I'm getting mad. I'm getting really, really mad. I'm getting vocal. I'm pissing people off. I'm happily making an obnoxious ass out of myself. But here's one of the problems: too often, when we start talking about birth choices, and making options truly available to women, those who've chosen non-traditional births (I'm using the word traditional in the, well, traditional sense, to mean the sort of births that women have been having since the dawn of Creation) and gone a more medical route, become defensive. Arguments start being made about the importance of medical intervention, the value of pain-managing medications, the reassuring availability of caesarian sections.

I struggle to express to people that my issue is not with their personal choices – after all, those choices should be theirs and theirs alone – but with the fact that for many, many women, their choices are not their own: they belong to a nurse, a doctor, a midwife. But not to the labouring parents.

I'm not fighting other mothers to make decisions the way I would make them: I am fighting a system that is telling mothers, all mothers, what decisions to make about their bodies, their babies, their births. I am not in the practice of fighting mothers. I am fighting the medical establishment. I am fighting social norms. But I am not fighting the mother in front of me.

For far, far too many people, birth continues to be viewed as a black and white issue. You're either all-natural, crunchy-granola, kum-ba-ya and western medicine is the work of Satan, or you're not. And so many of the people – men and women – seem to assume that we who are natural-birthers, who are birth activists or working with birthing women, see things that way, too.

I don't. Western medicine has saved countless women and children from certain death. This is a fact. Surgery has literally saved the lives of mothers and babies I've known. And thank God for it. Thank God that J, our prenatal instructor, and her son were saved when she suffered a placental abruption with her first birth. But thank God, as well, that she was able to go on to have two midwife-attended homebirths after that. I

t isn't so simple as saying “old is bad: new is good”. It's equally not so simple as saying the reverse. There is a place for life-saving medicine in birth. But let it be life-saving. Let's not let it be time-saving or pride-saving. Let's not let it be about the doctors. Let's let the reasons for intervening in a birth be good ones, important ones, lives-hanging-in-the-balance ones. Let's not let it be about dates or estimated weights or breech presentation. Let's let it be about need.

So I will continue to tell people about birth. I will continue to cull statistics and research results and store them away in my mind for those conversations with sceptics and the uninformed where there is the possibility of educating one. More. Person.

And maybe, someday we won't have to. Maybe, just maybe, someday...everyone will already know. Originally posted on knit me a new one